Autologous Scleral Graft for Bleb Reconstruction after Early Overfiltration following Trabeculectomy: A Case Report

Early postoperative overfiltration after trabeculectomy due to scleral flap damage is a rare but serious complication, and optimal surgical management remains challenging. We report a case successfully managed with bleb reconstruction using an autologous scleral graft harvested from the same eye.

A 58-year-old man with primary open-angle glaucoma underwent trabeculectomy with 0.04% mitomycin C. Partial flap loss occurred during the creation of a 4 × 4 mm superficial scleral flap. Despite placement of 6 10-0 nylon sutures, a large bleb and shallow anterior chamber developed on postoperative day (POD) 1. Conservative management with pressure patching failed, and by POD 6, marked choroidal detachment occurred with an intraocular pressure (IOP) of 3 mm Hg. Surgical revision was performed on POD 7. Because additional scleral flap sutures could not control the leakage, a 6 × 5 mm half-thickness autologous scleral graft was harvested from the superotemporal sclera and secured over the flap with 13 interrupted 10-0 nylon sutures. On POD 1 after revision surgery, IOP improved to 17 mm Hg, the anterior chamber deepened, and a functioning bleb was observed. Laser suture lysis and needling were subsequently performed to optimize filtration. At 12 months, IOP was 8 mm Hg without medication, with no graft melting or adhesion between the graft and scleral flap.

Autologous scleral grafting provided effective structural reinforcement and restored filtration control in this case of early postoperative overfiltration due to scleral flap damage. To the best of our knowledge, this is the first reported case demonstrating the use of an autologous scleral graft for early postoperative overfiltration caused by scleral flap loss.