Tennent Institute of Ophthalmology, Glasgow, UK.
Cornea. 2010 May;29(5):577-9. doi: 10.1097/ICO.0b013e3181b532e5.
To describe a novel use of conjunctival autograft in the management of surgically induced scleral necrosis that occurred after squint surgery.
Interventional case report.
A 22-year-old man underwent bilateral adjustable squint surgery. Two weeks postoperatively, he developed conjunctival retraction and an area of scleral necrosis/melting with 80% thinning. The surrounding conjunctiva was markedly inflamed with raised edges. Screening for autoimmune and vasculitic conditions did not provide any positive results. The conjunctiva surrounding the area of scleral melt was excised and the area covered by a conjunctival autograft resulting in complete healing of the scleral melt within 1 month of surgery.
The pathogenesis of surgically induced scleral necrosis not associated with autoimmune conditions may be the result of the products of inflammation and lytic enzymes released by the surrounding conjunctival tissue initiating the scleral melting process. This type of surgically induced scleral necrosis may be successfully managed by excision of the surrounding inflamed conjunctiva, thus removing a potential source of collagenases, and covering the exposed sclera by a conjunctival transplant obviating the need for prolonged high-dose immunosuppression.
描述一种在斜视手术后发生的巩膜坏死的新型治疗方法，即使用结膜自体移植物。
介入性病例报告。
一名 22 岁男性患者接受了双眼可调节斜视手术。术后 2 周，他出现了结膜退缩和巩膜坏死/融化，厚度减少了 80%。巩膜周围的结膜明显发炎，边缘隆起。自身免疫和血管炎的筛查没有提供任何阳性结果。切除了巩膜融化区域周围的结膜，并使用结膜自体移植物覆盖，结果在手术后 1 个月内巩膜完全愈合。
与自身免疫条件无关的手术引起的巩膜坏死的发病机制可能是由周围结膜组织释放的炎症产物和溶酶体引发的巩膜融化过程。这种类型的手术引起的巩膜坏死可以通过切除周围发炎的结膜来成功治疗，从而消除潜在的胶原酶来源，并通过结膜移植覆盖暴露的巩膜，避免长期大剂量免疫抑制的需要。
