Conjunctival retraction with deposits after trabeculectomy

TL;DR

A rare case of conjunctival flap retraction after eye surgery led to yellow crystalline deposits and infection, which improved with antifungal and antibiotic treatment.

Contribution

This paper reports a rare complication of trabeculectomy involving conjunctival retraction and crystalline deposits with chronic fungal infection.

Findings

Conjunctival flap retraction after trabeculectomy led to subconjunctival yellow crystalline deposits.

Chronic fungal infection (Cladosporium spp.) and bacterial infection (Micrococcus luteus) were identified in the patient.

Treatment with antifungal and broad-spectrum antibiotics significantly improved the patient's condition.

Abstract

To describe a case of late-onset conjunctival flap retraction after fornix-based trabeculectomy, presenting with chronic subconjunctival accumulation of yellow crystalline material, which responded to antifungal and broad-spectrum antibiotic therapy.

A 26-year-old female patient with a history of congenital glaucoma underwent combined trabeculotomy and fornix-based trabeculectomy in the left eye at 4 months of age. Over the years, the patient experienced recurrent episodes of redness, responding to topical antibiotics. Two months prior to presentation, the patient developed persistent ocular redness and yellow discharge in the left eye. Examination revealed conjunctival hyperemia, conjunctival flap retraction with sub-conjunctival yellow crystalline deposits, and suture debris. Microbiological testing of the conjunctival sac contents identified fungal (Cladosporium spp.) and opportunistic bacterial (Micrococcus luteus) infections. The patient improved significantly after removal of the debris and administration of topical antifungal and broad-spectrum antibiotics.

Complications of trabeculectomy-related conjunctival flap have most commonly been reported as conjunctival flap fibrosis and infection. We present a rare case of conjunctival flap retraction leading to the formation of a subconjunctival cavity with crystalline deposits, complicated by chronic fungal infection.

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