Surgical Treatment of Scleral Ulceration as a Complication of Pterygium Excision

ABSTRACT

Mitomycin C is now being used not only as an adjunct in the surgical treatment of pterygia but also in glaucoma surgery. However, several serious complications that are possibly related to mitomycin C treatment have been reported. We report on a series of 8 patients(10 eyes) who experienced scleral ulcer after pterygium excision. The period from operation to onset of scleral ulcer was between 5 months and 20 years. Complications included corneoscleral perf oration(1 eye), scleral ulceration(9 eyes), corneal ulceration(2 eyes), complicated cataract(5 eyes) and uveitis(4 eyes). We used autogenous temporalis fascia to reinforce the weakened lesion of 10 eyes with scleral or corneoscleral ulceration. Three eyes underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation after stable grafting. Grafts remained stable in 9 eyes over a mean follow-up of 10.8 +/- 10.4 months(3 to 37 months). One graft melted but regrafting salvaged the eye. Six of 10 eyes improved vision. All patients resolved their subjective symptoms after temporalis fascia grafting. We found autogenous temporalis fascia grafting is efficacious in both treating and preventing ocular perforation due to progressively destructive scleral ulceration.