Repair of Scleromalacia Using Preserved Scleral Graft With Amniotic Membrane Transplantation

Oh, Jung Hwan; Kim, Jae Chan

doi:10.1097/00003226-200305000-00002

Cited by 42 publications

(26 citation statements)

References 21 publications

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“…Changes in TNF-␣ in this study may suggest that attempts at inhibiting TNF-␣ reaction can be considered as an additional management for SINS as in corneal ulceration or necrotizing infection. Anti-TNF-␣ therapy has been proven to be effective not only in rheumatoid arthritis and other immunologic diseases, but also in ocular infl ammatory disorders including scleritis, orbital myositis and optic neuritis [5,[18][19][20][21][22] . In some recalcitrant cases, anti-TNF-␣ treatment can be considered as an alternative management for SINS rather than early enucleation or surgical interventions.…”

Section: Discussionmentioning

confidence: 99%

“…She had received systemic corticosteroid treatment and conjunctival fl ap surgery from her previous physician. We performed homologous scleral graft and amniotic membrane transplantation on the graft [5] . Intravenous steroid treatment (1,000 mg/day, for 3 days) and oral corticosteroid (prednisolone 40 mg/day for 2 months) treatment were continued after surgery.…”

mentioning

confidence: 99%

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Expression of Tumor Necrosis Factor Alpha and Matrix Metalloproteinase-9 in Surgically Induced Necrotizing Scleritis

2006

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Background: Surgically induced necrotizing scleritis is primarily managed with immunosuppressive regimens. Such treatments can alter inflammatory cytokines and products such as tumor necrosis factor-α (TNF-α) and matrix metalloproteinase-9 (MMP-9), which are an important proinflammatory cytokine and a tissue-degrading protease involved in necrosis of some ocular tissues. Object: To evaluate TNF-α and MMP-9 in the tear or sclera of surgically induced necrotizing scleritis. Methods: After tear collection from healthy and diseased eyes of 2 patients, immunoblot analysis using monoclonal antibody specific for human TNF-α and MMP-9 was performed. In another patient, scleral tissues were obtained during scleral allograft surgery, and the same immunoblot analysis was done. Results: The level of TNF-α and MMP-9 was increased in tear fluid from patients compared to that of control volunteers and returned to the control level after treatment. The diseased sclera showed an increased expression of MMP-9 compared to that of the normal donor sclera. Conclusions: TNF-α and MMP-9 may suggest disease activity of surgically induced necrotizing scleritis and can be altered by proper immunosuppressive treatment.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Expression of Tumor Necrosis Factor Alpha and Matrix Metalloproteinase-9 in Surgically Induced Necrotizing Scleritis

2006

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“…The cadaveric donor sclera is an avascular structure which has an advantage of being immunologically inert and has good acceptance without undue inflammatory reaction, but this avascular nature and absence of epithelium in scleral grafts may result in a lack of vascularization followed by necrosis and sloughing. 7 The whole survival and tectonic success of the graft is jeopardized owing to this avascularity. Here the superimposition of amniotic membrane on cadaveric scleral patch graft becomes helpful.…”

Section: Discussionmentioning

confidence: 99%

Management of Ciliary Body Staphyloma and Complicated Cataract with Cadaveric Scleral Patch and Superimposed Amniotic Membrane Grafting

Patil¹

2017

DJO

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“…[26][27][28] The speed with which the wounds healed agreed with those reported previously. Oh and Kim 29 reported that epithelialization of the scleral surface occurred in 1 week when they used amniotic membrane in seven of eight patients with scleromalacia. Hanada et al 30 also reported that an average period of 16.5 days was required for complete epithelialization when a multilayered amniotic membrane was used to treat severe corneal and scleral ulcerations.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of necrotic scleral calcification using combined conjunctival autografting and an amniotic membrane inlay filling technique

2011

Eye

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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. ConclusionThe 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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Repair of Scleromalacia Using Preserved Scleral Graft With Amniotic Membrane Transplantation

Abstract: Preserved scleral graft with AMT was simple, fast, and effective. It was particularly advantageous when large scleral defects or conjunctival scarring was present. With these therapeutic results, preserved scleral graft with AMT qualifies as a new treatment alternative for scleromalacia.

Cited by 42 publications

References 21 publications

Expression of Tumor Necrosis Factor Alpha and Matrix Metalloproteinase-9 in Surgically Induced Necrotizing Scleritis

Expression of Tumor Necrosis Factor Alpha and Matrix Metalloproteinase-9 in Surgically Induced Necrotizing Scleritis

Management of Ciliary Body Staphyloma and Complicated Cataract with Cadaveric Scleral Patch and Superimposed Amniotic Membrane Grafting

Surgical treatment of necrotic scleral calcification using combined conjunctival autografting and an amniotic membrane inlay filling technique

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