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 encountered in eyes that have undergone multiple procedures, resulting in significant bulbar conjunctival scarring and episcleral fibrosis.


METHODS
To preserve the pre-existing filtration site, the authors successfully treated five such patients in whom conjunctival scarring adjacent to and surrounding the blebs precluded local revision, by transplanting free conjunctival autografts. Two patients required grafting from the fellow eye. Specific modifications from previously reported conjunctival flap techniques were used to enhance graft healing and continued filtration.


RESULTS
Satisfactory intraocular pressure control was maintained in all patients receiving minimal to no anti-glaucomatous medications with an average follow-up of 42.6 months (range, 7-90 months). No patient had a significant decrease in visual acuity or surgical complications.


CONCLUSIONS
Free conjunctival autografting techniques are a useful adjunct in the surgical revision of leaking, failed, or migrating filtration blebs.
Buxton
J N
JN
Department of Ophthalmology, New York Eye and Ear Infirmary, NY 10003.
Lavery
K T
KT
Liebmann
J M
JM
Buxton
D F
DF
Ritch
R
R
D000368:Aged; D003228:Conjunctiva / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D015355:Glaucoma, Neovascular / Q000601:surgery*; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012599:Sclerostomy / Q000379:methods*; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D014792:Visual Acuity