Early-Onset Scleral Dellen After Primary Pterygium Excision: Consecutive Case Series And Management Algorithm
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR468 | Type: Free paper | DOI: 10.82333/4x21-a235
Authors: Dr Salma Hamidi* 1 , Dr Soukayna Ouadghiri 1 , Dr Younes Laarif 1 , Dr Oussama El Bassim 1 , A/Prof. Noureddine Boutimzine 1 , A/Prof. Lalla Ouafae Cherkaoui 1
1Ophtalmology A,Specialty Hospital of Rabat,RABAT,Morocco
Purpose
To describe the clinical characteristics, potential risk factors, management strategy, and outcomes of early-onset scleral dellen following primary pterygium excision, and to highlight preventive surgical considerations.
Setting
Tertiary referral center for corneal and ocular surface surgery.
Methods
Retrospective analysis of four consecutive male patients (38–65 years) who developed scleral dellen within 5–16 days after primary pterygium excision with conjunctival autograft. Mitomycin C was not used in any case. Surgical details, postoperative treatment, clinical presentation, management approach, and outcomes were reviewed. Initial management included intensive preservative-free lubrication, topical antibiotics, autologous serum 30%, and patching. Surgical intervention with amniotic membrane transplantation (AMT) was performed in cases of progressive deep thinning.
Results
All cases presented with localized scleral thinning without infection or systemic inflammatory disease. Mean time to onset was 11.8 days. Contributing factors included partial bare sclera exposure, graft instability, perilimbal cautery, and intensive postoperative steroid use.
Three patients (75%) responded to aggressive medical therapy, achieving complete epithelial and stromal recovery within four weeks. One patient (25%) with deep scleral thinning and uveal show required AMT, resulting in successful anatomical restoration. No residual scleral defects, perforation, or vision-threatening sequelae occurred.
Conclusions
Early-onset scleral dellen is a rare but potentially sight-threatening complication of pterygium surgery, typically occurring within the first two postoperative weeks.
Prompt recognition and a stepwise management approach—intensive lubrication, steroid adjustment, autologous serum, and timely AMT when indicated—lead to excellent outcomes.
Preventive strategies including complete scleral coverage, minimal cautery, secure graft fixation, and cautious steroid tapering are critical to reducing postoperative risk.