title: Surgical approach for scleral ischemia and melt.
abstract: OBJECTIVE
  To describe the combined use of tenonplasty, lamellar corneal patch graft, and amniotic membrane transplantation in managing scleral ischemia and/or melt by using sutures or fibrin glue.
  
  
  METHODS
  We subjected five eyes of 4 patients with scleral ischemia and/or melt of diverse etiologies to debridement of all necrotic tissue, followed by a lamellar corneal graft (cases with melt, n = 3) or a cryopreserved amniotic membrane (cases without melt, n = 2), and a Tenon pedicle graft was used to cover the ischemic zone; surgery was completed by using a second layer of cryopreserved amniotic membrane. These procedures were performed by using either sutures or fibrin glue. Reduction of photophobia, facilitation of epithelialization, and correction of scleral ischemia and/or melt with preservation of the globe integrity were considered the main outcome measurements.
  
  
  RESULTS
  Surgical measures were effective to reduce or eliminate photophobia, facilitate epithelialization, halt scleral ischemia and/or melt, and preserve the globe integrity in all eyes except for 1 eye, in which a second attempt was needed to completely correct scleral ischemia. Complications included granuloma formation in 1 case and dellen formation and extreme gaze horizontal diplopia caused by a small symblepharon formation in another case.
  
  
  CONCLUSIONS
  The combination of tenonplasty and amniotic membrane transplantation with or without lamellar corneal patch grafting, by using sutures or fibrin glue, is a feasible alternative for treating scleral ischemia and/or melt.
authors.affiliation: Ocular Surface Center, Miami, FL 33173, USA.
authors.forename: Victoria E
authors.initials: VE
authors.lastname: Casas
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kheirkhah
authors.forename: Gabriela
authors.initials: G
authors.lastname: Blanco
authors.forename: Scheffer C G
authors.initials: SC
authors.lastname: Tseng
mesh_terms: D000368:Aged; D000650:Amnion / Q000637:transplantation*; D003238:Connective Tissue / Q000637:transplantation*; D016039:Corneal Transplantation; D015925:Cryopreservation; D003646:Debridement; D005260:Female; D015718:Fibrin Tissue Adhesive; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012590:Sclera / Q000098:blood supply*; D015422:Scleral Diseases / Q000601:surgery*; D013536:Suture Techniques; D014021:Tissue Preservation
chemical_list: D015718:Fibrin Tissue Adhesive