Autologous scleral graft for bleb reconstruction after early overfiltration following trabeculectomy: A Case Report

We report a rare case of early overfiltration after trabeculectomy successfully managed with bleb reconstruction using an autologous scleral graft harvested from the same eye. A 58-year-old man with primary open-angle glaucoma underwent trabeculectomy with 0.04% mitomycin C. Partial loss of a 4 × 4 mm superficial scleral flap occurred during surgery. Despite placement of six 10-0 nylon sutures, a large bleb and shallow anterior chamber developed on postoperative day (POD) 1. Conservative management with pressure patching failed, and by POD 6, marked choroidal detachment occurred with an intraocular pressure (IOP) of 3 mmHg. Surgical revision was performed on POD 7. Because additional scleral flap sutures could not control the leakage, a 6 × 5 mm half-thickness autologous scleral graft was harvested from the superotemporal sclera and secured over the flap with 13 interrupted 10-0 nylon sutures. On POD 1 after revision surgery, IOP improved to 17 mmHg, the anterior chamber deepened, and a functioning bleb was observed. Laser suture lysis and needling were subsequently performed to optimize filtration. At 12 months, IOP was 8 mmHg without medication, with no graft melting or adhesion between the graft and scleral flap. This case highlights that autologous scleral grafting can provide effective structural reinforcement and restore filtration control when scleral flap damage leads to early postoperative overfiltration unresponsive to conventional management. To the best of our knowledge, this is the first reported case of autologous scleral grafting used specifically for early postoperative overfiltration caused by scleral flap loss.