title: Autologous Transplantation of a Free Tenon's Graft for Repairing Excessive Bleb Leakage after Trabeculectomy: A Case Report.
abstract: OBJECTIVE
  To report a case of autologous transplantation of a free Tenon's graft to repair excessive bleb leakage after trabeculectomy.
  
  
  METHODS
  A 39-year-old Japanese woman presented with severe hypotony in her left eye. She had undergone trabeculectomy with mitomycin C 14 years ago. Slit-lamp examination showed an ischemic and ruptured bleb, excessive bleb leakage, and an extremely shallow anterior chamber. A large scleral defect was vaguely observed through the bleb conjunctiva. The hypotony was attributed to excessive bleb leakage. A surgical revision was required. First, the avascular bleb conjunctiva and the melted scleral flap were excised. A scleral defect was observed. Thick fibrotic tissue, i.e., the autologous Tenon's graft, was separated from the underlying sclera, cut to the desired size to cover the defect, and sutured to the sclera with 10-0 nylon sutures. Irrigation with balanced salt solution through the paracentesis confirmed deepening of the anterior chamber with no bleb leakage. In the current case, a layer of amniotic membrane was applied to cover the largely exposed sclera. Two weeks postoperatively, the surgical site was totally re-epi-thelialized with no aqueous leakage. Three months postoperatively, vascularization into the surgical site was observed. The intraocular pressure remained within normal levels without recurrent bleb leakage.
  
  
  CONCLUSIONS
  Autologous transplantation of a free Tenon's graft successfully repaired excessive bleb leakage through a scleral defect after trabeculectomy. This technique is easier, safer, and may be more cost effective for repairing excessive bleb leakage after trabeculectomy than conventional management techniques.
authors.affiliation: Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Tomakomai, Japan.
authors.forename: Motofumi
authors.initials: M
authors.lastname: Kawai
authors.affiliation: Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Tomakomai, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Nakabayashi
authors.affiliation: Department of Ophthalmology, Oji General Hospital, Tomakomai, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Tomakomai, Japan.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Hanada
authors.affiliation: Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Tomakomai, Japan.
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Yoshida
keywords: Autologous Tenon's graft; Bleb leak; Hypotony; Trabeculectomy