Treatment of scleral melt associated with uveal prolapse by pericardium grafting in Wegener's granulomatosis.

PURPOSE: To report the use of preserved pericardium tissue in the treatment of scleral melt associated with uveal prolapse secondary to Wegener's granulomatosis. Wegener's granulomatosis may initially present with ophthalmic findings including scleral melting with uveal prolapse. In order to preserve the globe and treat this potentially fatal disease, prompt diagnosis, surgical correction of uveal prolapse, and subsequent immunosuppressive therapy are imperative. If advanced scleral melt associated with uveal prolapse is present, pericardium grafting with conjunctival advancement is a useful technique.

METHODS

Case report of a 70-year-old white female who initially presented with a unilateral sderal melt associated with uveal prolapse involving 6 clock hours of the surgical limbus. Emergent pericardium grafting of the involved limbus with conjunctival advancement performed to correct the endangered globe. Laboratory data including sedimentation rate, cANCA, computerized tomography of the chest, and urinalysis confirmed the diagnosis of Wegener's granutomatosis.

RESULTS

After pericardium grafting and immunosuppressive therapy the patient returned to baseline visual acuity, the sedimentation rate normalized, and the pulmonary lesions and renal failure resolved. The patient has been followed for 3 years since the initial diagnosis of Wegener's granulomatosis and there has been no recurrence.

CONCLUSIONS

To the best of the author's knowledge, this is the first report using processed pericardium to emergently treat scleral melt associated with uveal prolapse, thereby allowing preservation of the globe. In addition to management of the scleral melt, systemic evaluation and treatment with immunosuppressive therapy are necessary.