Digital ocular massage to the rescue of failing blebs after filtering surgery

Abstract

Modalities for the prevention and treatment of early bleb failure include augmentation with antimetabolites like mitomycin C, an intensive regimen of topical steroids, and various forms of bleb manipulation such as massage. Digital ocular massage involves application of gentle, controlled pressure with a finger on the eye through the upper eyelid to encourage aqueous flow through the bleb and prevent scarring. This article reports the outcomes of massage and other interventions in 3 patients after trabeculectomy.

All patients had mitomycin C (MMC) augmented trabeculectomy (0.4mg/ml MMC applied for 3 minutes); cases #1 and #2 underwent fixed sutures technique, while case #3 had releasable sutures technique. Patients were instructed to massage by applying gentle pressure to the globe using the thumb through the upper eyelid.

Case # 1 was a 6-year-old female noticed to have intraocular pressure (IOP) elevated to 22 mmHg 4 weeks post-operatively; and IOP reduced to 5 mmHg by the 9th post-operative week. Case #2 was a 10-year-old male noticed to have an IOP of 40 mmHg 6 weeks after surgery; he received 5-fluorouracil (5 FU)  injections in addition to the massage, and IOP reduced to 13 mmHg by the 8th week after surgery. Case #3 was a 24-year-old male whose IOP increased to 23 mmHg 3 weeks after surgery.  The patient had 5FU injections, needling and with ocular massage IOP reduced to 6 mmHg. Bleb fibrosis can be managed in the early post-operative period with ocular massage along with other interventions to improve bleb function.