Management of Extensive Corneoscleral Melt After Pterygium Surgery

1. Mohit Jain¹
2. Anita Panda¹
3. Anoop Kumar¹
4. Sasi Krishna¹

¹Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences,New Delhi, India.

Purpose: We report a series of scleral melting after pterygium surgery and their management with sclerocorneal patch graft.

Materials and method: This retrospective, noncomparative, interventional case series reviewed medical records of twenty eyes of twenty patients (male 13, female 7, mean age 52 ± 8.34 years) who underwent sclerocorneal patch graft at a tertiary care centre between 1982 and 2006 for corneoscleral melt following pterygium surgery. After removal of all the devitalized tissue, MK preserved sclerocorneal tissue was tailored to fit the recipient defect, adequately sutured and covered with either host conjunctiva (if sufficient) or amniotic membrane.

Results: Pre operatively sterile scleral melt was present in all but two who were associated with infection. Despite adequate pre operative control of infection, post graft reinfection was noted in one eye which was successfully managed with drugs. Recurrence of melting, leading to severe graft necrosis was noted in three eyes, two were managed successfully with regraft while one eye was lost. While anatomical success was achieved in 19/20 eyes, the functional gain varied from 20/80(7), 20/60 (8) and 20/30 (5)

Conclusion: This case series, the largest in world literature, revealed corneo scleral patch graft is a suitable approach to preserve globe integrity in severe scleral melting after pterygium surgery.