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OPHTHALMIC IMAGE
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 172

The mirage of a perfect bleb – Studying morphological appearance of a pseudobleb using anterior segment optical coherence tomography and Scheimpflug imaging


1 Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
2 Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
3 Department of Paediatric Ophthalmology and Strabismus, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India

Date of Web Publication01-Apr-2021

Correspondence Address:
Dr. Prasanna Venkatesh Ramesh
Mahathma Eye Hospital Private Limited, No 6, Tennur, Seshapuram, Trichy - 620 017, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2673_20

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How to cite this article:
Ramesh PV, Ramesh SV, Ramesh MK, Rajasekaran R. The mirage of a perfect bleb – Studying morphological appearance of a pseudobleb using anterior segment optical coherence tomography and Scheimpflug imaging. Indian J Ophthalmol Case Rep 2021;1:172

How to cite this URL:
Ramesh PV, Ramesh SV, Ramesh MK, Rajasekaran R. The mirage of a perfect bleb – Studying morphological appearance of a pseudobleb using anterior segment optical coherence tomography and Scheimpflug imaging. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Apr 20];1:172. Available from: https://www.ijoreports.in/text.asp?2021/1/2/172/312391



A 62-year-old presented with whitish elevation in the temporal part of his right eye, following suture-less cataract surgery. He had no history of glaucoma surgery. His best-corrected visual acuity was 20/20 with intraocular pressure of 12 mmHg. Examination showed a cystic bleb, with a negative Seidel's test, at the temporal incision site with adjacent corneal dellen [Figure 1].
Figure 1: (a) Slit-lamp smartphone photography picture revealing inadvertent temporal cystic bleb due to internal wound fish-mouthing following suture-less small incision cataract surgery with corneal dellen (red arrow). (b) Anterior segment optical coherence tomography picture of the bleb architecture revealing loculations (asterisk) with septa (red arrow). (c) Scheimpflug imaging system reveals the bleb vascularity. (d) Scheimpflug imaging system of the same picture in inverse color

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Improper internal wound construction with fish-mouthing, which can be diagnosed with gonioscopy, can lead to pseudobleb formation.[1] Patients may complain of irritation or visual disturbances with permanent wound slippage, late induced against-the-rule-astigmatism, and endophthalmitis as rare sequelae.[2] Intraoperative mindfulness with appropriate management is warranted.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gimbel HV, Sun R, DeBroff BM. Recognition and management of internal wound gape. J Cataract Refract Surg 1995;21:121-4.  Back to cited text no. 1
    
2.
Stonecipher KG, Parmley VC, Jensen H, Rowsey JJ. Infectious endophthalmitis following sutureless cataract surgery. Arch Ophthalmol 1991;109:1562-3.  Back to cited text no. 2
    
3.
Jain SS. Inadvertent filtering bleb following sutureless cataract surgery. Indian J Ophthalmol 2005;53:196-8.  Back to cited text no. 3
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