Management of bleb leaks after glaucoma filtering surgery. Use of autologous fibrin tissue glue as an alternative.
PURPOSE: To study the nature of bleb leaks after contemporary glaucoma filtering surgery as well as to evaluate various treatment modalities, including autologous fibrin tissue glue (AFTG) prepared in a modified manner. METHODS: Patients who presented to a Glaucoma Service during a 1-year period with a postoperative bleb leak were studied. Evaluation of various treatment modalities, including AFTG, was performed. RESULTS: Thirty-five episodes of bleb leaks were encountered in 25 eyes of 22 patients in a 1-year period. There was no statistically significant association between late or early leaks and the age or the race of the patient, previous eye surgery, or the use of antimetabolites at the time of filtering surgery. Eleven (31.4%) of the leaks were refractory to nonsurgical treatment modalities, 8 or them being of the late type. Successful healing of the leaks was obtained in 9 of the 12 episodes in which AFTG was used. However, there were no statistically significant differences between AFTG and the other treatment modalities. CONCLUSION: Bleb leaks are a common complication of contemporary glaucoma filtering surgery. Various nonsurgical and surgical modalities can be used in the treatment. In early as well as late bleb leaks, AFTG offers an alternative nonsurgical treatment and is at least as efficacious and may, in some ways, be superior to other nonsurgical modalities of treatment.
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