Amniotic Membrane Transplantation for Exuberant Bleb Following Filtration Surgery

The use of antimetabolites in filtration surgery, cystic, large, leaking blebs often lead to complications. We report a case of glaucoma that received amniotic membrane transplantation for repairing the exuberant bleb. This female patient had a history of several eye surgeries, including a scleral buckle and cyclocryotherapy for one eye and the other received filtering surgery. The latter had been revised once with autologous conjunctival advancement after an episode of bleb leakage. The large bleb, overlaying the cornea 3 mm from the limbus, had caused corneal erosion beneath the bleb and the patient suffered burning sensations. Further conjunctival advancement of the exuberant bleb is difficult to achive, because it had been revised once with this treatment. Amniotic membrane was used for further reconstruction after the excision of the pre-existing bleb. A normal intraocular pressure was regained. The symptom of burning sensations subsequently subsided. A ten-month follow-up was conducted. Amniotic membrane transplantation is a feasible option for exuberant or late onset bleb leakage, to prevent further destruction of ocular surface tissue and to maintain the intraocular pressure. (Chang Gung Med J 2006;29(4 Suppl):85-9)