Treatment of Progressive Scleromalacia Perforans by Tectonic Enhancement With Lyophilized Equine Pericardium

Abstract

To describe the off-label use of lyophilized equine pericardium for tectonic enhancement of the sclera in a case of progressive scleromalacia perforans.Methods: An 82-year-old woman with a history of varicella zoster virus sclerokeratitis presented with a progressively expanding scleral thinning at the superonasal quadrant of the anterior sclera of her left eye. The eye was blind because of intractable glaucoma. To avoid perforation of the exposed choroid, a single layer of lyophilized equine pericardium was sutured over the scleral perforation. After performing a conjunctival peritomy in the involved superonasal area, the pericardium was trimmed, fixated on the anterior sclera with 4 Nylon 9 to 0 interrupted sutures, and tucked underneath the conjunctival pocket. The conjunctiva was adapted with 6 Vicryl 8 to 0 interrupted sutures. Results:The postoperative course was uneventful. At 12 months after surgery, slit-lamp biomicroscopy showed a stable subconjunctival sheet covering the staphyloma, whereas anterior segment optical coherence tomography demonstrated thickening of the ocular wall, suggesting successful integration of the pericardium.Conclusions: Suturing of equine pericardium over a scleral defect was feasible allowing successful reinforcement of the staphyloma in a case of severe scleromalacia perforans.

Mimickers of anterior uveitis, scleritis and misdiagnoses- tips and tricks for the cornea specialist

“…Medical management of patients with necrotizing scleritis require systemic therapy with steroids and immunosuppression (often cyclophosphamide or biologic agents), as well as control of associated systemic disease . In severe cases with exposure of underlying uvea, tectonic patch grafting may be required [ 210 , 211 ].…”

“…SINS is more commonly associated with the use of antimetabolites, for example, mitomycin C in pterygium surgery or trabeculectomy. However, SINS has been reported after a variety of procedures, including cataract surgery, strabism surgery, corneal grafting, vitrectomy and pterygium excision with conjunctival autograft [207][208][209][210][211][212][213][214][215][216][217].…”