A novel bleb revision technique: lining with tenon's patch graft for treatment of large, ischemic, leaking blebs with severe conjunctival scarring after trabeculectomy.
Bleb leakage
Ischemic bleb
Tenon’s tissue
Trabeculectomy
glaucoma Surgery
Journal
Japanese journal of ophthalmology
ISSN: 1613-2246
Titre abrégé: Jpn J Ophthalmol
Pays: Japan
ID NLM: 0044652
Informations de publication
Date de publication:
12 Dec 2023
12 Dec 2023
Historique:
received:
01
08
2023
accepted:
19
10
2023
medline:
12
12
2023
pubmed:
12
12
2023
entrez:
12
12
2023
Statut:
aheadofprint
Résumé
We report a new bleb lining technique with Tenon's patch graft for late-onset leakage from large ischemic bleb with severe conjunctival scarring and impractical conjunctival mobilization after trabeculectomy. Retrospective case series. This study includes six cases with late-onset leakage from large ischemic blebs. Small Tenon's tissue is dissected from the incisional site or a previously made inferior incision for Tenon's anesthesia. A passage is created from the small incision to the leaking area of the bleb using a bleb knife or micro scissors. The Tenon's tissue, stained with indocyanine green, is inserted under the ischemic bleb's conjunctiva. A transconjunctival compression suture is placed across the leaking point to fix the Tenon patch graft positionally. In all cases, bleb leakage was completely sealed immediately after surgery. In 4 cases, the closure of the bleb leakage was maintained after surgery during the follow-up period (6-17 months). In two cases, bleb leakage recurred from different leaking points 7 or 9.5 months after the surgery; however, repeated tenon's patch lining revisions successfully closed these leakages. The intraocular pressure at the final visit was 5-13 mmHg (median, 10 mmHg) without glaucoma medication or additional glaucoma surgery. Tenon's patch-lining technique is a promising method for bleb leakage with large ischemic bleb and impractical conjunctival mobilization.
Identifiants
pubmed: 38085401
doi: 10.1007/s10384-023-01037-z
pii: 10.1007/s10384-023-01037-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Japan Society for the Promotion of Science
ID : 22K09808
Informations de copyright
© 2023. Japanese Ophthalmological Society.
Références
Kiuchi Y, Inoue T, Shoji N, Nakamura M, Tanito M. Glaucoma Guideline Preparation Committee JGS. The Japan Glaucoma Society guidelines for glaucoma, 5th edition. Jpn J Ophthalmol. 2023;67:189–254.
doi: 10.1007/s10384-022-00970-9
pubmed: 36780040
Luebke J, Neuburger M, Jordan JF, Wecker T, Boehringer D, Cakir B, et al. Bleb-related infections and long-term follow-up after trabeculectomy. Int Ophthalmol. 2019;39:571–7.
doi: 10.1007/s10792-018-0851-0
pubmed: 29426967
Tomlinson CP, Belcher CD, Smith PD, Simmons RJ. Management of leaking filtration blebs. Ann Ophthalmol. 1987;19:405–8.
pubmed: 3322135
Burnstein AL, WuDunn D, Knotts SL, Catoira Y, Cantor LB. Conjunctival advancement versus nonincisional treatment for late-onset glaucoma filtering bleb leaks. Ophthalmology. 2002;109:71–5.
doi: 10.1016/S0161-6420(01)00838-7
pubmed: 11772582
Blok MD, Kok JH, van Mil C, Greve EL, Kijlstra A. Use of the Megasoft Bandage Lens for treatment of complications after trabeculectomy. Am J Ophthalmol. 1990;110:264–8.
doi: 10.1016/S0002-9394(14)76342-1
pubmed: 2396651
Maeda H, Eno A, Nakamura M, Negi A. Safe management of a late-onset bleb leak with a needling technique. Eye (Lond). 2000;14:802–4.
doi: 10.1038/eye.2000.217
pubmed: 11116718
Smith MF, Magauran RG, Betchkal J, Doyle JW. Treatment of postfiltration bleb leaks with autologous blood. Ophthalmology. 1995;102:868–71.
doi: 10.1016/S0161-6420(95)30941-4
pubmed: 7777292
Tannenbaum DP, Hoffman D, Greaney MJ, Caprioli J. Outcomes of bleb excision and conjunctival advancement for leaking or hypotonous eyes after glaucoma filtering surgery. Br J Ophthalmol. 2004;88:99–103.
doi: 10.1136/bjo.88.1.99
pubmed: 14693784
pmcid: 1771950
Gupta N. Incision-free minimally invasive conjunctival surgery (MICS) for Late-Onset Bleb leaks after trabeculectomy (an American Ophthalmological Society Thesis). Am J Ophthalmol. 2019;207:333–42.
doi: 10.1016/j.ajo.2019.04.031
pubmed: 31095952
Sugimoto K, Murata H, Yamashita T, Asaoka R. Bleb plication: a minimally invasive repair method for a leaking ischemic bleb after trabeculectomy. Sci Rep. 2020;10:14978.
doi: 10.1038/s41598-020-72056-w
pubmed: 32917919
pmcid: 7486366
Tanito M, Okada A, Mori Y, Sano I, Ikeda Y, Fujihara E. Subconjunctival implantation of ologen collagen matrix to treat ocular hypotony after filtration glaucoma surgery. Eye (Lond). 2017;31:1475–9.
doi: 10.1038/eye.2017.98
pubmed: 28574500