Fungal Sclero Keratitis Following Pterygium Excision With Mitomycin Application : A Case Report

Use of Mitomycin C in pterygium surgery may present with serious post-operative complications like scleral melting. The authors report a case of severe fungal sclero-keratitis with scleral melting presenting two months after the patient had undergone pterygium excision with intra operative mitomycin application.

Hospital setting

A step wise management of a case of severe sclero-corneal melting complicated with corneal perforation and superadded fungal infection was done. The case underwent therapeutic keraoplasty for the corneal perforation and lamellar corneal grafting for the scleral melt. The corneal graft over the sclera melted and was managed by  preparation of the scleral bed with antifungals. Scleral patch graft  was done subsequently for tectonic support over the scleral thinning . The case highlights the difficulties in surgical management of a post-mitomycin scleral melt due to altered sclero-conjunctival anatomy. 

The ocular integrity was  restored with multiple surgeries with restoration of vision of finger counting at one meter. 

Large post-mitomycin scleral melts can be well managed with planned surgeries and adjuvant conservative measures. The use of mitomycin C is not without risk and is best avoided in primary pterygium surgery