title: Treatment with sodium hyaluronate eye drops in a patient who had early-onset bleb leakage after trabeculectomy with mitomycin C.
abstract: We present the case of a 47-year-old man who had bilateral proliferative diabetic retinopathy and neovascular glaucoma. Schirmer I test revealed tear secretions of 5 mm and 3 mm in the right and left eyes, respectively. Tear breakup times in the right and left eyes were 7 and 8 seconds, respectively. The ocular surface staining in both eyes was scored as Grade 1 as per the Oxford scheme. Retinal photocoagulation was performed for correction of the proliferative diabetic retinopathy and rubeosis iridis, which resolved with treatment. However, the intraocular pressure in the left eye could not be adequately controlled. Therefore, trabeculectomy with mitomycin C using limbal-based conjunctival flap was performed. Three hours after the surgery, the patient developed a large and diffuse filtering bleb, but no leakage occurred from the conjunctival scar. However, on the first postoperative day, leakage was noted and the conjunctiva was at the leakage point. The leakage resolved transiently, but recurred the next day. Severe keratoconjunctival epithelial failure was detected, and the patient was administrated 0.1% sodium hyaluronate eye drops six times daily. The epithelial failure improved, and many microcysts were detected on the bleb surface where the epithelial failure improved. The leakage resolved 2 days after initiation of the sodium hyaluronate eye drops. The microcysts disappeared and the bleb surface became smooth 1 month later.
authors.affiliation: The Marui Eye Clinic, Minamisoma, Japan ; Department of Ophthalmology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Sagara
authors.affiliation: Department of Ophthalmology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Tetsuju
authors.initials: T
authors.lastname: Sekiryu
authors.affiliation: Department of Ophthalmology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Noji
authors.affiliation: Department of Ophthalmology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Ogasawara
authors.affiliation: Department of Ophthalmology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Imaizumi
authors.affiliation: Northern Fukushima Medical Center, Fukushima, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Yago
keywords: bleb; bleb leak; microcyst; sodium hyaluronate; trabeculectomy