OSLI Retina

October 2016

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948 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ T E C H N I Q U E ■ Dehydrated Allogenic Human Amniotic Membrane Graft for Conjunctival Surface Reconstruction Following Removal of Exposed Scleral Buckle Dilraj S. Grewal, MD; Tamer H. Mahmoud, MD, PhD ABSTRACT: A 54-year-old male developed symp- tomatic scleral buckle exposure 16 years after place- ment and presented with large conjunctival defects with fibrosed edges. Following surgical removal of the buckle elements, primary conjunctival closure could not be achieved due to significant wound ten- sion despite undermining the conjunctival edges to mobilize the conjunctiva. A dehydrated amniotic membrane graft (Ambio5; IOP Ophthalmics, Costa Mesa, CA) was placed on the scleral bed and se- cured in place with fibrin sealant (TISSEEL; Baxter International, Westlake Village, CA). The amniotic membrane allowed successful closure of the large conjunctival defect with a good cosmetic outcome and resolution of symptoms. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:948-951.] INTRODUCTION One of the most common reasons for silicone scleral buckle removal is extrusion through the con- junctiva. 1,2,3 The rates of extraocular scleral buckle extrusion and infection are reported to be 0.5% to 5.6%. 4-7 Observation of exposed exoplants with topi- cal broad-spectrum antibiotic ophthalmic solutions is generally found to be inadequate in most of these cases. Extruded scleral buckles can be symptomatic, causing redness, irritation, and discomfort, which also warrant removal, even in the absence of infec- tion. Although primary conjunctival closure can of- ten be attempted with smaller conjunctival defects, it may not be possible to close large defects, especially near the fornices without excessive wound tension and the risk of forniceal shortening. We describe the use of cryopreserved amniotic membrane graft for closure of a large conjunctival de- fect following removal of an extruded scleral buckle with good cosmetic and functional results. CASE REPORT AND SURGICAL TECHNIQUE A 54-year-old male presented with irritation, discomfort, and redness in his left eye. He had un- dergone a scleral buckle placement during retinal detachment repair 16 years prior and was found to have an exposed scleral buckle superotemporally and inferotemporally (Figures 1A and 2A). The retina was attached with extensive chorioretinal scarring with pigmentary changes and his visual acuity was 20/25. A 2-week trial of topical antibiotics and lubricating drops did not alleviate his symptoms. From the Department of Ophthalmology, Duke University School of Medicine, Durham, NC. Originally submitted April 13, 2016. Revision received April 13, 2016. Accepted for publication August 9, 2016. Supported in part by the Heed Fellowship (DSG) and the Ronald G. Michels Fellowship (DSG). Dr. Mahmoud reports grants from Alcon, personal fees from Alimera, personal fees from DORC, and grants from Genentech outside the submitted work. Dr. Grewal has no relevant financial disclosures. Address correspondence to Tamer H. Mahmoud, MD, PhD, Duke Eye Center, 2351 Erwin Road, Durham, NC 27710; email: tamer.mahmoud@duke.edu. doi: 10.3928/23258160-20161004-08

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