Scleral Thinning After Pterygium Surgery Treated With Scleral Patch

To describe a patient with scleral thinning after pterygium excision with mitomycin C (MMC) treated with scleral patch.

It is known that scleral thinning is one of the late complications after pterygium surgery followed by the use of adjuvant topical of mitomycin C  for preventing its recurrence. The case has been reported at Visioclíncia, a private clinic in Caxias do Sul, Brazil.

A 64 years-old women complaining of discomfort, foreing body sensation and tearing in her right eye (OR) that began one year after she was submitted to a surgery for pterygium excision associated with adjuvant topical mitomycin. She reported that, after the first procedure, she had two more surgeries to correct the scleral thinning using conjunctival flap without solving the thinning.

The best corrected visual acuity (BCVA) was 20/20 in both eyes (OU). In OR it was observed an area  of avascular limbus extending from 1 to 4 o’clock, scleral thinning of 50% in the nasal portion, adjacent to the limbus, measuring 3x2cm, where was possible to observe the choroidal tissue through the thinning. Above this area, a keratotic plaque was present without retaining fluorescein dye. Other aspects of ophthalmologic exam were normal.

Because of the patient's symptoms and the scleral thinning, a procedure was performed for remove the keratotic plaque associated with scleral patch sutured with nylon 10-0 and covered by rotational flap from the adjacent conjunctiva sutured with vicryl 7-0.

The surgery occurred without complications and for the postoperative period was prescribed an association of antibiotic and dexamethasone and intense lubrication with preserve-free drops and ointment until complete epithelization.

After one month, the limbus was revascularized, the scleral thining was solved and the patient had no more symptoms regarding ocular surface.

Scleral thinning after pterygium surgery associated with adjuvant MMC it’s a rare complication and its acknowledgment and managing is of fundamental importance. The sclera can be used as a patch to perform different kinds of ocular surface thinning with excellent results.