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Abstract
Filtering bleb as a treatment of glaucoma (either as a primary or as a final treatment) has been applied for decades and many researches have been done considering the indications, the techniques, and most of all the complications; yet up till now this type of management is still considered a risky and unpredictable measure.
The fact that glaucoma filtering surgery leaves the eye in a non-physiological state with the aim to have this situation as a permanent successful solution (which is a matter of controversy) gives the bleb the innate character of being unstable and liable to complications with incidence that increases with time.
This will necessitate the continuous and close follow-up with the ability to interfere either surgically or medically at any time to correct and to restore the function; which may need effort, time and understanding and full cooperation from the patient.
So, when the surgeon takes the decision of doing a filtering bleb he must be aware of the importance of the careful and accurate evaluation of the clinical history (ie., the history of the patient including his general state and of the disease, family history, the presence of risk factors, the success of the surgery in the other eye if being operated before), the clinical findings (the type of the glaucoma, the state of the IOP, the state of the optic nerve, the state of the proposed site, the presence of other ocular diseases).
The surgeon must has a previously set plane of the aimed IOP, the desired amount of filtration, the technique of approach, the site of the bleb; taking care to choose the simpler, easier, and the least manipulative way knowing that the state of the eye at the end of the surgery is most probably the state he will find postoperatively and the fact that avoiding the complication is much better than treating it.
Unlike other ocular surgeries that usually ends at the end of the operation; the filtration surgeries last much more with the continuous need of follow-up and further interference. Here comes the importance of good knowledge about the possible complications regarding their expected time of occurrence, their clinical picture, and the way to reach accurate and fast diagnosis, their differential diagnosis.