V S Sangwan1, V Jain, P Gupta. 1. LV Prasad Eye Institute, Banjara Hills, Hyderabad, Andhra Pradesh, India. vsangwan@lvpei.org
Abstract
PURPOSE: To evaluate the visual and structural outcomes of scleral patch grafting in cases of scleral defect. METHODS: The study was a retrospective interventional case series. Medical records of all patients who underwent scleral patch grafting at a tertiary care centre between 1997 and 2003 for scleral defects were reviewed. After removal of all the devitalized tissue, alcohol-preserved full-thickness sclera was tailored to fit the defect and sutured in place. The graft was covered with a conjunctival flap or amniotic membrane. Structural integrity and visual outcome were assessed as the main outcome measures. RESULTS: A total of 13 eyes of 13 patients required scleral patch grafting for scleral defects of varying aetiologies, the most common being necrotizing scleritis following pterygium surgery (40%). The patients were followed up for 6-60 months, an average period of 24.3 months. Tectonic success was achieved in 10 eyes (76.9%). Three complications were noted: endophthalmitis, graft necrosis, and graft dehiscence with uveal prolapse. However, no regrafts were needed. Epithelialization and vascularization were seen in the remaining eyes after an average duration of 3-4 weeks. Visual acuity remained stable in the majority (9/13, 60%), improved in one and deteriorated in three eyes. CONCLUSIONS: Scleral grafting with overlying conjunctival or amniotic membrane graft is an effective and simple measure for preserving globe integrity both structurally and functionally.
PURPOSE: To evaluate the visual and structural outcomes of scleral patch grafting in cases of scleral defect. METHODS: The study was a retrospective interventional case series. Medical records of all patients who underwent scleral patch grafting at a tertiary care centre between 1997 and 2003 for scleral defects were reviewed. After removal of all the devitalized tissue, alcohol-preserved full-thickness sclera was tailored to fit the defect and sutured in place. The graft was covered with a conjunctival flap or amniotic membrane. Structural integrity and visual outcome were assessed as the main outcome measures. RESULTS: A total of 13 eyes of 13 patients required scleral patch grafting for scleral defects of varying aetiologies, the most common being necrotizing scleritis following pterygium surgery (40%). The patients were followed up for 6-60 months, an average period of 24.3 months. Tectonic success was achieved in 10 eyes (76.9%). Three complications were noted: endophthalmitis, graft necrosis, and graft dehiscence with uveal prolapse. However, no regrafts were needed. Epithelialization and vascularization were seen in the remaining eyes after an average duration of 3-4 weeks. Visual acuity remained stable in the majority (9/13, 60%), improved in one and deteriorated in three eyes. CONCLUSIONS: Scleral grafting with overlying conjunctival or amniotic membrane graft is an effective and simple measure for preserving globe integrity both structurally and functionally.
Authors: George D Kymionis; Argyro D Plaka; Vasilios F Diakonis; Michael A Grentzelos; Georgios A Kontadakis; Andreana C Mersinoglou; Efstathios T Detorakis; Fotis Topouzis Journal: Open Ophthalmol J Date: 2013-10-30