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S. Kompa, O. Arend, C. Redbrake, A. Remky; Scleral patch grafts in the management of large scleral and corneo–scleral defects . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3936.
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Purpose:Excessively draining fistulas may lead to enucleation, when primary suture closure is not effective in closing. In these cases preserved cadaver tissues such as sclera, fascia lata, dura mater and peritoneum have been used for patch graft repair with variable results. In this study, clinical outcomes after transplantation of full thickness scleral patch grafts have been investigated. Methods:Twenty–eight patients (age 56+/–17) underwent surgery with homologues scleral patch grafts for repair of excessively draining scleral fistulas after cataract surgery (n=2), leaking filtering blebs following full–thickness filtration surgery (n=7), large scleral perforations due to trauma (n=7), corneo–scleral ulcerations due to severe eye burns (n=9) or after radiotherapy of malignant melanoma (n=3). The mean size of the rectangular grafts was 8.6 x 6.7 mm (±2.8/3.1 mm) with the possibility to trim the grafts to special fits, e.g. a ring–shaped graft (<font face="symbol">Æ</font> 15 mm) in case of a dehiscent optical cylinder of a keratoprosthesis. Clinical follow–up was up to 73 months (mean = 29.75 months). Results:During the clinical follow–up 23 of 28 eyes (= 82.1%) showed functional closure after initial surgery without any wound complication such as patch retraction or leakage and without evidence of inflammation. In five eyes surgical revision was necessary. Two of these eyes had to be enucleated due to unrulable dehiscence after the second operation. Two eyes were enucleated on patient’s demand due to pain. The fifth eye showed effective closure after the second operation. Conclusions:In our study scleral patch grafts were useful in adequately closing large scleral or corneo–scleral defects in 24 of 28 eyes (85.7%). The antigen load and therefore the rejection of the scleral grafts is minimized due to the denaturation of proteins during the alcohol treatment before storage.
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