Short-term observation of management of sclera patch grafts used in the scleral defects

Background:To explore the safety and effectiveness of Sclera patch grafts in the management of scleral defects.Methods:This is a retrospective uncontrolled study.Medical records were retrospectively reviewed for 8 eyes of 8 patients with sclera patch grafts.Two patients had necrotizing scleritis,2 patients had scleral melting/perforation secondary to thermal burns,4 patients had scleral staphyloma secondary to surgery.Sclera was reconstructed with allogenic sclera patch grafts,6 in 8 patients combined autologous conjunctival pedicle flap,1 patient combined partial medial rectus translocation,1 patient combined autologous pedicle tenon graft,simultaneously.Treatment outcomes were evaluated using structural integrity,best corrected visual acuity(BCVA),scleritis remission,sclera rejection and melt,and ocular symptoms.Results:Eight patients were reviewed.In all of these cases,satisfactory anatomic and functional outcomes were achieved.In the at least half a year follow-up,the BCVA of all the eight patients were no worse than that of preoperative.No eye pain,foreign body sensation and other discomforts showed in all the patients,except one woman,who showed sclera rejection and melt 1 month postoperative.In addition,one patient showed high intraocular pressure(28 mmHg),which can be controlled by a kind of medicine.Conclusions:In this series,sclera patch grafts is an effective method for management scleral defects in the at least half a year following-up.Attention should be paid to the sclera patch rejection and melt post operatively.

Comparison of anatomical and functional outcomes of different surgical techniques in myopic macular hole without retinal detachment

AIM:To define the anatomic and functional outcomes of pars plana vitrectomy(PPV)with internal limiting membrane(ILM)peeling,inverted ILM flap and free ILM patch graft technique for the treatment of myopic macular hole(MH)without retinal detachment.METHODS:Sixty-four eyes of 64 patients who underwent PPV for myopic MH were included.Group 1 consists of patients underwent ILM peeling(n=26),and Groups 2 and 3 consists of patient underwent free ILM patch graft(n=20)and inverted ILM flap procedure(n=18)respectively.Outcomes following surgery were MH closure and best corrected visual acuity(BCVA)in logMAR at 6mo.RESULTS:Closure of MH was obtained in 20 eyes(76.9%)of the Group 1,in 16 eyes(80%)of the Group 2 and in 16 eyes(88.9%)of the Group 3.The mean preoperative and postoperative BCVA was 1.60±0.53 logMAR and 1.27±0.58 logMAR,respectively(P<0.05).There was no significant difference in the postoperative BCVA and anatomical closure rates in the three groups.Although the anatomical closure rate did not differ significantly in the groups,closure of MH tended to be better in the inverted ILM flap technique group at 6mo.CONCLUSION:Different surgical techniques may provide favorable visual and anatomical results for myopic MH surgery.ILM flap techniques offer higher closure rates compared to ILM peeling technique.However,in terms of visual outcomes,the study reveals no difference in three surgical techniques.

Surgically induced scleral staphyloma

Background: To report the clinical features of surgically induced scleral staphyloma and investigate the management.Methods: Retrospective uncontrolled study.Results: A full ophthalmological evaluation of surgically induced scleral staphyloma in four patients was performed. The first patient was a 3-year-old young girl underwent corneal dermoid resection. The second patient was a 60-year-old man underwent nasal pterygium excision and conjunctival autograft without Mitomycin C(MMC). The other two were respectively a 74-year-old woman and a 69-year-old man underwent cataract surgery. All patients performed allogeneic sclera patch graft. In the at least half a year follow-up, the best corrected visual acuity(BCVA) of all the four patients were no worse than that of preoperative. Ocular symptoms disappeared, including eye pain, foreign body sensation, and so on. Unfortunately, the fourth patient showed sclera rejection and partial dissolution at postoperative 1 month. Conclusions: Surgically induced scleral staphyloma must be considered in the differential diagnosis of patients with staphyloma following corneal dermoid, pterygium, and cataract surgery. Allogeneic sclera patch graft is one of the methods for treating scleral staphyloma. However sclera rejection and dissolution should be considered postoperatively.

Bleb-associated endophthalmitis treated by sclera patch graft, vitrectomy and endoscopic cyclophotocoagulation

Background Bleb-associated endophthalmitis （BAE） is a rare but severe complication of trabeculectomy with poor outcome. Various surgical methods were explored to treat such patients. However, there is no defined protocol. The aim of this study was to describe a new combined operation, and to demonstrate the outcome of the treatment. Methods Nine patients with BAE were enrolled in our study. The combined operation including pars plana vitrectomy （PPV）, sclera patch graft （SPG） and endoscopic cyclophotocoagulation （ECP） was used to treat these patients. Results In the follow-up of 18-24 months, all patients with the endophthalmitis were cured, the useful visual acuity was preserved in 7 patients, and the intraocular pressure （lOP） of 8 patients was controlled just after first operation, only one needed another trans-scleral cyclophotocoagulation. Conclusion This combined operation is a useful method for treating the patients with BAE, with SPG and vitrectomy to control the endophthalmitis and ECP to balance the postoperative lOP.