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V. E. Casas, A. Kheirkhah, G. Blanco, S. C. G. Tseng; Surgical Approach for Scleral Ischemia and Melt. Invest. Ophthalmol. Vis. Sci. 2007;48(13):359.
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To describe the use of amniotic membrane transplantation, tenonplasty and, lamellar corneal patch grafting as an alternative in the management of scleral ischemia and/or melt.
Five eyes of 4 patients with scleral ischemia and/or melt of diverse etiologies where included in these non-comparative interventional case series. The surgical technique for repairing scleral ischemia included removing the unhealthy tissue, covering the ischemic zone with cryopreserved amnion graft; placing an overlying pedicle Tenon’s graft followed by a second layer of cryopreserved amniotic membrane to cover the entire area. Meanwhile for patching up the scleral melt, once all necrotic tissue was removed; a lamellar corneal graft or cryopreserved amniotic membrane were use to fill in the scleral defect; then a pedicled Tenon’s graft was use to cover this area with overlying cryopreserved amniotic membrane to cover the entire area. The above grafts were attached by fibrin glue. The eradication of progressive scleral ischemia and/or melt with preservation of globe integrity was considered the main outcome measurement.
This surgical technique was effective in all but one eye, in which partial success was achieved. Although scleral ischemia was greatly improved in this case, residual scleral ischemia was observed due to the severity of the causative injury, requiring further surgery to correct it. The following complications were noticed: residual scleral ischemia and granuloma formation in one case; dellen formation and horizontal diplopia in one case.
The combination of amniotic membrane transplantation, tenonplasty and lamellar corneal patch grafting is a good alternative for treating scleral ischemia and/or melt of various etiologies. The technique is relatively easy to perform under topical anesthesia when fibrin glue is used and is effective for preserving ocular integrity.
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