The first day after trabeculectomy, a patient with primary open angle glaucoma presents with a bleb that is almost flat, a very shallow anterior chamber, and vision decreased from 20/30 to 20/100. The IOP is 1 to 2 mmHg. What is the most likely cause?

Thursday, April 17, 2008
The first day after trabeculectomy, a patient with primary open angle glaucoma presents with a bleb that is almost flat, a very shallow anterior chamber, and vision decreased from 20/30 to 20/100. The IOP is 1 to 2 mmHg. What is the most likely cause?
  1. Aqueous misdirection (malignant glaucoma)
  2. Pupillary block
  3. Early failure of the bleb with episcleral fibrosis
  4. Ciliary body shut down
  5. Bleb leak

Correct Answer: Bleb leak

The most likely scenario is bleb leak, and should be confirmed with a Seidel test of the bleb and repaired.

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