Abstract
Purpose
We report a new bleb lining technique with Tenon’s patch graft for late-onset leakage from large ischemic bleb with severe conjunctival scarring and impractical conjunctival mobilization after trabeculectomy.
Study design
Retrospective case series.
Methods
This study includes six cases with late-onset leakage from large ischemic blebs. Small Tenon’s tissue is dissected from the incisional site or a previously made inferior incision for Tenon’s anesthesia. A passage is created from the small incision to the leaking area of the bleb using a bleb knife or micro scissors. The Tenon’s tissue, stained with indocyanine green, is inserted under the ischemic bleb’s conjunctiva. A transconjunctival compression suture is placed across the leaking point to fix the Tenon patch graft positionally.
Results
In all cases, bleb leakage was completely sealed immediately after surgery. In 4 cases, the closure of the bleb leakage was maintained after surgery during the follow-up period (6–17 months). In two cases, bleb leakage recurred from different leaking points 7 or 9.5 months after the surgery; however, repeated tenon’s patch lining revisions successfully closed these leakages. The intraocular pressure at the final visit was 5–13 mmHg (median, 10 mmHg) without glaucoma medication or additional glaucoma surgery.
Conclusion
Tenon’s patch-lining technique is a promising method for bleb leakage with large ischemic bleb and impractical conjunctival mobilization.
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Acknowledgements
This research was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant number 22K09808 awarded to TA). The funding organization had no role in the design or conduct of this research. We would like to thank Editage (www.editage.co.kr) for English language editing.
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T. Akagi, Research support (Inami, Nipro), Lecture fee (Senju, Kowa, Santen, AMO, Inami, Novartis, Bayer); T. Togano, None; R. Iikawa, Lecture fee (Senju); R. Igarashi, None; M. Arimatsu, None; M. Miyajima, Lecture fee (Santen); Y. Sakaue, None; T. Fukuchi, Research support (Santen, Senju, Kowa, Novartis, Otsuka, Chugai), Lecture fee (Shiga Medical Instruments, Retina Kitanihon, AMO, Otsuka, Santen, Senju, Alcon, HOYA, Kowa).
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Corresponding Author: Tadamichi Akagi
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Akagi, T., Togano, T., Iikawa, R. et al. A novel bleb revision technique: lining with tenon’s patch graft for treatment of large, ischemic, leaking blebs with severe conjunctival scarring after trabeculectomy. Jpn J Ophthalmol 68, 32–36 (2024). https://doi.org/10.1007/s10384-023-01037-z
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DOI: https://doi.org/10.1007/s10384-023-01037-z