Free conjunctival autologous graft for bleb repair and bleb reduction after trabeculectomy and nonpenetrating filtering surgery

Purpose: To describe methods and outcomes of excisional revision of a filtering, bleb (bleb revision) using free conjunctival autologous graft either for bleb repair or rot, bleb reduction after trabeculectomy and deep sclerectomy with in implant. Methods: Retrospective medical records were reviewed for a consecutive noncomparative case series comprising patients who underwent excisional revision of a filtering bleb between May 1998-January 2001. Excisional revision using free conjunctival autologous graft (bleb revision) was performed either for bleb repair. to treat early and late leaks and hypotony with maculopathy, or for bleb reduction, to improve ocular pain. discomfort, burning, foreign body sensation, tearing, and fluctuations of visual acuity. The revision consisted of bleb excision and free conjunctival autologous graft. The bleb histopathology was analyzed in patients who underwent bleb repair. Results: Sixteen patients were included in the study, consisting of nine patient.,, who had a trabeculectomy and seven patients, who had a deep sclerectomy, with an implant. Bleb revision was necessary in 14 Patients due to leaking filtering bleb (bleb repair). and in 2 patients due to bleb dysesthesia (bleb reduction). After a follow-up of 15.1 +/- 8.4 months. the mean intraocular pressure (IOP) rose from 7.8 +/- 6.3 mm Hg to 14.3 +/- 6,5 mm Hg, and the visual acuity from 0.4 +/- 0.3 to 0.7 +/- 0.3. with a P value of 0.008 and 0.03, respectively. The complete success rate at 32 months, according to the Kaplan-Meier survival curve, was 38.3%. and the qualified success rate was 83.%. Four patients (25%) required additional suturing for persistent bleb leak. To control IOP. antiglaucoma medical therapy was needed for six patients (37.5%) and repeated glaucoma surgery was needed for one patient. Conclusion: Free conjiunctival autologous graft is a safe and successful procedure for bleb repair and bleb reduction. However, patients should be aware of the postoperative possibility of requiring medical or surgical intervention for IOP control after revision.