Encapsulated Bleb and Fibrous Ingrowth in the Ahmed Glaucoma Valve System and Bleb Revision with Mitomycin-C

Abstract

Purpose: To report a case of fibrous tissue ingrowth after Ahmed valve implantation and bleb revision using mitomycin-C.Case summary: A 50-year-old man, who had received an Ahmed implantation 6 months prior, underwent bleb revision due to persistent high intraocular pressure, despite massage and multiple needling attempts. Bleb encapsulation over the entire valve plate was observed, and the bleb was gently dissected. Fibrous ingrowth over the entire valve system was confirmed. The broad stalk-like fibrous tissue was firmly adhered to the valve system. It was removed by pulling the connected bleb, taking care not to cut the stalk. Then, the long stalk-like fibrous ingrowth along the cleft between valve leaflets and main plate was removed, in the same manner. A sponge soaked with mitomycin-C (0.3 mg/mL) was instilled for 2 minutes, and the conjunctiva was sutured. Two weeks after the surgery, conjunctival suture was performed due to Ahmed valve exposure. Three weeks later, the Ahmed valve was removed due to re-exposure. Trabeculectomy surgery was performed due to uncontrolled intraocular pressure.Conclusions: There is a possibility of extensive fibrous tissue ingrowth after Ahmed valve implantation; thus, care should be taken when using mitomycin-C for bleb revision.