Oral Mucosa as a Treatment Option in Perforating Scleral Necrosis after Proton Beam Radiation Therapy

Background

Scleral necrosis is a rare post-radiogenic complication with a mean onset between 32 and 70.4 months after radiotherapy [1]. Protrusion of a previously irradiated tumor mass after plaque therapy has already been described [2], but it is very rare after proton beam therapy. In plaque therapy, the largest radiation dose is applied on the sclera, whereas in proton beam radiotherapy, the main radiation dose reaches the intraocular tumor. There are different therapeutic options, such as scleral patch grafts [3], amniotic membrane grafts [4], or corneal grafts [5]. Oral mucosa grafts have been successfully used for eye lid reconstructions [6] as well as a cover in osteo-odonto-keratoprothesis [7]. As far as we know, an oral mucosa graft has not yet been used successfully in treating perforating scleral necrosis secondary to radiotherapy.

• References

• 1 Radin PP, Lumbroso-Le Rouic L, Levy-Gabriel C. et al. Scleral necrosis after radiation therapy after uveal melanoma: report of 23 cases. Graefes Arch Clin Exp Ophthalmol 2008; 246: 1731-1736
• 2 Kaliki S, Shields CL, Rojanaporn D. et al. Scleral necrosis after plaque radiotherapy of uveal melanoma: a case-control study. Ophthalmology 2013; 120: 1004-1011
• 3 Barman M, Finger PT, Milman T. Scleral patch grafts in the management of uveal and ocular surface tumors. Ophthalmology 2012; 119: 2631-2636
• 4 Hino T, Sotozono C, Inatomi T. et al. Indications and surgical outcomes of amniotic membrane transplantation. Nihon Ganka Gakkai Zasshi 2012; 116: 374-378
• 5 Naseripour M, Aghaei H, Sedaghat A. et al. Corneal patch graft: a new approach for scleral necrosis secondary to plaque radiotherapy. Cornea 2016; 35: 565-568
• 6 Fu Y, Liu J, Tseng SC. Oral mucosal graft to correct lid margin pathologic features in cicatricial ocular surface diseases. Am J Ophthalmol 2011; 152: 600-608
• 7 Berg BI, Hilber N, Hille K. et al. Der Zahn im Auge – die erste in der Schweiz eingebrachte Osteo-Odonto-Keratoprothese. Praxis 2013; 102: 545-548