title: Scleral punch method with topical mitomycin C for safe revision of failed deep sclerectomy in nanophthalmic uveal effusion syndrome.
abstract: 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.
authors.affiliation: Vitreoretinal Service, Moorfields Eye Hospital, London, UK. nsabrosa@terra.com.br
authors.forename: Nelson A
authors.initials: NA
authors.lastname: Sabrosa
authors.forename: Henry B
authors.initials: HB
authors.lastname: Smith
authors.forename: Robert E
authors.initials: RE
authors.lastname: MacLaren
mesh_terms: 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
chemical_list: D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin