Name of the Procedure:

Repair of scleral staphyloma with graft (Scleral staphyloma repair)

Summary

The repair of a scleral staphyloma with a graft involves surgically correcting an abnormal protrusion or bulge in the white outer layer of the eye (sclera) by using a graft material to strengthen the weakened area.

Purpose

This procedure addresses the issue of scleral staphyloma, a condition where the sclera thins and bulges outward, often due to disease or injury. The goal is to reinforce the sclera, prevent further protrusion, and protect the underlying structures of the eye, potentially improving vision and reducing discomfort.

Indications

• Visible protrusion or bulging of the sclera
• Eye pain or discomfort
• Impaired vision due to the protrusion
• Progressive thinning of the sclera observed in conditions like scleritis, degenerative myopia, or following trauma or surgery
• Patients who have not responded to other treatments

Preparation

• Patients may need to fast for a few hours before the procedure
• Medication adjustments, particularly anticoagulants, as advised by the doctor
• Preoperative assessments including a full ocular exam, imaging studies like ultrasound or MRI, and general health evaluation

Procedure Description

1. Administration of local or general anesthesia as per the patient's condition.
2. A small incision is made near the area of the scleral staphyloma.
3. The surgeon carefully places a graft (commonly sourced from donor sclera, synthetic materials, or other biocompatible materials) over the weakened scleral area.
4. The graft is secured with sutures to provide structural support.
5. The incision is closed, and a protective bandage is applied over the eye.

Duration

The procedure usually takes about 1 to 2 hours, depending on the complexity and extend of the staphyloma.

Setting

This surgery is performed in a hospital operating room or a specialized surgical center.

Personnel

• Ophthalmic surgeon
• Surgical nurses
• Anesthesiologist (for general anesthesia)
• Support staff

Risks and Complications

• Infection
• Bleeding
• Graft rejection or failure
• Glaucoma (increased intraocular pressure)
• Vision changes or loss
• Persistent pain or discomfort

Benefits

• Reinforcement of the sclera, preventing further bulging
• Potential improvement in vision
• Alleviation of pain and discomfort
• Protection of the inner eye structures

Recovery

• Post-procedure care includes wearing an eye patch or bandage, using prescribed eye drops or ointments to prevent infection and manage pain
• Avoiding strenuous activities and eye strain
• Follow-up appointments for monitoring healing and graft integration
• Recovery time can range from a few weeks to a couple of months, depending on individual healing rates

Alternatives

• Observation and monitoring for mild cases
• Use of protective eyewear
• Medical management of the underlying condition (e.g., anti-inflammatory medications for scleritis)
• Each alternative has its pros and cons, and none may offer the definitive structural support provided by a surgical repair with grafting.

Patient Experience

During the procedure, patients under local anesthesia might feel minimal discomfort, while those under general anesthesia will be unconscious. Post-procedure, there might be some pain and swelling managed with prescribed medications. Patients may also experience temporary blurred vision and will need to follow specific care instructions for optimal recovery.