Novel Repair of Scleral Melt

Drs. Scott Anderson, Dean Mah, and Khaliq Kurji present a case of a 54-year-old woman with a history of scleritis leading to scleral melt secondary to granulomatosis with polyangiitis. She was treated 3 years earlier with a traditional scleral patch graft. The patient was referred urgently for assessment after suffering a recurrence of scleral melt through the original scleral patch graft at the same site. Given the failure of the prior patch graft, the authors used a novel technique with a complex of sclera, partial thickness cornea, and amniotic membrane. This technique ensures enhanced reinforcement while avoiding a thick patch graft complex. The patient was comanaged with the rheumatology service, having previously been treated with intravenous solumedrol during acute flares followed by a taper of oral prednisone. She was also treated with 3 rounds of cyclophosphamide while transitioning to long-term immunomodulatory therapy. At last follow-up, the patient was stable on low-dose oral prednisone, azathioprine, and rituximab infusions every 6 months as needed.

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