Name of the Procedure:

Scleral Reinforcement (Separate Procedure); with Graft

Summary

Scleral reinforcement with graft is a surgical procedure used to strengthen the sclera, the white outer layer of the eye. A graft, often made of donor tissue or synthetic material, is attached to the sclera to provide additional support and prevent further degeneration or injury.

Purpose

This procedure is typically performed to address thinning or weakening of the sclera, which can lead to serious eye conditions such as scleral staphyloma or myopic degeneration. The goal is to stabilize the eye, prevent further deterioration, and improve or preserve visual function.

Indications

• Progressive myopia (nearsightedness) with risk of retinal detachment
• Scleral staphyloma (outpouching of the sclera)
• Ectasia or thinning of the sclera
• Previous eye injuries that have weakened the sclera

Patient criteria or factors that make the procedure appropriate include:

• Significant visual impairment
• Rapid progression of the condition
• Failure of other less invasive treatments

Preparation

Patients may be required to fast for a specified period before the procedure. They should adjust or discontinue certain medications as directed by their healthcare provider. Pre-operative assessments often include a comprehensive eye examination, imaging studies like ultrasound or MRI, and blood tests to ensure the patient is fit for surgery.

Procedure Description

1. The patient is given local or general anesthesia to ensure comfort.
2. The surgeon makes a small incision in the conjunctiva (the outer membrane covering the sclera).
3. The graft material, which may be donor sclera or a synthetic substitute, is prepared.
4. The graft is meticulously sutured onto the weakened area of the sclera.
5. The conjunctiva is closed with fine sutures.
6. Antibiotic ointment is applied, and the eye is covered with a sterile bandage.

Tools and equipment used include surgical microscopes, fine sutures, and microsurgical instruments.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Scleral reinforcement with graft is usually performed in a hospital or outpatient surgical center.

Personnel

• Ophthalmic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

Common risks include infection, bleeding, and inflammation. Rare complications may involve graft rejection, double vision, or an adverse reaction to anesthesia. Long-term risks can include recurrent thinning or detachment of the graft.

Benefits

The primary benefit is the stabilization of the sclera, which can halt the progression of scleral thinning and associated vision loss. Patients may notice improved structural integrity of the eye and potential stabilization of their visual acuity within a few weeks to months after the procedure.

Recovery

Post-procedure care includes using prescribed antibiotic and anti-inflammatory eye drops. Patients should avoid strenuous activities and follow specific guidelines to protect their eye during recovery. Follow-up appointments are crucial to monitor healing and graft integration. Full recovery can take several weeks to a few months.

Alternatives

Alternative treatments may include:

• Pharmacologic management, such as using systemic medications to slow scleral thinning
• Less invasive retinal therapies for specific eye conditions
• Scleral buckle, used in cases of retinal detachment without scleral reinforcement

Each alternative has its pros and cons; surgery provides a more durable solution but comes with higher risks, whereas pharmacologic methods are less risky but might be less effective.

Patient Experience

During the procedure, patients under local anesthesia might feel minimal discomfort, while those under general anesthesia will be asleep. Post-surgery, patients can expect some pain and swelling, which can be managed with prescribed medications. Vision may be blurry initially but should improve as healing progresses.