Iatrogenic bleb following manual small incision cataract surgery: A case series

Phacoemulsification has become the standard of care for cataract surgery in most parts of the world. Manual small incision surgery is a low cost, safe and effective alternative in high volume, resource scarce settings. The distinct advantages include short operating time, less need for technology and self-sealing sutureless wound. In the learning phase, one can encounter problems with creating a perfect sclerocorneal tunnel. Poor wound construction can lead to leaky wounds, hypotony, inadvertent filtering blebs and infections. We report a series of 4 patients with unintended blebs following manual small incision cataract surgery and describe the clinical features with appropriate imaging technologies including gonioscopy and anterior segment optical coherence tomography. Proper care and caution must be exercised while fashioning the sclerocorneal tunnel during cataract surgery to avoid iatrogenic blebs and related complications. Any superior conjunctival cyst in a patient with history of cataract surgery should be worked up properly before planning cyst excision, to avoid intraoperative surprises.