Scleral punch method with topical mitomycin C for safe revision of failed deep sclerectomy in nanophthalmic uveal effusion syndrome.
OBJECTIVE
To describe a novel surgical technique for revision of deep sclerectomy surgery in nanophthalmic uveal effusion syndrome.


METHODS
A 46-year-old woman with recessively inherited nanophthalmos and chronic uveal effusions underwent a revision of previous failed deep sclerectomy surgery. In the presence of scar tissue, revision of sclerectomies was greatly facilitated by the use of a Kelly scleral punch (Katena Products, Inc., Denville, NJ, USA). To inhibit further scarring, mitomycin-C (MMC) was applied topically in each quadrant posterior to the equator.


RESULTS
The scleral punch allowed outward scleral dissection from the suprachoroidal space, and brisk enlargement of sclerectomies in all quadrants without perforation of choroidal tissue. Post-operative conjunctival wound healing appeared unimpeded by the posteriorly placed MMC sponges. Near-total resolution of the effusions had occurred by 3 months.


CONCLUSIONS
The scleral punch provides a safe and effective method for constructing and revising full-thickness sclerectomies in the nanophthalmic eye, minimizing the risk of choroidal trauma. The use of topical MMC may reduce the risk of late failure of trans-scleral outflow due to fibrosis.
Sabrosa
Nelson A
NA
Vitreoretinal Service, Moorfields Eye Hospital, London, UK. nsabrosa@terra.com.br
Smith
Henry B
HB
MacLaren
Robert E
RE
D000287:Administration, Topical; D001826:Body Fluids / Q000378:metabolism; D002921:Cicatrix / Q000517:prevention & control; D005260:Female; D006801:Humans; D008850:Microphthalmos / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage*; D013508:Ophthalmologic Surgical Procedures; D012086:Reoperation / Q000379:methods; D012590:Sclera / Q000601:surgery*; D013577:Syndrome; D014603:Uveal Diseases / Q000378:metabolism / Q000601:surgery*; D014945:Wound Healing
D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin