Management of bleb leak in filtration surgeries and novel use of lyophilized amniotic membrane – A multi-center case-series

Purpose To describe a novel use of lyophilized amniotic membranes in the management of recurrent conjunctival erosions.Patients and methods This study was a multi-center retrospective case-series study including thirteen patients who were surgically treated for a leaking filtration bleb with an amniotic membrane patch following various types of glaucoma surgery. Baseline was defined as the time of the first amniotic membrane surgery. All patients had a minimum follow-up of 3 months after the procedure. The primary endpoint assessed was the surgical success rate, defined as a watertight bleb with no leak recurrence.Results Thirteen patients were included between April 2019 and March 2023. The mean number of prior filtering procedures was 1.15. All patients except one presented a leaking bleb, for which an amniotic membrane overlay was performed; one patient had an amniotic membrane patch graft concurrently with his glaucoma shunt surgery. Primary amniotic membrane patching was performed with a lyophilized amniotic membrane in 12 patients. The primary surgery was successful at stopping bleb leakage in 61.5% of cases. A secondary amniotic membrane patch was necessary in 5 cases, all of which had a functional and watertight bleb at last follow-up. One patient presented exogenous endophthalmitis due to a bleb leak before initial amniotic membrane patching.Conclusion This case series describes lyophilized amniotic membrane use in the management of bleb leak as a valid patching option in several types of filtration surgery.