The art of fixing a ticking time bomb: Combined phacoemulsification and amniotic membrane transplantation

Bleb leakage is a notorious complication of glaucoma filtration surgery which increases the risk of sight-threatening conditions. A 25-year-old female with severe bilateral juvenile open-angle glaucoma was treated for blebitis and exogenous endophthalmitis secondary to chronic bleb leak after undergoing XEN implantation, followed by multiple rounds of bleb needling, and augmented trabeculectomy. In the right eye, visual acuity was hand movement with cataract, intraocular pressure was 6 mmHg and the bleb was large, highly elevated from 10 to 1 o'clock, avascular, thin wall, and cystic with leaking points. Combined surgery of low-setting phacoemulsification and amniotic membrane transplantation without excising and manipulating the bleb was performed in the same setting. At postoperative 1 month, 6 months, and 1 year, her right vision had improved to 6/24, and the intraocular pressure was 12-14 mmHg, and the bleb leakage had resolved. This successful treatment was accomplished by maintaining the bleb's viability, preventing additional injury, and promoting wound healing.