J Korean Ophthalmol Soc.  2011 Oct;52(10):1227-1231. 10.3341/jkos.2011.52.10.1227.

Ocular Reconstruction Using Autologous Tragal Perichondrium for a Refractory Necrotizing Scleral Perforation: A Case Report

• Koo H
• Jeong JH
• Chun YS
• Kim JC

• KMID: 2215007
• DOI: http://doi.org/10.3341/jkos.2011.52.10.1227

Abstract

PURPOSE
To report the effectiveness of an autologous tragal perichondrium graft for a necrotizing scleritis case which was refractory to conventional surgery.
CASE SUMMARY
A 75-year-old woman was referred to our clinic with recurrent necrotizing scleritis of the left eye which occurred after pterygium removal five years earlier. The patient underwent scleral graft, pericardium graft, and amniotic membrane graft in other clinics; however, necrosis of the sclera progressed. The best corrected visual acuity was 0.06, and choroidal tissue was nearly exposed below the melted pericardium graft in the nasal area. The authors harvested tragal perichondrium from the right ear, and the scleral defect was successfully reconstructed with an autologous tragal perichondium graft. The graft showed rapid epithelization and neovascularization within a week and conjunctivalization after three months. No complications have been observed up to one year after surgery.
CONCLUSIONS
Autologous tragal perichondrium graft is an effective treatment to alter necrotized sclera via neovascularization and rapid epithelization in refractory necrotizing scleritis cases.

Keyword

Epithelization; Necrotizing scleritis; Neovascularization; Tragal perichondrium

MeSH Terms

Aged
Amnion
Choroid
Ear
Eye
Female
Humans
Necrosis
Pericardium
Pterygium
Sclera
Scleritis
Transplants
Visual Acuity

Figure

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  Figure 1. A photograph of 75-year-old woman with recurrent necrotizing scleritis of the left eye which occurred after pterygium removal 5 years earlier. (A) After undergoing sclera graft, pericardium graft, and amniotic membrane graft, sclera necrosis has still progressed and choroid is bulging out through the melted graft tissue. (B) Choroid is being exposed after removing the pericardium graft during surgery. (C) Autologous tragal perichondrium graft has been made.

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  Figure 2. The photographs show postoperative recovery after the autologous tragal perichondrium graft in refractory necrotizing scleritis patient. (A, B) One week after the surgery, vascularization has developed over the grafted perichondrium, and grafted tissue has been epithelized showing no defects on fluorescein staining. (C, D) After 3 months, conjunctivalization has started over the graft. (E, F) One year after the tragal perichondrium graft, conjunctivalization has been completed, and there was no complication.

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  Figure 3. The hematoxylin and eosin staining of (A) human tragal perichondrium and (B) human sclera (×200). Both tissues show similar lamellar collagen fiber array (Photographs were taken by the authors).

Reference

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