Outcome of bleb revision using scleral patch graft and conjunctival advancement

To evaluate our surgical technique of bleb revision using scleral patch graft and conjunctival advancement, the long-term outcome and the ability to maintain adequate intraocular pressure (IOP) control.

Retrospective review.

Eighteen patients were identified. The mean age was 72.1+/-4.3 years (95% confidence limits). In 12 of the 18 cases, the posterior edge of scleral patch graft was secured with fixed sutures, in another 3 with releasable sutures and in the remaining 3 with adjustable sutures. The mean follow-up period was 23.7+/-5.4 months (95% confidence limits). The mean preoperative IOP was 7.6+/-3.0 mm Hg (95% confidence limits), increased to 13.1+/-1.6 mm Hg (P=0.02) postoperatively. Twelve of the 18 patients had a minimum of 2-year follow-up. At this time point, 7 out of 12 (58%) patients had IOP <21 mm Hg without any medication, 9 out of 12 (75%) patients had IOP <21 mm Hg with medication, 7 out of 12 (58%) patients had IOP <16 mm Hg without medication, and 9 out of 12 (75%) had IOP <16 mm Hg with medication. The mean number of 5-fluorouracil injections with or without needling was significantly higher in the success group than in the failure group (P=0.035).

This series illustrates a useful technique using a scleral patch graft in cases of full-thickness scleral defect encountered during bleb revisions. The success rates achieved are comparable to those in the published literature, and furthermore our successful cases achieved lower IOPs appropriate for patients with advanced glaucoma.