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.