A FULL-THICKNESS SCLERAL GRAFT FOR THE SURGICAL-MANAGEMENT OF A LATE FILTRATION BLEB LEAK

BACKGROUND AND OBJECTIVES: Late bleb leak may follow months to years a fter 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. PATIENTS AND METHODS: 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. Conj unctival closure was performed either by its advancement to the limbus or by free conjunctival autograft. Follow-up ranged from 4 months to 7 years. RESULTS: Surgery stopped the leak in all cases, and hypotony was relieved without loss of long-term IOP control. However, early pos toperative IOP rises (> 30 mm Hg) occurred in 2 eyes, and a pressure-l owering medication was necessary to achieve long-term IOP control (IOP < 22 mm Hg) in 3 eyes. CONCLUSIONS: The technique described is an eff ective procedure for the treatment of late bleb leaks and is especiall y useful for the treatment of leaks found in association with full-thi ckness scleral defects. IOP spikes in the early postoperative period m ay occur, but long-term IOP control can be expected without the need f or further filtration surgery.