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Manabjyoti Barman, Paul T. Finger, Tatyana Milman; Scleral Patch Grafts in Ophthalmic Oncology. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4935.
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To evaluate the outcome of scleral patch grafts in a series of patients undergoing management for intraocular and ocular surface neoplasms.
This is a retrospective, interventional, non-comparative chart review in a tertiary eye care centre in the USA between Sept. 2003 and Jan. 2011, who underwent treatment for different ocular tumors along with scleral surface reconstruction. IRB approval was obtained and the study was conducted following the guidelines of the Declaration of Helsinki and those of the HIPPA of 1996. Sclera was reconstructed with allogenic scleral grafts. Outcomes were defined as structural integrity, appearance and stability of the grafts.
Ten cases were reviewed with mean follow up 3.4 years. Five cases had uveal melanoma with extrascleral extension, 2 scleromalacia secondary to plaque radiotherapy for uveal melanoma, 2 uveo-scleral nevi and 1 conjunctival squamous cell carcinoma with scleral invasion. All melanoma cases received plaque radiotherapy with palladium-103 and in the cases with nevi and squamous cell carcinoma, local resection with cryotherapy was done along with scleral graft. In 8 cases, grafts were performed as part of initial surgery. In one of these cases, the graft was placed on the macula beneath a posterior choroidal melanoma. This patient developed neovascular glaucoma and had to be enucleated for a blind and painful eye after 2 years. Histopathological analysis of the enucleated eye showed residual choroidal tumor with focal infiltration of the underlying sclera, associated with chronic inflammation. Vascularized scar was present at the host and graft junction. The graft was incorporated into Tenon’s fascia. In the 2 cases with scleromalacia secondary to radiotherapy for uveal melanoma, grafts were placed years after initial treatment. One showed signs of graft retraction whereas another showed graft thinning. Rest of the cases achieved satisfactory functional and cosmetic outcome. No patient experienced graft necrosis, infection or tumor recurrence.
In this clinical case series, all scleral grafts were accepted when done as part of the primary tumor management despite synchronous radiotherapy, cryotherapy or scleral resection. They were less successful where performed as late procedure for radiation induced scleromalacia due to degenerative changes of the scleral bed.
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