Buccal mucous membrane for the reconstruction of complicated leaking trabeculectomy blebs

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.