Surgical approach for scleral ischemia and melt

Victoria E. Casas, Ahmad Kheirkhah, Gabriela Blanco, Scheffer C.G. Tseng

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

PURPOSE: To describe the combined use of tenonplasty, lamellar corneal patch graft, and amniotic membrane transplantation in managing scleral ischemia and/or melt by using sutures or fibrin glue. METHODS: We subjected five eyes of 4 patients with scleral ischemia and/or melt of diverse etiologies to debridement of all necrotic tissue, followed by a lamellar corneal graft (cases with melt, n = 3) or a cryopreserved amniotic membrane (cases without melt, n = 2), and a Tenon pedicle graft was used to cover the ischemic zone; surgery was completed by using a second layer of cryopreserved amniotic membrane. These procedures were performed by using either sutures or fibrin glue. Reduction of photophobia, facilitation of epithelialization, and correction of scleral ischemia and/or melt with preservation of the globe integrity were considered the main outcome measurements. RESULTS: Surgical measures were effective to reduce or eliminate photophobia, facilitate epithelialization, halt scleral ischemia and/or melt, and preserve the globe integrity in all eyes except for 1 eye, in which a second attempt was needed to completely correct scleral ischemia. Complications included granuloma formation in 1 case and dellen formation and extreme gaze horizontal diplopia caused by a small symblepharon formation in another case. CONCLUSIONS: The combination of tenonplasty and amniotic membrane transplantation with or without lamellar corneal patch grafting, by using sutures or fibrin glue, is a feasible alternative for treating scleral ischemia and/or melt.

Original languageEnglish (US)
Pages (from-to)196-201
Number of pages6
JournalCornea
Volume27
Issue number2
DOIs
StatePublished - Feb 2008
Externally publishedYes

Keywords

  • Cryopreserved amniotic membrane
  • Fibrin glue
  • Lamellar corneal patch graft
  • Scleral ischemia and melt
  • Tenonplasty

ASJC Scopus subject areas

  • Ophthalmology

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