MANAGEMENT OF BLEB LEAKS AFTER GLAUCOMA FILTERING SURGERY - USE OF AUTOLOGOUS FIBRIN TISSUE GLUE AS AN ALTERNATIVE

Purpose: To study the nature of bleb leaks after contemporary glaucoma filtering surgery as well as to evaluate various treatment modalities , including autologous fibrin tissue glue (AFTG) prepared in a modifie d manner. Methods: Patients who presented to a Glaucoma Service during a 1-year period with a postoperative bleb leak were studied. Evaluati on of various treatment modalities, including AFTG, was performed. Res ults: Thirty-five episodes of bleb leaks were encountered in 25 eyes o f 22 patients in a 1-year period. There was no statistically significa nt association between late or early leaks and the age or the race of the patient, previous eye surgery, or the use of antimetabolites at th e time of filtering surgery. Eleven (31.4%) of the leaks were refracto ry to nonsurgical treatment modalities, 8 of them being of the late ty pe. Successful healing of the leaks was obtained in 9 of the 12 episod es in which AFTG was used. However, there were no statistically signif icant differences between AFTG and the other treatment modalities. Con clusion: Bleb leaks are a common complication of contemporary glaucoma filtering surgery. Various nonsurgical and surgical modalities can be used in the treatment. In early as well as late bleb leaks, AFTG offe rs an alternative nonsurgical treatment and is at least as efficacious and may, in some ways, be superior to other nonsurgical modalities of treatment.