Scleral patch grafts in the management of uveal and ocular surface tumors.

Abstract

OBJECTIVE:

To evaluate the outcome of scleral patch grafts in a series of patients undergoing management for uveal and ocular surface tumors.

DESIGN:

Case series.

PARTICIPANTS:

Ten patients underwent scleral patch grafting. Five patients had uveal melanoma with extrascleral extension, 2 patients had scleromalacia secondary to plaque radiotherapy for uveal melanoma, 2 patients had suspicious uveoscleral nevi, and 1 patient had invasive conjunctival squamous cell carcinoma with scleral necrosis.

METHODS:

Retrospective, interventional, noncomparative chart review of patients undergoing treatment for ocular tumors followed by scleral grafts in a tertiary eye care center in the United States between September 2003 and January 2011. Sclera was reconstructed with allogenic scleral grafts. Clinical observations were performed after grafting.

MAIN OUTCOME MEASURES:

Structural integrity, appearance, and stability of the grafts.

RESULTS:

Ten patients were reviewed. All melanoma cases received plaque radiotherapy with palladium 103. The cases with nevi and squamous cell carcinoma underwent local resection with cryotherapy as primary treatment. In 8 cases, scleral grafting was performed as part of the initial surgery. In all of these cases, satisfactory anatomic and functional outcomes were achieved. In 2 cases with scleromalacia secondary to radiotherapy for uveal melanoma, grafts were placed several years after the initial treatment. In these 2 cases, one showed signs of graft retraction, whereas another showed graft thinning. No patients experienced graft infection, rejection, or tumor recurrence.

CONCLUSIONS:

In this series, scleral grafts were well accepted when placed as part of the primary tumor management despite synchronous radiotherapy, scleral resection, or cryotherapy. Grafting was less successful when performed as a late procedure for radiation-induced scleromalacia.

FINANCIAL DISCLOSURE(S):

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

• Authors: Manabjyoti Barman, Paul T Finger, Tatyana Milman
• Journal: Ophthalmology (Ophthalmology) Vol. 119 Issue 12 Pg. 2631-6 (Dec 2012) ISSN: 1549-4713 [Electronic] United States
• PMID: 22858126 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Radioisotopes
• Palladium

Topics

• Adult
• Aged
• Brachytherapy (adverse effects)
• Carcinoma, Squamous Cell (pathology, surgery)
• Combined Modality Therapy
• Conjunctival Neoplasms (pathology, surgery)
• Cryotherapy
• Female
• Free Tissue Flaps
• Humans
• Male
• Melanoma (pathology, radiotherapy, surgery)
• Middle Aged
• Neoplasm Invasiveness
• Nevus, Pigmented (pathology, surgery)
• Ophthalmologic Surgical Procedures
• Palladium (therapeutic use)
• Radiation Injuries (etiology, pathology, surgery)
• Radioisotopes (therapeutic use)
• Retrospective Studies
• Sclera (transplantation)
• Scleral Diseases (etiology, pathology, surgery)
• Transplantation, Homologous
• Uveal Neoplasms (pathology, radiotherapy, surgery)
• Visual Acuity (physiology)