Comparison Amongst Scleral, Corneal and Amniotic Membrane Grafts to Restore Scleral Thinning Secondary to Pterygium Surgery With Betatherapy Charles C. Farias, Rossen M. Hazarbassanov, Luiz A. Vieira, Luciene B. Souza, Telma Sternlicht, Jose AP Gomes Corneal and External Disease Departament of Ophthalmology Federal University of São Paulo - Brazil The authors have no financial interest in the subject matter of this poster P 736

PURPOSE To evaluate the use of preserved scleral, corneal and AM graft for the surgical repair of scleral thinning in patients who underwent surgery of pterygium with associated betatherapy . PARTICIPANTS Prospective, comparative, interventional and controlled study 28 eyes of 28 patients (one bilateral case) The mean age was 64,5± SD (47-82) 16 were female and 12 male All patients were operated by one surgeon (CCF) Surgical procedure was randomized: 1. Scleral graft (9 eyes) 2. Corneal graft (9 eyes) 3. AM graft (10 eyes)

METHODS Complete eye examination: BCVA, Biomicroscopy, Tonometry, Fundoscopy, UBM, USG Surgical Techniques Conjunctival peritomy, dissection and cleaning of the conjunctiva, regularity of the thinning edge with trephine, preparation of donor tissue, sclera was covered by conjunctival flap (scleral graft cases), 10-0 nylon suture Postoperative Topical prednisolone acetate 1% Topical ofloxacine 0,3% All suture were removed within 3 months Follow up One day, 7, 15, 30, 90 and 180 days after surgery.

RESULTS All eyes that received scleral (9/9) and corneal grafts (10/10) presented stability of the ocular surface with rapid re-epithelialization and restauration of the scleral thickness Eyes that received the AM grafts also presented stability of the OS with re-epithelialization (10/10), but the transplanted tissue absorbed on average after 30 d of follow up (p<0.05) 4/10 partial AM re-absortion 6/10 total AM re-absortion

Scleral – conjunctival graft group Sex/age Assoc Disease Oculoarfinding preop UBM pre(mm) Size V/H (mm) Type of surgery Reepithelization Ocular finding postop UBM 6 Months(mm) Success/ Failure 1 F/62 HBP Scleral Thining/ Choroidal exposure 0,451 4/2 Scleral graft with conjunctival transplantation 11 days Stable ocular surface 0,931 Success 2 F/47 Hypothy roidism 0,486 3/1.5 8 days 1,157 3 F/79 Dislipidemia 0,534 8/1 7 days 0,671 4 M/51 DM 0,417 4 days 0,914 5 F/81 Arthrosis Scleral Thining 0,482 3/1 1,065 6 M/72 Coronary (heart) Disease 0,475 30 days 0,625 7 M/83 0,556 n/a 8 M/78 Tendinitis 0,394 2/2 14 days 0,729 9 M/55 HBP, DM 0,428 6/3 0,613 HBP- high blood pressure; DM-Diabetes Mellitus; ST- scleral thickness

Scleral Thining/ Choroidal exposure Corneal graft group N= Sex/age Assoc Disease Finding preop UBM pre Size V/H Type of surgery Reepithelization Finding postop UBM 6 Months Success/ Failure 1 F/51 HBP Scleral Thining/ Choroidal exposure 0,510 5/3 Corneal graft 22 days Stable ocular surface 0,903 Success 2 F/47 Hypothy roidism 0,532 2,5/2,5 7 days 0,521 3 F/62 Scleral Thining 0,602 4/2,5 17 days 4 M/62 0,394 0,799 5 Rheumatoid arthritis 0,428 40 days 0,706 6 M/71 HBP, Dislipidemia 0,567 4/2 0,585 7 F/70 HBP, DM 0,498 15 days 0,660 8 roidism, HBP 0,556 4/3 0,451 9 F/49 0,371 4/5 HBP- high blood pressure ; DM-Diabetes Mellitus

Amniotic membrane graft group Sex/age Assoc Disease Finding preop UBM pre Size V/H Type of surgery Reepithelization Finding postop UBM 6 Months Success/ Failure 1 M/72 DM Scleral Thining/ Choroidal exposure 0,359 3/5 AMT 29 days AM dissolved 0,347 2 F/52 HBP Scleral Thining 0,579 5/3 21 days 0,313 3 F/50 Gastritis 0,417 n/a 4 M/69 HBP, DM 0,451 4/2,5 10 days AM partly present 0,139 Partial success 5 M/66 0,522 2/4 28 days 0,660 6 F/58 0,477 9 days 0,222 7 M/76 Prostatism 0,405 17 days 0,176 8 F/60 0,185 9 M/71 Rheumatoid arthritis 0,440 3/3 18 days 10 F/65 0,463 5/2,5 AMT- Amniotic membrane transplantation ; DM-Diabetes Mellitus; HBP- high blood pressure

p=0.002; Mean t test between SG pre vs 6M Results p=0.116, one way ANOVA between the groups before and after 6 M p=0.002; Mean t test between SG pre vs 6M p<0.001; one way ANOVA with Student-Newman-Keuls test, between SG vs. CO and AM 6 M

Figure 1 Scleral with calsified plaque and neovascularization Figure 2 Six months of scleral patch covered by conjunctiva

Figure 3 A focal area of thinning surrounded by edematous conjuntiva Figure 4 Stability of ocular surface after six months of corneal patch

Figure 5 Scleral thinning showing the uvea Figure 6 One day after amniotic membrane transplantion Figure 7 Six months of amniotic membrane transnplantation absorbed

CONCLUSION Our results suggest that both scleral and corneal grafts are good options to be used for restoring scleral defects with thinning. AM is also an option to be considered for less severe cases, however it reabsorved partially or totally in most of the cases.