Bleb-like Finding Caused by Idiopathic Scleral Thinning in an Eye With Absolute Glaucoma.

Purpose

To evaluate a bleb-like finding in an eye with absolute glaucoma using anterior-segment optical coherence tomography (AS-OCT).

Methods

A 35-year-old woman complained of sudden-onset pain in the right eye. She had been diagnosed with keratitis at 1.5 years old and the onset of secondary glaucoma was identified at 13 years old. At the age of 26 years, transscleral contact diode laser cyclophotocoagulation therapy was performed, except for the upper quadrant, because scleral thinning was noted at that time. At the age of 35 years, she was blind in her right eye and corneal opacity and a bleb-like structure in the upper conjunctiva was seen with a slit-lamp examination. This bleb-like structure was removed surgically at bulbar exenteration, and the pathology was examined.

Results

AS-OCT showed a bleb-like internal structure with a single large empty space and thin scleral tissue and relatively thin walls with high optical density. Pathology indicated that the high optical density bleb wall was connective tissue. On AS-OCT, the internal surface of the empty space was very smooth, which matched the pathology. Histochemically, there were goblet cells, as in normal conjunctiva, but not in the conjunctiva over the aqueous space.

Conclusions

AS-OCT images found that the intrableb structure was in good agreement with the pathology results; these conjunctival changes were very similar to those after a standard trabeculectomy.