Sclerokeratoplasty for the early management of acquired anterior staphyloma

Objective: To report a case of acquired anterior staphyloma after trauma and its first surgical management. Methods: This is a case report of a 17-year-old man who had a history of trauma by insect on the right eye, without a previous history of eye conditions, and evolved with local pain and low visual acuity. The ophthalmological exam showed light perception visual acuity in right eye and 1,0 in left eye, anterior staphyloma and impossibility to blink. The first surgical procedure proposed was sclerokeratoplasty and the second one an optical transplantation but, after step one, the patient did not return to the service and missed the follow-up. Results: Sclerokeratoplasty was proposed once the posterior segment and the crystalline were preserved in topical position. The anterior tumor was excised in free-cut and corneal-scleral graft sutured in single points with 10-0 mononylon. Gatifloxacin 0.3% with Prednisolone Acetate 1%, Epitezan® and Atropine 1% were prescribed immediately postoperative. After 60 postoperative days, he maintained the use of Dexamethasone 0.1% and Atropine 1% and the patient had visual acuity of perception of hand movement in the affected eye. Conclusion: Few treatment options are alternatives to evisceration. In this case report, the sclerokeratoplasty was the chosen technique for the initial management. The second step was not possible due to loss of follow-up. Despite the uncomplicated procedure, we need greater compliance by the patient to conclude the treatment.

[Successful treatment of Fusarium-associated keratitis with multiresistant pathogen and multimorbid patient]

A 75-year-old man (not a contact lens wearer) presented with Fusarium-associated hypopyon keratitis. After several weeks of empirical and subsequently targeted antimycotic treatment, no considerable improvement was observed. However, after sclerokeratoplasty (11.2 × 11.2 mm) combined with prolonged antimycotic therapy a good local result with relapse-free long-term follow-up was achieved.

[The biomechanical properties of sclera after posterior sclera reinforcement operation]

This study sought to characterize the biomechanical properties of rabbit sclera after posterior sclera reinforcement operation (PSR), which may provide valuable information for PSR in clinical setting. Uniaxial tension and ball-pressing methods were used. Different areas of the sclera samples from PSR were examined in pretest, relaxation and creep experiments respectively by using Instron5544 mechanical machine. The experimental results showed: When the implanted area of sclera samples was compared with that of other groups, the unit width stiffness coefficient increased remarkably at the linear stage, and the anti-deformation capacity was higher at the relaxation stage. However, the creep rate showed a significant decrease at the creep stage. That is to say, PSR could enhance the anti-deformation capacity of the weakened and thinned sections, reduce the sclera creep rate in the posterior sclera, and thus prevent the development of progressive myopia.

[Long-term results of xenoscleroplasty of the posterior pole of the eyeball in the treatment of patients with progressive myopia]

The study deals with the development of an effective, atraumatic and easy-to-use treatment for patients with progressive myopia, by using a discoid xenograft. The treatment involves implantation of a discoid xenograft to the episclera of the posterior pole of the eye. The xenograft is a white disk prepared from the treated bovine pericardium and it has 2 mm in thickness and a diameter of 13 mm. Clinical studies were performed in 89 patients (161 eyes) operated on by the proposed procedure, by evaluating the stabilized progression of myopia 4 years later. In the late period of a follow-up, the stabilization effect was 88.3 to 92.6% in relation to the degree of myopia. There was evidence for increases in the thickness of the sclera (and its acoustic density) on the posterior pole of the eye, for improved regional hemodynamics and better electrophysiological functions of the retina in the postoperative period. Xenoscleroplasty of the posterior pole of the eye with a bovine pericardial xenograft is an easy-to-use, pathogenetically oriented, highly effective, and safe treatment in patients with progressive myopia.

[Prevention of spontaneous scleral perforation during repeated surgery for regmatogenic retinal detachment]

Scleroplastic operations, such as circlage, filling, and their combination widely used in modern surgery so far, have a variety of advantages; however, their drawbacks may also cause severe complications. Among them, there is scleral decubitus (erosion) that is detectable at resurgery when the retina has failed to adjoin after the first operation or when recurrent retinal detachment has developed. The occurrence of this complication makes it impossible to perform an adequate pressing-in due to the fact that spontaneous scleral perforation may occur, which makes it necessary to conduct scleroplasty in this area. For this situation, the authors propose a procedure for surgically treating retinal detachment during re-interventions, which makes it possible to prevent spontaneous scleral perforation, to diminish surgical traumaticity, and to perform a necessary adequate pressing-in for blocking ruptures of the retina with its subsequent adjoining.

[Progressing myopia in children: does it need treatment or not?]

The purpose of the case study was to evaluate the remote consequences of a complex of laser and repeated surgical sclerorestorative procedures made in progressing myopia and its complications. Three hundred and forty-six children, aged 8-10, with rapidly progressing uncomplicated myopia of 4.25 to 9.5 D were shared between 2 groups. Two hundred and forty patients of the experimental group were made sclerorestorative procedures and transscleral low-energy laser stimulation of the ciliary muscle by means of infrared laser MACDEL-09. No such treatment was applied to patients of the control group. When indicated, preventive laser coagulation of the retina was made in both groups. The dynamic 10-year follow-up over the status of refraction and eye bottom showed that the complex scheme of repeated sclerorestorative procedures and low-energy laser treatment combined with preventive peripheral laser coagulation of the retina cut the rate of progressing myopia and prevented peripheral vitreoretinal dystrophy and retinal detachment in children and teenagers with progressing myopia.

Imaging scleral expansion bands for presbyopia with optical coherence tomography

A 57-year-old woman was treated for mild presbyopia with implantation of scleral expansion bands (SEB). Although near vision was temporarily restored, the effect dissipated after 1 year. Slitlamp-adapted optical coherence tomography (OCT) at 1310 nm allowed precise cross-sectional visualization of the hyporeflective intrascleral segments. The OCT method provided precise images of the segment depth and thickness, the scleral thickness at the scleral spur, the anterior chamber angle, and the angle-opening distance. Intrascleral tilting of 1 segment was seen; this required removal of the SEB because of marked foreign-body sensation. Noncontact, slitlamp-adapted OCT can be used to evaluate scleral changes after SEB implantation.

[Retrospective evaluation of eyes with high progressive myopia in children and youth ten years after Snyder and Thompson's scleroplasty]

PURPOSE

Of the study was, to assess the safety and efficiency of scleral reinforcement after Snyder and Thompson surgery.

MATERIAL AND METHODS

The scleroplasty was performed on 129 eyes of 75 children with progressive myopia from 6 to 10 years of age. The control study group included 40 eyes of 25 children with similar age, mean eyeball axial length and refraction. In the control study group scleroplasty was not performed. The main indication criteria for surgery included: severe myopia more than -6.0 D, and the increase in refraction error more than -1.0 D per year. We evaluated the eyeball axial length in all subjects, before time of surgery and ten years after surgery, using Ultrasound Alcon Imaging System. The visual acuity, tonometry, visual field were evaluated as well.

RESULTS

In the study group the mean eyeball axial length measured before surgery was 25.95 mm +/- 0.62 mm. Ten years after surgery the length of the eyeball was 26.97 mm +/- 0.64 mm. The average increase was 1.03 mm +/- 0.29 mm. In the control group, at the time when study group children were operated, the mean eyeball axial length was 25.91 mm +/- 0.48 mm, and ten years later it was 28.06 mm +/- 0.59 mm. The average increase in the eyeball length was 2.13 mm +/- 0.3 mm. There was statistically significant difference between the eyeball axial length progression in the study group and the control group, where surgery was not performed. In the study group no serious complications after surgery were reported.

CONCLUSIONS

Scleral reinforcement is an effective and safe surgery, that can stabilize the progression of severe myopia in children.

[Plasma-modified silicone graft for scleroplasty in progressive myopia]

Plasma-chemical modification of synthetic transplant material (proliferous silicone) intended for scleroplasty in progressive myopia was theoretically substantiated, developed in the experiment and tested in practice. This treatment was shown to enhance the biocompatibility of a graft which tightly joins the sclera through the connective tissue intergrown from the surrounding capsule into the graft. The efficacy of the proposed plasma-modified grafts in stabilizing progressive myopia in 18 patients operated on (33 eyes) aged 6 to 49 years (spherical equivalent myopia degree 3.0-28.0 D) during 3- year followup was 97%. There was an elevation of uncorrected and corrected visual acuity, are active course of the postoperative period.

Posterior scleroplasty in children with severe myopia

PURPOSE

To assess the influence of scleral reinforcement on the evolution of severe myopia in children.

MATERIAL AND METHODS

Scleral reinforcement after Thompson was performed on 251 eyes of 154 children with high myopia from 2 to 18 years of age. The main indication criteria for surgery during the period 1992-2000 included: severe myopia more than -7 Diopters and the increase in refraction more than -1 D(per year. Zenoderm (porcin skin) was the main alloplastic material used during surgery. No serious complications were observed. The following main indicators of myopia advancement were investigated on a long-term basis and evaluated: axial length, refraction, visual acuity, fundus findings and perimetry.

RESULTS

The positive influence of surgery on myopia advancement was observed in 100% of patients. In about 53% of operated eyes, myopia was absolutely stopped, and in about 47% of operated eyes, its advancement was considerably reduced. During 10 years of postsurgical check-up, stabilisation of myopia was achieved, the following in individual indicators: axial length--53.8% of eyes, refraction--52.9% of eyes, visual acuity--85% of eyes, fundus findings--58.6% of eyes, perimetry--59.1% of eyes. The advancement of myopia in other 47% of patients has been decreased from 1.1 D/per year before surgery to 0.1 D till 10 years after surgery.

CONCLUSION

Scleral reinforcement is an effective and safe surgery that can stabilise the progression of severe myopia in children. (Tab. 6, Fig. 7, Ref. 12.).

Corneoscleroplasty with maintenance of the angle in two cases of extensive corneoscleral disease

PURPOSE

We report a 2 year follow-up in two patients after corneoscleroplasty.

METHOD

Using lamellar corneoscleral dissection to maintain the drainage angle and its function, we performed a 14 mm allograft corneoscleroplasty in 2 eyes. For surgical treatment in both cases a 9.5 mm corneal button was excised from the recipient after peritomy and scleral lamellar preparation up to 14 mm. A 14 mm donor button was inserted and held in place with multiple Prolene sutures. One eye presented with a large perforating corneal ulcer after herpetic keratitis in a patient with recurrent rheumatoid uveitis associated with rubeosis iridis. The second eye had had a penetrating keratoplasty for keratoconus 30 years previously and presented with decompensating keratoglobus. Immune suppression was performed with systemic cyclosporin A and additional steroids when required.

RESULTS

Both patients had a clear graft at the last follow-up visit and visual acuity was improved to a best corrected visual acuity of 0.6. Intraocular pressure in the keratoglobus eye was maintained at 6 mmHg without treatment, whereas the second case required continuing treatment with systemic acetazolamide because of neovascular glaucoma. The anterior chamber angles remained open in both patients. Contact lenses were helpful in the prevention of epithelial irregularities and defects. Both patients had an episode of immunological graft reaction which was reversed by immunosuppressive treatment. Phacoemulsification with intraocular lens implantation, which was performed 2 years after transplantation in the keratoglobus eye, did not affect the graft clarity or cause rejection episodes.

CONCLUSION

Our results using corneoscleroplasty have been encouraging in severe destructive corneal disease.

[Reinforcement of the sclera with new types of synthetic materials in progressive myopia]

The possibility of using a new synthetic material mersilene for scleroplastic operations has been evaluated in experiments and clinical trials were carried out in patients with progressive myopia subjected to sclera fortification. Morphological studies showed the formation of a connective tissue capsule round mersilene; new collagen fibers grow through its cellular structures, thus fortifying the strength of the sclera-graft complex. Clinical results indicate that sclera fortification by a mersilene graft arrested the progress of myopia in almost all (98%) patients by the end of the first year postoperation; by the end of the second year, myopic refraction stabilized in 92% patients. Hence, mersilene transplants are recommended for scleroplasty in progressive myopia.

[The morphological characteristics of the take of synthetic transplants following experimental scleroplasty]

The morphology of taking in of synthetic transplants after scleroplasty is studied in 24 eyes of chinchilla rabbits. Polytetrafluorethylene-based materials (composite filtration fluoroplast membrane--Teflon) and polyester jersey with reticular structure (scleracod) were used for transplantation. Study of two materials showed common processes and differences in the grafts taking in. Implants made of both materials are characterized by good biocompatibility, which prompts further investigation of their probable use in sclera-fortifying treatment of progressive myopia.

[The possibilities for optimizing the surgical prevention of the progression of myopia]

Progressive myopia is a pressing problem of ophthalmology. Scleroplastic surgery is a pathogenetically validated method for treating this condition. The authors propose a new method for allotissue preservation, ensuring preservation of biological characteristics of tissues for any period without restriction, so that the material for transplantation were constantly available. A new shape of the graft is proposed: with a duplicature pouch and lateral incisions on one end, like a fur-tree. Such a design ensures a reliable position of the graft on scleral surface with an accent on the posterior pole and prevents pushing out of the graft from Tenon's space, which often occurs with common grafts. Transplants of a new shape were used in 2050 patients; the operation is easy to perform and its results are highly effective.

[The optimization of a surgical intervention to stabilize progressive myopia]

Results of 236 sclera-fortifying surgeries are followed up for more than 25 years. Progressive myopia stabilized in 95.8% cases after bandaging scleroplasty and in 87.03% cases after chondroplasty. Clinical refraction and posteroanterior axis of the eye did not increase after surgery; visual functions stabilized, and brightness sensitivity threshold was lowered. The technique of operation and clinical course of the postoperative period are described. Based on analysis of the clinical material, the authors propose the optimal approach to scleroplastic operations aimed at stabilization of progressive myopia.

Lamellolamellar sclerokeratoplasty. Where do we stand today?

PURPOSE

To determine the efficacy of lamellar sclerokeratoplasty for patients with extensive corneal/corneoscleral lesions.

METHODS

One hundred and sixty-six eyes with extensive corneal/corneoscleral lesions of different aetiology who were poor candidates for conventional lamellar keratoplasty/penetrating keratoplasty were selected for lamellar sclerokeratoplasty.

RESULTS

Corneal clarity of 3+ or more was achieved in 62 eyes by a single procedure. In the remaining 104 eyes graft clarity was < 2+ due to post-surgical complications (n = 56) or remaining recipient deep opacity (n = 48).

CONCLUSIONS

Astigmatism, the bugbear of final visual achievement despite a clear graft, was not a frequent problem following lamellar sclerokeratoplasty. Similarly, a gain in visual acuity to 6/18 or more in 30% of eyes, cosmetic improvement in the majority of cases and prevention of recurrence of the original disease process in susceptible cases all point towards the safety and effectiveness of the procedure. Thus, lamellar sclerokeratoplasty should be considered as a management option for patients with extensive corneal/corneoscleral lesions.

[The morphological changes in different grafts in scleroplasty]

In the paper experimental and morphological investigations of cadaveric aorta wall and dura mater grafting for scleroplasty are analysed. The experiments were performed of 20 chinchilla rabbit eyes. The investigations have shown the processes of aortic allotransplants replacement by recipient tissues. Histological peculiarities of the sclera structural regeneration in the conditions of the aorta and dura mater grafting have been established.

Deep sclerectomy with collagen implant: medium term results

AIMS

To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI), a new non-penetrating filtration procedure.

METHODS

Non-randomised prospective trial involving consecutive patients. 100 eyes of 100 patients with medically uncontrolled primary and secondary open angle glaucoma. A superficial scleral flap was raised and a deep sclerectomy was performed in the scleral bed. Schlemm's canal was opened and dissection of the cornea was performed up to Descemet's membrane, at which point aqueous percolated through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed. Visual acuity, intraocular pressure (IOP) measurements, and slit lamp examinations were performed before surgery and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24, 30, and 36 months.

RESULTS

The mean follow up period was 17.8 (SD 8.7) months. The mean preoperative IOP was 27.8 (8.6) mm Hg; the mean postoperative IOP was 5.7 (4.0) at day 1, 11.2 (4.6) at month 1, 14.0 (3.5) at month 12, and 13.0 (3.8) at month 36. Complete success rate, defined as an IOP lower than 21 mm Hg without medication, was 44.6% at 36 months. Qualified success rate, defined as an IOP lower than 21 mm Hg with medication, was 97.7% at 36 months. Early postoperative complications included hyphaema in seven patients, would leak in 10 patients, and subtle choroidal detachment in 11 patients. Goniopuncture was performed in 41 of the patients, and 5-fluorouracil injections were made in 23 patients; cataract progression occurred in seven patients. When comparing the different types of open angle glaucoma, no difference was found in terms of reduction in IOP, number of patients requiring antiglaucoma medications, or success rate.

CONCLUSIONS

Deep sclerectomy with collagen implant appears to provide reasonable control of IOP at medium term follow up, with few immediate postoperative complications.

[Progressive myopia and posterior scleral reinforcement: retrospective studies]

We evaluated the long and middle terms results in a retrospective study of Posterior Scleral Reinforcement in progressive myopia. We discuss the inclusion criteria and the results in terms of refraction, visual acuity, axial length, intra-ocular pressure, complications and patient's subjective appreciation. The surgical procedure of Posterior Scleral Reinforcement stabilises the evolution of progressive myopia in time. A systemic prospective study is needed for more precisions on those first encouraging results.

[Block excision with tectonic corneoscleroplasty for cystic and/or diffuse epithelial invasion of the anterior eye segment. Report of 51 consecutive patients (1980-1996)]

PURPOSE

Many surgical and nonsurgical techniques for the treatment of cystic and/or diffuse sheet-like epithelial ingrowth of the anterior chamber led to recurrences or even enucleation of the eye.

PATIENTS AND METHODS

There were 32 (62.7%) men and 19 (37.3%) women ranging in age from 1 month to 80 years (median, 55.5 years). Cystic epithelial ingrowth occurred in 45 patients, and diffuse sheet-like epithelial downgrowth in 6 patients. Block excision consisted of simultaneous en bloc removal of epithelial ingrowth together with adjacent iris, pars plicata of the ciliary body, and cornea and sclera in full-thickness. The resulting defect was covered with a tectonic corneoscleral graft. The median follow-up was 7.9 years.

RESULTS

The main causes for epithelial ingrowth were trauma (41.2%) and complicated cataract extractions (27.5%). Eleven patients had undergone surgery of epithelial ingrowth before block excision, elsewhere. Epithelial ingrowth involved up to 5 clock hours of the circumference of the chamber angle (median, 3 clock hours). The median preoperative visual acuity was 0.3 (range, hand motions -1.0). The median diameter of the block excision was 8.0 mm (range, 5.5-12.0 mm). The main postoperative complications were vitreous hemorrhage (27.5%) and corneal endothelial decompensation (21.6%). The median postoperative visual acuity was 0.2. Visual acuity was > or = 0.3 in 43.1% of patients and < 0.1 in 35.3% of patients. Visual results were significantly better after simultaneous cataract extraction with intraocular lens implantation (n = 5). Histopathologically, the invading epithelium mainly consisted of nonkeratinizing squamous epithelium with goblet cells (64.7%). There was a secondary proliferation of corneal endothelium on the cyst's surface in 82.4% of patients. There was no clinical evidence of recurrence of epithelial ingrowth, and no enucleation had to be performed during follow-up.

CONCLUSION

Block excision with tectonic corneoscleral grafting is the treatment of choice for cystic and/or diffuse sheet-like epithelial ingrowth of the anterior chamber or anterior uvea, retrospectively.

[Limbo-sclerotomy--a refractive procedure outside the cornea. Preliminary report]

BACKGROUND

Complications of refractive corneal procedures are a consequence of inevitable corneal deformation or thinning. We aim to reduce corneal refractive power but omit laceration on the cornea itself.

METHODS

1. Rabbits: The procedure war first studied in 16 chinchilla rabbits (32 eyes). Seven eyes were enucleated in different intervals for microscopic evaluation. In rabbits the corneal diameter increased and refractive power of the cornea was diminished by 3.0 to 6.0 diopters. Refraction was controlled after 1, 2, 6 and 12 months. 2.

SURGICAL TECHNIQUE

Incision of the conjunctiva 4 mm peripheral to the limbus in all 4 quadrants and mobilisation to the corneal insertion. In each quadrant 4 to 5 radial incisions are placed from the exposed limbus in the adjacent sclera. The incisions have a depth of 500 micrometers and extend until 4 to 5 mm. The conjunctiva was restored by running sutures. So far, we observed no complications.

PATIENTS

Thereafter the procedure was carried out in eleven patients (16 eyes) aged between 18 and 55 years. Preoperative errors varied between -5.0 and -19.0 diopters.

RESULTS

In patients the power of the procedure was in the same range as in animals. Visual acuity improved in all cases. Preoperatively, 10 eyes had uncorrected visual acuity of 0.01 to 0.1 and 6 eyes 0.1 to 0.3. Postoperatively, uncorrected visual acuity improved to 0.02/0.06 and 0.5 in 5 eyes. In eleven eyes visual acuity improved to 0.2/0.7 and 0.8 eyes. Refraction was stable during a follow-up of 3 years.

CONCLUSIONS

Limbosclerotomy is an effective and safe approach to correct myopic refractive errors. Its effect may be explained by weakening of circular collagen fibers in the pericorneal area.

[Causes of insufficient effectiveness of collagen plasty (an experimental study)]

Morphological and biomechanical features of the sclera after collagen plasty were studied in 90 eyes of 45 chinchilla rabbits. A reduction of the viscous elastic properties of the sclera 1 month after surgery was revealed, not described previously. The data on the changed mechanical characteristics of the sclera following collagen plasty are confirmed by the results of optic and electron microscopy; these data permit us to propose that the sclera in the immediate postoperative period (less than 1 month after the operation) represents a somewhat chaotic structure at the stage of active restructuring. Rational postoperative management of patients after collagen plasty is recommended.

[Lamellar horseshoe sclerokeratoplasty and thermoplasty in keratoconus with peripheral ectasia of the cornea]

PURPOSE

Peripheral ectasia of the cornea is a rare, but rather complicated form of keratoconus, which in its severest form cannot be corrected by glasses or contact lenses. Penetrating corneal grafts must be positioned directly at the limbus. Such transplants mostly fail because of a high risk of immune reactions which can only be circumvented by systemic Ciclosporin A. To avoid the potential risks of such a systemic immunomodulation we performed instead of a penetrating keratoplasty a special lamellar procedure which restored the normal configuration of the cornea.

PATIENT

The 35-year-old man presented with best corrected visual acuity of 0.1 in both eyes. Contact lenses were not tolerated any longer.

RESULT

After lamellar dissection, thermoplasty and lamellar horse-shoe sclerokeratoplasty the patient now wears well-fitting contact lenses and has a visual acuity of 0.8 with his right and 0.5 with his left eye after a follow-up period of 25 and 14 months respectively. There were no postoperative complications.

CONCLUSION

Lamellar horse-shoe sclerokeratoplasty preceded by lamellar corneal dissection and thermoplasty is a technically difficult, but efficient surgical measure to restore the normal corneal curvature in patients with advanced peripheral ectasia of the cornea.

[Use of a sclera-fortifying collagen plasty with trophic component in the treatment of high progressive myopia]

A modified scleroplastic operation is suggested, trophic collagenoplasty in which sclera-fortifying collagenoplasty is combined with subtenon implantation of a collagen infusion system. Using this system drugs stimulating trophic processes in the tissues of the posterior segment of the eyeball are infused within 7 to 9 days after surgery. Such operations were carried out in 42 eyes of 22 patients with high progressive myopia (8.0 to 27.0 diopters). The patients' ages varied from 30 to 57. Three months after surgery a manifest improvement of hydro- and hemodynamic parameters of the eyes, as well as of visual acuity with correction, of visual field, and of retinal light discriminating sensitivity were observed in the majority of patients (p < 0.05). The results of pre- and postoperative examinations demonstrate a high efficacy of such operations in patients with high progressive myopia combined with marked dystrophic changes in the tissues of the posterior segment of the eye.

[The late results of Murmamedov-Atameredova's modified scleroplasty in children]

Late results (a follow-up of 3 to 4 years) of 87 scleroplastic interventions according to Nurmamedov-Atameredova are analyzed. Scleroplasty in the authors' modification was carried out in children with progressive myopia aged 8 to 14. The technique is simple and low-traumatic. The process was stabilized in 39 (44.8%) eyes, in the rest eyes (n = 48, 55.2%) myopia still progressed after surgery with an average rate of 0.7 diopters a year; this progress was most frequent after high myopia or in children whose both parents suffered from myopia. Such scleroplasty technique is therefore not recommended for this patient population.

[The use of new scleroplastic materials in the surgery of traumatic retinal detachment]

New textile-based material is suggested for scleroplastic surgery for detachment of the retina. Features of the design of the new material are described and the efficacy of the implants assessed. Textile-based implants are recommended for clinical practice.

[A method of tracing Schlemm's canal in the combined treatment of open-angle glaucoma]

Tracing Schlemm's canal in the course of sinusotomy, added to multiple-modality treatment of open-angle glaucoma, helps improve the localization of the site of initially traced external wall of Schlemm's canal in gonioscopy and carry out laser trabeculopuncture at the site of the intervention with a lower level of laser energy, as well as reduce the possibility of complications and cicatrix of the trabecula and the adjacent tissues. A follow-up of 23 patients over 1.5 years has proved that the described intervention provides a good hypotensive effect and stabilization of the glaucomatous process in the overwhelming majority of patients.

[Technique and results of modified trabeculectomy]

The author suggests double trabeculectomy with episclera resection and anguloplasty to be performed in cases with uncompensated open-angle glaucoma. Each of the elements of such surgery is aimed at slowing down the reparative processes in various sections of the fistulous route and therefore this route can function longer. Forty-six patients (50 eyes) with primary open-angle glaucoma were operated on. Normalization of the ophthalmic tone immediately after surgery was achieved in 100% of cases. The results of surgery were followed up in 30 patients (32 eyes) for 6 months to 2 years. Stable normalization of intraocular pressure was achieved in 97% of cases, vision acuity in 81%, and visual field in 91% of those operated on. Good stable hypotensive effect of such surgery recommends it most of all for patients at a high risk of excessive cicatrization (young patients, repeated surgery, etc.).

[Scleral fortification in children at high risk of progressive myopia]

To improve scleroplasty efficacy in children at a high risk of postoperative progress of myopia the authors have developed a new surgical method involving increase of the transplant size and its preoperative treatment with a foamy composition intended for filling the body cavities. Experimental biomechanical and morphologic studies have demonstrated that such treatment improves the transplant elasticity and strength, provides its better adhesion and fixation to the sclera at the expense of excellent adhesive properties of the foamy composition, and intensifies revascularization and stabilization processes in the connective tissue. Such surgery was effectively performed in 46 patients.

[Umbilical tissue transplantation in progressive myopia]

A new allo-scleroplasty material, umbilical tissue, easily available in clinical practice, is suggested for allo-scleroplasty in progressive myopia. A total of 229 operations were carried out in 144 patients. Indications to and contraindications against umbilical allo-scleroplasty in progressive myopia were defined and the choice of the surgical technique validated. Immediate results of surgery and postoperative complications are analyzed. Umbilical tissue preservation in thymol and lithium chloride solution was found proof enough against the development of postoperative complications. The functional effects achieved by umbilical allo-scleroplasty persisted in remote periods after surgery.

[Use of Tissucol, a tissue glue, in reconstructive surgery of large scleral defects]

In a 14-year-old female patient the postoperative course of myectomy of the musculus rectus oculi externus on account of concomittant strabism was complicated by necrosis of the sclera (diameter 9 mm) at the site of intrascleral stitches and exudation into the anterior chamber and the vitreous body. For fixation of the transplant from lyophilized sclera the tissue glue Tissucol Kit was used. Tissucol rapidly and firmly joined the wound areas, its direct contact with uveal tissue did not produce an inflammatory reaction and the exudate from the anterior chamber and vitreous body was absorbed rapidly and completely.