Scleral Graft Research Articles

Use of double short tandem scleral tunnels for repairing eroded ahmed glaucoma valve tubes

PurposeTo evaluate the effectiveness and safety of a method for repairing an eroded Ahmed glaucoma valve (AGV) tube using two short scleral tunnels made in tandem with a 22G needle instead of covering the eroded tube with another scleral graft.MethodsFrom May 12, 2015, to July 27, 2019, we retrospectively reviewed eight patients at Ningbo Aier Eye Hospital who developed AGV tube erosion secondary to necrosis of their overlying conjunctiva and scleral grafts. This defect was repaired in all the patients using the double short tandem scleral tunnel technique, which involved the creation of double short tandem scleral tunnels made by a 22G needle. Two parallel-to-limbus scleral incisions were made 3 mm and 6 mm from the limbus first, then a curved 22G needle was inserted between the two scleral cuts to make one scleral tunnel, the other scleral tunnel was completed during the first surgery, inserted the tube into the two tunnels. The mean length of time between the AGV placement and the first erosion was 12.25 ± 6.36 months (3–24 months). The mean age of the patients was 65.50 ± 11.70 years (49–78 years).ResultsThe surgical outcome was assessed in terms of the tectonic integrity of the conjunctiva over the follow-up period (12 months). There was no AGV tube erosion, scleral thinning, or ocular infection after a mean of 41.25 ± 26.54 months of follow-up in all eight patients.ConclusionAGV tube erosion following shunt surgery can be successfully managed using the improved double short tandem scleral tunnel technique.

Lamellar scleral patch autograft after ballistic accident: A case report

Scleral graft has been used in clinical situations including perforating eye trauma to treat traumatic scleral dehiscence. A 28-year-old male patient presented for a painful left eye following a firearm-related injury few hours ago. Visual acuity was limited to light perception with a 2 mm wide, oval-shaped inferior scleral gap. Due to the size of the scleral defect, we decided to perform a scleral autograft. The graft was fashioned from the inferonasal sclera, deposited over the recipient hole, and secured with 10–0 nylon sutures on the corneal and scleral sides of the surgical bed with favorable anatomical and refractive outcomes.

Autologous Pericranium Graft for Necrotizing Scleritis.

The purpose of this study was to describe the clinical outcome of scleral staphyloma secondary to necrotizing scleritis treated with autologous pericranial grafting. A 63-year-old woman with necrotizing scleritis and choroidal protrusion underwent homologous scleral grafting, which failed. The patient's medical management was optimized for control of her systemic inflammation, and she underwent a second surgery consisting of autologous pericranium grafted to the parietal region. A 3- × 2-cm tissue patch was harvested and sutured over the staphyloma borders with 8/0 polyglactin sutures. Complete re-epithelialization was observed at 3 weeks, the graft was well integrated, and no signs of inflammation were observed at 18 months. The pericranium offers a viable alternative for scleral thinning because of necrotizing scleritis.

Scleral Grafts in Ophthalmic Surgery. A Review.

To summarize the history and current trends in the use of scleral grafts in ophthalmology. We conducted a review of the literature through the MEDLINE and Cochrane Library databases. The search terms were "sclera", "graft", and "surgery". The search resulted in 1596 articles, of which we evaluated 192 as relevant. The relevant articles were sorted chronologically and according to the method of using scleral grafts, which enabled the development of a review article. The sclera has been routinely used in ophthalmology since the 1950s in many different indications. Some of these indications have become practically obsolete over time (for example, use in the surgical management of retinal detachment), but a large number still find application today (especially use in glaucoma or oculoplastic surgery, or as a patch for a defect in the sclera or cornea). Even though allogeneic sclera is currently used less frequently in ophthalmology compared to other tissue banking products and the range of its indications has partially narrowed, it remains a useful material due to its availability and properties.

Surgical Outcome After Treatment of Radiation-Induced Scleral Necrosis in Patients With Uveal Melanoma.

Surgical repair might be required in patients with uveal melanoma (UM) that develop advanced forms of radiation-induced scleral necrosis (RISN). In this monocentric long-term observational study, we aimed at analyzing the treatment outcome after RISN surgery. All consecutive cases with UM who underwent surgical intervention for RISN between 1999 and 2020 were included. Achievement of the tectonic stability and evaluation of incidence and the risk factors for a repetitive patch surgery (RPS) were the main endpoints. The final analysis included 57 patients (mean age: 58.7 years; 63.2% female patients), where 55 individuals underwent a patch grafting, and 2 cases were treated with conjunctival reconstructive surgery. The mean follow-up time after grafting was 38.5 months (0.03-221.1 months). Tectonic stability was achieved in 56 (98.3%) patients. Scleral graft (38/55, 69.1%) was the most frequent patching material, followed by Tutopatch (7/55, 12.7%), corneal graft (7/55, 12.7%), dura graft (2/55, 3.6%), and fascia lata (FL) graft (1/55, 1.8%). Eleven patients (20%) underwent RPS after the mean time of 12.9 months (0.3-50.3 months). In the final multivariate Cox regression analysis, the use of Tutopatch (5/7; 71.4%, adjusted hazard ratio = 4.66, P = 0.044) and RISN progression after patch grafting (9/11; 81.8%, adjusted hazard ratio = 9.67, P = 0.008) were independent risk factors for RPS. RISN surgery maintains long-term tectonic stability in most of the cases underwent surgical repair for RISN after brachytherapy for UM. Depending on graft material and, particularly, further RISN progression, an RPS might be necessary in certain cases.

Pits of Fire: Post Scleral Graft Vasculitis in Patients With Optic Disc Pit Maculopathy.

Occlusive vasculitis is a rare complication following an uneventful surgery. In this article, we report two cases of optic disc pit maculopathy that underwent scleral graft and developed vasculitis following uneventful surgery. Both patients underwent autologous scleral graft for optic disc pit maculopathy through 25-gauge pars plana vitrectomy. Scleral graft was harvested from patient's same eye and plugged in the optic disc pit. After a postoperative period of approximately 3 months, both patients developed features of occlusive vasculitis with vitreous base contraction. Uveitic workup did not reveal other causes of vasculitis. Both patients were treated with topical and systemic steroids and responded well until the last follow-up. [Ophthalmic Surg Lasers Imaging Retina 2024;55:172-175.].

Low-level laser therapy combined with scleral graft transplantation in the treatment of contracted socket: a clinical study

ObjectiveTo analyse the efficacy of the therapeutic use of low-level laser therapy (LLLT) on the tissue repair process of allogeneic scleral grafts in patients with contracted sockets by analysing the speed of graft vascularisation and fornice depth of contraction percentage.MethodsA retrospective chart review was performed from April 2015 to April 2021 including 39patients with socket contraction. Allogeneic scleral grafts were used to repair the sockets in all patients. They were randomly enrolled into two groups. The laser group included 18 patients treated with LLLT after the surgery, whereas the control group included 21 patients without LLLT after the surgery who healed naturally. The LLLT equipment used in the research had a wavelength of 650 nm, 10 mW power, and 3.8 J/cm2 dosimetry, and the procedure was performed once daily for 5 min over 7 days, beginning 1 week postoperatively. All patients were followed up over 6 months to examine the changes in the size of the area of the non-vascularised graft and upper and inferior fornice depth.ResultsThe laser group presented a significantly increased speed of conjunctival vascularisation compared with the control group (P = 0.003). The fornice depth of contraction percentage was more apparent in the control group than that in the laser group (P = 0.000).ConclusionLLLT accelerates conjunctival vascularisation, stimulates conjunctival incision healing within a short period, shortens the tissue repair process, reduces the local inflammatory response, and causes no significant shrinkage of the conjunctival sac.

Bleb excision with donor scleral patch graft and conjunctival advancement using fibrin glue for late hypotony and overfiltering bleb

Late-onset bleb-related complications like ocular hypotony can lead to serious visual disabilities if not managed appropriately. The ideal treatment of overfiltering bleb has yet to be conclusively established. Here, we describe our successful technique of bleb reconstruction using donor patch scleral graft and conjunctival advancement with fibrin glue in a 90-year-old man who presented with late hypotony maculopathy and choroidal detachment secondary to the overfiltering bleb.

Burnishing of exposed porous polyethylene orbital implant: is it useful?

ObjectifDécrire les résultats chirurgicaux du brunissage d'implants orbitaires en polyéthylène poreux (PP) qui ont été exposés. MéthodesOn a procédé à une revue de synthèse rétrospective de patients consécutifs du Hong Kong Eye Hospital et du Queen Elizabeth Hospital de Hong Kong dont l'implant orbitaire en PP a dû être réparé en raison d'une exposition entre janvier 2002 et avril 2022. On a eu recours à une perceuse électrique pour réaliser le brunissage des implants orbitaires en PP exposés. La zone exposée a été recouverte d'une greffe sclérale provenant d'un donneur, et la plaie conjonctivale a ensuite été refermée. Les patients dont le fornix palpébral inférieur était peu profond ont subi d'autres interventions pour approfondir le fornix afin de mobiliser la conjonctive et d'assurer un recouvrement approprié de l'implant. RésultatsAinsi, les implants orbitaires en PP de 6 patients, qui ont été exposés suite à une énucléation (n = 4) ou une éviscération (n = 2), ont été réparés. Aucune récurrence ne s'est produite chez 5 des 6 patients après un suivi moyen de 25 mois (fourchette : 7-42 mois). Le 6e patient, atteint d'une endophtalmie, a subi une nouvelle exposition de l'implant orbitaire 16 mois après la réparation initiale; la prise en charge a reposé sur la réinsertion d'un implant en acrylique avec un emballage réalisé par une greffe sclérale provenant d'un donneur et une greffe dermo-graisseuse. ConclusionNous avons décrit une technique de brunissage pour réparer des implants orbitaires en PP qui ont été exposés. Notre technique est facile à utiliser et empêche efficacement une nouvelle exposition de l'implant.

Novel use of an autologous scleral button graft to close the anterior defect in evisceration surgery

ABSTRACT Purpose To present an alternative evisceration technique with long-term follow-up data. This technique involves the insertion of an acrylic implant into a modified scleral shell which is closed using an autologous scleral graft. Methods This was a retrospective analysis of eviscerations performed in a district-general hospital in the UK. All patients underwent conventional ocular evisceration after total keratectomy. A full thickness scleral graft is harvested from the posterior sclera, using an internal approach, with an 8 mm dermatological punch. An 18–20 mm acrylic implant is placed into the shell, and the scleral graft is used to close the anterior defect. Demographic characteristics, implant size and type, and cosmetic results from pictures of all patients were recorded. All patients were invited for a review to measure motility, eyelid height, patient recorded satisfaction and complications. Results Of the five patients identified, one had since died. The remaining four attended a review in person. The mean time between surgery and review was 48 months. The mean implant size was 19 mm. There were no cases of implant extrusion or infection. All four had a <1 mm asymmetry in measured eyelid height and ≥5 mm horizontal gaze motility. All patients self-reported “good” cosmesis. An independent assessment identified “mild asymmetry” in two cases and “moderate” in the other two. Conclusion Evisceration with this novel autologous scleral graft technique restores volume in the anterior orbit with good cosmetic results, and with no cases of implant exposure reported in this small case series. This technique should be compared prospectively to established techniques.

Application of Decellularized Porcine Sclera in Repairing Corneal Perforations and Lamellar Injuries.

Scleras are mainly used for the treatment of glaucoma, eyelid damage, and scleral ulcers. Given that the sclera and cornea collectively constitute the complete external structure of the eyeball and both have the same tissue and cell origin, we attempted to identify scleral materials to treat lamellar and penetrating corneal injuries. Based on research in our center, antigenic components in decellularized porcine sclera (DPS) were removed using a simplified decellularization method, leaving the collagen structure and active components undamaged. DPS preserved the mechanical properties and did not significantly inhibit the proliferation and replication of human corneal epithelial cells. In vivo, the graft epithelium healed well after lamellar and penetrating scleral grafting, and the graft thickness did not change evidently. DPS can resist suture traction during scleral transplantation and maintain anterior chamber stability until day 28 post-operatively, especially in penetrating repairs. No obvious immune rejection of lamellar or penetrating scleral grafts was found 28 days after DPS transplantation. This study shows that DPS could be used as an alternative material for the emergency repair of corneal perforations and lamellar injuries, representing another application of sclera.

Short-Term Postoperative Outcome of Baerveldt Glaucoma Implant with Two Tubes Inserted into the Vitreous Cavity

Here, we report a new surgical technique designed to increase filtration volume and reduce intraocular pressure (IOP) in glaucoma and its one-year outcome. Two tubes were created from a single Baerveldt glaucoma implant (BI) by folding the tube in a U-shape and incising only the outer edge of the stretched loop tip. The tubes were placed into the vitreous cavity via the pars plana through a long scleral tunnel, without a scleral valve or graft patch. Twenty eyes of 18 patients with neovascular glaucoma were included. This technique was performed in 10 eyes of 10 patients (double group), and outcomes were compared to 10 eyes of eight patients in which a single tube BI was inserted (single group). The primary outcome measures included IOP, supplemental medical therapy score (SMTS), and intraoperative and postoperative complications before and after surgery at 12 months. The mean IOP (SMTS) were 32.0 ± 11.33 mmHg (4.1) in the double group and 29.7 ± 6.31 mmHg (5.7) in the single group, preoperatively reduced to 11.8 ± 2.70 mmHg (0.2) (63% reduction, p &lt; 0.004) and 14.2 ± 4.05 mmHg (1.1) (52% reduction, p &lt; 0.002) after 12 months, respectively. SMTS showed 95% (p = 0.005) and 89% (p = 0.005) reductions, respectively. Although there was no significant difference in IOP between the two groups at 12 months (p = 0.16), there were significant differences in the SMTS between the two groups before, and 6 and 12 months after, surgery (p = 0.01, 0.04 and 0.04, respectively). A reduction in the SMTS suggests that increasing filtration volume by placing two tubes has the potential to further reduce IOP as compared with a single tube.

Peripheral Ulcerative Keratitis in Relapsing Polychondritis: An Ophthalmic Challenge

Peripheral ulcerative keratitis (PUK) is an inflammatory condition leading to ocular morbidity. It can be associated with underlying autoimmune diseases which often goes undetected if the ocular manifestation precedes the systemic manifestation. The objective of this case report is to highlight that, the management of such entity is challenging. We present a case of a 36-year- old female with diminution of vision, PUK with necrotizing scleritis in both the eyes for which she was on regular treatment. Along with medications, she underwent multilayered amniotic membrane transplantation and scleral graft. Later on she developed tracheal stenosis and polychondritis for which she underwent tracheostomy. The ocular presentation of relapsing polychondritis can precede the systemic manifestations which may lead to delay in diagnosis and management of the disease. Unless the underlying disease is addressed, ocular morbidity progresses regardless the ocular treatment.

Role of Immunotherapy in Pythium insidiosum Keratitis.

Pythium keratitis is a potentially devastating ocular condition. Incidence of Pythium keratitis has been reported in tropical and subtropical areas. In previous reports, there were no effective or standard treatments, and combinations of medication, immunotherapy, and surgery were proposed. Pythium insidiosum antigen immunotherapy (PIAI) showed an acceptable safety profile, but its efficacy is questionable in Pythium keratitis. This retrospective review included 10 eyes from 10 patients. All cases were confirmed diagnosis of P. insidiosum keratitis by culture and/or polymerase chain reaction. Three doses of PIAI were injected at 2-week intervals in all patients. The infiltration diameter ranged from 5.2 mm to total corneal involvement, and eight cases (80%) had hypopyon. Therapeutic penetrating keratoplasty (TPK) or scleral graft were undertaken in nine cases. Enucleation was done in one case on the first visit. A second TPK was undertaken in three cases, and two globes were saved. Two cases in the globe salvage group received voriconazole via eyedrops and intracameral injection. No case received either linezolid or azithromycin. Three of nine eye globes (33.33%) were saved. PIAI did not show efficacy in the treatment of Pythium keratitis. Radical surgery including resurgery in recurrence is an approved effective treatment. The recently reported medications may offer supportive management.

The usability of lamellar scleral autograft in ocular perforation treatment.

Open globe injury is a frequent and preventable healthcare problem with an annual incidence of 3.5/100,000 worldwide. Management and treatment methods aim to ensure globe integrity. Unfortunately, it is not possible to achieve globe integrity in some of the cases, and these can result in poor visual outcomes. To evaluate the usability of lamellar scleral graft in the repair of ocular perforations. This was a retrospective review of 11 patients who underwent lamellar scleral graft surgery for ocular perforation between June 2015 and June 2020. Due to the failure of the repairs when other techniques were used, the perforation zones were sealed with lamellar scleral autografts. The primary measures of the outcomes were globe integrity, postoperative best corrected visual acuity, and intraocular pressure (IOP). Visual acuity was determined using the Snellen eye chart, and IOP was measured using the automated pneumatic tonometry during standard examination. The participants enrolled in this study included 11 patients who underwent lamellar scleral patch graft between 2015 and 2020. The mean age of the patients was 58.81 ± 16.6years (range, 16-77), and the mean follow-up period was 12.5 ± 3.8months (range, 8-20). During the surgery, the perforation zone was treated and no leakage was observed. IOP significantly increased, and visual acuity improved in almost all eyes. The factors that made it necessary to use scleral grafts in patients were star-shaped wounds, delayed presentation, lost corneal / scleral tissue. Lamellar scleral graft is a method that can be used in the treatment of defective ocular perforation with acceptable complications and provides adequate functional and structural stability. Scleral patch grafting can be considered as an alternative option for surgeons treating a variety of ocular conditions that cause tectonic imbalance or poor cosmesis.

Facial cosmetic enhancement by secondary implant and ocular prosthesis to avoid camouflaging hair style

Aim: Aim of this study is to access the improvement in psychosocial awareness and self-image of surgical anophthalmic patient after cosmetic rehabilitation with secondary implant followed by ocular prosthesis. Materials and Methods: It was conducted with 15 surgical anophthalmic patients who maintained a special and unnatural hair style to hide the facial deformity from others. These hair styles included growing long hair on a particular side of the head, covering part of the forehead and eyes. This makes other people curious and it does not look normal. Result: After reconstruction of the a anophthalmic socket by secondary ball implant along with scleral graft and followed by fitting of a well matching custom designed ocular prosthesis, the psychological condition, self-confidence of the patients were improved significantly. The follow up photographs of the same patient revealed that they no longer maintained the earlier special type of hair style. They looked confident in normal hair pattern. Conclusion: The study suggest that the psychological well being of those living with facial deformity due to eye loss is related to having a pessimistic outlook and the beliefs a patients has about their appearance and how accepted they feel by the society. Keywords: Contracted socket, Orbital implant, Socket reconstruction, Scleral graft.

Complications after Modified Evisceration with Closure of the Anterior Scleral Shell by Donor Scleral Graft.

Complications after Modified Evisceration with Closure of the Anterior Scleral Shell by Donor Scleral Graft.

Sclera to the Rescue in the Covid-19 Pandemic- Therapeutic Scleral Grafting in Perforated Corneal Ulcers due to Donor Cornea Shortage

Sclera to the Rescue in the Covid-19 Pandemic- Therapeutic Scleral Grafting in Perforated Corneal Ulcers due to Donor Cornea Shortage

Assessing patient cosmetic satisfaction after glaucoma drainage device surgery for different patch grafts

BackgroundThe use of a tissue patch graft is common practice with a glaucoma drainage device (GDD). Patch grafts can be visible in the palpebral fissure and may be cosmetically displeasing for some patients. The aim of this study was to report the cosmetic satisfaction of pericardial, scleral, and corneal patch grafts related to superior GDD surgery.MethodsBaseline clinical data were collected for consecutive patients with glaucoma operated between 2014 and 2019 at two tertiary eye care institutions (for superiorly-placed) Ahmad glaucoma valve implant using sclera, cornea and pericardium patch graft. A patient questionnaire that contained 4 concise questions, with a Likert-scale grading relating to cosmetic satisfaction was administered by a telephone-based interview. Responses and scores for each question were compared across patients who received the three different types of graft. A binominal logistic regression analysis was used to assess the effects of age, gender, type of graft, number of previous ocular surgeries, and final visual acuity to explain differences.ResultsWe included 92 patients who met our inclusion criteria (24 patients received a corneal patch graft, 30 who received sclera and 38 who received pericardium). The mean (±SD) age was 50 (±17.5) years, and the average follow up was 20.7 (± 18.6) months. Regardless of the type of patch graft, most (67–84%) of patients were satisfied with the appearance of their eyes. Patients who received cornea or sclera were more likely to report that their eye looked ‘abnormal’ by others. Younger age was significantly associated with the response to this question.ConclusionPatients are generally satisfied with the appearance of their eye following GDD surgery with each of the patch grafts for superiorly-placed GDDs. Younger patients with cornea or sclera were more likely to report that their eyes looked abnormal.

Biological role of postoperative low level laser therapy in preventing hydroxyapatite orbital implantation exposure: A case report.

Conjunctival sac stenosis is the contraction of the conjunctival sac as a result of trauma or disease. The aim of the present study was to observe the clinical effects of low-level laser therapy (LLLT) combined with hydroxyapatite (HA) orbital implantation as a treatment strategy for conjunctival sac stenosis. A total of 10 patients with conjunctival sac stenosis were treated with scleral graft transplantation in conjunction with HA implantation and postoperative LLLT. In addition, a rabbit model was used to investigate the biological mechanism underlying the effects of LLLT with the aim of preventing and treating orbital implantation exposure. The right eyeball was removed, orbital implantation performed and LLLT applied to experimental groups. 99mTc-Methyl diphosphonate scanning methods were performed at different timepoints to compare the average radioactivity count of the region of interest between surgical (right) and control (left) eyes (R/L). Histopathological examination was performed 8 weeks post-surgery, followed by analysis of fiber vascularization. Following LLLT, moderate conjunctival wounds were completely healed within 2 weeks and severe stenosis wounds healed within 3 weeks. Following prosthesis implantation in the rabbit model, a significantly elevated R/L ratio was observed after 4 weeks, whereas no significant difference was observed compared with the control group at 6 and 8 weeks postoperatively. Histopathological examination revealed that all implants were fibrotic. Overall, the present study demonstrated that LLLT promoted the survival of conjunctival grafts, stimulated conjunctival incision healing and promoted early vascularization of HA implants. Clinical trial registration no: ChiCTR-DDT-12002660 (www.chictr.org/cn/).