By Cynthia Mattox, MD, FACS
    Glaucoma, Open-Angle Glaucoma, Surgical Management

    In cases of recurrent bleb leak or blebitis, a bleb excision may be required. In this video, Dr. Cindie Mattox performs a bleb excision with conjunctival advancement and a relaxing incision to correct a malfunctioning bleb.

    The surgeon creates a peritomy around the entire avascular area of the bleb, making sure to preserve as much normal conjunctiva as possible. She then dissects the epithelium from the remaining bleb to provide a broad area for adhesion at the limbus. Subconjunctival dissection is performed peripherally and posteriorly to mobilize the conjunctiva. If there isn’t sufficient healthy adjacent conjunctiva to cover the bleb, a conjunctival autograft may be used instead.

    To close the conjunctival defect, Dr. Mattox uses 8-0 Vicryl sutures on a tapered needle. Multiple horizontal mattress sutures are placed at the limbus to create a watertight closure. Due to unexpected tension at the incision site, the surgeon opts to place a small posterior relaxing incision parallel to the limbus. These incisions tend to heal quickly and completely in the immediate postoperative period.