1. 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

2. 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)

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

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

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

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

12. 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.