Cause and Repair of Corneoscleral Fistula in Two Patients
Gračner B., Pahor D., Gračner T.
Oddelek za očesne bolezni Splona bolninica Maribor, Slovenija
Purpose: A slowly progressing bulbar hypotension with maculopathy in a male patient and an endophthalmitis in a female patient, both required surgical repair of posttraumatic leaks.
Method: In a 32-year-old male patient, a filtration bleb leak occurred four months after a penetrating stab wound in the corneoscleral region. Persistent bulbar hypotension demanded microsurgical revision, revealing a 1 x 1 mm scleral defect. The leakage area was close to the limbus. In a 75-year-old female patient, signs of endophthalmitis occurred four years after extracapsular cataract extraction with posterior intraocular lens implantation. The entrance place of inflammation was a 1 x 3 mm subconjunctival fistula in the corneoscleral scar. In both cases the leakage areas were repaired by autologous 4 x 4 mm scleral graft obtained from the pars plana region in the same eye.
Results: The postoperative course was without complications, intraocular pressure was back to normal within a few days in both cases. Two weeks after surgical repair, in the first patient normal ocular fundus and normal visual acuity were observed. In both cases complete and permanent leakage closure was achieved.
Conclusions: There are various surgical possibilities for the repair of scleral defects. Patching the defects with autologous scleral grafts has several advantages. Dissection of the graft in the pars plana region is relative
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