Use of conjunctiva-Muller muscle pedicle flap in surgical treatment of necrotizing scleritis

Abstract

Purpose: To describe a new surgical technique for scleral repair in eyes with necrotizing scleritis. Methods: The surgical technique involved placing an autologous fascia lata graft over the scleral defect and covering the graft with an inferiorly based conjunctiva-Muller muscle pedicle flap from the upper eyelid. The flap pedicle was divided 2 months after the initial procedure. The medical records of 2 patients (2 eyes) who underwent a scleral repair with this technique were reviewed. Results: Both patients had progressive, diffuse scleral necrosis secondary to rheumatoid arthritis, and were receiving immunosupressive therapy. One patient had previously undergone unsuccessful scleral reconstructions with patch grafting. In both cases, the eye integrity was preserved after repair with conjunctiva-Muller muscle flap, and postoperative visual acuity improved. No complication developed during follow-up periods of 28 and 54 months. Conclusion: Conjunctiva-Muller muscle pedicle flap may provide efficient and safe scleral repair in eyes with necrotizing scleritis.