Abstract
Purpose
To introduce a novel technique to treat necrotic scleral calcification caused by previous regional conjunctivectomy using conjunctival autografting and amniotic membrane inlay filling, and to evaluate the clinical outcome.
Methods
Ten patients (11 eyes, 12 regions) who had undergone regional conjunctivectomy with postoperative mitomycin C (MMC) for pterygia or pingueculae were included. Scleral calcification was removed using a bevel-down crescent knife. After the conjunctival donor tissue was harvested from the upper bulbar conjunctiva, the tissue was grafted to the scleral defect and secured with sutures. Amniotic membrane was inserted randomly into spaces between the conjunctival graft and the scleral bed. Protective amniotic membrane was transplanted over the graft, with stromal side up.
Results
Scleral calcification developed in ischaemic areas in 11 of the 12 regions; 50% of cases had a surface defect seen with a fluorescent dye. The grafted conjunctiva epithelialized successfully in all cases. In 10 regions, the epithelialization occurred in 1 or 2 weeks. In the remaining two regions, one region required another surgery because of graft failure, and epithelialization occurred in the last region in 9 weeks. Vascular growth into the graft from the surrounding tissue occurred in all cases in 1 to 10 weeks. The surgical wound stabilized 3 weeks postoperatively.
Conclusion
The combined technique had high success rates of graft survival and good revitalization of the necrotic area of scleral calcification, eliminated the need for invasive and time-consuming scleral autografting or allografting, and provided good cosmesis. Scleral ischaemia, which was caused by MMC, may induce scleral calcification.
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References
Yamanouchi U . A case of scleral calcification due to mitomycin C instillation after pterygium operation. Folia Ophthalmol Jpn 1978; 29: 1221–1225.
Rubinfeld RS, Pfister RR, Stein RM, Foster CS, Martin NF, Stoleru S et al. Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology 1992; 99: 1647–1654.
Dunn JP, Seamone CD, Ostler HB, Nickel BL, Beallo A . Development of scleral ulceration and calcification after pterygium excision and mitomycin therapy. Am J Ophthalmol 1991; 112: 343–344.
Okhravi N, Odufuwa B, McCluskey P, Lightman S . Scleritis. Surv Ophthalmol 2005; 50: 351–363.
Mauriello JA, Pokorny K . Use of split-thickness dermal grafts to repair corneal and scleral defects—a study of ten patients. Br J Ophthalmol 1993; 77: 327–331.
Chechelnitsky M, Mannis MJ, Chu TG . Scleromalacia after retinal detachment surgery. Am J Ophthalmol 1995; 119: 803–804.
Raviv T, Greenfield DS, Liebmann JM, Sidoti PA, Ishikawa H, Ritch R . Pericardial patch grafts in glaucoma surgery. J Glaucoma 1998; 1: 27–32.
Schein OD . The use of processed pericardial tissue in anterior ocular segment reconstruction. Am J Ophthalmol 1998; 125: 549–552.
Melamed S, Ashkenazi I, Belcher III DC, Blumenthal M . Donor scleral graft patching for persistent filtration bleb leak. Ophthalmic Surg 1991; 22: 164–165.
Kosmin AS, Wishart PK . A full-thickness scleral graft for the surgical management of a late filtration bleb leak. Ophthalmic Surg Lasers 1997; 28: 461–468.
Mistlberger A, Biowski R, Grabner G . Repair of a late-onset filtering bleb leak using a corneal graft shaped with an excimer laser. Ophthalmic Surg Lasers 2001; 32: 428–431.
Soong HK, Meyer RF, Wolter JR . Fistula excision and peripheral grafts in the treatment of persistent limbal wound leaks. Ophthalmology 1988; 95: 31–36.
Ti SE, Tan DT . Tectonic corneal lamellar grafting for severe scleral melting after pterygium surgery. Ophthalmology 2003; 110: 1126–1136.
Teping C, Reim M . Tenonplasty as a new surgical principle in the early treatment of the most severe chemical eye burns. Klin Monatsbl Augenheilkd 1989; 194: 1–5.
Casas VE, Kheirkhah A, Blanco G, Tseng SC . Surgical approach for scleral ischemia and melt. Cornea 2008; 27: 196–201.
Mansour AM, Bashshur Z . Surgically induced scleral necrosis. Eye 1999; 13: 723–724.
Gregory ME, Weir CR, Ramaesh K . Excision of granulation tissue and free conjunctival autograft in the management of necrotizing scleritis. Cornea 2010; 29: 577–579.
Kim B . Regional conjunctivectomy with postoperative mitomycin C to treat chronic hyperemic conjunctiva. Cornea (in press).
Lee SH, Tseng SC . Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol 1997; 123: 303–312.
Hao Y, Ma DH, Hwang DG . Identification of antiangiogenic and antiinflammatory proteins in human amniotic membrane. Cornea 2000; 19: 348–352.
Kim JC, Tseng SCG . The effects on inhibition of corneal neovascularization after human amniotic membrane transplantation in severely damaged rabbit corneas. Korean J Ophthalmol 1995; 9: 32–46.
Kobayashi N, Kabuyama Y, Sasaki S, Kato K, Homma Y . Suppression of corneal neovascularization by culture supernatant of human amniotic cells. Cornea 2002; 21: 62–67.
Faulk WP, Matthews R, Stevens PJ . Human amnion as an adjunct in wound healing. Lancet 1980; 1: 1156–1158.
Kim JS, Kim JC, Na BK . Amniotic membrane patching promotes healing and inhibits proteinase activity on wound healing following acute corneal alkali burn. Exp Eye Res 2000; 70: 329–337.
Solomon A, Meller D, Prabhasawat P, John T, Espana EM, Steuhl KP et al. Amniotic membrane grafts for non-traumatic corneal perforations, descemetoceles and deep ulcers. Ophthalmology 2002; 109: 694–703.
Guo M, Grinnell F . Basement membrane and human epidermal differentiation in vitro. J Invest Dermatol 1989; 93: 372–378.
Meller D, Pires RTF, Tseng SC . Ex vivo preservation and expansion of human limbal epithelial cells by amniotic membrane. Invest Ophthalmol Vis Sci 1999; 40: 329.
Khodadoust AA, Silverstein AM, Kenyon DR, Dowling JE . Adhesion of regenerating corneal epithelium. The role of basement membrane. Am J Ophthalmol 1968; 65: 339–348.
Oh JH, Kim JC . Repair of scleromalacia using preserved scleral graft with amniotic membrane transplantation. Cornea 2003; 22: 288–293.
Hanada K, Shimazaki J, Shimmura S, Tsubota K . Multilayered amniotic membrane transplantation for severe ulceration of the cornea and sclera. Am J Ophthalmol 2001; 131: 324–331.
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This work was presented in part as a paper at the Third Joint Meeting of China–Korea–Japan Ophthalmologists in September 2010.
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Kim, BH. Surgical treatment of necrotic scleral calcification using combined conjunctival autografting and an amniotic membrane inlay filling technique. Eye 25, 1484–1490 (2011). https://doi.org/10.1038/eye.2011.209
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DOI: https://doi.org/10.1038/eye.2011.209
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