title: Donor scleral patch for treating hypotony due to leaking and/or overfiltering blebs.
abstract: OBJECTIVE
  To report a modified technique of bleb revision with the use of a donor scleral patch in cases in which scleral melting did not allow effective suturing and closure of the aqueous leak. The suturing technique ensures tight adaptation of the scleral patch over the leaky region, and allows better-controlled aqueous flow with loose suturing of the posterior edge of the scleral patch.
  
  
  METHODS
  Records of patients who underwent bleb revision with donor scleral graft from 1997 to 2003 were reviewed retrospectively. Chart information including demographic and clinical data was recorded preoperatively and 1 day, 1 week, 1 month, 6 months, and at final follow-up.
  
  
  RESULTS
  Fifteen patients underwent this surgical procedure for bleb revision. The mean follow-up time was 22.0 +/- 24.0 months (median = 8.0 months). The mean preoperative visual acuity was 20/50 and the mean intraocular pressure (IOP) was 2.9 +/- 2.3 mm Hg, which improved to 20/30 and 14.1 +/- 3.3 mm Hg respectively, on last follow-up.
  
  
  CONCLUSIONS
  The scleral patch with 4-nylon sutures should be proposed in cases in which a macerated scleral bed is revealed during the revision. The loose suturing of the scleral patch at its posterior border was found to prevent intraocular pressure spikes.
authors.affiliation: The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer Hospital, Israel.
authors.forename: Noga
authors.initials: N
authors.lastname: Harizman
authors.forename: Ran
authors.initials: R
authors.lastname: Ben-Cnaan
authors.forename: Modi
authors.initials: M
authors.lastname: Goldenfeld
authors.forename: Hana
authors.initials: H
authors.lastname: Levkovitch-Verbin
authors.forename: Shlomo
authors.initials: S
authors.lastname: Melamed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D018463:Filtering Surgery / Q000009:adverse effects*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D015814:Ocular Hypotension / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012590:Sclera / Q000637:transplantation*; D013529:Surgical Wound Dehiscence / Q000150:complications*; D013536:Suture Techniques; D014019:Tissue Donors; D014792:Visual Acuity