More frequently developed following full-thickness filtration surgery or an antiproliferative-enhanced trabeculectomy.
Complications commonly associated with full thickness filtration procedures are formation of an exuberant bleb due to a lack of aqueous flow resistance, over-filtration with resultant early hypotony, shallow anterior chamber, cataract, corneal decompensation and choroidal detachment.
Complications associated with antiproliferative application include corneoscleral, ciliary body and vitreoretinal toxicity, conjunctival wound leak, bleb rupture, and progression of cataract.
Vision loss due to hypotony or hypotonic maculopathy, although rare, is more likely associated with the use of mitomycin-C.
Management
Thorough evaluation of the bleb post-operatively to assess potential filter failure, conjunctival leak, infection and other complications.
Large soft contact lenses (18 - 22 mm) have been reported to be helpful in the management of leaking blebs.
Rigid glaucoma shell is also useful in managing friable conjunctival tissues with multiple holes.
Excision of the conjunctival tissue or subconjunctival fibrosis, cryotherapy, argon laser, or revision surgery may be needed to improve the filtration bleb.