J Korean Ophthalmol Soc.  2010 Apr;51(4):485-491. 10.3341/jkos.2010.51.4.485.

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

• Lee BH
• Mun HJ
• Park YJ
• Lee KW

• KMID: 2213378
• DOI: http://doi.org/10.3341/jkos.2010.51.4.485

Abstract

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 only fibrin glue and no suturing, while seven eyes of seven patients whose defect was large (>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.

Keyword

AMT; Fibrin glue; Scleral graft; Scleromalacia

MeSH Terms

Amnion
Eye
Fibrin
Fibrin Tissue Adhesive
Follow-Up Studies
Humans
Safety
Sclera
Transplantation, Homologous
Transplants
Fibrin
Fibrin Tissue Adhesive

Figure

• 

  Figure 1. (A) The scleromalacia lesion is cleaned. (B) The preserved sclera is cut according to the size and shape of the lesion. (C, D) Fibrin glue is applied to the lesion and then the sclera graft is placed and adhered to the lesion. (E) Large sclera defect (>6 mm) is operated using fibrin glue and minimum suturing (F) The amniotic membrane is peeled off from the carrier paper from the storage medium. (G) Thrombin solution is administered on the exposed sclera, and fibrinogen solution is applied on stromal side of amniotic membrane. (H) The amniotic graft is immediately transferred onto the exposed sclera. (I) The amniotic patch is then secured to the conjunctiva by continuous sutures with 10–0 nylon.

• 

  Figure 2. (A, B, C, D-1) Preoperative photograph showing sclera thinning with exposed uveal tissue at the site of previous pterygium excision. (A, B, C, D-2) 1 month postoperative photograph. In all cases conjunctival re-epithelization is shown but completely vascularized over the exposed scleral graft is not yet shown. (A, B, C, D-3) 6 months postoperative photograph. Sclera graft is completely covered by fibrovascular patch and in 2 cases partial reabsorption of scleral graft are shown. (A, B, C, D-4) Last follow-up photograph showing stable ocular surface but in all cases partial reabsorption of sclera graft are shown.

Reference

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