title: [Scleral injury caused by needling revision with adjunctive mytomicin-C: case report].
abstract: A 70-year-old female patient underwent cataract and glaucoma surgery on her left eye in 1996. Eleven years later, we performed two bleb needling revisions with adjunctive mytomicin-C, in order to decrease an uncontrolled intraocular pressure of 32 mmHg. After the second needling, she developed severe overfiltration, with flat anterior chamber, choroidal effusion, and impending corneal decompensation. Conservative treatment with cycloplegic and corticosteroid eye drops, acetazolamide and therapeutic contact lenses was unsuccessfully tried. Anterior chamber reformation was successively tried with air, 4% ophthalmic viscosurgical device and 1% sodium hyaluronate, with only temporary results. Compressive sutures above the overfiltering bleb were applied, unsuccessfully. In order to avoid additional corneal endothelium damage, a surgical bleb revision was performed and revealed a large area of ciliary body and choroidal exposure under the conjunctiva. It was covered by a donor scleral patch graft providing successful resolution. Nevertheless, we had to reintroduce hypotensive eyedrops. While bleb needling is a relatively safe and effective procedure, ophthalmologists should be aware of the possibility of potentially serious complications, such as in this case report.
authors.affiliation: Clínica Oculare, Belo Horizonte, MG, Brasil. wlod@terra.com.br
authors.forename: Heloisa Andrade
authors.initials: HA
authors.lastname: Maestrini
authors.forename: Thatiana Almeida Pereira
authors.initials: TA
authors.lastname: Fernandes
authors.forename: Hérika Danielle De Miranda Santos
authors.initials: HD
authors.lastname: Matoso
authors.forename: Willer Otávio Guimarães
authors.initials: WO
authors.lastname: Amaral
authors.forename: Angela Andrade
authors.initials: AA
authors.lastname: Maestrini
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D056965:Injections, Intraocular / Q000009:adverse effects; D007429:Intraocular Pressure / Q000187:drug effects; D016685:Mitomycin / Q000008:administration & dosage*; D009339:Needles / Q000009:adverse effects*; D012590:Sclera / Q000293:injuries*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D016685:Mitomycin