Acute scleral thinning after pterygium excision with intraoperative mitomycin C: a case report of scleral dellen after bare sclera technique and review of the literature.
ABSTRACT To describe a patient with scleral dellen after pterygium excision with intraoperative mitomycin C.
Case report and MEDLINE review of the medical literature on scleral dellen after bare sclera technique.
A 48-year-old man had a left nasal pterygium excised by the bare sclera technique with intraoperative mitomycin C. Eight days after surgery, the patient noticed a small black spot in the bare sclera area with mild irritation. Slit-lamp examination revealed a focal area of extreme thinning, centered on the nonepithelialized bare sclera, surrounded by edematous conjunctiva. The ciliary body was visible through the thin and dry scleral lesion. After topical lubricant therapy, the scleral lesion appeared normal thickness and white in color 3 days later. Therapy was continued until the sclera epithelialized.
Scleral dellen is an early postoperative complication of bare sclera technique owing to delayed conjunctival wound closure. Hydration of the thinned sclera will rapidly thicken it. However, medical therapy should be continued until the surrounding conjunctiva has flattened and the sclera has epithelialized. Surgical wound closure is an alternative management and may be the way to prevent scleral dellen formation after bare sclera technique. All patients after bare sclera surgery should be followed up until the conjunctival wound has healed. If delayed healing is found, frequent artificial tears, patching, or surgical intervention is necessary.
- SourceAvailable from: Luis A Santiago-Cabán[Show abstract] [Hide abstract]
ABSTRACT: To report a case of delayed-onset bilateral scleral thinning and calcium deposition following a cosmetic ocular-whitening procedure (I-BRITE(®)). A 33-year-old male patient with a history of right-sided ptosis repair and left-sided anterior uveitis had previously undergone bilateral I-BRITE treatment for chronic conjunctival hyperemia. Four years after the procedure, the patient was referred to our institution with bilateral scleral thinning and overlying calcific depositions. A literature review was performed through PubMed from 1980 through 2014 using the search terms 'cosmetic', 'ocular', 'conjunctivectomy', 'regional conjunctivectomy', 'I-BRITE', 'eye-whitening', 'scleritis', 'necrotizing scleritis', 'anterior uveitis', 'mitomycin C', '5-fluorouracil', and 'bevacizumab', along with associated cross-referencing from relevant articles. Examination of the patient revealed bilateral necrotizing scleritis within the nasal region of both eyes. Calcified plaques were also present within the areas of scleromalacia, along with epithelial defects demonstrated with fluorescein staining. Although evidence of previous intraocular inflammation was apparent within the left eye, there were no active signs of inflammation evident within either eye on initial presentation. Complication rates reported in the literature include: scleral thinning (1.8%), calcific plaque formation (2.9%), fibrovascular proliferation (13%), diplopia (1.2%), elevation of intraocular pressure (4.2%), and recurrence of conjunctival hyperemia (2.1%). Cosmetic ocular whitening procedures have an attendant high complication rate, and have been associated with several adverse postoperative complications, which have in turn generated several reservations regarding the veritable benefit of the procedure. Many postsurgical complications may demonstrate delayed apparition, varying from several months to several years after primary surgical intervention as in the case reported here.Clinical ophthalmology (Auckland, N.Z.) 03/2015; 9:445-51. DOI:10.2147/OPTH.S78390
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ABSTRACT: The purpose of this study was to report outcomes of infectious scleritis after pterygium surgery, managed with antibiotic therapies and early scleral debridement. Retrospective chart review of 13 consecutive cases of infectious scleritis after pterygium excision between 1999 and 2009 was conducted. Collected data included prior medical and surgical history, latency period between pterygium surgery and presentation of infectious scleritis, culture and histopathologic findings, antibiotic regimen, length of hospital stay, visual acuity before and after treatment, and complications. Median follow-up was at 14 months. Twelve patients underwent prompt surgical debridement after infectious scleritis diagnosis (median, 2.5 days). Debridement was delayed in one patient. Median hospital stay was 3 days. Best-corrected visual acuity improved in ten patients, remained stable in one patient, and decreased in two patients following treatment. Complications included scleral thinning requiring scleral patch graft (1/13), glaucoma (3/13), and progression to phthisis bulbi (1/13). No patients required enucleation. In contrast to the generally poor outcomes in the literature, early surgical debridement of pterygium-associated infectious scleritis appears to offer improved prognosis.02/2012; 2(2):81-7. DOI:10.1007/s12348-012-0062-1
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ABSTRACT: We report necrotizing scleritis as a serious complication of a cosmetic eye whitening procedure that involves the use of intraoperative and postoperative topical mitomycin C. This is a single case report. A 59-year-old Caucasian male with a history of blepharitis status post uncomplicated LASIK refractive surgery reported chronic conjunctival hyperemia for 15 years prior to undergoing a cosmetic eye whitening procedure. He presented to our clinic 12 months after the cosmetic eye whitening procedure with progressive bilateral necrotizing scleritis and scleral calcification. Chronic conjunctival hyperemia may prompt patients to seek surgical correction with cosmetic eye whitening procedures. However, conjunctival hyperemia secondary to tear deficiency and evaporative dry eye may predispose to poor wound healing. Serious complications including necrotizing scleritis may result from cosmetic eye whitening procedures and the use of topical mitomycin C.02/2013; 3(1):39. DOI:10.1186/1869-5760-3-39