Filtering bleb modification with a THC:YAG (Holmium) laser.

OBJECTIVE To present a method for remodeling oversized blebs using the THC:YAG laser and describe its use in treating hypotony and bleb leaks. METHODS Retrospective medical record review of 13 patients who underwent holmium laser bleb revision. RESULTS Thirteen eyes of 13 patients were analyzed. All the patients had an oversized bleb and 2 patients presented an associated late-onset leaking bleb. Mean preoperative IOP was 4.1 mm Hg. THC:YAG laser energy was applied to the bleb to remodel and/or close the leak. After a mean follow up of 17.3 months, the mean IOP was 7.84 mm Hg +/- 2.3. Postsurgery complications included hyphema and the inadvertent rupture of a conjunctival microcyst. Visual acuity improved in 9 of the eyes and remained stable in 4 of the eyes. CONCLUSION The THC:YAG laser can be used effectively to sculpt large blebs, reduce symptoms associated with large blebs, increase IOP in hypotonous eyes, and under specific circumstances, close bleb leaks.