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Case ReportOpen Access
Intra-Bleb Pigmentation after Trabeculectomy
Wanichwecharungruang B 
,
Narumitchai W
,
Narumitchai W Purpose
: To report the presence of intra-bleb pigmentation (IBP), appearing after trabecu-
lectomy and combined clear cornea phacoemulsification, intraocular lens (IOL) implantation and
trabeculectomy (combined surgery).
Method
: Ten eyes of 8 Asian patients with IBP were studied. Four eyes underwent trabecu-
lectomy for uncontrolled glaucoma, and 6 eyes underwent combined surgery for cataract coexisting
with glaucoma. Seven of the 10 eyes had adjunctive mitomycin C for the procedures.
Results
: Mean follow-up time was 11.6 months (range 3-15 months). Five of the 10 eyes
had intra-operative and post-operative complications requiring intraocular manipulation (ruptured
posterior capsule and in-the-sulcus IOL, flat anterior chamber, malignant glaucoma, iris prolapse).
Blebs were thin (8 eyes), or with moderate thickening of conjunctiva (2 eyes) with IBP either overlying
the scleral flap or spread beneath the conjunctiva. IBP initially appeared at 2 to 44 weeks after the
procedures. Nine of the 10 eyes (90%) had
lOPs~
22 mmHg without medication.
Conclusion
: IBP is associated with iris trauma at surgery and dispersal of pigment into the
bleb, where it spreads or proliferates. A thin bleb provides a clear view of IBP as well as functional
filtration. IBP appears to be a favorable sign of the filtration.
Key word
: Trabeculectomy, Combined Surgery, Complications, Filtering Bleb, Pigmentation
: To report the presence of intra-bleb pigmentation (IBP), appearing after trabecu-
lectomy and combined clear cornea phacoemulsification, intraocular lens (IOL) implantation and
trabeculectomy (combined surgery).
Method
: Ten eyes of 8 Asian patients with IBP were studied. Four eyes underwent trabecu-
lectomy for uncontrolled glaucoma, and 6 eyes underwent combined surgery for cataract coexisting
with glaucoma. Seven of the 10 eyes had adjunctive mitomycin C for the procedures.
Results
: Mean follow-up time was 11.6 months (range 3-15 months). Five of the 10 eyes
had intra-operative and post-operative complications requiring intraocular manipulation (ruptured
posterior capsule and in-the-sulcus IOL, flat anterior chamber, malignant glaucoma, iris prolapse).
Blebs were thin (8 eyes), or with moderate thickening of conjunctiva (2 eyes) with IBP either overlying
the scleral flap or spread beneath the conjunctiva. IBP initially appeared at 2 to 44 weeks after the
procedures. Nine of the 10 eyes (90%) had
lOPs~
22 mmHg without medication.
Conclusion
: IBP is associated with iris trauma at surgery and dispersal of pigment into the
bleb, where it spreads or proliferates. A thin bleb provides a clear view of IBP as well as functional
filtration. IBP appears to be a favorable sign of the filtration.
Key word
: Trabeculectomy, Combined Surgery, Complications, Filtering Bleb, Pigmentation
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