Treatment of Progressive Scleromalacia Perforans by Tectonic Enhancement With Lyophilized Equine Pericardium.

This research article focuses on a case study where a specific surgical method involving the use of equine pericardium was employed to treat a progressive case of scleromalacia perforans, a severe eye condition involving the thinning of the sclera.

Overview of Scleromalacia Perforans and the Patient

• Scleromalacia perforans is a serious eye disorder, leading to thinning of the sclera – the white outer coat of the eye. If untreated, it can lead to a significant threat to vision.
• In this case study, an 82-year-old woman with a history of varicella zoster virus sclerokeratitis, which is inflammation of the cornea and sclera due to a viral infection, presented the condition.
• Her case was exacerbated by the fact that she was already blind in the affected eye due to intractable glaucoma. Intractable glaucoma is a type of eye disorder where the pressure within the eye cannot be controlled with medication.

Surgical Procedure Employed

• To stem the progression of the condition and prevent rupturing of the exposed choroid (layer containing blood vessels in the eye), the surgical team used an “off-label” method involving lyophilized equine pericardium.
• Lyophilized equine pericardium is a freeze-dried tissue from the protective sac around a horse’s heart. While it is not originally meant for this purpose, hence the term ‘off-label’, its effectiveness was tested in this case.
• The tissue was sutured over the area where the sclera had thinned, and the conjunctiva (mucous membrane covering the front of the eye and lining the inside of the eyelids) was adapted with sutures to secure it.

Post-surgical Results

• The postoperative course for the patient was without any complications.
• A year after the surgery, examinations revealed that the equine pericardium had successfully integrated with the ocular wall. The tissue provided a stable sheet that covered the staphyloma (outward bulge of the eye due to thinning of tectonics).
• This successful operation indicated that the use of equine pericardium for an off-label purpose, in this case, was feasible and effective in reinforcing the sclera in severe scleromalacia perforans.