Late-Onset Scleral Flap Injury After Trabeculectomy Successfully Repaired Using a Preserved Scleral Patch: A Report of Two Cases.

Scleral flap repair may be required during or after filtration surgery or tube shunt surgery. This report discusses two cases wherein preserved scleral patching was successfully used to treat scleral flap damage that occurred after combined use with mitomycin C (MMC) trabeculectomy. The first case was a 59-year-old female who sustained right-eye trauma, resulting in conjunctival damage, a scleral flap defect, and prolapse of the choroid under the conjunctiva. She had a history of trabeculectomy for primary open-angle glaucoma (POAG) in both eyes five years ago. This patient was treated by attaching a preserved scleral patch to the site of the scleral flap defect, resulting in good intraocular pressure (IOP) and no complications. The second case was a 76-year-old male who consulted for right vision loss without any identifiable cause and was found to have avascular bleb damage, aqueous humor leakage, scleral flap melting, and choroidal detachment. He had a previous history of trabeculectomy for POAG in both eyes three years ago, as well as a right-bleb infection treated with intravitreal antibiotic injection and conjunctival resection two years ago. This patient was treated with a preserved scleral patch to the damaged area, plus conjunctival advancement. The aqueous humor leakage and choroidal detachment improved after surgery. However, the IOP remained elevated (approximately 20 mmHg), and this was successfully treated by inserting an Ahmed Glaucoma valve™ (FP7, New World Medical, Inc., Rancho Cucamonga, CA, USA). These cases demonstrate that the application of a preserved scleral patch may be viable for late-onset flap injuries after glaucoma surgery.