Compression sutures with autologous blood injection for leaking trabeculectomy blebs

Leaks may follow trabeculectomy surgery, particularly where antimetabolite useage has resulted in thin or avascular filtration blebs. Leaking blebs are associated with endophthalmitis, low intraocular pressure (IOP), hypotony maculopathy and choroidal haemorrhage. Treatment aims to stop the leak while preserving filtration. Conservative management of bleb leaks involves aqueous suppressants, pressure patching, contact lens application or topical autologous serum drops.1 Surgical treatments include application of trichloracetic acid, cyanoacrylate glue, autologous fibrin tissue glue, cryotherapy and argon laser or Nd YAG Laser “remodelling” of the bleb. Intrableb injection of autologous blood2 has been successful in sealing bleb leaks, although blood can track into the anterior chamber (AC). Compression sutures3 have been used to control overdraining blebs but are used less often for bleb leaks. More major procedures include conjunctival autografts or amniotic membrane, scleral or processed pericardial tissue transplantation. Haynes and Alward4 used compression sutures in conjunction with autologous blood injection to enhance their efficacy in the treatment of postfiltration hypotony maculopathy. We have successfully used compression …