Autologous rotational partial thickness scleral flap – A salvage technique for late leaking blebs with scleral fistula

Success rates for trabeculectomy have notably advanced with the adjunctive use of antifibrotic agents, particularly mitomycin C. Despite this, the increased prevalence of thin, cystic blebs and late-onset bleb leaks, particularly those complicated by scleral fistula formation, represents a visually threatening sequela. This manuscript delineates a modified autologous rotational partial-thickness scleral flap technique employed as a salvage procedure in managing late, leaking, thin cystic blebs with underlying scleral fistulae. In two patients managed with this technique, we observed re-establishment of an anatomically stable, moderately vascularized bleb, and maintenance of intraocular pressure within target range over 18–24 months. The procedure utilizes trypan blue-assisted peeling of the epithelium and a rotational, partial-thickness scleral flap, with conjunctival advancement, thereby achieving tectonic support and functional preservation of filtration.