Scleral patch graft for exposed orbital implant
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This is Richard Allen at University of Iowa. This video demonstrates repair of an exposed porous orbital implant with a scleral patch graft. The exposure is inspected and the conjunctiva with underlying Tenon's is widely undermined around the defect. This is performed in order to have little tension on the edges of the repair. Additional undermining is performed along the surface of the porous polyethylene implant. The defect is then measured with calipers. A piece of donor sclera is then cut in order to cover the defect. The edges of the conjunctiva will then be advanced over the sclera. This is performed by placing mattress sutures with 5–0 Vicryl suture. The suture is placed through the conjunctiva and Tenon's. The suture then engages the underlying sclera. The suture should engage sclera so that the conjunctiva can be advanced over the sclera. In this case, the defect is being repaired vertically. An additional suture is placed inferiorly. Again a mattress suture is used which engages the sclera so that when tying the sutures, the conjunctiva will be advanced over the sclera. The suture is tied superiorly followed by inferiorly. Doing this results in closure of the defect over the sclera. The edges of the conjunctiva are then opposed with interrupted 7–0 Vicryl sutures. Ideally, the edges should be under minimal tension. The goal in repair of exposed orbital implants is to advance vascularized tissue over the implant with an underlying barrier such as sclera. At the conclusion of the case, ophthalmic antibiotic ointment is placed over the repair and the patient is patched for 2 days.