Scleral Patch Graft Research Articles

The "Pocket" Technique: A Novel Surgical Technique for Repair of Glaucoma Drainage Device Tube Exposure.

Presented is a novel surgical technique, termed the "pocket" technique, of scleral patch graft placement into a subconjuntival pocket to cover exposed glaucoma tube shunts, which is particularly useful in cases of scarred and thinned conjunctiva and Tenons. Exposure of glaucoma tube shunts is an uncommon postoperative complication which poses a significant risk to the patient and may be difficult to repair. In this case series, the authors present 2 cases using a novel surgical technique, the "pocket" technique, to place a scleral patch graft to address tube exposure. Patient 1 remained free of tube exposure at most recent follow-up visit after 21 months, and patient 2 remained free of tube exposure at most recent follow-up visit after 4 months. This technique offers an elegant surgical option that has multiple benefits; it allows for stability of the scleral patch graft even in cases of scarred down, thinned conjunctiva with minimal Tenons, allows for repair along the entire length of the tube shunt including perilimbal exposures, and allows for secondary healing when there is not enough conjunctiva to cover both the opening and the patch. These advantages make the "pocket" technique a quick to perform, minimally invasive surgical approach that is useful for addressing both difficult and straightforward tube exposure cases.

Scleral patch graft for emergency open-sky repair

Scleral patch graft for emergency open-sky repair

Surgical induced necrotizing scleritis following intraocular lens replacement

PurposeTo report a surgical-induced necrotizing scleritis, as well as its medical and surgical management.MethodsCase-report.ResultsAn 88 year-old patient with a three-day severe single-left-eye ocular pain. One-time surgery involving PPV with removal of dislocated intraocular lens and secondary implantation of iris-claw Artisan® lens was performed 6 months earlier. Visual acuity of 20/100. Slit-lamp examination revealed a 5 × 2 mm non-suppurative superior scleral defect. Empirical topical antibiotic treatment with dexamethasone, as well as oral doxycycline was started. Infectious and autoimmune diseases were ruled out. Non-infectious scleritis treatment was conducted with intravenous Methylprednisolone 3 day pulses, followed by weekly tapered Prednisone and intramuscular Methotrexate. However, 1 month after the diagnosis, the defect was worsened; hence, a heterologous scleral patch graft was performed and, days after the intervention, Adalimumab was initiated. To date, 6 months later, remains with proper scleral patch, a diary low-dose Prednisone, and spacing Adalimumab treatment.ConclusionSurgery-induced necrotizing scleritis is a severe condition that compromise the ocular and visual integrity. Proper diagnosis, as well as early treatment is required to achieve remission, prevent relapses, and avoid structural complications. In refractory cases, anti-TNF-α immunotherapy associated with surgical tectonic graft interventions can achieve promising results.

Giant anterior scleral staphyloma caused by blunt ocular trauma: a case report

BackgroundAnterior scleral staphyloma is a relatively rare disease characterized by thinning and expansion of sclera. We described the clinical presentation, diagnosis and treatment of a case with giant anterior scleral staphyloma caused by blunt ocular trauma.Case presentationA 24-years-old male, presented with a black cyst-like mass protruding from the right eyeball for 9 years after a history of glass crush contusion. The ultrasound biomicroscopy examination showed two cysts in the right eyeball. The larger one was about 5.92 mm*4.69 mm in size and the scleral lacerations were connected to the posterior chamber below the cyst. For treatment, resection of the anterior scleral staphyloma and the scleral patch graft transplantation was performed. The vision of the patient was improved compared with that before surgery. There were no obvious complications.ConclusionThe clinical presentation, diagnosis, and treatment of the case with giant anterior scleral staphyloma can provide a reference for the management of anterior scleral staphyloma. Surgical resection and scleral patch graft should be a good option for the treatment of giant anterior scleral staphyloma.

MYCOBACTERIUM ABSCESSUS SCLERAL BUCKLE INFECTION.

To report the successful management of a rare case of Mycobacterium abscessus scleral buckle infection. Case report. A 63-year-old woman with a history of sarcoid anterior uveitis and macula-off retinal detachment repaired by scleral buckle and pars plana vitrectomy presented with eye pain, redness, and purulent drainage in the left eye. Slit-lamp examination showed superonasal scleral buckle exposure, purulent conjunctival discharge, corneal edema, nongranulomatous keratic precipitates, and anterior chamber cell and flare. The patient underwent urgent scleral buckle removal. Intraoperatively, an area of scleral thinning without perforation underneath the exposed buckle was discovered and covered with a scleral patch graft, and an amniotic membrane graft was used to cover an area of bare sclera with significant conjunctival scarring and retraction. Cultures grew M. abscessus panresistant except to amikacin. After 6 weeks of fortified amikacin drops and a long taper of topical steroid therapy for persistent postoperative anterior uveitis, the patient's symptoms resolved. Mycobacterium is an emerging causative agent of scleral buckle infections. Our report provides insights about the management of such cases.

Post trabeculectomy hypotonous maculopathy: Miraculous result with autologous blood injection in a young lad

A 28-year-old male patient was referred to us for the management of hypotonous maculopathy developed post trabeculectomy for angle recession glaucoma. After examination, the patient was advised cycloplegics, oral and topical steroids, but maculopathy had not settled even after treatment for 3 weeks and so scleral patch grafting was done. Post grafting also macular folds persisted and a part of the graft was exposed and so amniotic membrane grafting was done, still hypotony persisted with the development of neurosensory detachments. The over-filtration hypotonus maculopathy finally resolved with peri bleb injection of autologous whole blood.

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.

Comparison of conjunctiva-related complications between scleral and corneal patch grafts in Ahmed glaucoma valve implantation.

Comparison of the conjunctiva related complication rates and success rates among eyes with Ahmed glaucoma valve (AGV) implantation in which eye bank derived scleral and corneal patch grafts had been used to cover the tube. Retrospective comparative study. Patients who underwent AGV implantation between January 2000 to December 2016 were included. Demographic, clinical data, intra and post operative data was obtained from electronic medical records. Conjunctiva related complications were divided into two groups: with and without implant exposure. Conjunctiva related complication rates, success rate, risk factors among eyes with corneal and scleral patch graft were compared. Three hundred and twenty three eyes of 316 patients underwent AGV implantation. Scleral patch graft was used in 214 eyes of 210 patients (65.9%) and corneal patch graft was used in 109 eyes of 107 patients (34%). Median follow up was 14 months. There was no significant difference in the conjunctiva related complication rate (7.3 % in corneal patch graft versus 7.0% in scleral patch graft;p=0.5) and conjunctival dehiscence rate (3.7% versus 4.6%, P = 0.7) among the two groups. Success rate was significantly higher in the corneal patch graft group versus the scleral patch graft group (98% versus 72%; p=0.001). Eyes with corneal patch graft had a higher survival rate (P = 0.01). There was no significant difference in the rate of conjunctiva related complications following corneal and scleral patch grafts used to cover the AGV tube. Eyes with corneal patch graft had a higher success rate and survival rate.

Commentary: Comparison of conjunctiva-related complications between scleral and corneal patch grafts in Ahmed glaucoma valve implantation.

Commentary: Comparison of conjunctiva-related complications between scleral and corneal patch grafts in Ahmed glaucoma valve implantation.

Bilateral peripheral ulcerative keratitis

A 13-year-old girl presenting with mucopurulent conjunctivitis (left > right) was diagnosed with Behçet's disease. Intraoperatively, the left eye had 360° culture-negative marginal corneal ulcer with scleral necrosis, managed with a scleral patch graft. Postoperatively, the right eye also developed a peripheral corneal lesion that resolved with immunosuppressants along with the skin lesions. Subsequently, wound gaping and uveal prolapse were noted in the left eye and was managed with a lamellar corneal graft and later with a corneoscleral patch graft. Following this, the patient improved very well in terms of visual acuity. Peripheral ulcerative keratitis can be a clinical presentation in pediatric Behçet's disease despite the unusual occurrence. Hence, any pediatric case with peripheral ulcerative keratitis should be thoroughly investigated for Behçet's disease, for which immunosuppressants may prove to be beneficial.

Management of perforated peripheral ulcerative keratitis (PUK-Mooren’s ulcer) with iris prolapse study in two cases

Aim: The aim of this study was to describe the management of two cases of perforated peripheral ulcerative keratitis (PUK-Mooren’s ulcer) with iris prolapse by using dried sclero-corneal patch graft and subsequently replacing donor sclero-corneal patch graft. Methods: After sectoral conjunctival resection, ulcer margin excision, and prolapsed iris excision, preserved dried sclero-corneal tissue is fashioned, and patch grafting is done as an emergency. After getting the donor sclerocorneal rim, it was again fashioned (matching the size and removal of Descemet’s membrane) and replaced the dried scleral patch graft followed by a bandage contact lens. Results: Eleven to 16 months after their initial evaluation, these patients still had some useful vision and selfsatisfaction. Conclusion: A dried sclera-corneal patch graft could be a satisfactory option in the temporary management of perforated PUK with iris prolapse until donor tissue is available. This patch graft prevents hypotony, posterior synechiae, and secondary glaucoma.

Case series on scleral patch graft for peripheral corneal perforations

Case series on scleral patch graft for peripheral corneal perforations

Clinical profile and management of granulomatosis with polyangiitis-associated scleritis from a tertiary care hospital in South India.

To describe the clinical features and management of patients with scleritis associated with granulomatosis with polyangiitis (GPA) at a tertiary eye care center in South India. The clinical profile and management of patients presenting to a tertiary eye care center in South India with scleritis secondary to GPA from 2003 to 2021 were analyzed retrospectively. Scleritis was classified into anterior diffuse, nodular, and necrotizing scleritis with inflammation according to Watson and Hayreh's classification. Demographic characteristics, clinical features, anti-neutrophil cytoplasmic antibody (ANCA) positivity, treatment response, ocular complications, and status at the last follow-up were analyzed. Statistical analysis of data was performed using Microsoft Excel 2019. Nineteen eyes of 17 patients (15 cytoplasmic staining ANCA [c-ANCA], two p-ANCA positive) were included. Fifteen eyes had necrotizing scleritis, two had diffuse anterior scleritis, and two had nodular scleritis. Remission was induced using a combination of steroids and cyclophosphamide or rituximab. Maintenance therapy was instituted using tapering steroids and immunosuppressants like cyclophosphamide, mycophenolate mofetil, methotrexate, or rituximab. Three eyes required a scleral patch graft. Fourteen patients had good anatomical and visual outcomes, and three were lost to follow-up. GPA is a rare disease, while it is the most common ANCA-associated vasculitis with scleritis. As scleritis may be the presenting sign of the disease, ophthalmologists must be aware of the various features suggestive of GPA. GPA-associated scleritis can have a good prognosis when diagnosed promptly and managed aggressively in the acute stage, and remission is maintained with adequate systemic immunosuppression.

Occult anterior uveal melanomas presenting as extrascleral extension

ObjectiveTo describe the management of patients with occult anterior uveal melanomas presenting with extrascleral extension.Methods and analysisRetrospective case series including five patients with small pigmented nodular mass on the episclera....

Anterior staphyloma repair following trauma and surgery – A retrospective review of techniques and outcomes over 25 years

To review surgical options, techniques, and outcomes of anterior staphyloma repair done following trauma and surgery. This was a retrospective case study of patients who underwent staphyloma repair with scleral or tibial periosteal patch grafts following trauma and surgery with a minimum follow-up of 3 months postoperatively. Preoperative risk factors, choice of graft materials, surgical details, and outcomes in terms of graft uptake and tectonic integrity were analyzed. Seventeen eyes of 17 patients underwent successful staphyloma repair (scleral 15, tibial periosteal two). Mean follow-up was 47.1 months (3-159 months). Postoperative intraocular pressure rise noted in four eyes was controlled medically or surgically. Three patients underwent successful repeat patch grafting (graft melt one and recurrent ectasia two). Tectonic integrity of the eyeball was restored and maintained in all patients at the final follow-up. Comprehensive evaluation of the risk factors, control of ocular comorbid conditions, and early and meticulous surgery can optimize results.

Clinical Spectrum and Management Outcome of Ocular and Adnexal Rhinosporidiosis.

To describe the clinical spectrum and management outcomes of ocular rhinosporidiosis. All histopathologically diagnosed cases of ocular rhinosporidiosis between January 2000 and December 2016 were included in the study. The lesions were classified based on the site of involvement, namely conjunctiva, lacrimal sac, eyelid, and orbit. The frequency and percentages for each of the lesions and the different treatment modalities were noted and calculated. Any recurrence and its subsequent management were also noted. A total of 34 patients were included with a male-to-female ratio of 2.7:1. Conjunctiva was the most common site involved (19, 55.8%), followed by lacrimal sac (11, 32.3%) and eyelid (3, 8.82%). One patient had orbital involvement secondary to sinonasal extension. The mean duration of symptoms was 14.8 ± 19.1 months (range, 1-84 months). Seven (36.8%) patients in the conjunctival group needed scleral patch graft. Five patients (45.4%) with lacrimal sac rhinosporidiosis underwent dacryocystectomy and modified dacryocystorhinostomy (DCR). The mean follow-up period was 5.43 ± 7.9 months (range, 1-36 months). Five (14.7%) patients (2 conjunctival, 2 lacrimal, and 1 eyelid) had recurrence. Conjunctiva is the most common site for ocular rhinosporidiosis, followed by lacrimal sac. While conjunctival lesions respond well to complete excision with cauterization of the base, lacrimal sac lesions can be managed by a modified DCR. Eyelid rhinosporidiosis can mimic a neoplasm and should be considered in differential diagnosis in suspicious lesions, especially in endemic areas.

Comment on: Case series of scleral patch grafts during COVID-19 pandemic

Comment on: Case series of scleral patch grafts during COVID-19 pandemic

Conjunctival oculosporidiosis-associated ciliary staphyloma, managed with scleral patch graft using box sutures

To report four cases of oculosporidiosis associated with scleral thinning and staphyloma formation, including recurrent bulbar conjunctival oculosporidiosis, retrospective reviews of case records of four patients with bulbar conjunctival oculosporidiosis were undertaken. All cases were managed with excision of growth followed by diathermy and scleral patch graft. Box sutures were used for securing the graft in place, followed by oral dapsone therapy. This case series describes successful management of oculosporidiosis and associated scleral ectasia even in a recurrent case. It also highlights the utility of box sutures for securing scleral patch grafts.

Different management strategies of scleral necrosis

Surgically induced necrotizing scleritis is a rare complication of ocular surgeries. Mitomycin C (MMC) when used intraoperatively may be related to serious postoperative complications. We report management of two cases in which patients underwent pterygium excision with adjunctive use of MMC and they both developed scleral necrosis. In the first case, scleral patch grafting was performed, while the other case underwent advanced Tenon's flap with a sliding conjunctival flap. Tectonic coverage can be done by various methods such as scleral patch grafting and advanced Tenon's flap and both provide structural and functional stability to eyes with scleral defects.

Scleral Necrosis in Porphyria Cutanea Tarda: A Case Report

Scleral necrosis is a rare but well documented ocular manifestation of Porphyria Cutanea Tarda (PCT). The PCT is caused by a deficiency of Uroporphyrinogen Decarboxylase (Uro-D). The typical clinical manifestations of PCT in the form of cutaneous photosensitivity are due to the accumulation of fluorescent polycarboxylated porphyrins. Here, a case of 30-year-old male patient who was referred to the cornea services department for scleral thinning in right eye has been presented. Slit lamp biomicroscopy revealed focal area (5×5 mm2 ) of punched out scleral thinning (>80%) with uveal show in the interpalpebral area, 2 mm temporal to the limbus in right eye and a partial thickness scleral melt in nasal area. The left eye was phthisical. Patient had multiple blisters and pigmented, slightly depressed scars on the skin, especially in the sun-exposed parts such as face, hands and legs. Digital shortening, atrophy and contractures were seen in hands and legs. Based on the clinical, biochemical and dermatological evaluation, the diagnosis of PCT was made. A rare case of scleral necrosis with uveal show in a patient with PCT which was successfully treated with allogenic scleral patch graft has been reported. On follow-up visits scleral patch graft was well taken up.