Bleb Revision

Dr. Steven Vold presents a simple technique of slit lamp bleb revision using mitomycin C (MMC) and Healon 5 (Abbott Medical Optics). Injection of Healon 5 in the sub-conjunctival space aids in homeostasis, visualization, and maintain the sub-conjunctival space for up to seven days which may improve surgical outcomes.

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Comments (2)

Risk of MMC going into anterior chamber is zero if the MMC is injected behind the bleb outside the "ring of steel" which forms around the avascular portion of this type of failed bleb. When I do these in the OR I usually wait two minutes to let the MMC diffuse into the subconjunctival tissues before puncturing the scar tissue around the bleb, lifting the flap with the needle, and entering the anterior chamber. I'm currently doing all my bleb needlings in the OR, but as of January 1st, 2011, Medicare will reimburse for needling done at the slit lamp (CPT 66250), so this will offset the cost of the MMC and Healon 5, making this procedure more convenient for patient and surgeon, assuming the patient is cooperative enough at the slit lamp. Great video, Steve!

ghtanaka (50 months ago)

what about the risk of mmc going into anterior chamber

syed irshad (51 months ago)