Bleb reduction using combined photodisruptive and photocoagulative neodymium-doped yttrium-aluminum-garnet laser

This case report aims to highlight the role of photodisruptive neodymium-doped yttrium-aluminum-garnet (Nd:YAG) (1064 nm) laser in the treatment of bleb dysesthesia, which occurs in overhanging blebs or with perilimbal spread. Although treatment of such dysesthetic blebs with laser photocoagulation has been previously described, cases where the height of bleb precludes laser penetration, desired effect might not be seen. We herein describe a technique using a combination of photocoagulative (532 nm) and photodisruptive (1064 nm) Nd:YAG laser for a high bleb migrating nasally and inferiorly along the limbus in a 64-year-old female, causing hypotony and consequent macular edema. Successful reduction could be achieved within a week of treatment. By 6 weeks, intraocular pressure improved to 8 mmHg, macular edema subsided, and visual acuity improved to 6/6. Although surgical procedures to correct bleb dysesthesia are available, laser procedures being quick outpatient modalities are more comfortable for the patients.