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Abstract #94774 Published in IGR 22-2
Bleb reconstruction using donor scleral patch graft for late bleb leak and hypotony
O'Rourke M; Moran S; Collins N; Doyle AEuropean Journal of Ophthalmology 2021; 31: 1039-1046
PURPOSE: Bleb dysfunction may occur as a late complication following glaucoma filtration surgery. Over-filtering, thinning and cystic blebs can lead to hypotony, leak and corneal dellen. We report our surgical management and outcomes of this specific entity using donor scleral patch grafts. METHODS: This is a 10-year non-comparative, retrospective interventional case series. Bleb reconstruction involved excision of encysted conjunctiva and sclera to identify the original fistula. A functioning donor scleral patch graft was sited over this with fixed and releasable sutures and the conjunctiva advanced. Intraocular pressure, visual acuity and post-operative issues were assessed. RESULTS: A total of 18 eyes of 17 patients with mean age 65 years (standard deviation 13.5) were included. Trabeculectomy was the primary procedure in 72% ( = 13) and deep sclerectomy in 28% ( = 5). Bleb leak accounted for 61% ( = 11), hypotony 33% ( = 6) and corneal dellen 6% ( = 1). Mean pre-operative intraocular pressure was 7 mm Hg (standard deviation 4.6) which increased to 18.5 mm Hg (standard deviation 12) at day 1 ( < 0.001), 11.8 mm Hg (standard deviation 4.6) at 3 months ( < 0.05), 12.1 mm Hg (standard deviation 4.2) at 1 year ( < 0.01) which was maintained at 12.1 mm Hg (standard deviation 5.3) at last follow-up ( < 0.001). Post-operative interventions included bleb needling, re-suturing, suture removal, further glaucoma management, bleb leak and cataract surgery. Visual acuity also improved post-operatively and was maintained. CONCLUSION: Reconstruction of the filtering bleb architecture with donor sclera results in improved intraocular pressure while maintaining visual acuity. Post-operative care is required to support the restored bleb function. Our findings support the use of scleral patch graft as an effective and safe method for the long-term management of hypotony and bleb leak as a late complication of glaucoma filtration surgery.
Department of Ophthalmology, 58010Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
Full articleClassification:
12.8.11 Complications, endophthalmitis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
