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Patient creates filtering bleb: hypotony following traumatic rupture of an old scleral incision for intracapsular cataract surgery
  1. Sophie Lemmens,
  2. Minh-Tri Hua and
  3. Ingeborg Stalmans
  1. Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Flanders, Belgium
  1. Correspondence to Professor Ingeborg Stalmans; ingeborg.stalmans{at}


An 86-year-old woman presented with symptomatic hypotony on the left eye since a few weeks, blurry vision and a very sensitive eye. She had a history of bilateral intracapsular cataract extraction (ICCE) in 1982 and secondary intraocular lens implantation in 1988. The patient mentioned a fall on the left side of the head 6 months earlier. The diagnosis of a superior scleral fistula was made, confirmed by gonioscopy and anterior segment optical coherence tomography. Direct surgical repair of the fistula led to a favourable outcome. This case demonstrates the occurrence of symptomatic hypotony due to the traumatic creation of a scleral fistula with an inadvertent filtering bleb many years after ICCE, and the resolution of signs and symptoms after surgical repair. Conventional as well as contemporary modalities can be valuable in the assessment of such fistulae. Management depends on the clinical course and the mechanism and extent of fistulation.

  • anterior chamber
  • macula

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  • Contributors SL conceptualised the case description, examined the patient, acquired and interpreted the images, and drafted and finalised the manuscript. M-TH examined the patient, interpreted the images, performed the surgery and critically revised the manuscript. IS conceptualised the case description, examined the patient, interpreted the images and critically revised the manuscript. SL, M-TH and IS approved the submitted version, are accountable for the article, and ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.