title: Acute scleral thinning after pterygium excision with intraoperative mitomycin C: a case report of scleral dellen after bare sclera technique and review of the literature.
abstract: OBJECTIVE
  To describe a patient with scleral dellen after pterygium excision with intraoperative mitomycin C.
  
  
  METHODS
  Case report and MEDLINE review of the medical literature on scleral dellen after bare sclera technique.
  
  
  RESULTS
  A 48-year-old man had a left nasal pterygium excised by the bare sclera technique with intraoperative mitomycin C. Eight days after surgery, the patient noticed a small black spot in the bare sclera area with mild irritation. Slit-lamp examination revealed a focal area of extreme thinning, centered on the nonepithelialized bare sclera, surrounded by edematous conjunctiva. The ciliary body was visible through the thin and dry scleral lesion. After topical lubricant therapy, the scleral lesion appeared normal thickness and white in color 3 days later. Therapy was continued until the sclera epithelialized.
  
  
  CONCLUSIONS
  Scleral dellen is an early postoperative complication of bare sclera technique owing to delayed conjunctival wound closure. Hydration of the thinned sclera will rapidly thicken it. However, medical therapy should be continued until the surrounding conjunctiva has flattened and the sclera has epithelialized. Surgical wound closure is an alternative management and may be the way to prevent scleral dellen formation after bare sclera technique. All patients after bare sclera surgery should be followed up until the conjunctival wound has healed. If delayed healing is found, frequent artificial tears, patching, or surgical intervention is necessary.
authors.affiliation: Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan. yiyutsai@seed.net.tw
authors.forename: Yi-Yu
authors.initials: YY
authors.lastname: Tsai
authors.forename: Jane-Ming
authors.initials: JM
authors.lastname: Lin
authors.forename: Jium-Dar
authors.initials: JD
authors.lastname: Shy
mesh_terms: D000208:Acute Disease; D006801:Humans; D007432:Intraoperative Period; D007785:Lactose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008153:Lubrication; D008297:Male; D008747:Methylcellulose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D010078:Oxazines; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy; D011625:Pterygium / Q000188:drug therapy* / Q000601:surgery*; D012590:Sclera / Q000187:drug effects / Q000473:pathology*; D015422:Scleral Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014945:Wound Healing / Q000187:drug effects
chemical_list: D010078:Oxazines; D016685:Mitomycin; D008747:Methylcellulose; C071191:MK 458; D007785:Lactose