Management of large, leaking, and inadvertent filtering blebs with the neodymium: YAG laser

Abstract

Objective The purpose of the study was to test the efficacy of the neodymium:YAG (Nd:YAG) laser for repairing filtering blebs. Design The study design was a prospective study. Participants Five eyes of five patients with leaking blebs (group 1), five eyes of five patients with large irritating blebs (group 2), and four eyes of four patients with inadvertent filtering blebs in the surgical wound after cataract surgery (group 3) were studied. Intervention The thermal mode of the Lasag Microrupter II Nd:YAG laser was used to treat the filtering blebs. The area of the bleb targeted for treatment was “painted” with methylene blue and then exposed to Nd:YAG laser treatment with an energy level of 2.5 to 3.75 J in a grid pattern. The aiming beam was focused on the conjunctiva, but the laser beam was offset according to the height of the bleb (offset of 0.9–1.5 mm, 4–5 on the Lasag) to selectively treat the internal surface of the bleb. Main outcome measures Symptomatology, intraocular pressure (IOP), and complications were measured. Results After the laser treatment, all the leaks in group 1 were healed, all the patients in group 2 reported relief of their symptoms, and all blebs in group 3 shrank considerably. The IOP increased significantly ( P < 0.001) after laser treatment in all three groups. This elevation appeared to diminish over time, with the major increase in IOP being recorded within the first month after the laser treatment. However, satisfactory IOP control was maintained in nearly all patients (13 of 14) who received none or one antiglaucoma medication. The visual acuity of one patient decreased significantly because of cataract formation. Complications included transient pressure rise (1 eye), bleb failure (1 eye), pupillary retraction toward the bleb (6 eyes), iatrogenic bleb leak (6 eyes), and cataract (1 eye). Conclusion The continuous wave Nd:YAG laser is an effective tool for repairing bleb-related problems while maintaining successful filtration.