Abstract
Background: Bleb related inflammation following trabeculectomy is usually seen in the late post operative period and is unusual in the first 6 months after surgery We report the clinical findings and course of two patients with early bleb related inflammation secondary to retained cellulose sponge fragments used to apply mitomycin C on the scleral surface. Methods: Retrospective review of medical records of two patients and pathology from one patient. Results: Both patients developed bleb related inflammation four months after a combined fornix based trabeculectomy and cataract procedure in which mitomycin C was applied using filter paper discs (Whatman filter paper #1). Material suggestive of cellulose fragments was noted in the filtering bleb in both patients. Patient 1 had a bleb leak at time of presentation and pathologic examination of foreign body material obtained from the site of the leak demonstrated a granulomatous reaction surrounding cellulose fibers. The foreign body material was removed in both patients. This led to resolution of the bleb leak in the first patient and at one year following the procedure both patients had functioning blebs in the affected eye. Conclusions: Retention of sponge fragments is rare but may be a cause of bleb inflammation as a result of a foreign body granulomatous reaction. The choice of sponge material that does not shred may help in avoiding this unusual complication.
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DeBry P, Perkins TW, Heatley G, Kaufman P, Brumback LC (2002) Incidence of late onset bleb related complications following trabeculectomy with mitomycin. Arch Ophthalmol 120:297–300
Greenfield DS, Liebmann JM, Jee J, Ritch R (1998) Late-onset bleb leaks glaucoma filtering surgery. Arch Ophthalmol 116(4):443–447
Martson M, Viljanto J, Hurme T (1999) Is cellulose sponge degradable or stable as an implant material? Biomaterials 20:1989–1995
Mietz H, Diestelhorst M, Rump AF, Theisohn M, Klaus W, Krieglstein GK (1998) Ocular concentrations of mitomycin C using different delivery devices. Ophthalmologica 212(1):37–42
Poole TRG, Gillespie IH, Knee G, Hitworth J (2002) Microscopic fragmentation of ophthalmic surgical sponge spears used for delivery of antiproliferative agents in glaucoma filtering surgery. Br J Ophthalmol 86:1448–1449
Shin DH, Tsai CS, Kupin TH, Olivier M (1994) Retained cellulose sponge after trabeculectomy with adjunctive subconjunctival mitomycin C. Am J Ophthalmol 118:111–112
Tinker MA, Teicher I, Burdman D (1977) Cellulose granulomas and their relationship to intestinal obstruction. Am J Surg 133:134–139
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Al-Shahwan, S., Edward, D.P. Foreign body granulomas secondary to retained sponge fragment following mitomycin C trabeculectomy. Graefe's Arch Clin Exp Ophthalmol 243, 178–181 (2005). https://doi.org/10.1007/s00417-004-1011-y
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DOI: https://doi.org/10.1007/s00417-004-1011-y