Inferior exten filtering bleb formation after laser goniopuncture in a patient with conjunctivochalasis.

PURPOSE: Inferior extension of filtering blebs after glaucoma surgery is rare. Conjunctivochalasis, an age-related redundancy of the conjunctiva, may influence bleb morphology but is often overlooked. This report describes an inferiorly extended filtering bleb following deep sclerectomy and subsequent Nd:YAG laser goniopuncture in a patient with pre-existing conjunctivochalasis.

METHODS

A 66-year-old man with advanced primary open-angle glaucoma underwent combined phacoemulsification, deep sclerectomy, and intraoperative mitomycin C in the right eye. Initial recovery was uneventful, with IOP at 15 mmHg and a mildly elevated bleb.

RESULTS

At six weeks, bleb flattening and an IOP rise to 19 mmHg prompted Nd:YAG laser goniopuncture. Two weeks later, a diffuse, hypovascular bleb extended inferiorly into the fornix, corresponding to an area of conjunctivochalasis. IOP was 9 mmHg, with no hypotony, leak, or symptoms. The bleb regressed spontaneously over one month, stabilizing superiorly with IOP at 13 mmHg without medications.

CONCLUSIONS

This case suggests that conjunctivochalasis may act as a low-resistance pathway for aqueous diffusion after increased outflow from goniopuncture, leading to atypical bleb spread. While self-limiting here, such morphology could have implications for comfort, contact lens use, or hypotony risk. Pre-existing conjunctival redundancy may influence postoperative bleb morphology and should be considered in surgical planning and follow-up after bleb-forming glaucoma surgeries.