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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.
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.
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.
Table 1.
Clinical outcome and complication of preserved sclera graft and amniotic membrane transplantation with fibrin glue for repair of scleromalacia
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 |
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