Scleral Graft Research Articles

Thyroid lid surgery.

A retrospective study of 58 thyroid patients undergoing eyelid surgery for thyroid related lid malposition is reported. A treatment strategy is suggested, based on the results of this experience. The following points are stressed: (1) The importance of recognising and relieving the inferior rectus tethering component of upper lid retraction when present. (2) The usefulness of a scleral graft in lower lid retractor recession. (3) The inadequacy of lateral tarsorrhaphy in relieving lid retraction but its value in camouflage.

Scleral Reinforcement Two Case Reports

We report two cases of unilateral scleral reinforcement undergone for progressive pathologic myopia. Examination ten years after the operations showed the supportive effect of the scleral grafts. The effect, however, was localized and did not appear to block the overall progression of posterior staphyloma formation significantly.

Choice of surgical treatment for Graves' disease

Functional and cosmetic ophthalmic complications of Graves' (1835) disease are dysthyroid optic neuropathy, exophthalmos, eyelid retraction and oculomotor disturbances. This paper describes and elaborates on the surgical procedures used when these complications are present. In severe exophthalmos and optic neuropathy we use an orbital decompression of the orbital floor sometimes combined with the medial wall, via an anterior approach. In eyelid retraction, we perform a recession of the levator muscle with scleral graft implantation. In concomitant strabismus, surgery is usually limited to recessions of the involved muscles, most of the surgery is directed to the inferior and medial rectus, as these are the most commonly affected muscles. The indications depend on the status of the patient at the time of referral. For severe exophthalmos with true retraction of the upper eyelid, we begin by treatment of the retraction and if this is not sufficient, we perform orbital decompression. For severe exophthalmos with oculomotor disturbances, we perform orbital decompression and later, the strabismus surgery. For oculomotor disturbances with eyelid retraction, we perform the strabismus surgery at the first and the eyelid retraction at the second stage. When there is a combination of exophthalmos, eyelid retraction and oculomotor disturbance, the indications and the choice of treatment are difficult and depend on numerous factors. If orbital decompression is indicated, it will be done first, followed by the strabismus surgery and at a later stage, the eyelid retraction. If only the eyelid retraction is treated, it will be done after the strabismus surgery. The chronological order of treatment depends on the modification we observe on the other components of the ophthalmopathy.

Is scleral transplantation necessary in the treatment of upper eyelid retraction?

Upper eyelid retraction caused by endocrine ophthalmopathy can be corrected by lengthening of the lid retractors. A number of operative procedures have been used for this purpose. In the more severe cases, it has been recommended that a graft be placed between the retractors and their former attachments. Sclera is commonly used but may induce a persistent tissue reaction making the results unpredictable. In the present study, 41 eyelids were operated with retractor recession via the conjunctiva. No graft was used. Surgery was easily performed and the intra-and postoperative troubles not important. The cosmetic and functional results were good and stable and point to the conclusion that scleral grafts are unnecessary in the surgical treatment of upper eyelid retraction.

Sclerochorioretinal Resection for Choroidal Melanoma: A Clinicopathologic Correlation of a Postmortem Eye

AbstractA 51-year-old patient underwent a technically successful sclerochorioretinal resection with scleral graft for a medium-sized choroidal melanoma, which proved to be of mixed cell type. Though there was complete resection of the tumor and a favorable visual result, the patient developed metastatic melanoma and died 42 months after the original diagnosis and 34 months after the surgical procedure. Postmortem examination of the involved eye demonstrated excellent anatomic preservation of intraocular structures. Of particular interest was the lack of ischemic necrosis in the anterior segment in spite of surgical disinsertion of two rectus muscles and the ablation of the medial long ciliary artery.

Cosmetic correction of eyelid deformities associated with exophthalmos.

Several procedures are detailed for correction of endocrine exophthalmos, including lateral tarsorrhaphy, levator marginal myotomy, excision of Muller’s muscle and levator recession, scleral implantation, scleral grafting, and tarsal grafting. The most predictable results were found with ear cartilage grafts to lengthen the posterior lamella.

Scleral Grafting in the Management of Ligneous Conjunctivitis

Ligneous conjunctivitis is a rare, usually bilateral, chronic membranous conjunctivitis, which begins acutely in childhood and persists for many years. In view of the poor results obtained with other forms of therapy in the past, the resection of the involved conjunctiva and tarsus with the grafting of donor sclera is offered as another alternative in the management of this distressing condition.

Complications Associated with Use of Tantalum-Mesh — Covered Implants

In 1948, ophthalmologists started implanting plastic spheres partially covered with tantalum mesh (eg, the Valley Forge Implant) in anophthalmic sockets. Numerous patients have developed complications ten to 15 years after surgery: pain (“pinching” or “deep”), headache, heavy mucopurulent discharge and diffuse conjunctival inflammation, migration of the implant, thinning or erosion of tissues covering the implant (extrusion), and inability to wear an artificial eye. Management includes refabrication of the artificial eye and replacement of the implant with a dermis-fat graft or a silicone ball plus scleral graft. Tantalum-mesh—covered orbital implants should probably not be used.

A Long-Term Follow-Up Study of Scleral Grafting for Exposed or Extruded Orbital Implants

We conducted a long-term follow-study of 20 patients whose exposed or extruded orbital implants had been replaced or salvaged with scleral grafts. We judged 11 cases to be successes and six failures. Three patients were lost to follow-up. Among the failures were three orbits that had received radiation therapy for retinoblastoma. They could not retain an orbital implant despite several scleral grafts.

Cosmetic Correction of Eyelid Deformities Associated with Exophthalmos

Several procedures are detailed for correction of endocrine exophthalmos, including lateral tarsorrhaphy, levator marginal myotomy, excision of Muller’s muscle and levator recession, scleral implantation, scleral grafting, and tarsal grafting. The most predictable results were found with ear cartilage grafts to lengthen the posterior lamella.

Primary scleral atrophy and retinal detachment.

In a retrospective study 27 patients with retinal detachment had an advanced primary scleral atrophy, needing treatment with a scleral graft. Among these 27 patients none was younger than 47. There was s good correlation between the location of the atrophic sclera and the retinal tears. Many of these eyes had an oblique astigmatism. Lattice degeneration was found to be rare. A history of retinal detachment was common in the fellow eye. The scleral grafts were well accepted by the eyes.

Combined scleral grafts, cosmetic blepharoplasty and orbital lipectomy in a case of moderate exophthalmos from hyperthyroidism. (Spanish)

Combined scleral grafts, cosmetic blepharoplasty and orbital lipectomy in a case of moderate exophthalmos from hyperthyroidism. (Spanish)

Surgical Treatment of Dysthyroid Eyelid Retraction and Orbital Fat Hernia

Upper eyelid retraction secondary to thyroid disease can be relieved in a controlled manner by a graded detachment and excision of Müller's muscle and stripping and recession of the levator aponeurosis. This improves cosmesis, lessens the exophthalmic appearance, and relieves ocular irritation secondary to exposure keratopathy and conjunctivopathy. Recessing the lower eyelid retractors and placing a scleral graft between them and the tarsus can relieve lower eyelid retraction. Edema and inflammation of orbital fat secondary to thyroid disease cause separation of the orbital septum from the capsulopalpebral fascia, allowing fat to prolapse into the orbit as in a true hernia. To prevent full fledged lower eyelid retraction and to relieve slight amounts that already exist, the lower eyelid retractors are recessed when orbital fat is excised.

The effect of scleral grafts in osseous defects in rabbits.

Scleral grafts were implanted into bony cavities in the tibiae of 8 rabbits for periods of two to six weeks. By four weeks, control unfilled cavities were full of woven bone, which had been remodelled into mature compact bone by six weeks. Healing of cavities filled with scleral allografts was delayed and they were not filled with woven bone until six weeks. There was no evidence of osteogenetic induction of sclera. Human heterografts caused marked rejection responses.

Histomorphologic Evaluation of Scleral Grafts in Experimental Bony Defects

This study was undertaken in order to evaluate and compare the effectiveness and fate of the nonautogenous scleral graft in relation to similar grafts of bone marrow and epithelium-free connective tissue grafts from the palate. One hundred round osseous defects 2 mm in diameter, were surgically created in the calveria of 25 rats. Three defects in each animal were filled with the various graft materials obtained from isogenic rats sacrificed at the time of preparation of the bony defects. The fourth defect was left empty as a control. The animals were sacrificed at varying periods of time up to 150 days. Histomorphologic evaluation of the graft sites demonstrated the following: (a) Scleral grafts had effected a functionally adequate repair, without apparent histopathologic changes. (b) Fresh bone marrow provided the greatest osteogenic activity when used as a graft implant. The sclera had an insignificant osteogenic activity when used as a graft implant. The sclera had an insignificant osteogenic potential. (c) Epithelium-free connective tissue was the least effective, both as an osteogenic or functionally adequate graft.

Preserved Scleral Allografts in Periodontal Defects in Man: II. Histological Evaluation

1. The scleral grafts appeared to be well accepted as there were no signs of antigenicity or untoward reactions. 2. The gingival connective tissue, periodontal ligament and the periosteum were observed intertwined with sclera at the interface. 3. Sclera was invaded by host fibroblasts, capillaries, and appeared in some areas to be raplaced by a dense connective tissue. 4. Areas of cementogenesis could be observed in all specimens. 5. There were no signs of osteogenesis within the scleral grafts. 6. The alveolar crest appeared relatively nonreactive to sclera. 7. There were no signs of external root resorption or ankylosis. 8. Sclera may be able to be used to fill in osseous craters, other periodontal defects and as a scaffolding in conjunction with osseous grafts. This requires further investigation. 9. Sclera may possibly be used in areas where there was loss of gingival contour or need for ridge augmentation.

Histoacryl tissue adhesive in some types of retinal detachment surgery.

Preserved human scleral graft and histoacryl-blue tissue adhesive were used in four cases of retinal detachment surgery to obtain scleral buckling effect and to protect staphylomatous or necrotic scleral areas. The use of histoacryl produced a strong and resistant adhesion between the host and the preserved scleral patch. The postoperative inflammatory reaction was mild and disappeared within one week.

Reconstructive and Plastic Surgery of the Eyelids

This book is intended as a guideline for established ophthalmologists and residents interested in ophthalmic plastic and reconstructive surgery of the eyelids. As such it is compromised by its length. In the book's 98 pages, 14 major areas of oculoplastic surgery are briefly considered. Inadequate technical detail is presented to prevent the pitfalls of these procedures. Little discussion regarding indications for various procedures and their postoperative management is given. I was disappointed that this collection of modern principles and techniques of eyelid restoration omitted what I regard as the most important recent advances in this field: (1) levator aponeurosis repairs for ptosis, (2) scleral grafting for lid retraction, (3) medial canthal tendon plication for ectropion, and (4) cryosurgery for trichiasis. This book suffers from the common plight of most other oculoplastic surgical texts. The numerous problems, principles, and procedures involved in this type of surgery cannot be encompassed in

Periodontal scleral grafts and combined grafts of sclera and bone: two-year appraisal.

Periodontal scleral grafts and combined grafts of sclera and bone: two-year appraisal.

Necrogranulomatous scleritis treated by an onlay scleral graft.

Necrogranulomatous scleritis treated by an onlay scleral graft.