A Full-Thickness Scleral Graft for the Surgical Management of a Late Filtration Bleb Leak

Abstract

Late bleb leak may follow months to years after filtration surgery. This article describes the surgical repair of eight leaking blebs using a full-thickness scleral graft and analyzes the efficacy of the procedure and its effect on intraocular pressure (IOP) control. The indications for surgical bleb revision were hypotony maculopathy (2 eyes), endophthalmitis (2 eyes), bleb infection (2 eyes), and chronic epiphora and blurring of vision (2 eyes). All eyes were treated surgically through bleb excision and repair of the scleral defect with a full-thickness scleral graft. Conjunctival closure was performed either by its advancement to the limbus or by free conjunctival autograft. Follow-up ranged from 4 months to 7 years. Surgery stopped the leak in all cases, and hypotony was relieved without loss of long-term IOP control. However, early postoperative IOP rises (> 30 mm Hg) occurred in 2 eyes and a pressure-lowering medication was necessary to achieve long-term IOP control (IOP < 22 mm Hg) in 3 eyes. The technique described is an effective procedure for the treatment of late bleb leaks and is especially useful for the treatment of leaks found in association with full-thickness scleral defects. IOP spikes in the early postoperative period may occur, but long-term IOP control can be expected without the need for further filtration surgery.