Recurrent Wound Dehiscence after Trabeculectomy in Uveitic Glaucoma: A Case Report

Abstract

Objective: To report an unusual case of recurrent wound dehiscence after trabeculectomy and its management.

Observation: A 47-year-old Thai male with non-granulomatous anterior uveitis of his left eye underwent
trabeculectomy with mitomycin C due to uncontrolled intraocular pressure. At postoperative 1 week, conjunctival
retraction was observed with the exposure of the base of scleral flap. Conjunctival flap advancement with 10-0 nylon
was performed to prevent bleb leakage and risk of intraocular infection. Ten days after conjunctival flap advancement,
recurrent conjunctival wound retraction was seen with more amount of scleral flap exposure and positive Seidel test.
Conjunctival flap advancement with amniotic membrane transplantation over the scleral flap was performed. A week later,
an exposed scleral flap with conjunctival retraction was encountered again. We decided to reconstruct the conjunctival
flap with corneoscleral patch graft covering the anterior two thirds of the scleral flap area. At follow up 10 months,
corneoscleral patch graft was still in a good position on scleral flap. The intraocular pressure was 10 – 12 mmHg with
0.5% timolol maleate eye drop. No recurrent wound dehiscence occurred.

Conclusion: Recurrent conjunctival dehiscence after trabeculectomy is an unusual complication after trabeculectomy
despite multiple surgical corrections with watertight wound closure. The only distinctive personal risk factor that associated
with this condition was current smoking. Delay wound healing has been reported in smokers. We assumed that smoking
may be a potential cause of poor wound healing in this patient. Conjunctival resuture alone may not enough to handle a
large size leakage. Wound reconstruction with biological tissue graft should be considered.