Scleroplasty is a surgical procedure whose goal is to reinforce the sclera to check the advancement of progressive myopia. When eyesight decreases by more than 1.0 diopter a year, it is considered as progressive myopia. Progressive myopia presents with an increasingly elongated eye that causes the sclera to weaken and bulge, a condition known as posterior staphyloma. To prevent posterior staphyloma progression, the surgeon places a band of tissue behind the eye for reinforcement purposes. Besides strengthening the sclera, scleroplasty comes with the added benefit of improving blood supply in the eye through expanding the number of vessels involved in supplying nourishment to the eyeball’s posterior pole.
Progressive myopia is a serious issue because of its high prevalence rate and the fact that it can lead to retinal detachment, a potentially sight-threatening condition. Scleroplasty can be considered when other interventions like hypotensive agents, contact lenses, and glasses do not stop myopia’s progression.
According to literature, scleroplasty is popular in Europe and Asia, and not America due to the concern of risks and complications. There is controversy over the effectiveness of the procedure. However, certain studies have shown the benefits of scleroplasty in limiting myopia progression.
The medical field is still exploring the various uses of scleroplasty when combined with other procedures to treat certain conditions. One includes kerato-scleroplasty that uses keratoplasty and scleroplasty to treat keratoglobus. Another example is combining cataract extraction with scleroplasty to stabilize the antero-posterior axis elongation and improve visual acuity. The cataract-scleroplasty combination is only recommended after scleroplasty has stabilized myopia to 8-15 diopters.
Patients with the following conditions should not undergo a scleroplasty:
- Acute and chronic inflammatory eye diseases
- Exophthalmia (abnormal protrusion of the eyeball)
- Neoplasm (new and abnormal growth of tissue, particularly cancerous)
Also Known As
- Scleral reinforcement surgery
Before the Procedure
The procedure is an outpatient one and should take approximately 15-20 minutes. The ophthalmologist will discuss with the patient the procedure and provide details of the benefits and potential risks and complications. The patient’s medical history is taken alongside an ophthalmic examination conducted. The patient should ensure a responsible adult is at hand to drive them back home after the procedure.
Local or general anesthesia will be used on the patient. There are many modifications to scleroplasty but the most popular is Thompson’s procedure where the surgeon:
- Excises a strip from the sclera
- Excises the conjunctiva and Tenon’s capsule
- Isolates tendons of the following muscles: inferior oblique muscle, superior muscle, lateral muscle, and inferior rectus muscle
- Passes one end of the scleral flap under the superior rectus. S/he secures it by using two sutures
- Passes the free end of the transplant (a strip of donor sclera broadening in the upper third) under the inferior rectus, the inferior oblique, and lateral rectus muscles
- Shifts the scleral flap from the equator to the posterior pole
- Stretches the transplant until s/he feels that it has settled on the eye’s posterior pole
- Fastens the scleral flap’s inferior end using two sutures
Different approaches can also be used in scleroplasty. Some patients may require repeated interventions using low invasive procedures on 6-18 months intervals. In some surgical interventions, the surgeon inserts a special disk into the eye's bulb, which serves as a 'frame' for the sclera. Its purpose is to reinforce the eye's wall so that it stops growing and helps check myopia progression.
The transplant can be designed from artificial materials such as from animal tendons, fascia lata, lyophilized human dura, porcine skin dermis, and a human donor/sclera. The human sclera is the best choice due to less risk of rejection.
Risks & Complications
The risks and complications involving scleroplasty may include:
- Choroidal edema
- Vortex vein damage
- Sutures may get separated
- Increased intraocular pressure
- Modest scarring of the conjunctiva
- Chemosis (swelling of the conjunctiva)
- Difficulties of getting and storing donor material
- Iridocyclitis (inflammation of the iris and ciliary body)
- Risk of scleral rejection especially if animal tendon material was used
Aftercare & Recovery
Follow up for scleroplasty is critical, and the first visit will occur the day following surgery with progressive follow up on a weekly or monthly basis, every six months, and years later. How long the patient will be followed up depends on how the patient is responding to treatment. The surgeon especially thoroughly checks the periphery of the eye. S/he may administer argon laser photocoagulation of the retina if there is a need.
According to studies, in most of the patients who underwent scleroplasty, the progression of myopia declined to satisfactory levels, and no serious complications were recorded. These studies conclude that scleroplasty can produce good outcomes when used to treat progressive myopia and that it is a safe method for long-term preservation of visual functions.
Research also indicates that 90% of myopia patients who have undergone scleroplasty can tolerate contact lenses for more than 8 hours better than those who have myopia but have not undergone the procedure. 63% of patients achieved visual acuity of 6/6 to 6/9 in contact lens wearers compared to 29% of spectacle wearers after scleroplasty.