Buccal Mucous Membrane for the Reconstruction of Complicated Leaking Trabeculectomy Blebs

Abstract

Purpose 

Late onset trabeculectomy bleb leaks often require surgical repair to avoid hypotony and/or infection. Repair using local conjunctiva is typically performed. However, in cases in which local conjunctiva is limited and/or has failed, buccal mucous membrane can be used as a conjunctival substitute.

Methods 

Four cases of buccal mucous membrane repair for leaking trabeculectomy blebs are reported. Surgical technique is described.

Results 

In each case of bleb leak, multiple nonincisional techniques failed to control the leak. In 3 of 4 cases, earlier reconstruction attempts with conjunctival advancement and/or free flaps failed. Each was ultimately repaired with buccal membrane autograft. One case required additional minimally invasive procedures to control postoperative leaking. One case required a second adjacent buccal graft for leaking residual conjunctival bleb. Each graft was functioning well at most recent follow-up ranging from 1 to 17 months.

Discussion 

Buccal membrane is an abundant and effective conjunctival substitute for the repair of recalcitrant leaking trabeculectomy blebs. It may be useful in cases in which earlier conjunctival-based repairs have failed.