The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.




Photo by Professor Chua Chung Nen

A 70 year-old man with right uncontrolled glaucoma on three topical medications (latanoprost, timolol and trusopt) underwent combined trabeculectomy and phacoemulsification and intraocular lens implant. The intraocular pressure was initially controlled at around 14mmHg. However, the pressures rose to 30mmHg at 4 weeks post-operative. Despite laser suture lysis, the pressure remained high. Needling was performed to lift part of the scleral flap. Post-needling, the pressure dropped to 15mmHg.


Flat bleb and raised intraocular pressure 4 weeks post-trabeculectomy.


Needling to lift the scleral flap after suture lysis failed to reform the bleb.


Bleb formed despite some subconjunctival haemorrhage.

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