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   Table of Contents      
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 197

Comments on: Recurrent unintentional filtering blebs after vitrectomy

1 Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
2 Aravind Eye Hospital, Coimbatore, Tamil Nadu, India

Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. Prasanna Venkataraman
Glaucoma Services, Aravind Eye Hospital, Poonamallee High Road, Noombal, Chennai - 600 077, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_652_20

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How to cite this article:
Venkataraman P, Chandran P. Comments on: Recurrent unintentional filtering blebs after vitrectomy. Indian J Ophthalmol 2021;69:197

How to cite this URL:
Venkataraman P, Chandran P. Comments on: Recurrent unintentional filtering blebs after vitrectomy. Indian J Ophthalmol [serial online] 2021 [cited 2021 Jan 22];69:197. Available from: https://www.ijo.in/text.asp?2021/69/1/197/303346

Dear Editor,

We would like to appreciate Shanmugam et al.[1] for their work. This report sheds light on the myriad of presentations of Traboulsi syndrome. Though the authors did not find communication between the bleb and anterior chamber on anterior segment optical coherence tomography, we highly recommend gonioscopy for the same. We would like to know the angle status of the other eye too as it can reveal a fistulous tract.

We have previously reported the 14th individual with Traboulsi syndrome and the first one from India, with a novel 5 bp homozygous deletion mutation in the ASPH gene.[2] We have noted scleral thinning with a communicating fistula between the anterior chamber and subconjunctival space with gonioscopy in our patient. It would be prudent to associate the typical facies and microspherophakia with Traboulsi syndrome when examining a patient with spontaneous filtering blebs and hypotony.[3]

Recognition of this entity is of paramount importance to avoid postoperative surgical surprises. When faced with microspherophakia and lens subluxation in these patients, a safe approach would be to plan clear-corneal phacoemulsification away from the site of the filtering bleb. The technique of intraocular lens implantation depends on the amount and location of scleral thinning. Care must be taken while creating pockets for a scleral-fixated intraocular lens (IOL). Other options include an iris-claw lens and suture fixation of a three-piece IOL to the iris.

A decision to repair the filtering bleb with patch graft will depend on the amount of scleral thinning, uveal ectasia, hypotony, and posterior segment status. Avoiding unnecessary surgical interventions and conservative management will help us tackle these spontaneous filtering blebs. The importance of examining the family members too cannot be overemphasized.[4]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Shanmugam PM, Sagar P, Konana VK, Simakurthy S, Ramanjulu R, Sheemar A, et al. Recurrent unintentional filtering blebs after vitrectomy: A case report. Indian J Ophthalmol 2020;68:660-2.  Back to cited text no. 1
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Chandran P, Chermakani P, Venkataraman P, Thilagar SP, Raman GV, Sundaresan P. A novel 5 bp homozygous deletion mutation in ASPH gene associates with traboulsi syndrome. Ophthalmic Genetics 2019;40:185-7.  Back to cited text no. 2
Patel N, Khan AO, Mansour A, Mohamed JY, Al-Assiri A, Haddad R, et al. Mutations in ASPH cause facial dysmorphism, lens dislocation, anterior-segment abnormalities, and spontaneous filtering blebs, or traboulsi syndrome. Am J Hum Genet 2014;94:755-9.  Back to cited text no. 3
Shawaf S, Noureddin B, Khouri A, Traboulsi EI. A family with a syndrome of ectopia lentis, spontaneous filtering blebs, and craniofacial dysmorphism. Ophthalmic Genet 1995;16:163-9.  Back to cited text no. 4


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