Conjunctival Flap Surgery Using Calcium Plaque Scissors for Calcified Scleromalacia after Cosmetic Conjunctivectomy

PURPOSE: To research the advantage of using calcium plaque scissors in conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. METHODS: We analyzed 55 eyes that had undergone conjunctival flap surgery for calcified scleromalacia occurring after cosmetic conjunctivectomy. Surgical blade was used in 30 eyes (Group 1) and calcium plaque scissors in 25 eyes (Group 2). Time after conjunctivectomy, plaque size, operation time and visual acuity before and after the flap surgery were analyzed and compared. Additionally, necessity of additional scleral surgery was evaluated. Optical coherence tomography (OCT) of the sclera was performed both pre- and postoperatively and the results were compared. RESULTS: An average of 3.9 +/- 1.0 years elapsed until conjunctival flap surgery and follow-up time was 5.2 +/- 3.8 months. Post conjunctivectomy time and plaque size were similar in both groups (p = 0.87 and 0.49, respectively). The surgery time in Group 2 was shorter than in Group 1 (17.5 +/- 6.3 minutes and 21.9 +/- 8.5 minutes, respectively, p = 0.20). Uncorrected visual acuity was similar in both groups before and after conjunctival flap surgery (p = 0.53 and p = 0.20, respectively). In Group 1, one sclera transplantation and three Ologen(TM) insertion surgeries were performed as an additional scleral surgery. Based on OCT, calcium plaque scissors were confirmed as a new surgical tool for calcium plaque removal with minimal scleral damage. CONCLUSIONS: Using calcium plaque scissors when performing conjunctival flap surgery for calcium plaque removal that occurred after cosmetic conjunctivectomy reduces the necessity of an additional scleral surgery and surgery time.

Treatment of Scleromalacia with Scleral Autograft

PURPOSE: To report a case of a patient who developed scleromalacia after cosmetic eye whitening conjunctivectomy and treated with scleral and conjunctival autograft. CASE SUMMARY: A 42-year-old male patient who received cosmetic eye whitening conjunctivectomy in both eyes on the nasal side in 2008 developed scleromalacia in the left eye. Calcium deposits and deformed conjunctiva were removed from the left eye. Autogenous sclera and conjunctiva were obtained from the upper side of the left eye and autogenous graft was performed. Topical antibiotics, topical steroid, topical autologous serum, and antibiotic ointment were applied postoperatively. The patient was given oral steroid for 1 month after surgery. During the postoperative 6 months, the grafted autogenous sclera was well maintained and improved cosmetically. CONCLUSIONS: In cases of scleromalacia occurring after cosmetic eye whitening conjunctivectomy, autogenous sclera can be considered as a treatment filler.

The Development of Scleromalacia after Regional Conjunctivectomy with the Postoperative Application of Mitomycin C as an Adjuvant Therapy

A 40-year-old woman presented with ocular discomfort in both eyes that had persisted for several months. Six months ago, she had undergone a bilateral nasal and temporal conjunctivectomy using a bare scleral technique followed by a postoperative application of 0.02% mitomycin C (MMC) to treat her chronic hyperemic conjunctiva for cosmesis. Slit-lamp examination revealed that the patient had bilateral nasal and temporal scleral thinning, and a calcified plaque on her nasal conjunctiva. There was no episcleral tissue present around the wound area, and it was difficult to detect any normal conjunctival tissue in the adjacent area for covering the lesion. We believe that performing an aggressive conjunctival excision procedure followed with MMC application for cosmetic enhancement may be disastrous in certain cases.

Scleral Graft, Free Conjunctival Autograft Using Tissue Adhesive and Temporary Amniotic Membrane Transplantation in Scleromalacia

PURPOSE: To evaluate the surgical results and complications arising from scleral graft and free conjunctival autograft using tissue adhesive and temporary amniotic membrane transplantation as the surgical treatment for scleromalacia. METHODS: Scleral graft and free conjunctival autograft using tissue adhesive and temporary amniotic membrane transplantation was performed in 20 eyes of 20 patients with scleromalacia caused by pterygium excision. The surgical results and complications arising from the procedure were monitored and analyzed through follow-up. RESULTS: During the follow-up period of 17.6 +/- 5.9 months, the wound injection and edema at the free conjunctival autograft and operation site healed in all the cases except 1 at postoperative 1 month. The stability of the ocular surface for graft transplantation was maintained at postoperative 3 months. Although a partial absorption of the conjunctival autograft induced by careless treatment occurred 2 weeks postoperative in 1 case, the ocular surface stabilized due to suitable treatment after 6 months. Although the edges of the scleral graft in 3 patients were partially absorbed 6 months postoperatively, the ocular surface stability was maintained by covering the conjunctival autografts. CONCLUSIONS: For scleromalacia patients, scleral graft and free conjunctival autograft using tissue adhesive and temporary amniotic membrane transplantation rapidly stabilized the ocular surface and presented excellent aesthetic results.

Scleral Allografting and Amniotic Membrane Transplantation With Fibrin Glue in the Management of Scleromalacia

PURPOSE: To examine the effects, complications, and safeties of sclera allograft and amniotic membrane transplantation with fibrin glue as surgical treatment methods for scleromalacia. METHODS: The study included 14 eyes of 14 scleromalacia patients who needed surgical treatment. Among them, seven eyes of seven patients whose scleral defect was small (6 mm) were operated on using fibrin glue and minimum suturing. Amniotic membrane transplantation was performed at the site of the conjunctival defect. RESULTS: In all of the cases, the results of grafting were successful throughout the follow-up period, which was 14.6+/-4.4 months, on average (ranging from 12 to 27 months). No particular complication was observed during the follow-up period after using fibrin glue. CONCLUSIONS: For scleromalacia patients, sclera allograft and amniotic membrane transplantation were performed using fibrin glue. The grafted sclera survived successfully, allowing this treatment modality to be considered an effective and safe option without complications.

A Case of Scleromalacia Perforance That Developing after Surgery for Excision of the Pterygium in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

The ocular manifestations of rheumatoid arthritis (RA) are common and they can vary from patient to patient. However, necrotizing anterior scleritis without inflammation (scleromalacia perforans) is a rare and serious opthalmic complication, and it is typically associated with long-standing RA. Although the etiology and pathogenesis of scleromalacia perforans are diverse and they are not completely understood, ophthalmic surgery is one of the well known causes of scleromalacia perforans. Patients with systemic autoimmune disease such as RA have an especially higher risk of scleromalacia perforans after opthalmic surgery. Because scleromalacia perforans is a potential threat not just to eyesight, but to life as well, early diagnosis and prompt treatment are required for its successful management. We experienced a case of scleromalacia perforans that developed after scleral excision of pterygium in a 58 year old woman who had a 7 year history of RA, and this was well treated with an early screral graft. We report here on this case along with a review of the relevant literature.

Acellular Dermal Allograft Transplantation in Patients with Scleromalacia After Pterygium Excision

PURPOSE: To report two cases of successful acellular dermal allograft transplantation for scleromalacia following pterygium excision. CASE SUMMARY: A 72-year-old female patient developed scleromalacia on the nasal side of the right eye, and a 79-year-old female patient developed scleromalacia with inflammation on the nasal side of the left eye. They had previous histories of pterigia removal on the sites of scleromalacia. Acellular dermal allograft (AlloDerm(R), Lifecell, NJ, USA) transplantations were done. After the operations, inflammation and pain ameliorated and the grafts survived without any particular complications. CONCLUSIONS: In treating scleromalacia, the transplantation of acellular dermal allografts produced relatively satisfactory results without undesirable problems commonly encountered when using conventional materials.

Autogenous Temporalis Fascia Grafting and Conjunctival Flap Transposition in Scleromalacia after Pterygium Excision

PURPOSE: To evaluate the result and complications of autogenous temporalis fascia grafting and conjunctival flap transposition as a treatment of scleromalacia after pterygium excision. METHODS: We used autogenous temporalis fascia and conjunctival flap to treat scleromalacia of 9 patients(9 eyes) who underwent pterygium excision and checked the postoperative result and complications. RESULTS: We could keep the temporalis fascia graft without necrosis during follow-up examination. Pain, inflammation and scleral discoloration were disappeared after temporalis fascia grafting in all cases. Postoperative complications were included 2 cases of progression of cataract and 1 case of mild chamber inflammation. CONCLUSIONS: We obtained good surgical result of scleromalacia after pterygium excision by autogenous temporalis fascia grafting with conjunctival flap transposition.

Repair of scleromalacia with Preserved Scleral and Amniotic Membrane Transplantation

PURPOSE: This study was performed to evaluate the use of preserved scleral and amniotic membrane transplantation in the treatment of scleromalacia. METHODS: This surgical treatment were used to reconstruct scleromalacia in 8 eyes of 8 patients who had painful, non-infectious scleromalacia with impending perforation. Although a variety of graft material such as cartilage, fascia lata, and tibial periosteum on sclera has been used in the surgical treatment of scleromalacia, these tissues must be covered by conjunctiva to prevent necrosis of the grafted material. But in this study, the glycerin preserved sclera had been grafted and then covered by amniotic membrane with thick basement membrane instead of conjunctival flap. RESULTS: Postoperatively, all the patients showed loss of ocular pain and inflammation, fast reepitheliza-tion of ocular surface, and marked improvement in visual acuity. CONCLUSION: This surgical method seemed to be simple, fast and effective. Especially, it was more advantageous in case of large scleral defect or conjunctival scarring. Therefore, amniotic membrane transplantation with preserved scleral graft may be utilized as a new treatment modality for scleromalacia.

A Case of Enucleation due to Extensive necrotizing Scleritis after Pterygium Excision in a Rheumatoid Arthritis Patient

The scleritis is developed after taruma, infection or associated with systemic disease in 505 such as connective tissue disease, granulomatous disease & metabolic disease, in which the most common disease is rheumatoid arthritis[RA]. Scleromalacia perforans characterized by progressive thinning of the sclera in the absence of symtoms and with minimal inflammatory signs is a typical type of scleritis in rhematoid arthritis patient. And necrotizing scleritis is associated with long-standing and severe RA in 4-10%. However, there has been no effective method for preventing those diseases. In order to prevent recurrence of pterygium, anti-metabolic agent or radioactive material has been applied to excision site. However, in case of RA, excessive application of above method or aggressive excision of pterygeal mass is rather avoided to prevent postoperative necrotizing scleritis. In this study, we reported a case of enucleation with histology due to severe necrotizing scleritis with extensive exposure of choroid in a 67-year-old man having a past history of RA for 20 years and pterygium excision[OS] 15 years ago.