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Scleral patch grafts in the management of uveal and ocular surface tumors
Manabjyoti Barman1, Paul T Finger, Tatyana Milman
1The New York Eye Cancer Center, New York, New York; The New York Eye and Ear Infirmary, New York, New York 10065, USA.
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.
