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We read with great interest the article by Biswas et al on the use of compression sutures with autologous blood injection for leaking trabeculectomy blebs.1 We have used intrableb autologous blood injection at the slit lamp as initial management in early and late persistent bleb leaks. In a retrospective study in our unit, four of five persistent leaks were successfully sealed with intrableb autologous blood injection alone. All five eyes had antimetabolites during the original trabeculectomy. Three required two repeat injections, with only one of five requiring surgical revision of the bleb. With a mean follow-up of 3.3 years (0.75 months to 6 years), all four patients maintained an intraocular pressure less than 21 mm Hg, without topical medication and no further leaks.
Blood is thought to seal leaks by providing a source of trophic factors that induce migration and proliferation of adjacent fibroblasts, thereby promoting healing around and within the bleb.2 Antimetabolites can cause irreversible fibroblast inhibition, and it is possible that limited success with this technique in some patients is due to an inability to overcome the antiproliferative qualities of the antimetabolites used.3
Our results appear comparable with the results reported by Biswas et al. In particular, we note that repeat intrableb autologous blood injections were required when the leak persisted, despite placement of the compression sutures. In light of the fact that placing a compression suture also requires theatre time, intrableb autologous injection alone presents a repeatable opportunity to address this potentially sight-threatening complication in a minimally invasive fashion. Although success with autologous blood injection has been previously reported, we hereby report our long-term success with this technique.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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