Ocular Reconstruction Using Autologous Tragal Perichondrium for a Refractory Necrotizing Scleral Perforation: A Case Report

Hyun Koo; Jae Hoon Jeong; Yeoun Sook Chun; Jae Chan Kim

doi:10.3341/jkos.2011.52.10.1227

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Koo, Jeong, Chun, and Kim: Ocular Reconstruction Using Autologous Tragal Perichondrium for a Refractory Necrotizing Scleral Perforation: A Case Report

Original Article

J Korean Ophthalmol Soc 2011;52(10):1227-1231.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.10.1227

Ocular Reconstruction Using Autologous Tragal Perichondrium for a Refractory Necrotizing Scleral Perforation: A Case Report

Hyun Koo, MD¹, Jae Hoon Jeong, MD², Yeoun Sook Chun, MD, PhD¹, Jae Chan Kim, MD, PhD¹

¹Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea

²Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

Address reprint requests to Jae Chan Kim, MD, PhD Department of Ophthalmology, Chung-Ang University Hospital #224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, Korea Tel: 82-2-6299-1689, Fax: 82-2-6299-1077, E-mail: jck50ey@kornet.net

Received 16 February 2011 Accepted 15 March 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the effectiveness of an autologous tragal perichondrium graft for a necrotizing scleritis case which was refractory to conventional surgery.

Case summary

A 75-year-old woman was referred to our clinic with recurrent necrotizing scleritis of the left eye which occurred after pterygium removal five years earlier. The patient underwent scleral graft, pericardium graft, and amniotic membrane graft in other clinics; however, necrosis of the sclera progressed. The best corrected visual acuity was 0.06, and choroidal tissue was nearly exposed below the melted pericardium graft in the nasal area. The authors harvested tragal perichondrium from the right ear, and the scleral defect was successfully reconstructed with an autologous tragal perichondium graft. The graft showed rapid epithelization and neovascularization within a week and conjunctivalization after three months. No complications have been observed up to one year after surgery.

Conclusions

Autologous tragal perichondrium graft is an effective treatment to alter necrotized sclera via neovascularization and rapid epithelization in refractory necrotizing scleritis cases.

Keywords: Epithelization, Necrotizing scleritis, Neovascularization, Tragal perichondrium

References

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Figure 1.

A photograph of 75-year-old woman with recurrent necrotizing scleritis of the left eye which occurred after pterygium removal 5 years earlier. (A) After undergoing sclera graft, pericardium graft, and amniotic membrane graft, sclera necrosis has still progressed and choroid is bulging out through the melted graft tissue. (B) Choroid is being exposed after removing the pericardium graft during surgery. (C) Autologous tragal perichondrium graft has been made.

Figure 2.

The photographs show postoperative recovery after the autologous tragal perichondrium graft in refractory necrotizing scleritis patient. (A, B) One week after the surgery, vascularization has developed over the grafted perichondrium, and grafted tissue has been epithelized showing no defects on fluorescein staining. (C, D) After 3 months, conjunctivalization has started over the graft. (E, F) One year after the tragal perichondrium graft, conjunctivalization has been completed, and there was no complication.

Figure 3.

The hematoxylin and eosin staining of (A) human tragal perichondrium and (B) human sclera (×200). Both tissues show similar lamellar collagen fiber array (Photographs were taken by the authors).

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