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Eye surgeon Harry Quigley.
Eye surgeon Harry Quigley.


When There’s a Bleb after Glaucoma Surgery

Last winter, Captolia Lamb, 78, had just come through surgery for the eye disease glaucoma and was shoveling snow when she felt something like a pebble in her left eye. In the mirror she beheld a “huge blob” protruding from the top of her eyeball. “I was really terrified,” the retired nurse from Odenton, Md. says. “I couldn’t close my eye.”

Lamb’s blob was actually something ophthalmologists called a “bleb”–a bizarre symptom that occasionally follows glaucoma surgery (in some cases, the bleb develops a leak and bacteria from external tears back flush into the eye, causing infection and possible loss of vision). Until recently physicians had no sure-fire way to correct the unsightly protrusion. Now, Wilmer Eye Institute’s Harry Quigley has come up with a remedy—bleb revision surgery.

Quigley offers a technical explanation for a bleb: During glaucoma surgery (called a trabeculectomy), an eye surgeon cuts a valve into the tissue of the eye wall so that fluid from inside the eye will drain quickly and lower intraocular eye pressure. But in up to 4 percent of the 250,000 glaucoma surgeries each year, the valve works too well and the eye pressure becomes too low. In the severest 1 to 2 percent of these cases, the fluid leaks beneath the conjunctiva—the delicate membrane covering the front of the eye—causing it to balloon and protrude from the top of the eyeball—the bleb.

The two surgeries Quigley has developed—bleb reduction, in which he removes just the front part of the protrusion, and bleb repair in which he removes the entire bulge—have succeeded wonderfully in the more than 30 cases he’s done. “To our pleasant surprise,” he says, “we’re not losing the positive effect of the original glaucoma operation, and we’re fixing the symptom the patient was having.”

Lamb says she’s living proof of that: “I can close my eyelid, and you can’t tell that thing was ever there.”

-— GL