Severe cough: A cause of late bleb leak

Purpose: To highlight coughing as a potential cause for late postoperative trabeculectomy bleb leaks. Methods: A retrospective study of 2 patients in whom late bleb leaks developed after a bout of severe coughing. Perioperative 5-fluorouracil was used at the time of the initial filtration procedure for one of the patients, while the second patient had had an ordinary trabeculectomy. Both patients required surgical repair of their bleb leak to manage the resultant hypotony. Results: Postoperatively, both patients had good intraocular pressure control and maintained their visual fields without topical medications. Both patients demonstrated bleb avascularity after leak repair. Conclusions: Trabeculectomy bleb leaks are well recognized. Bleb leaks in the late postoperative period are more common after the perioperative use of antimetabolites, and spontaneous leaks after minimal trauma have been described. The authors describe 2 cases of late spontaneous bleb leaks after severe coughing, both of which responded well to surgical correction. The importance of inquiring about a history of coughing with late bleb leaks in the absence of other causative factors is stressed.