Scleral Dellen: Early Complication Of Pterygium Surgery And Literature Review

Abstract

Introduction : Severe Scleral Dellen is a rare and early postoperative complication of pterygium surgery. The various cases reported in the literature are mostly related to this surgical technique; simple excision of the conjunctiva, notably either without adjuvant treatment or using mitomycyine C in preoperative or otherwise beta radiation. The particularity of our case is that the scleral Dellen is associated with excision and simple suture of the conjunctiva without adjuvant treatment or cauterization of the vessels. The other particularity of this case is that it is to our knowledge the first case of scleral dellen reported in Morocco, and even at the African level. Case report This case is a 38-year-old military patient with no medical history The patient was scheduled for pterygium surgery. 16 days later, the patient came back after noticing the appearance of a blackish brown spot at the nasal side of the right eye associated with mild eye pain. The slit lamp examination of the involved eye revealed a severe scleral thining, surrounded by an oedematous conjunctiva and the visualization of the ciliary body through the fine sclera. The conjunctival sutures were no longer in place. After three days and with treatement, we observed a scleral cicatrization, followed by a gradual covering of the sclera by conjunctiva. Discussion : In our case as in that described by Garcia-Medina and collaborators, we performed a conjunctival suture with two stitches to cover the sclera. Otherwise, both of the stitches were not found later, which suggests that, like in the Garcia-Medina report; a bad handling by the patient  (eye rubbing), loose stitches or even both. Thus, the sclera would have been exposed in the two cases. Regarding the treatment of this complication, the graft of a conjunctival flap was performed in two cases with favorable evolution. In all other cases, only medical treatment has been successfully initiated. In our case we opted for medical treatment only, including local antibiotic therapy, intensive lubrication with artificial tears (hourly drop) and the occlusion of the eye. The evolution was also favorable under this treatment. Hence, our case is similar to the Garcias-Medina and collaborators one, concerning the surgical technique, and also the scleral Dellen treatment. Although the difference and the particularity of our case was the absence of cauterization use during the surgical act. Conclusion: Scleral Dellen is rare complication of pterygium surgery, which occurs early after the surgical act. Its exact physiopathology remains unknown, but some factors may be incriminated; first of them is the surgical technique as a simple excision with exposed sclera. This complication can occur in patients, without any particular medical or ophthalmological history or any underlying pathology. It could also occur for primary pterygium. Medical treatment alone may be appropriate to manage this complication.