|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 197
Comments on: Recurrent unintentional filtering blebs after vitrectomy
Prasanna Venkataraman1, Premanand Chandran2
1 Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
2 Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
|Date of Web Publication||15-Dec-2020|
Dr. Prasanna Venkataraman
Glaucoma Services, Aravind Eye Hospital, Poonamallee High Road, Noombal, Chennai - 600 077, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|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
We would like to appreciate Shanmugam et al. 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. 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.
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.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
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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.
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.
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.