Outcomes of Bleb Excision With Free Autologous Conjunctival Patch Grafting for Bleb Leak and Hypotony After Glaucoma Filtering Surgery

Purpose: To determine the outcomes of bleb excision with free autologous conjunctival patch grafting for bleb leak and hypotony after glaucoma filtering surgery. Patients and Methods: Retrospective, consecutive, noncomparative case series. Outcome measures were closure of bleb leak, intraocular pressure (IOP), and best corrected visual acuity after patch grafting and complications from intervention. Complete success was defined as resolution of the bleb leak or hypotony, with IOP between 6 and 18mm Hg. Results: Fifty-eight eyes (57 patients) were included: 51 with bleb leaks and 7 with hypotonous maculopathy without a bleb leak. Eight eyes required scleral flap resuturing and 2 required scleral patch grafts in addition to free conjunctival patch grafting. The mean postoperative follow-up period was 112.65 +/- 128.74 weeks (median 80.0 wk). At 6 weeks and final follow-up, the IOP increased from baseline of 4.41 +/- 4.61mm Hg (median 4.00mm Hg) to 11.98 +/- 6.25mm Hg (median 11.50mm Hg) (P < 0.001) and 12.67 +/- 4.83mm Hg (median 12.00) (P < 0.001), respectively. Visual acuity increased from baseline of 0.87 +/- 0.95 logMAR (median 0.60) to 0.65 +/- 0.80 logMAR (median 0.48) (P = 0.001) and 0.76 +/- 0.93 logMAR (median 0.48) (P = 0.35) at 6 weeks and last follow-up, respectively. The complete and qualified success rates at the final follow-up were 75.8% and 79.3%, respectively. Failure events occurred in 12 (20.6%) eyes, including 2 eyes with hypotony, 5 with raised IOP, and 3 with postoperative bleb leaks. Conclusions: Free conjunctival patch grafting is a successful procedure for bleb repair and hypotony providing moderate IOP control with minimal postoperative complications in majority of patients.