title: Laser bleb reduction for bleb dissection with krypton green laser: technique and outcomes.
abstract: OBJECTIVE
  Lasers have been used to treat dysfunctional blebs, but the laser remodeling of blebs that dissect into the palpebral fissure has not been reported. We describe the unique use of krypton green laser to treat dissected blebs and discuss treatment outcomes.
  
  
  METHODS
  Retrospective review of consecutive patients undergoing laser bleb reductions (LBRs) over a 6-year period. Failure was defined as persistent dissection and/or symptoms or loss of intraocular pressure (IOP) control despite medications.
  
  
  RESULTS
  Sixteen patients underwent a total of 23 LBRs and were followed-up for a mean of 12.4 months (median = 9.5 mo). Ten patients (63%) were treated successfully, and 6 patients (37%) failed treatment. Persistent dissection and/or symptoms were the most common reasons for failure (5/6), whereas 1 patient lost IOP control. Three (30%) of those treated successfully required the reintroduction of ocular hypotensive medications for pressure control. The mean IOP increased from 9.1 +/- 5.2 mm Hg before treatment to 11.7 +/- 8.1 mm Hg after treatment (P = 0.02). Common complications included intraoperative discomfort (26%), conjunctival injection (22%), postoperative discomfort (13%), and dissection into the untreated side (9%). In the failure group, more laser spots (P = 0.05) and higher power levels (P = 0.00001) were used.
  
  
  CONCLUSIONS
  Krypton LBR may be a useful initial treatment modality for symptomatic bleb dissection. Success rates may be modest, but most adverse effects are mild and/or transient; however, significant loss of IOP control can occasionally occur.
authors.affiliation: Department of Ophthalmology, Dean A. McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. baw@jervey.com
authors.forename: Brian A
authors.initials: BA
authors.lastname: Welcome
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Skuta
authors.forename: Adam C
authors.initials: AC
authors.lastname: Reynolds
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000601:surgery*; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012189:Retrospective Studies; D014792:Visual Acuity