Long-term results of amniotic membrane transplantation-assisted bleb revision for leaking blebs

Abstract

AMT-assisted bleb revision successfully treated intractable late-onset bleb leak. Further comparative studies are needed to confirm the present result.

Conjunctival Advancement With Subconjunctival Amniotic Membrane Draping Technique for Leaking Cystic Blebs

“…[1][2][3][4][5][6][7][8][9][10] There are many conservative methods for closing late-onset leaking blebs; however, many patients still require surgical revision. 2 Since the advent of trabeculectomy with adjunctive 5-FU or MMC, the rates of successful long-term postoperative IOP control have increased.…”

“…Various surgical approaches have been reported in the literature with varying levels of success. [2][3][4][5][6][7][8][9] Amniotic membrane transplantation (AMT) has been safely used for corneal epithelial defects and limbal stem cell transplantation. It promotes epithelial maturation and has been shown to effectively promote healing in ocular surface reconstruction.…”

Surgical revision of dysfunctional filtration blebs with bleb preservation, sliding conjunctival flap and fibrin glue

“…After an average follow-up of 23 months, neither eye developed a leak nor required glaucoma medication. Similarly, AMT grafting was examined in six eyes by Nagai-Kusuhara et al 23 One eye required bleb excision; however, the bleb in the remaining eyes was preserved. After a median follow-up of 49 months, there were no recurrent leaks and all patients required glaucoma medication.…”

“…11,16,23,24 Amniotic membranes have been used successfully in other ocular surface reconstructions and are hypothesized to be advantageous in bleb repair due to its ability to promote epithelialization while suppressing inflammation and scarring. Kee and Hwang 24 reported the successful treatment of two eyes with leaking blebs without bleb excision by covering the leaking bleb with the amniotic membrane graft.…”

“…Most commonly, surgical revision involves bleb excision with conjunctival advancement, [10][11][12][13][14][15][16][17] autologous conjunctival grafting, [18][19][20][21][22] or amniotic membrane transplantation. 11,16,23,24 The most effective surgical approach to bleb repair remains unclear. Amniotic or autologous conjunctival grafts risk poor healing and graft failure, whereas vascularized conjunctival flaps, although more likely to heal, may undergo retraction and wound dehiscence.…”