Scleral Melt & Ischemia


The sclera serves as a protective coat and a stable support for the intraocular tissues . Its thickness is not uniform, being the thickest at the posterior pole (1-1.35 mm), gradually decreasing to be the thinnest immediately posterior to the rectus muscle insertion (0.3 mm), and increasing again towards the limbus (0.8 mm). The scleral matrix is compact and made of collagen fibers and interfibrillar proteoglycans. In a normal healthy eye, the scleral stroma is avascular, receiving its nutrition from choroidal blood vessels and the vascular plexus in the Tenon's capsule and on the episcleral surface. Scleral melt is a serious and challenging clinical problem as it threatens the integrity of the eye. Clinically, scleral melt is almost always the result of ischemia which interrupts the blood flow of episcleral blood vessels. Therefore, scleral ischemia and melt can be caused by a number of diseases that interrupt the blood circulation. Acutely, scleral ischemia can occur in chemical or thermal burns. When such ischemia extends near the limbus, it further compromises the limbal epithelial stem cells. Chronically, scleral ischemia can happen when excessive‚ beta irradiation or Mitomycin C are used to treat pterygia or develop after systemic vasculitis and connective tissue disorders.

This Guide demonstrates how Tenonplasty can be used to restore the blood supply. Once the blood supply is established on the ischemic sclera, lamellar corneal graft and/or amniotic membrane transplantation can be used as a tectonic substitute for the missing scleral tissue depending on the depth of the scleral defect. Furthermore, the overlying conjunctival surface healing is facilitated by the transplantation of a cryopreserved amnion graft. As illustrated in this Guide, lamellar corneal tissue and amniotic membrane transplantation can be accomplished without sutures by using fibrin glue. As a result, the surgical time is shortened (allowing topical anesthesia), the patient's recovery time is reduced, and the postoperative care is simplified.

[Expand all]

  • Key Pre-Operative Points
  • Supplies for Scleral Melt & Ischemia Surgery
  • Scleral Melt & Ischemia Surgical Steps
  • Scleral Melt Ischemia Post Operative Points
  • Scleral Ischemia & Melt Literature Summary
  • Supplies for Treating LSCD with Amniotic Membrane Transplantation
  • Frequently Asked Questions (FAQ)
  • References


Scleral Melt & Ischemia surgical guide



Introduction Videos

  • Tenonplasty for Scleral Melt & Ischemia Intro Video

  • Overview of Tenonplasty for Scleral Melt & Ischemia Video
Tenonplasty for Scleral Ischemia Surgical Videos

  • Tenonplasty for Scleral Ischemia Video

  • Tenonplasty Surgery Post-Op Results Video

  • Tenonplasty for Scleral Ischemia Second Surgery Video
Tenonplasty for Scleral Melt Surgical Videos

  • Tenonplasty for Scleral Melt Surgery Video 1

  • Post-op Review for Scleral Melt in Surgery Video 1

  • Tenonplasty for Scleral Melt Sample Video 1-b

  • Tenonplasty for Scleral Melt Sample Video 2

  • Tenonplasty for Scleral Melt Sample Video 3

If you have additional surgical questions after viewing this information, contact OSREF's Research Director, Scheffer C.G. Tseng, MD, PhD, by e-mail at or by phone at 305-274-1299.

Videos edited by: Scheffer C.G. Tseng, MD, PhD, Hosam Sheha, MD, PhD, Ahmad Kheirkhah, MD, Antonio Elizondo, MD, Victoria Casas, MD

Note: The videos are for peer discussion purposes and the creators are not participating in commercial promotion of any product.

Financial Interest Disclosure: Dr. Tseng and his family are more than 5% shareholders in TissueTech, Inc. and Bio-Tissue, Inc. which currently distributes AMNIOGRAFT® and PROKERA™

Copyright © 2011 Ocular Surface Research & Education Foundation. Content is protected under intellectual property laws and are licensed for non-commercial viewing only. Any distribution, copying transmission or alteration is prohibited. All rights reserved.