Bleb Leak

A patient with past ocular history of trabeculectomy for juvenile open angle glaucoma and DSAEK for Fuch’s endothelial corneal dystrophy presented to the emergency room with left eye blurred vision and redness. The patient was diagnosed with acute graft rejection. The patient was started on topical steroids which were slowly tapered over several months without improvement. The patient underwent uncomplicated DSAEK of the left eye. On post-operative day 1, the patient was noted to have an intraocular pressure of 0 and flat chamber secondary to a bleb leak. The patient underwent trabeculectomy bleb revision which included excising ischemic bleb tissue and posterior needling of the bleb. Intraoperative AS-OCT showed the DSAEK graft to be attached. At post-operative month 1, corneal edema is nearly resolved with an attached DSAEK graft and improved visual acuity as well as a functioning bleb with intraocular pressure of 10 on no glaucoma meds. Plan for a slow steroid taper.

Presentation Date: 04/11/2024

Issue Date: 04/19/2024