Journal List > J Korean Ophthalmol Soc > v.51(4) > 1008776

Lee, Mun, Park, and Lee: Scleral Allografting and Amniotic Membrane Transplantation With Fibrin Glue in the Management of Scleromalacia

Abstract

Purpose

To examine the effects, complications, and safeties of sclera allograft and amniotic membrane transplantation with fibrin glue as surgical treatment methods for scleromalacia.

Methods

The study included 14 eyes of 14 scleromalacia patients who needed surgical treatment. Among them, seven eyes of seven patients whose scleral defect was small (<6 mm) were operated on using only fibrin glue and no suturing, while seven eyes of seven patients whose defect was large (>6 mm) were operated on using fibrin glue and minimum suturing. Amniotic membrane transplantation was performed at the site of the conjunctival defect.

Results

In all of the cases, the results of grafting were successful throughout the follow-up period, which was 14.6±4.4 months, on average (ranging from 12 to 27 months). No particular complication was observed during the follow-up period after using fibrin glue.

Conclusions

For scleromalacia patients, sclera allograft and amniotic membrane transplantation were performed using fibrin glue. The grafted sclera survived successfully, allowing this treatment modality to be considered an effective and safe option without complications.

References

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Figure 1.
(A) The scleromalacia lesion is cleaned. (B) The preserved sclera is cut according to the size and shape of the lesion. (C, D) Fibrin glue is applied to the lesion and then the sclera graft is placed and adhered to the lesion. (E) Large sclera defect (>6 mm) is operated using fibrin glue and minimum suturing (F) The amniotic membrane is peeled off from the carrier paper from the storage medium. (G) Thrombin solution is administered on the exposed sclera, and fibrinogen solution is applied on stromal side of amniotic membrane. (H) The amniotic graft is immediately transferred onto the exposed sclera. (I) The amniotic patch is then secured to the conjunctiva by continuous sutures with 10–0 nylon.
jkos-51-485f1.tif
Figure 2.
(A, B, C, D-1) Preoperative photograph showing sclera thinning with exposed uveal tissue at the site of previous pterygium excision. (A, B, C, D-2) 1 month postoperative photograph. In all cases conjunctival re-epithelization is shown but completely vascularized over the exposed scleral graft is not yet shown. (A, B, C, D-3) 6 months postoperative photograph. Sclera graft is completely covered by fibrovascular patch and in 2 cases partial reabsorption of scleral graft are shown. (A, B, C, D-4) Last follow-up photograph showing stable ocular surface but in all cases partial reabsorption of sclera graft are shown.
jkos-51-485f2.tif
Table 1.
Clinical outcome and complication of preserved sclera graft and amniotic membrane transplantation with fibrin glue for repair of scleromalacia
Case No. Age/Sex Size (mm) Pterygium op.(years ago) Adjuvant therapy Follow-up (months) Visual change Complication Final outcome
Group using only fibrin glue without suturing
1 67/F 4 4 ? 17 0.7→0.7 None Stable
2 56/F 2 2 ? 14 0.7→0.7 None Stable
3 55/F 2 2 MMC 13 1.0→1.0 None Stable
4 50/F 4 3 MMC 12 0.8→0.8 None Stable
5 64/M 3 4 ? 12 0.5→0.6 None Stable
6 63/M 3 2 ? 12 0.6→0.7 None Stable
7 70/M 3 2 MMC 12 0.7→0.8 None Stable
Group using fibrin glue and minimum suturing
8 67/F 7 1 ? 27 0.6→0.5 None Stable
9 75/M 6 3 ? 20 0.4→0.6 None Stable
10 46/M 6 2 ? 17 1.0→1.0 None Stable
11 62/F 7 5 ? 12 1.0→1.0 None Stable
12 77/F 7 4 MMC 12 FC1.5M→ FC2.0M None Stable
13 73/F 6 5 ? 12 0.2→0.15 None Stable
14 79/M 7 6 ? 12 0.8→0.8 None Stable
Table 2.
Previous reports of preserved sclera graft with conjunctival flap or amniotic membrane transplantation for repair of scleromalacia
Author(s) Number of eyes Previous history Surgery technique Mean follow-up (months) Results Complication (eyes)
Kim et al8 16 Pterygium surgery with Lamellar sclera grafting with 12 Stable ocular Corneal erosion (6)
    MMC* (9) conjunctival flap (13)   surface Conjunctival cyst
    With Strontium (5) Simple conjunctival flap (3)   (15, 93.8%) formation (2)
    Thermal burn (1)       Sclera graft melting (1)
    Cryotherapy (1)       Partial absorption of
            conjunctival flap (1)
Oh and Kim9 8 Pterygium surgery with Preserved sclera allograft 24 Stable ocular None
    MMC (6) with AMT§   surface  
    Cataract op. (2)        
Na et al10 5 P Pterygium excision with Preserved sclera allograft 19 Stable ocular None
    MMC or irradiation with conjunctival   surface  
      advancement (4) or with      
      AMT (1)      
Ozcan et al11 8 Intraocular surgery (6) Corneoscleral graft (3) 13.1±3.9 Stable ocular Recurrence (1)
    Trauma (1) Scleral graft (4)   surface  
    Both (1) Fascia lata (1)      
Sangwan et al12 13 Pterygium surgery (6) Scleral patch graft with 24.3 Stable ocular Endophthalmitis (1)
    Injury (3) conjunctival flap (10) or   surface Graft dehiscence (1)
    None (3) with AMT (3)   (10, 76.9%) Necrotizing scleritis (1)
    Cataract surgery and        
    TSCP (1)        
    OSSN excision (1)        
This study 14 P Pterygium surgery (10) Preserved scleral allograft 14.6±4.4 Stable ocular None
    With MMC (4) with AMT with fibrin glue   surface  

* MMC=mitomycin C; membrane transplantation

TSCP=transcleral cyclophotocoagulation

OSSN=ocular surface squamous neoplasia

§ AMT=amniotic

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