VII Pan-American Research Day

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					  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
                       PURPOSE
• 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 .

                 PARTICIPANTS

• 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)
                      METHODS

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

• Surgical 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

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

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

• 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/a      Assoc       Oculoarfinding     UBM     Size V/H     Type of         Reepitheli     Ocular        UBM 6     Success/
      ge       Disease          preop                               surgery          zation        finding       Months(
                                               pre(m     (mm)                                                               Failure
                                                 m)                                                postop         mm)

1    F/62       HBP         Scleral Thining/   0,451     4/2       Scleral graft     11 days     Stable ocular    0,931    Success
                                                                       with                        surface
                               Choroidal                            conjunctival
                               exposure                           transplantation


2    F/47     Hypothy       Scleral Thining/   0,486    3/1.5      Scleral graft     8 days      Stable ocular    1,157    Success
                                                                       with                        surface
              roidism          Choroidal                            conjunctival
                               exposure                           transplantation


3    F/79    Dislipidemia   Scleral Thining/   0,534     8/1       Scleral graft     7 days      Stable ocular    0,671    Success
                                                                       with                        surface
                               Choroidal                            conjunctival
                               exposure                           transplantation


4    M/51        DM         Scleral Thining/   0,417    3/1.5      Scleral graft     4 days      Stable ocular    0,914    Success
                                                                       with                        surface
                               Choroidal                            conjunctival
                               exposure                           transplantation

5    F/81     Arthrosis     Scleral Thining    0,482     3/1       Scleral graft     8 days      Stable ocular    1,065    Success
                                                                       with                        surface
                                                                    conjunctival
                                                                  transplantation

6    M/72     Coronary      Scleral Thining/   0,475    3/1.5      Scleral graft     30 days     Stable ocular   0,625     Success
                                                                       with                        surface
               (heart)         Choroidal                            conjunctival
               Disease         exposure                           transplantation


7    M/83       HBP         Scleral Thining    0,556     4/2       Scleral graft     8 days      Stable ocular     n/a     Success
                                                                       with                        surface
                                                                    conjunctival
                                                                  transplantation

8    M/78    Tendinitis     Scleral Thining    0,394     2/2       Scleral graft     14 days     Stable ocular   0,729     Success
                                                                       with                        surface
                                                                    conjunctival
                                                                  transplantation

9    M/55     HBP, DM       Scleral Thining/   0,428     6/3       Scleral graft     14 days     Stable ocular    0,613    Success
                                                                       with                        surface
                               Choroidal                            conjunctival
                               exposure                           transplantation




       HBP- high blood pressure; DM-Diabetes Mellitus; ST- scleral thickness
                                        Corneal graft group
N=        Sex/age        Assoc        Finding     UBM pre   Size V/H   Type of   Reepitheli     Finding       UBM 6    Success/
                        Disease        preop                           surgery    zation        postop        Months    Failure
1           F/51           HBP         Scleral     0,510      5/3      Corneal    22 days     Stable ocular    0,903    Success
                                      Thining/                          graft                   surface
                                      Choroidal
                                      exposure


2           F/47         Hypothy       Scleral     0,532     2,5/2,5   Corneal     7 days     Stable ocular    0,521    Success
                         roidism      Thining/                          graft                   surface
                                      Choroidal
                                      exposure


3           F/62           HBP        Scleral      0,602      4/2,5    Corneal     17 days    Stable ocular    0,521    Success
                                      Thining                           graft                   surface


4           M/62           HBP        Scleral      0,394      5/3      Corneal     7 days     Stable ocular    0,799    Success
                                      Thining                           graft                   surface


5           F/47       Rheumatoid     Scleral      0,428      5/3      Corneal    40 days     Stable ocular    0,706    Success
                        arthritis     Thining                           graft                   surface


6           M/71          HBP,        Scleral      0,567      4/2      Corneal    40 days     Stable ocular    0,585    Success
                      Dislipidemia    Thining                           graft                   surface



7           F/70        HBP, DM       Scleral      0,498      5/3      Corneal     15 days    Stable ocular    0,660    Success
                                      Thining                           graft                   surface


8                        Hypothy      Scleral      0,556      4/3      Corneal     7 days     Stable ocular    0,451    Success
            F/70                      Thining                           graft                   surface
                       roidism, HBP


9           F/49          HBP,        Scleral      0,371      4/5      Corneal    40 days     Stable ocular    0,428    Success
                      Dislipidemia    Thining                           graft                   surface



HBP- high blood pressure ; DM-Diabetes Mellitus
                     Amniotic membrane graft group
N          Sex/age     Assoc       Finding    UBM pre   Size V/H   Type of   Reepitheliz    Finding    UBM 6    Success/
                      Disease       preop                          surgery     ation        postop     Months    Failure



1           M/72        DM         Scleral     0,359      3/5       AMT       29 days         AM       0,347    Failure
                                  Thining/                                                 dissolved
                                  Choroidal
                                  exposure

2            F/52       HBP       Scleral      0,579      5/3       AMT       21 days         AM       0,313    Failure
                                  Thining                                                  dissolved


3            F/50     Gastritis   Scleral      0,417      5/3       AMT         n/a           AM        n/a     Failure
                                  Thining                                                  dissolved


4           M/69      HBP, DM     Scleral      0,451     4/2,5      AMT       10 days      AM partly   0,139     Partial
                                  Thining                                                   present             success


5           M/66        HBP       Scleral      0,522      2/4       AMT       28 days      AM partly   0,660     Partial
                                  Thining                                                   present             success


6            F/58     HBP, DM     Scleral      0,477      5/3       AMT        9 days         AM       0,222    Failure
                                  Thining                                                  dissolved


7           M/76     Prostatism   Scleral      0,405      5/3       AMT       17 days      AM partly   0,176     Partial
                                  Thining                                                   present             success


8            F/60       HBP       Scleral      0,359     4/2,5      AMT       21 days      AM partly   0,185     Partial
                                  Thining                                                   present             success

9            M/71    Rheumatoid   Scleral      0,440      3/3       AMT       18 days         AM        n/a     Failure
                      arthritis   Thining                                                  dissolved


10           F/65     HBP, DM     Scleral      0,463     5/2,5      AMT       21 days         AM        n/a     Failure
                                  Thining                                                  dissolved


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

                                                                                                                      Thickness of the Sclera before and after treatment
                               Reepithelization between the groups                                                                with different patch graft
              50
                           AM graft
                                                                                                               1400
                           Corneal Graft
                           Scleral graft
              40                                                                                               1200




                                                                                 Scleral thickness (microns)
                                                                                                               1000
time (days)




              30

                                                                                                               800

              20
                                                                                                               600


              10                                                                                               400


                                                                                                               200
              0
                   0       1      2        3   4    5     6   7   8   9   10
                                                                                                                 0
                                                   eyes

                                                                                                                         SGpre   SG6M    COpre   CO6M    AMpre      AM6M


                       p=0.116, one way ANOVA between the
                                                                                                                        p=0.002; Mean t test between SG pre vs 6M

                       groups before and after 6 M                             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
                CONCLUSION



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.

				
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posted:9/17/2012
language:English
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