title: Role of oral doxycycline and large diameter bandage contact lens in the management of early post-trabeculectomy bleb leak.
abstract: A 27-year-old man with juvenile open angle glaucoma and medically uncontrolled intraocular pressure (IOP) underwent a trabeculectomy with mitomycin C in his right eye. One week postoperatively, he developed ischaemic necrosis of the conjunctiva with a bleb leak. This was managed conservatively with oral doxycycline 100 mg twice daily along with a topical low-dose steroid, antibiotic and cycloplegic and a large diameter bandage contact lens (BCL). There was dramatic improvement in the bleb appearance, the necrosis healed and the leak resolved. The patient had well-controlled IOP with a diffuse healthy bleb at 4 weeks, which was maintained at 2 years. This case illustrates the utility and importance of oral doxycycline in the management of early post-trabeculectomy conjunctival necrosis and the use of BCL in the management of a bleb leak. This safe and non-invasive method not only hastened the recovery but also helped in maintaining good bleb function.
authors.affiliation: Department of Glaucoma, L V Prasad Eye Institute, Hyderabad, Telangana, India.
authors.forename: Turaga
authors.initials: T
authors.lastname: Kiranmaye
authors.affiliation: Department of Glaucoma, L V Prasad Eye Institute, Hyderabad, Telangana, India.
authors.forename: Chandrasekhar S
authors.initials: CS
authors.lastname: Garudadri
authors.affiliation: Department of Glaucoma, L V Prasad Eye Institute, Hyderabad, Telangana, India.
authors.forename: Sirisha
authors.initials: S
authors.lastname: Senthil
mesh_terms: D000284:Administration, Oral; D000328:Adult; D057868:Anastomotic Leak / Q000175:diagnosis / Q000628:therapy*; D001458:Bandages; D003228:Conjunctiva / Q000473:pathology*; D003261:Contact Lenses; D004318:Doxycycline / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D009336:Necrosis / Q000209:etiology / Q000473:pathology; D009883:Ophthalmic Solutions; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D012380:Role; D013256:Steroids / Q000008:administration & dosage; D014065:Tonometry, Ocular / Q000379:methods; D014130:Trabeculectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D009883:Ophthalmic Solutions; D013256:Steroids; D004318:Doxycycline