Conjunctival Advancement With Subconjunctival Amniotic Membrane Draping Technique for Leaking Cystic Blebs

Abstract

To describe the successful use of a technique involving amniotic membrane graft for the repair of leaking cystic blebs following mitomycin C (MMC) trabeculectomy. A retrospective review of 17 eyes of 16 patients who had undergone trabeculectomy with MMC or combined cataract phacoemulsification and trabeculectomy with MMC and presented with leaky cystic blebs with or without hypotony was conducted. All patients were treated with amniotic membrane graft over the leaking area with conjunctival advancement without excision of the cystic bleb and had a minimum of 1-year follow-up. Success was defined as a final intraocular pressure (IOP) ≥ 6 and ≤ 21 mm Hg without glaucoma medications. Qualified success that met the above criteria, however, required the use of glaucoma medication for optimal IOP control. Failure was defined as any patient with persistent bleb leak requiring additional procedures and/or the presence of hypotony (IOP<6 mm Hg ± clinical evidence of hypotony maculopathy). Seventeen of the 17 eyes had complete resolution of bleb leak at last follow-up. Total success rate was 15 of the 17 patients, or 88%. Eleven eyes (64.7%) met criteria for complete success. Four eyes (23.5%) required glaucoma medications after the procedure and met criteria for qualified success. Two eyes (11.8%) met criteria for failure, as they presented with a pinpoint limbal leak requiring a suture at the slit lamp in the postoperative period. Mean IOP increased from 5.7 ± 2.8 mm Hg preoperatively to 13.1 ± 3.4 mm Hg at most recent follow-up (P<0.000007). LogMAR visual acuity likewise improved from 0.7 ± 0.8 preoperatively to 0.1 ± 0.1 LogMAR units at most recent follow-up (P<0.030). Mean follow-up time was 21.4 ± 7.3 months. The technique of amniotic membrane bleb draping with conjunctival advancement successfully restored bleb function, while facilitating fast resolution and stabilization of IOP and visual acuity.