By Leon W. Herndon, MD
    Glaucoma, Open-Angle Glaucoma, Surgical Management

    Dr. Leon Herndon shares a case of bleb revision for persistent bleb leak in a patient with a previous trabeculectomy with an Ex-PRESS shunt. The goal of the surgery is to excise ischemic, fibrotic tissue around the scleral flap and reapproximate the conjunctiva at the limbal edge. The surgeon creates a deep conjunctival pocket and applies liberal amounts of mytomycin C (MMC) to the posterior conjunctiva to prevent future fibrosis. The scleral flap is lifted to ensure the shunt is well placed, and the scleral flap is resecured. Dr. Herndon stresses the importance of reforming the anterior chamber with BSS before replacing the conjunctiva. He places 9-0 Vicryl wing sutures on both sides of the conjunctival flap, pulling tightly to ensure closure. At the conclusion of the case, the conjunctival flap is well approximated at the limbus and the seal is watertight.