May 24, 2023, Researchers discover therapeutic target to aid in glaucoma treatment Carrillo MM, Buys YM, Faingold D, Trope GE. Usual causes for this postoperative condition are conjunctival wound leaks, serous choroidal detachments and rarely, an inadvertent cyclodialysis cleft. As it progresses and more peripheral vision is lost, tunnel vision may develop. Transient hypotony is very common after glaucoma surgery, but it may lead to other possible complications including flat anterior chamber (Fig. Fourman S, Wiley L. Use of a collagen shield to treat a glaucoma filter bleb leak. The exam includes a visual field test to check your side vision. Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE. Surgery should be deferred till the complete absorption of hemorrhage. The efficacy and safety of glaucoma drainage devices has been well established, so they are a viable surgical option in patients who . Publication of the supplement was not supported by any external funding. Common cause for serous choroidal detachment is a conjunctival wound leak. Reported non-surgical interventions can be tried before resorting to the surgical revision of the bleb. To minimize the morbidity, it is very important that one should know how to prevent them, recognize them and treat them. Ifyouhave glaucoma,its importantto start treatment right away. The conjunctival defect is measured with calipers. [72] The morbidity of infections can be very high, almost one-third of bacterial infections following filtering surgery that were treated with intensive medical treatment ended up with no light perception at the end of one year. Steroids applied closest to the eye carry the highest risk. Costa VP, Wilson RP, Moster MR, Schmidt CM, Gandham S. Hypotony maculopathy following the use of topical topical mitomycin C in glaucoma filtration surgery. It is usually because of tight closure of the wound, however, one should perform gonioscopy if needed to rule out the obstruction to flow at the sclerotomy site. Otherwise, pressure can damage the rest of the eye and lead to permanent vision loss or . If there is leak, unstained aqueous will be seen to flow surrounded by dark green fluorescein tear film [Figs. The ocular hypertensive phase usually occurs one to three months following the surgery. Theylower the pressure in your eye and preventdamageto your optic nerve. Glaucoma surgery is difficult and fraught with complications. A variety of suturing techniques have been described. Chen CW. Most patients are not aware they have a narrow angle until they experience an acute attack of sudden eye pain, nausea, vomiting, headache, foggy vision or seeing halos or rainbows. Limbus-based trabeculectomy gives the advantage of a watertight closure; on the contrary, leaks are very common with a fornix-based flap. Federal government websites often end in .gov or .mil. A second pass is made posterior to the bleb after incising the conjunctiva and episclera. Thesymptomscanstartso slowly that youmaynot noticethem. It was initially indicated for open-angle glaucoma but has been proven to be efficacious for various types of glaucoma. Over time, youmay slowly losevision,usuallystarting with yourside(peripheral)vision especially the part of your vision thatsclosest to your nose. If patients undergo laser iridotomy or cataract surgery to open up their narrow angle, they will be able to take at risk medications without worry. The process happens slowly and can eventually affect peripheral vision. Why Do I Suddenly Have Cloudy Vision in One Eye? video Do genetics Play a Role in Eye Diseases Like Glaucoma? Some of those complications can be vision-threatening. Another recent hypothesis proposes that choroidal expansion contributes to the events causing anterior vitreal movement.[44]. Treatment involves aqueous suppressants and topical steroids. A scleral patch graft is used to repair areas of necrotic sclera wherever necessary. Minimally invasive glaucoma surgery (MIGS). Blunt trauma can cause bleeding in the eye. Pediatric ophthalmologist Courtney Kraus on glaucoma in children. Experience with the use of Baerveldt and Ahmed glaucoma drainage implants in an Asian population. November 13, 2017. Lost vision typically cannot be recovered, but it is possible to prevent progression with treatment. Topical and systemic antibiotics will be needed. If medical therapy fails, surgical treatment is required. To a large extent, the outcome of the trabeculectomy surgery is determined by postoperative care. Using a 30-gauge needle on a 1-ml syringe the subconjunctival space is entered away from the trabeculectomy site. Loss of side (peripheral) vision, blind spots, blindness, Dilated eye exam with visual field testing, Medicine (usually eye drops), laser treatment, surgery. In each postoperative visit, the examination consists of measurement of IOP, AC depth and evaluation of bleb characteristics. This causes pressure in the eye to rise. Trabeculectomy with releasable sutures. It's done in a hospital and usually takes 1 to 2 hours. In the absence of spontaneous leak, gentle pressure can be applied and suspicious area of leak should be examined. Complications associated with filtering surgery include infection, cataracts, bleeding, hypotony . The needle is observed entering the bleb, where 0.1-0.3 ml of blood is injected. Glaucoma occurs when the fluid your eye produces, called aqueous humor, is unable to drain normally. The bleb is firm with few or no microcysts. This type of surgery is used to treat several types of glaucoma, including congenital glaucoma, neovascular glaucoma, and glaucoma caused by an injury. [9] Acute retrobulbar hemorrhage presents as proptosis associated with hardening of the eye, discoloration of lids and subconjunctival hemorrhage following local anesthetic injection. Your eye doctor may suggest a MIGS procedure to lower your eye pressure. With adjunctive use of antimetabolites such as MMC, the window period for postoperative titration with suture removal is extended to several months; this timeframe is somewhat shorter with 5-FU. Si te diagnostican glaucoma, posiblemente debers recibir tratamiento de por vida, someterte a revisiones mdicas regulares y enfrentes la posibilidad de perder progresivamente la vista. The surface of the bleb and suture line should be tested for a leak. Suprachoroidal expulsive hemorrhage in glaucoma patients undergoing intraocular surgery. Some blood may enter the AC during the procedure, which can be washed via a paracentesis if required. Glaucoma develops when the optic nerve becomes damaged. [Figs.66 and and7].7]. The rigidities of tubes were also examined using a microcompression tester. Long-term cycloplegic drops may be needed and it must be kept in mind that the fellow eye is at high risk of developing the same problem in case of any surgical intervention. Direct repair of the buttonhole can be performed using a purse-string suture or single or multiple mattress sutures using a 10-0 Nylon suture on an atraumatic needle. Management depends upon the size and position of the leak, the appearance of the bleb, depth of the AC and whether antimetabolites were used or not. But skin creams and inhalers are also worrisome. Closure of leaking filtering blebs with cyanoacrylate tissue adhesive. This review article summarizes the few rare complications that can be seen with selective laser trabeculoplasty. This can be associated with a drop in the visual acuity[54] and hypotony maculopathy. Open-angle glaucoma, which doesn't usually produce early symptoms, is the most common. Maxine Lipner is a long-time health and medical writer with over 30 years of experience covering ophthalmology, oncology, and general health and wellness. Quigley HA, Friedman DS, Congdon NG. July 26, 2018. Asymptomatic high eye pressure is treatable and can be detected during a visit with your eye doctor. Tube migration can be corrected with tube extenders and migrating plate can be resutured again. Taking steroid drugs in any form orally, topically, through an inhaler or IV can worsen glaucoma for these patients. The American Academy of Ophthalmology prepared an ophthalmic technology assessment on non-penetrating glaucoma surgery in 2001. If the leak is large or not responding to conservative treatment, other modalities that result in closure of the leaks should be tried. It may take several months for the complete resolution of detachment and cataract formation is commonly seen.[53]. Both techniques can be associated with complications such as flat anterior AC and wound leaks. At the end of one year 60-80% maintain IOP of less than 22 mmHg. Symptoms of an angle-closure glaucoma attack can come on suddenly and can include: if you experience possible symptoms of angle-closure glaucoma, you should immediately seek medical assistance. Graham Lee 5839 Views Glaucoma stents are a recent innovation to improve outflow of aqueous from the eye and control intraocular pressure. The avascular necrotic area of the bleb is excised at the junction of avascular and vascular conjunctiva using Wescotts scissors. At first, glaucoma doesntusuallyhaveanysymptoms. The complications of deep sclerectomy include perforation leading to conversion to trabeculectomy, scleral ectasia, iris incarceration, Descemets detachment and late AC bleeding during gonioscopy. The fornix-based flap provides a better surgical view and exposure. Surface leaks are difficult to close surgically and conservative treatment should be tried. In blebs without antimetabolite use, these leaks can subside with conservative treatment which consists mainly of aqueous suppressants, broad-spectrum antibiotics and patching or soft contact lens application. Hypotony maculopathy after filtering surgery with mitomycin C: Incidence and treatment. Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin C. Yoon PS, Singh K. Update on antifibrotic use in glaucoma surgery, including use in trabeculectomy and glaucoma drainage implants and combined cataract and glaucoma surgery. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, 18 College Road, Chennai-600006, India. Deep sclerectomy is performed more often than viscocanalostomy. Cauterization may shrink the tissue and result in poor closure; in view of this cauterization should be avoided for scleral bleeding. It is estimated that there are about 66 million people in the world with glaucoma, and . In these cases, balanced salt solution (BSS) or viscoelastic is injected to deepen the anterior chamber and a superficial lamella is then dissected anteriorly into clear cornea. Busbee BG, Recchia FM, Kaiser R, Nagra P, Rosenblatt B, Pearlman RB. Each form of glaucoma can cause different symptoms. Excessive filtration (over-filtration) due to a loose scleral flap suture is the common cause for this postoperative complication. Some complications are common and mild, while others are rare and/or vision threatening. Jampel HD, Quigley HA, Kerrigan-Baumrind LA, Melia BM, Friedman D, Barron Y. Glaucoma Surgical Outcomes Study Group. It is mandatory to remove one suture at a time. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Aims: To recommend a list of complications of glaucoma surgery to be used in future glaucoma surgery research and reporting by exploring the spectrum of complications' names, the variety of definitions and time frames used for reporting them in glaucoma surgical trials. Ritch R, Potash SD, Liebmann JM. 13]. Scientists arent sure what causesthe most commontypesofglaucoma, butmany people with glaucoma have high eyepressure and treatments that lower eye pressure help to slow the disease. Long-term complications of incisional glaucoma surgery were evaluated among Medicare beneficiaries. Late onset of sequential multifocal bleb leaks after glaucoma filtering surgery with 5-fluorouracil and mitomycin C. Azuara-Blanco A, Katz LJ. DOI: 10.1016/j.ymthe.2023.03.008. The frequency of visits varies according to the IOP, AC depth and bleb characteristics. Identification of primary cause and appropriate treatment should be the first step in the management. Focal pressure: a new method to encourage filtration after trabeculectomy. [23] In the modern era it is preferable to do a pars plana vitrectomy with disruption of the anterior hyaloid face. [10] Elevated intraocular pressure (IOP) that occurs with retrobulbar hemorrhage can compromise blood flow to the optic nerve in advanced glaucoma. Complications can be classified as shown in Table 1. There are several different types of surgery that can help the fluid drain out ofyour eye. If the pressure in the eye is not treated, the optic nerve can be damaged soon after. The risk of SCH is greatly increased in patients with raised episcleral venous pressure like Sturge Weber syndrome and in dural sinus shunts. Large leaks along the suture line need closure. To avoid anesthesia-related complications, topical anesthesia is an option. Initial management consists of aqueous suppressants and cycloplegics [Figs. In cases of pigmentary dispersion syndrome, the pigment from the colored portion of the eye can rub off and clog the eye's drainage system. The site is secure. Symptoms are common with nasal or large blebs or blebs extending to the cornea [Figs. The technique also appears to cause a remodeling within the bleb [Fig. Complications can lead to serious vision problems: Vitreous hemorrhage. The presence of thin-walled blebs that is commonly seen with antimetabolite use is a risk factor for bleb infections. When hypotony (IOP of less than 5 mmHg) persists for more than three months it is called chronic hypotony. In this operation, the surgeon implants a tiny tube, or shunt, onto the white part of your eye. This so-called narrow angle can form gradually over time or it can come on suddenly, without warning. Onset of infection can vary from the first few days post surgery to 20 years following filtration surgery. Incidence of late-onset bleb related complications following trabeculectomy mitomycin. Hypotony without a visible bleb should alert the surgeon to the possibility of a conjunctival leak and the Seidels test usually localizes the site of the leak. The role of prophylactic use of topical antibiotics to prevent bleb-related infections is questionable. Trabeculectomy . Reported risk factors for this complication are young age and myopia. External revision with needling using antimetabolites is the commonly recommended procedure for bleb failure due to scarring. Preventive sclerotomies should be placed in high-risk eyes. [65] The frequency of the late bleb leaks ranges from 1.810% and the FFSS Group reported a 7% rate after three and five years follow-up. Three year follow-up of the Tube Versus Trabeculectomy Study. Early postoperative trabeculectomy leakage: Incidence, time course, severity, and impact on surgical outcome. WuDunn D, Ryser D, Cantor LB. [40,41], Encysted blebprominent blood vessels with thick wall. Choroidal drainage is usually done under general or local anesthesia. Preplacing scleral flap sutures facilitates closure of the scleral flap without resulting in significant duration of hypotony. When there is involvement of the AC and the vitreous cavity, a fluid tap should be taken and sent for microbiological examination. 5]. The best way to avoid postoperative leaks is to meticulously close the conjunctiva peroperatively. Compression sutures are placed using 9-0 or 10-0 nylon suture on a cutting needle. Risk factors for late-onset infection following glaucoma filtration surgery. Parrish RK, 2nd, Schiffman JC, Feuer WJ, Heuer DK. This pattern of peripheral loss of vision can also be a distinguishing characteristic from other forms of vision loss. Preliminary report of a new method. American Academy of Ophthalmology, What are common glaucoma symptoms? Sherwood MB, Spaeth GL, Simmons ST, Nichols DA, Walsh AM, Steinmann WC, et al. It is also referred to as Tenons cyst and it usually occurs during the second to fourth postoperative week as a tense, tight-appearing bleb. Bleb leaks are the predisposing factors for infection, clinicians should look for the leaks during follow-up visits and treat them immediately if present. [6] Aqueous drainage implants were initially introduced for refractory glaucomas; however, recently there has been a trend to use the implants with the aim of attempting to avoid trabeculectomy-related complications. The underlying sclera is inspected. Deeper dissections are prone to posterior premature entry. Persistent early hypotony can lead to chronic hypotony. Most glaucoma surgeries are done with local anesthesia and are outpatient. [23] Large choroidal effusions may need drainage. Wound healing at the conjunctival and episcleral plane is a limiting factor for the success of trabeculectomy. A limbus-based or a fornix-based flap is fashioned according to the surgeons preference. It is best managed in consultation with a retinal specialist. Objectives To investigate the incidence of postoperative complications arising in the first year after trabeculectomy and combined phacotrabeculectomy in eyes with primary angle-closure glaucoma (PACG) vs those with primary open-angle glaucoma (POAG).. Methods This was a retrospective study of all glaucoma operations done at a Singapore hospital from January 9, 2001, to December 30, 2004. October 9, 2020. [74,75] Long-term data on these procedures are limited. Other than the thickness, flap size seems to be an important parameter; a large flap seems to produce more diffuse blebs. If the bleeding persists one may have to close the flap and increase the IOP to stop the bleeding. National Library of Medicine Experimental perfusions through the anterior and vitreous chambers with possible relationships to malignant glaucoma. Copyright 2023 Welcome Cure Pvt. Bright Focus Foundation, Glaucoma: Signs & symptoms. The IOP, depth of the AC and height of bleb should be noted after the digital pressure. [3638] Temporary IOP reduction with medications such as aqueous suppressants is usually required. September 18, 2019. Patients with specific types of lipids may be at higher risk of developing blinding eye disease Since the surgical procedures for glaucoma disrupt the integrity of the globe, they are known to produce various complications. They may lead to hypotony, shallow anterior chamber (AC) and scarring of the bleb. Some immediate complications are a result of having the surgical procedure. If you have these symptoms, it may mean that the angle of your eye has become suddenly blocked. Minimally invasive glaucoma surgery (MIGS). Motility problems have been reported, especially with Baerveldt implants. The goal of management here is to separate the edges of the scleral flap with digital pressure. Complications Summary Glaucoma is an eye condition that results from a buildup of fluid in the eye. Because it happens so slowly,many peoplecant tellthattheirvision is changing at first. It affects more than 2 million individuals in the United States and 67 million individuals worldwide. However, please note that we do not claim to cure each and every case, and do not provide guarantee of any kind. Surgery. Preventive measures in high-risk groups include IOP reduction by medications including hyperosmotic agents and releasing aqueous gradually through the paracentesis tract. Be sure to mention any history of eye trauma to your eye doctor because traumatic glaucoma can occur even 10-20 years or more later. Drugs taken by mouth or through an IV enter the eye through the bloodstream about as close to the eye as you can get. Bleb-associated endophthalmitis: clinical characteristics and visual outcomes. Theres no way to prevent glaucoma. Most of the sutures can be cut using low energy and low exposures. National Eye Institute, Glaucoma, July 28, 2020. Usually, there are no symptoms, but at late stages, you might develop blind spots in your visual field as a result of damage to the optic nerve. Avoid low IOP, especially in eyes treated with antimetabolites, Patient education is important to minimize the risk of bleb leak and infections related to it, Failure of the bleb can occur any time following the surgery, post surgery follow-up is a must for all patients, Tear film disturbances are a common cause for symptomatic blebs and need artificial tears, Immediate and aggressive treatment of bleb infections can salvage the eye, Blebitis, encysted bleb, leaking bleb, needling, trabeculectomy complications. Approach Considerations No. I confirm that none of the articles appearing in the Glaucoma Supplement are sponsored articles. Epstein DL, Hashimoto JM, Anderson PJ, Grant WM. Glaucoma can be slowly progressive, but acute changes can occur with any type of glaucoma. Macular Degeneration vs. Glaucoma: What Are the Differences? Treatment of hypotonous maculopathy after trabeculectomy with mitomycin C. Choudhri SA, Herndon LW, Damji KF, Allingham RR, Shields MB. The ideal treatment would eliminate the leak as well as hypotony while maintaining the filtration function of the bleb. The content on Healthgrades does not provide medical advice. An official website of the United States government. Simmons RJ, Kimbrough RL. 29.3 ), choroidal effusions (Fig. [66] The lens and an intact posterior capsule with a posterior chamber intraocular lens are relative barriers to migration of bacteria but not absolute barriers. [1719] Strong association of SCH with higher preoperative IOP[20] and longer axial length[21] has been reported. Some early indications that an angle-closure attack may be brewing include blurry vision, colored halos around lights, eye pain, or a slight headache. Many factors play a role in disease development, and typically genetics are considered. With normal-tension glaucoma, otherwise known as low-pressure, eye pressure is in the normal range. Remember: If youre unsure whether a drug is safe, reach out to your ophthalmologist or prescribing physician for guidance. Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, International Society of Refractive Surgery. Glaucoma surgery is difficult and fraught with complications. Intraocular surgery and choroidal haemorrhage. Most cases usually resolve on conservative therapy that consists of frequent topical steroids and cycloplegics with or without systemic steroids along with management of the event precipitating hypotony. An adequate scleral flap depth during dissection is necessary to avoid tearing the flap in superficial dissection or premature entry in deep dissections. In select cases, sclerotomies are recommended to promote drainage of suprachoroidal fluid. Complications of surgery in glaucoma. Symptoms of congenital (from birth) glaucoma may be noticeable as early as when a child is 1 month of age. The national survey of trabeculectomy. The close structural and microcirculatory co-relation between anterior and posterior segments of eye make them very vulnerable to complications when one of them is affected surgically. Low energy argon laser suture lysis after trabeculectomy (letter). Glaucoma is a progressive vision condition that can lead to permanent blindness. Goldsmith JA, Ahmed IK, Crandall AS. Both diseases are more common in people as they get older. As this nerve gradually deteriorates, blind spots develop in your vision. In case the flap tears, it may be sutured to the anterior limbal tissue and a new flap created more posteriorly and in a deeper plane. However, good outcomes are still likely if those complications encountered are managed properly.This book is intended for those surgeons wishing to improve their skills and abilities to manage difficult problems that will come up during the care . Costa VP, Correa MM, Kara-Jose N. Needling versus medical treatment in encapsulated blebs. However, HealthMaker David Ab. the contents by NLM or the National Institutes of Health. [23] These methods are useful for a period of two to three weeks following trabeculectomy without antimetabolites. 29.2 ), corneal edema, Descemet's membrane folds (Fig. iary sulcus tube insertion of glaucoma drainage implants (GDIs). So be sure to let your ophthalmologist know if youre taking steroids for allergies, joint disease, asthma, autoimmune disorder, inflammatory bowel disease or any other condition. In eyes that receive antimetabolites, even small leaks may not heal and surgical closure may be needed. In the past, needle aspiration of the fluid vitreous was a commonly done procedure. If you have vision or eye symptoms, seek prompt attention. Quigley HA. Commonly used interventions aresoft contact lenses, bleb size reduction by cryotherapy,[58] autologous blood injection with or without compression sutures,[5961] and argon laser to the bleb. Efforts must be taken to avoid the cut edges of the conjunctiva touching the antifibrotic agent used. Most drug warnings apply to patients at risk of angle-closure glaucoma but many of these patients dont even know they have the condition, says Dr. McKinney. The reported incidence is 915% following trabeculectomy. [66] Stage I (blebitis) is likely to respond to intensive antibiotic treatment with more favorable outcome. Symptoms can occur after exertion, such as jogging, and may include: Seek medical attention if you experience these symptoms. To conclude, in filtering surgeries, postoperative management may at times be more challenging than the procedure itself. Keep in mind that other medications not listed here may also cause angle closure: If you experience eye pain, nausea or vomiting, foggy vision or see halos or rainbows after taking any of these medicines, stop taking the medication immediately and call your ophthalmologist or go to the emergency room without delay. 7,752,060 and 8,719,052. This is then placed on the scleral bed taking care to maintain limbal orientation. If the tear is large and satisfactory watertight closure appears difficult, a new surgical site can be chosen. Purpose: To review current literature on the complications of the use of glaucoma drainage device surgery. Graphical abstract. Shell tamponade in filtering surgery for glaucoma. Too thin or thick a flap can both produce complications. A releasable scleral flap tamponade suture for guarded filtration surgery. If this is not possible a new flap needs to be fashioned at another site. On examination, the bleb typically will have a milky white appearance with loss of clarity. [11] In another study lidocaine 2% jelly was compared with sub-Tenons anesthesia for trabeculectomy and it was found that patient comfort and surgeon satisfaction was similar in both groups.[12]. Larger hyphemas require drainage via an AC paracentesis. Edmunds B, Thompson JR, Salmon JF, Wormald RP. In some cases, these cells form adhesions to the colored part of the eye that can further block drainage. Results: The mean observation period was 20.0 (range, 6 to 60) months. [52] If all measures fail, surgical intervention is necessary, especially in cases of cornea-lenticular touch or large non-resolving effusions. Common symptoms are ocular pain, foreign body sensation, blurred vision and tearing with or without a history of red eye with discharge. Generally glaucoma surgery is done under local anesthesia. Khairy HA, Green FD, Nassar MK, Blanco AA. Traverso CE, Greenidge KC, Spaeth GL, Wilson RP. Glaucoma drainage devices (GDD) are of various designs; they are implanted according to the patient condition and surgeons' preference. Medical management. When simple methods fail or the leak is complicated, surgical revision is recommended. The anterior extent of the dissection is carried out to the limbus. After cleaning the antecubital region, the assistant withdraws blood into a 1-ml syringe and the surgeon changes the needle to 30-gauge and introduces the needle at least 5 mm away from the bleb. Theres nocureforglaucoma, butearly treatment can often stop the damage and protect your vision. This book is intended for those surgeons wishing to improve their skills and abilities to manage . Surgical management of encapsulated filtering blebs. To lower your eye pressure, doctors can use lasers tohelpthe fluid drainout of your eye. For reasons that doctors don't fully understand, this nerve damage is usually related to increased pressure in the eye. All Rights Reserved. . During iridectomy or inner block removal injury to the major arterial circle of iris can cause bleeding. The symptoms can start so slowly that you may not notice them. Cohen JS, Osher RH. It usually doesn't cause symptoms until vision loss occurs, when it's too late to treat. Globally, glaucoma is the leading cause of irreversible blindness [ Tham, 2014 ]. Children may become especially fussy, lose their appetite, or begin vomiting. Tube and plate migration can occur as late complications. Efficacy of autologous blood injection for treating overfiltering or leaking blebs after glaucoma surgery.
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