“SCLERAL THINNING AFTER PTERYGIUM EXCISION: CLINICAL COURSE, MANAGEMENT, AND ANTERIOR SEGMENT OCULAR TOMOGRAPHY (AS-OCT) MONITORING”

To describe two cases of scleral thinning following pterygium excision surgery, their clinical course, therapeutic management, and possible etiology.

Two male patients, aged 68 and 60 years, underwent pterygium excision with conjunctival autografts fixed using fibrin tissue adhesive at a terciary hospital. All procedures were performed by the same experienced surgeon. No cauterization or adjuvant therapy was used. The postoperative day 1 examination was uneventful. Postoperative treatment included topical tobramycin + dexamethasone eye drops four times daily, and at night, hydrocortisone + oxytetracycline ointment for one week.

*Case 1:* The first patient presented with a double pterygium. Ten days after surgery, two round areas of scleral thinning (40% of normal thickness) were observed: a 2.0 mm lesion on the nasal side and a 1.5 mm lesion on the temporal side. There were no signs of inflammation or pain. Topical corticosteroids were discontinued, and occlusion therapy with aureomycin ointment was started. After 24 hours of improvement, treatment was continued with aureomycin ointment three times daily and nighttime ocular occlusion with ointment.

*Case 2:* Ten days after surgery, an oval corneoscleral thinning (50% of normal thickness, 2.5 mm diameter in the nasal area) and loss of the conjunctival graft were observed, without signs of inflammation or pain. Corticosteroids were discontinued, and occlusion therapy with aureomycin ointment was initiated. Full central thickness recovery required 10 days of continuous occlusion, after which treatment continued with aureomycin ointment three times daily and nocturnal occlusion.

Both cases were followed up using slit-lamp examination and anterior segment OCT (AS-OCT).

After one week of treatment, partial recovery of scleral thickness was observed, although scleral exposure persisted. After one month of conservative management and close follow-up, complete scleral and conjunctival normalization was achieved in both cases.

Scleral thinning is a rare complication following pterygium surgery, even when using conjunctival autografts and fibrin adhesive without adjuvant therapies. Although the precise cause of these cases remains unknown, a review of the literature suggests possible ischemia related to extensive double pterygium surgery and the use of topical corticosteroid ointment. Intensive conservative treatment can achieve full recovery, and AS-OCT is a valuable tool for monitoring scleral thickness