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Intra-bleb pigmentation after trabeculectomy.

PURPOSE
To report the presence of intra-bleb pigmentation (IBP), appearing after trabeculectomy 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 trabeculectomy 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 IOPs < or = 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.