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Preserved scleral patch graft for unexpected extreme scleral thinning found at the scleral buckling procedure: a case report.

Stunf S, Lumi X, Drnovšek-Olup B - Indian J Ophthalmol (2011 May-Jun)

Bottom Line: The surgery was converted into a scleral graft procedure, as extreme scleral thinning was found intraoperatively.The anatomical outcome was excellent and the scleral rupture was prevented; the visual outcome was satisfactory.A conversion of the scleral buckling procedure into a scleral graft procedure has proved to be safe and effective for unexpected scleral pathology.

View Article: PubMed Central - PubMed

Affiliation: University Eye Hospital, University Clinical Center Ljubljana, Slovenia, Europe. spela.stunf@siol.net

ABSTRACT
Pre-existing scleral pathology is an important risk factor for globe rupture during scleral buckling procedures. We report here, the surgical management of an unexpected scleral pathology found at the scleral buckling procedure in a retinal detachment patient. A 77-year-old white female with retinal detachment underwent a scleral buckling procedure. The surgery was converted into a scleral graft procedure, as extreme scleral thinning was found intraoperatively. An alcohol-preserved donor sclera graft was used. The second surgery for definitive retinal alignment was performed two weeks later. The presented case of an unexpected scleral pathology in a retinal detachment patient was managed with a combination of scleral grafting and pars plana vitrectomy, without any major complications. The anatomical outcome was excellent and the scleral rupture was prevented; the visual outcome was satisfactory. A conversion of the scleral buckling procedure into a scleral graft procedure has proved to be safe and effective for unexpected scleral pathology.

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Related in: MedlinePlus

Extreme scleral thinning from the equator to the line of the rectus muscle insertions in the upper quadrants of the globe; superior temporal aspect
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Figure 1: Extreme scleral thinning from the equator to the line of the rectus muscle insertions in the upper quadrants of the globe; superior temporal aspect

Mentions: A scleral buckling procedure under general anesthesia was planned for retinal detachment repair. Limbal conjunctival peritomy and blunt episcleral dissection were carried out. The lateral, superior, and medial rectus muscles were exposed and looped. When the rectus muscles were retracted, extreme scleral thinning with visualization of the underlying uvea was discovered. The defect extended from the nine o‘clock to the three o′clock positions in the upper quadrants, from the muscle insertions to the equator of the globe [Fig. 1a and b]. Due to a high risk for globe rupture, with additional surgical manipulation, the scleral buckling procedure was stopped and converted into a scleral reinforcement procedure with a scleral patch graft. Donor scleral material preserved in alcohol was soaked in normal saline for 15 minutes, cut along its natural curvatur e, and tailored into a 40 mm long and 10 mm wide graft to fit the curvature and the size of the scleral defect. The graft was placed underneath the exposed rectus muscles to cover the entire defect. The graft was sutured to less thinned areas of the host with positional interrupted 8-0 nonabsorbable sutures and additional interrupted 7-0 absorbable sutures. The conjunctiva was then re-approximated at the limbus to entirely cover the graft, sclera and muscles. Pad and bandage, topical steroids, and antibiotics were prescribed postoperatively.


Preserved scleral patch graft for unexpected extreme scleral thinning found at the scleral buckling procedure: a case report.

Stunf S, Lumi X, Drnovšek-Olup B - Indian J Ophthalmol (2011 May-Jun)

Extreme scleral thinning from the equator to the line of the rectus muscle insertions in the upper quadrants of the globe; superior temporal aspect
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3118011&req=5

Figure 1: Extreme scleral thinning from the equator to the line of the rectus muscle insertions in the upper quadrants of the globe; superior temporal aspect
Mentions: A scleral buckling procedure under general anesthesia was planned for retinal detachment repair. Limbal conjunctival peritomy and blunt episcleral dissection were carried out. The lateral, superior, and medial rectus muscles were exposed and looped. When the rectus muscles were retracted, extreme scleral thinning with visualization of the underlying uvea was discovered. The defect extended from the nine o‘clock to the three o′clock positions in the upper quadrants, from the muscle insertions to the equator of the globe [Fig. 1a and b]. Due to a high risk for globe rupture, with additional surgical manipulation, the scleral buckling procedure was stopped and converted into a scleral reinforcement procedure with a scleral patch graft. Donor scleral material preserved in alcohol was soaked in normal saline for 15 minutes, cut along its natural curvatur e, and tailored into a 40 mm long and 10 mm wide graft to fit the curvature and the size of the scleral defect. The graft was placed underneath the exposed rectus muscles to cover the entire defect. The graft was sutured to less thinned areas of the host with positional interrupted 8-0 nonabsorbable sutures and additional interrupted 7-0 absorbable sutures. The conjunctiva was then re-approximated at the limbus to entirely cover the graft, sclera and muscles. Pad and bandage, topical steroids, and antibiotics were prescribed postoperatively.

Bottom Line: The surgery was converted into a scleral graft procedure, as extreme scleral thinning was found intraoperatively.The anatomical outcome was excellent and the scleral rupture was prevented; the visual outcome was satisfactory.A conversion of the scleral buckling procedure into a scleral graft procedure has proved to be safe and effective for unexpected scleral pathology.

View Article: PubMed Central - PubMed

Affiliation: University Eye Hospital, University Clinical Center Ljubljana, Slovenia, Europe. spela.stunf@siol.net

ABSTRACT
Pre-existing scleral pathology is an important risk factor for globe rupture during scleral buckling procedures. We report here, the surgical management of an unexpected scleral pathology found at the scleral buckling procedure in a retinal detachment patient. A 77-year-old white female with retinal detachment underwent a scleral buckling procedure. The surgery was converted into a scleral graft procedure, as extreme scleral thinning was found intraoperatively. An alcohol-preserved donor sclera graft was used. The second surgery for definitive retinal alignment was performed two weeks later. The presented case of an unexpected scleral pathology in a retinal detachment patient was managed with a combination of scleral grafting and pars plana vitrectomy, without any major complications. The anatomical outcome was excellent and the scleral rupture was prevented; the visual outcome was satisfactory. A conversion of the scleral buckling procedure into a scleral graft procedure has proved to be safe and effective for unexpected scleral pathology.

Show MeSH
Related in: MedlinePlus