Scleral Patch Grafting For Tectonic Stability Of The Ocular Surface In A Multitude Of Clinical Scenarios

To elucidate the indications , technique, outcome  and precautions of securing a
Scleral Patch Graft (SPG) for the management of scleral thinning
encountered in a wide variety of clinical situations 

Aditya Birla Sankara Nethralaya, Kolkata, West Bengal , India

In a retrospective clinical review, we analyzed 5 eyes of 5 patients who
underwent Scleral patch grafting by a single surgeon for surgical
reinforcement of significant scleral thinning noted in variable clinical
settings. Indications of surgery varied from 1 case each of post cataract
surgical wound dehiscence ,Tube exposure following glaucoma shunt
surgery ,post traumatic scleral dehiscence, anterior microbial scleritis and
ciliary staphyloma in ocular rhinosporidiosis. Scleral defect management
techniques using SPG of varying sizes to adequately encompass the areas
of weakness, with overlying conjunctival autograft+- Amniotic membrane
transplantation was performed and followed up to assess outcomes , both
anatomic and functional.

The mean age of patients was 38 (9–61) years. 3 were male, and 2 were
female. All patients presented with clinically significant scleral thinning
and none were associated with co existing systemic collagen vascular
diseases.

All patients experienced relief of pain/inflammation; eventual re -
epitheliazation of ocular surface and in some cases, improvement of
visual acuity. The grafts remained well integrated, providing stable
support and acceptable cosmetic outcomes at last follow up ranging
from 2 months to more than 3 years and there was no recurrence of
scleromalacia. 1 patient needed 4 months and 2 secondary procedures
to establish vascularity and epithelization of the SPG

Allogenic scleral grafting is an effective and simple measure for
preserving globe integrity both structurally and functionally. Surgical
reinforcement of the pathologically thinned sclera improves the tectonic
stability of the globe and helps prevent globe rupture. Preserved SPG
has several advantages compared to the other grafts for providing
tectonic augmentation of primary or secondary scleral thinning.
However, to avoid complications such as necrosis and melting of the
graft, the epithelization and vascularization of the avascular scleral patch
graft must be ensured.