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Scleral grafting for necrotizing scleritis
M Sainz de la Maza1, J Tauber, C S Foster
1Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114.
Ophthalmology
|March 1, 1989
Summary
Scleral homografts help maintain eye integrity in necrotizing scleritis patients. Combining grafts with chemotherapy improves outcomes, preventing globe perforation and preserving vision.
Area of Science:
- Ophthalmology
- Immunosuppression Therapy
- Surgical Grafting
Background:
- Necrotizing scleritis can lead to severe scleral thinning and globe perforation.
- Systemic immunosuppressive chemotherapy is effective but slow to act.
- Scleral homografts can provide structural support while chemotherapy takes effect.
Purpose of the Study:
- To review the experience with scleral homografts in patients with progressive necrotizing scleritis.
- To evaluate the efficacy of scleral homografts, with or without concomitant chemotherapy.
Main Methods:
- Retrospective review of 12 patients with progressive necrotizing scleritis undergoing scleral homograft surgery.
- Patients were categorized based on whether they received concomitant immunosuppressive chemotherapy.
- Follow-up data on graft stability, ocular integrity, and visual outcomes were analyzed.
Main Results:
- Scleral grafts remained stable in patients receiving both surgery and chemotherapy (mean follow-up 12 months).
- One graft failure occurred after chemotherapy discontinuation, but was salvaged by regrafting and renewed immunosuppression.
- Grafts in two patients not initially receiving chemotherapy failed rapidly, but eyes were salvaged by regrafting and/or chemotherapy.
Conclusions:
- Scleral homografting is a valuable adjunct to chemotherapy for managing necrotizing scleritis.
- Concomitant immunosuppressive chemotherapy is crucial for long-term graft stability.
- Scleral grafting can preserve ocular integrity and prevent perforation in severe cases.