Avascular Blebs and Late Bleb Leakage; A Review of Causes and Management

Trabeculectomy with mitomycin-C remains the gold standard for surgical glaucoma management; however, this technique includes some sight-threatening complications like avascular thin bleb, subsequent leakage and ultimately endophthalmitis. To date, various non surgical methods have been reported for the management of bleb leakage, but surgical management frequently becomes necessary especially in frank leakages. The most common surgical approach includes excision of the avascular and necrotic leaking bleb combined with the advancement of adjacent healthy conjunctiva. The aim of the present review is to discuss avascular bleb and late bleb leakage after trabeculectomy including their histopathology, risk factors, prevention and management.