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A Novel Hinged Scleral Patch Graft for the Repair of Overfiltration and Bleb Leaks

Introduction: The repair of the scleral flap is often needed in cases of severe hypotony or bleb leaks with overfiltration. We present a simple novel technique to restore the hinged flap using a scleral patch graft. Materials and Methods: We present 4 eyes of 4 patients who presented with hypotony [intraocular pressure(IOP) <6 mm Hg] from overfiltration secondary to loose scleral flap (2 eyes) and bleb leak (2 eyes). A scleral patch from a human donor, preserved in 95% ethanol, was cut in a trapezoidal shape and placed over the area of filtration after a conjunctival peritomy. The scleral graft was secured anteriorly with a single double-armed 9-0 nylon suture in a double-mattress manner so as to create a hinged flap. Permanent or releasable sutures were placed posteriorly to control aqueous outflow. Results: All 4 patients had complete resolution of hypotony and bleb leaks with increase in their IOP to early teens. All maintained aqueous flow posteriorly with preservation of bleb function. Conclusion: Reestablishing the original anatomy of the hinged scleral flap can maintain bleb function without risk of overfiltration or loss of IOP control. This can be achieved through a simple repair using a scleral patch graft.