RECONSTRUCTION OF FILTERING BLEBS WITH FREE CONJUNCTIVAL AUTOGRAFTS

Background: Situations arise in which the surgical repair or revision of filtering blebs is either technically impossible or inadequate, and total reconstruction becomes necessary. This is most frequently encou ntered in eyes that have undergone multiple procedures, resulting in s ignificant bulbar conjunctival scarring and episcleral fibrosis. Metho ds: To preserve the pre-existing filtration site, the authors successf ully treated five such patients in whom conjunctival scarring adjacent to and surrounding the blebs precluded local revision, by transplanti ng free conjunctival autografts. Two patients required grafting from t he fellow eye. Specific modifications from previously reported conjunc tival flap techniques were used to enhance graft healing and continued filtration. Results: Satisfactory intraocular pressure control was ma intained in all patients receiving minimal to no anti-glaucomatous med ications with an average follow-up of 42.6 months (range, 7-90 months) . No patient had a significant decrease in visual acuity or surgical c omplications. Conclusion: Free conjunctival autografting techniques ar e a useful adjunct in the surgical revision of leaking, failed, or mig rating filtration blebs.