# Inferior exten filtering bleb formation after laser goniopuncture in a patient with conjunctivochalasis

## TL;DR

A patient with conjunctivochalasis developed an unusual inferior bleb after glaucoma surgery and laser treatment, suggesting conjunctival redundancy may affect postoperative outcomes.

## Contribution

This case highlights how conjunctivochalasis may influence atypical bleb formation after laser goniopuncture in glaucoma surgery.

## Key findings

- An inferiorly extended filtering bleb developed in a patient with conjunctivochalasis after laser goniopuncture.
- The bleb spontaneously regressed over one month with stable IOP.
- Conjunctivochalasis may act as a low-resistance pathway for aqueous diffusion following increased outflow.

## Abstract

Inferior extension of filtering blebs after glaucoma surgery is rare. Conjunctivochalasis, an age-related redundancy of the conjunctiva, may influence bleb morphology but is often overlooked. This report describes an inferiorly extended filtering bleb following deep sclerectomy and subsequent Nd:YAG laser goniopuncture in a patient with pre-existing conjunctivochalasis.

A 66-year-old man with advanced primary open-angle glaucoma underwent combined phacoemulsification, deep sclerectomy, and intraoperative mitomycin C in the right eye. Initial recovery was uneventful, with IOP at 15 mmHg and a mildly elevated bleb.

At six weeks, bleb flattening and an IOP rise to 19 mmHg prompted Nd:YAG laser goniopuncture. Two weeks later, a diffuse, hypovascular bleb extended inferiorly into the fornix, corresponding to an area of conjunctivochalasis. IOP was 9 mmHg, with no hypotony, leak, or symptoms. The bleb regressed spontaneously over one month, stabilizing superiorly with IOP at 13 mmHg without medications.

This case suggests that conjunctivochalasis may act as a low-resistance pathway for aqueous diffusion after increased outflow from goniopuncture, leading to atypical bleb spread. While self-limiting here, such morphology could have implications for comfort, contact lens use, or hypotony risk. Pre-existing conjunctival redundancy may influence postoperative bleb morphology and should be considered in surgical planning and follow-up after bleb-forming glaucoma surgeries.