AUTOLOGOUS CONJONCTIVAL REPAIR OF LEAKING FILTERING BLEBS AFTER TRABECULECTOMY AND NON PENETRATING FILTERING SURGERY

C.C. Schnyder, T. Shaarawy, S. Uffer and A. Mermoud

Department of Glaucoma, Hôpital Ophtalmique Jules Gonin, Switzerland

Purpose: To report a new technique to repair leaking filtering blebs, occuring after trabeculectomy or non penetrating filtering surgery. Design: Retrospective, non comparative, consecutive case series.Participants :16 eyes of 16 patients with bleb leak, blebitis, hypotony maculopathy or bleb dysesthesia on presentation to the Glaucoma Unit between May 1998 to May 2000 who required surgical bleb revision. Intervention :Total excision of the leaking bleb and free conjonctival autologous graft technique for surgical bleb revision was performed.Main outcome measures: Seidel negative blebs, post operative complications, number of bleb revision, controlled glaucoma and histologic examination of the excised leaking bleb.Results: The pre-operative intra-ocular pressure (IOP) was 7.4 mmHg (range 2-17 mmHg). After an average follow up of 12.8 months (range 3-27 months), the IOP was 13.1 mmHg (range 2-30 mmHg). There were two failures : in one eye an IOPspike of 30 mmHg required one medication, and in one eye an IOP spike of 27 mmHg required 3 medications to control the glaucoma. Pre operative visual acuity on Snellen chart was 0.6 (range 0.1-1.25), and post operative visual acuity was 0.8 (range 0.1-1.5). Histologic examinations always showed an atrophy of the epithelium with stromal oedema, and inconstantly a non specific inflammatory response or an elastoпd degeneration. Conclusion: Conjonctival autologous graft is an effective technique to repair bleb leaks, maintaining glaucoma control and preserving vision with few post operative complications.