An 84 Y/F Elderly woman with a bleb leak: Case report
An 84-year-old woman presented with one week of left eye pain and blurry vision. She had a diagnosis of wet age-related macular degeneration (AMD) bilaterally and had received an intravitreal ranibizumab injection 4 weeks prior in the same eye. Medical history included hypertension, diabetes mellitus type 2, osteoarthritis and hypothyroidism.

On examination, her best-corrected visual acuity was count fingers in the right eye and 20/50 in the left eye. Her intraocular pressures (IOP) were 20?mmHg in the right eye and 8?mmHg in the left eye. Slit lamp exam was unremarkable in the right eye. Slit lamp evaluation of the left eye demonstrated a thin avascular superior conjunctival cyst with no associated mucopurulent infiltrate and a Seidel-positive leak, measured approximately 1.4mm from the limbus.

An underlying round scleral hole was illuminated through the thin leaking bleb. This sclerostomy was noted 3mm superior to the limbus. Her anterior chamber was deep with trace cell and 1+ flare, but there was no vitritis. Fundus exam revealed healthy optic nerves with cup-to-disc ratio of 0.3 and 0.4 in the right and left eyes respectively, and bilateral central macular scars with retinal pigment epithelial mottling. Anterior-segment optical coherence tomography (AS-OCT) confirmed presence of a full-thickness scleral hole.

The patient was started on topical antibiotics and scheduled for surgical bleb revision 2 days later. On post-operative day 1, the patient's vision was stable at 20/60. IOP was 12 and the conjunctiva was Seidel negative with good conjunctival closure over the site of the prior bleb leak. The patient's eye continued to improve at post-operative month 1.5 with vision 20/40, IOP 10 and deep and a quiet anterior chamber.

This case illustrates a unique complication of an inadvertent bleb in an eye following intravitreal injection.