Surgical reduction of symptomatic, circumferential, filtering blebs

We describe methods and outcomes of surgical reduction of symptomatic, circumferential, filtering blebs after trabeculectomy with antifibrotic agents. The medical records of 15 eyes of 14 patients with symptomatic, circumferential blebs who underwent surgical bleb reduction for bleb dysesthesia under topical anesthesia were reviewed. Each bleb was incised segmentally and the cut edges of the conjunctiva and Tenon capsule were sutured to the underlying sclera. Outcome measures included symptomatic relief, retention of bleb function, and intraocular pressure maintenance. Fourteen eyes had successful reduction of bleb size, symptomatic relief, and cosmetically acceptable appearance. One eye continued to have dysesthesia and 1 had a transient bleb leak that resolved spontaneously. Surgical reduction of circumferential, symptomatic, filtering blebs is a safe and effective technique to reduce bleb dysesthesia and improve cosmesis without loss of bleb function.