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SUMMARY
A case of scleromalacia perforans in a 60-year-old white male without any associated systemic disease is reported. The patient had central retinal artery occlusion and Mooren's type of peripheral corneal degeneration in this eye preceding the development of scleromalacia.
Various modalities of treatment, both medical and surgical, have been described in the literature and among surgical procedures various tissues were used as graft material in the areas of scleral thinning. We chose periosteum as the graft material on the basis of our experience with it in cases of "through-and-through" keratoprosthesis and the result has been very encouraging. Though our experience is limited to only one case, we feel that periosteum as graft material has a place in cases of scleromalacia.
Scleromalacia perforane is a condition characterized clinically by progressive melting of the sclera with secondary exposure and ectasia of the underlying uveal tissue. This condition is often associated with rheumatoid arthritis, and has its greatest incidence in post me p opa u sa I females.' The lesions may develop from pre-existing scierai nodules whose microscopic appearance resembles that of the rheumatoid nodule. The prognosis of this condition continues to be poor despite various medical and surgical modalities of treatment.1'18 The purpose of this communication is to discuss the role of periosteum as a graft material and to report a case of scleromalacia perforane in an eye with central retinal artery occlusion and Mooren's corneal degeneration successfully treated with a periosteal graft.
CASE REPORT
This 60-year-old white male was first seen by us on September 2, 1975. He was initially seen by his ophthalmologist in August 1973 with a history of sudden loss of vision in his left eye and was found to have a central retinal artery occlusion. The vision in his rig ht eye had al ways been poor following an injury sustained during his youth.
In October 1973 he was noted to have a 3+ injection of conjunctiva and sclera of his left eye and was given Maxitrol drops locally only with limited success. He sustained an episode of elevated intraocular pressure in both eyes in December 1973 which was recorded at 42 mm Hg in the right eye and 70 mm Hg in the left eye. This was controlled...