USE OF SPLIT-THICKNESS DERMAL GRAFTS TO REPAIR CORNEAL AND SCLERAL DEFECTS - A STUDY OF 10 PATIENTS

The use of split-thickness derm graphs for successful repair of cornea l and scleral defects is reported in 10 patients (11 eyes) who had non -infectious, impending, or overt ocular perforation. In all patients, traditional methods of reconstruction were deemed inappropriate or had already failed. Corneoscleral defects occurred after various operatio ns: pterygium excision, retinal detachment repair, insertion of a kera toprosthesis (Cardona implant) into an opaque, vascularised cornea, an d penetrating keratoplasty. Other causes of corneoscleral defects were scleromalacia perforans, idiopathic systemic vasculitis, alkali burn, ocular cicatricial pemphigoid, and band keratopathy with recurrent er osion following intraocular metallic foreign body. We propose the use of split-thickness grafts: (1) when adjacent conjunctiva is inadequate to cover a corneoscleral defect owing to its large size or great dept h or to conjunctival scarring from previous operations, injury, or ocu lar cicatricial pemphigoid; or (2) as an alternative to autogenous gra fts such as conjunctiva, cartilage, fascia lata, tibial periosteum, or mucous membrane as well as to homologous scleral and lamellar grafts. Dermal grafts are advantageous in that they are autogenous, non-antig enic, survive on avascular surfaces, and self-epithelialise and, thus, need not be covered by conjunctiva. Furthermore, they are pliable, ha ve excellent tensile strength, provide ample tectile support, and are abundantly available. Dermal grafts are harvested from the dermal bed of the thigh after an epidermal flap is hinged at one end.