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Year : 2022  |  Volume : 60  |  Issue : 1  |  Page : 130-131

Scleral patch graft for overhanging bleb

Department of Glaucoma, Aravind Eye Hospital, Puducherry, India

Date of Submission22-Jun-2021
Date of Decision27-Sep-2021
Date of Acceptance01-Oct-2021
Date of Web Publication22-Mar-2022

Correspondence Address:
Dr. Kavitha Srinivasan
Department of Glaucoma, Aravind Eye Hospital, Puducherry - 605 007
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjosr.tjosr_91_21

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How to cite this article:
Pabolu C, Srinivasan K. Scleral patch graft for overhanging bleb. TNOA J Ophthalmic Sci Res 2022;60:130-1

How to cite this URL:
Pabolu C, Srinivasan K. Scleral patch graft for overhanging bleb. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Jun 29];60:130-1. Available from: https://www.tnoajosr.com/text.asp?2022/60/1/130/340377

A man aged 55 years, 3 years post fornix-based trabeculectomy with mitomycin C in the right eye (RE), presented with whitish mass RE, obscuring vision. Visual acuity was 20/120 and intraocular pressure (IOP) was 3 mmHg. RE showed cystic, diffuse avascular bleb, overhanging on the cornea covering superior half of the pupi. Fundus showed advanced disc damage. An overhanging bleb is a complication of trabeculectomy, especially when antimetabolites are used. Bleb excision was done following which underlying scleral defect was noted. The scleral defect was closed with partial thickness rectangular (4 x 5 mm) scleral patch graft [Figure 1]A, [Figure 1]B, [Figure 1]C, [Figure 1]D using nylon sutures. IOP got normalized post-operatively in the next few weeks. [Figure 2]E, [Figure 2]F demonstrates pre and post-operative anterior segment images of the RE. Bleb revision with scleral patch graft is effective for treating overhanging bleb.[1],[2]
Figure 1: Figure A shows the bleb being excised, figure B demonstrates underlying scleral defect (black arrow), figure C demonstrates the creation of 4x5mm rectangular partial scleral graft from donor sclera, figure D demonstrates the patch graft, fixed with nylon sutures (blue arrow)

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Figure 2: Figure E demonstrates the overhanging bleb, covering the cornea reaching almost the pupillary axis, figure F shows post-operative anterior segment image, with good conjunctival apposition, intact scleral patch graft and well-formed anterior chamber

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Conflicts of interest

There are no conflicts of interest.

  References Top

Au L, Wechsler D, Spencer F, Fenerty C. Outcome of bleb revision using scleral patch graft and conjunctival advancement. J Glaucoma 2009;18:331-5.  Back to cited text no. 1
Halkiadakis I, Lim P, Moroi SE. Surgical results of bleb revision with scleral patch graft for late-onset bleb complications. Ophthalmic Surg Lasers Imaging 2005;36:14-23.  Back to cited text no. 2


  [Figure 1], [Figure 2]


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