charles c. farias,

Comparison Amongst Scleral, Corneal and Amniotic Membrane Grafts to Restore Scleral Thinning Secondary

to Pterygium Surgery With Betatherapy

Charles C. Farias, Rossen M. Hazarbassanov, Luiz A. Vieira, Luciene B. Souza,

Telma Sternlicht, Jose AP Gomes

Corneal and External Disease Departament of Ophthalmology

Federal University of São Paulo - Brazil

The authors have no financial interest in the subject matter of this poster

P 736

PURPOSEPURPOSE• To evaluate the use of preserved scleral, corneal and AM graft for

the surgical repair of scleral thinning in patients who underwent surgery of pterygium with associated betatherapy .

PARTICIPANTSPARTICIPANTS

• Prospective, comparative, interventional and controlled study• 28 eyes of 28 patients (one bilateral case) • The mean age was 64,5± SD (47-82) • 16 were female and 12 male • All patients were operated by one surgeon (CCF) • Surgical procedure was randomized:

1. Scleral graft (9 eyes)2. Corneal graft (9 eyes)3. AM graft (10 eyes)

METHODSMETHODS

• Complete eye examinationComplete eye examination: BCVA, Biomicroscopy, Tonometry, Fundoscopy, UBM, USG

• Surgical TechniquesSurgical Techniques– Conjunctival peritomy, dissection and cleaning of the conjunctiva, regularity of the thinning edge with trephine, preparation of donor tissue, sclera was covered by conjunctival flap (scleral graft cases), 10-0 nylon suture

• PostoperativePostoperative– Topical prednisolone acetate 1%– Topical ofloxacine 0,3%– All suture were removed within 3 months

• Follow upFollow up– One day, 7, 15, 30, 90 and 180 days after surgery.

RESULTSRESULTS

• All eyes that received scleral (9/9) and corneal grafts (10/10) presented stability of the ocular surface with rapid re-epithelialization and restauration of the scleral thickness

• Eyes that received the AM grafts also presented stability of the OS with re-epithelialization (10/10), but the transplanted tissue absorbed on average after 30 d of follow up (p<0.05)– 4/10 partial AM re-absortion– 6/10 total AM re-absortion

Scleral – conjunctival graft group

N= Sex/age

Assoc Disease

Oculoarfinding preop

UBMpre(mm)

Size V/H(mm)

Type of surgery

Reepithelization

Ocular finding postop

UBM 6 Months(

mm)

Success/Failure

1 F/62 HBP Scleral Thining/ Choroidal exposure

0,451 4/2 Scleral graft with

conjunctival transplantatio

n

11 days Stable ocular surface

0,931 Success

2 F/47 Hypothyroidism

Scleral Thining/ Choroidal exposure

0,486 3/1.5 Scleral graft with


n


1,157 Success

3 F/79 Dislipidemia




n


0,671 Success

4 M/51 DM Scleral Thining/ Choroidal exposure



n


0,914 Success

5 F/81 Arthrosis Scleral Thining 0,482 3/1 Scleral graft with


n


1,065 Success

6 M/72 Coronary (heart) Disease




n


0,625 Success

7 M/83 HBP Scleral Thining 0,556 4/2 Scleral graft with


n


n/a Success

8 M/78 Tendinitis Scleral Thining 0,394 2/2 Scleral graft with


n


0,729 Success

9 M/55 HBP, DM Scleral Thining/ Choroidal exposure



n


0,613 SuccessHBP- high blood pressure; DM-Diabetes Mellitus; ST- scleral thickness

Corneal graft group

N= Sex/age Assoc Disease

Finding preop

UBM pre Size V/H Type of surgery

Reepithelization

Finding postop

UBM 6 Months

Success/Failure

1 F/51 HBP Scleral Thining/

Choroidal exposure

0,510 5/3 Corneal graft


0,903 Success

2 F/47 Hypothyroidism

Scleral Thining/

Choroidal exposure

0,532 2,5/2,5 Corneal graft


0,521 Success

3 F/62 HBP Scleral Thining

0,602 4/2,5 Corneal graft


0,521 Success

4 M/62 HBP Scleral Thining



0,799 Success

5 F/47 Rheumatoid arthritis

Scleral Thining



0,706 Success

6 M/71 HBP, Dislipidemi

a

Scleral Thining



0,585 Success

7 F/70 HBP, DM Scleral Thining



0,660 Success

8F/70

Hypothy

roidism, HBPScleral Thining



0,451 Success

9 F/49 HBP, Dislipidemi

a

Scleral Thining



0,428 SuccessHBP- high blood pressure ; DM-Diabetes Mellitus

Amniotic membrane graft groupN Sex/age Assoc

DiseaseFinding preop

UBM pre Size V/H Type of surgery

Reepithelization

Finding postop

UBM 6 Months

Success/Failure

1 M/72 DM Scleral Thining/

Choroidal exposure

0,359 3/5 AMT 29 days AM dissolved

0,347 Failure



0,313 Failure

3 F/50 Gastritis Scleral Thining

0,417 5/3 AMT n/a AM dissolved

n/a Failure

4 M/69 HBP, DM Scleral Thining

0,451 4/2,5 AMT 10 days AM partly present

0,139 Partial success

5 M/66 HBP Scleral Thining

0,522 2/4 AMT 28 days AM partly present




0,222 Failure

7 M/76 Prostatism Scleral Thining

0,405 5/3 AMT 17 days AM partly present



0,359 4/2,5 AMT 21 days AM partly present


9 M/71 Rheumatoid arthritis

Scleral Thining


n/a Failure


0,463 5/2,5 AMT 21 days AM dissolved

n/a Failure

AMT- Amniotic membrane transplantation ; DM-Diabetes Mellitus; HBP- high blood pressure

Results

Reepithelization between the groups

eyes

0 1 2 3 4 5 6 7 8 9 10

tim

e (

day

s)

0

10

20

30

40

50

AM graft Corneal Graft Scleral graft

p=0.116, one way ANOVA between the

groups before and after 6 M

Thickness of the Sclera before and after treatment with different patch graft

SGpre SG6M COpre CO6M AMpre AM6M

Scl

era

l th

ickn

ess

(m

icro

ns

)

0

200

400

600

800

1000

1200

1400

p=0.002; Mean t test between SG pre vs 6M

p<0.001; one way ANOVA with Student-Newman-Keuls test, between SG vs. CO and AM 6 M

Figure 1 Scleral with calsified plaque and neovascularization

Figure 2 Six months of scleral patch covered by conjunctiva

Figure 3 A focal area of thinning surrounded by edematous conjuntiva

Figure 4 Stability of ocular surface after six months of corneal patch

Figure 5 Scleral thinning showing the uvea

Figure 6 One day after amniotic membrane transplantion

Figure 7 Six months of amniotic membrane transnplantation absorbed

CONCLUSIONCONCLUSION

Our results suggest that both scleral and corneal grafts are good options to be used for restoring scleral defects with thinning.

AM is also an option to be considered for less severe cases, however it reabsorved partially or totally in most of the cases.

charles c. farias,

Documents

scleral thicknesseyes

scleral defects

scleral thinning secondary

months of scleral patch

use of preserved scleral

corneal grafts

amniotic membrane grafts

thinning edge