University of Iowa Health Care

Ophthalmology and Visual Sciences

Iowa Glaucoma Curriculum Anki Study Questions

Supplementary Material

Chapter 44

Case from
Blebitis: 74-year-old with red eye after trabeculectomy

Trabeculectomy cases from

Iris into Sclerostomy - slit lamp only: This patient has primary open angle glaucoma. At age 50 he underwent a trabeculectomy in his right eye and, 7 months later had a needling performed of the bleb. After the bleb needling he was referred in with the clinical appearance seen here. His iris is peaked and there is pigmented material inside the filtering bleb. Thankfully, his intraocular pressure was 9 mmHg and his visual acuity was 20/25.

Bleb Leak (slit lamp only): This patient has undergone trabeculectomy elsewhere. He developed a bleb leak and had undergone a bleb revision. He presented at this time with a brisk leak. His intraocular pressure was 8 mmHg and as eye was well formed. This is a nice example of a positive Seidel test.

Internal Sclerostomy: This 80-year-old patient had a trabeculectomy performed 13 years before. This brief clip shows an open internal sclerostomy.

Suprachoroidal Hemorrhage: This patient had undergone a trabeculectomy and early after surgery had developed a giant suprachoroidal hemorrhage allowing one to see the retina through the pupil.

Bleeding after Trabeculectomy - slit lamp only: 85 year-old man who is one day out from a trabeculectomy. He has active bleeding in his anterior segment. This resolved with patching and his ultimate outcome was excellent with a final IOP of 10 mmHg.

Bleeding Trabeculectomy Site: This patient at age 83 presented with hyphema in the left eye. He had undergone a trabeculectomy a decade earlier and had a phacoemulsification about 6-years earlier. One can see bleeding from the trabeculectomy site. Attempts at laser coagulation were unsuccessful but a surgical revision of the bleb resolved this patients intermittent bleeding episodes.
Courtesy of Young H. Kwon, MD, PhD. The University of Iowa