title: Tarsoconjunctival pedicle flap for the management of a severe scleral melt.
abstract: OBJECTIVE
  To describe the use of a tarsoconjunctival pedicle flap for the repair of a large scleral melt in a patient with rheumatoid arthritis.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  A 36-year-old woman with a history of rheumatoid arthritis presented to the Rocky Mountain Lions Eye Institute with a large scleral melt in the right eye. Ophthalmic examination revealed a visual acuity of 20/400 and a superior scleral melt measuring 15 x 30 mm. After instituting systemic immunosuppression, a tarsoconjunctival pedicle was used to provide tectonic support to the globe. At her 3-month postoperative visit, her vision improved to 20/30, and the scleral melt was completely epithelialized.
  
  
  CONCLUSIONS
  A tarsoconjunctival pedicle flap provides an excellent alternative to help restore scleral integrity in patients with severe autoimmune necrotizing scleritis.
authors.affiliation: Department of Ophthalmology, Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine, Denver, CO 80041, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Davidson
authors.forename: Michael
authors.initials: M
authors.lastname: Erlanger
authors.forename: Michael
authors.initials: M
authors.lastname: Taravella
authors.forename: Darren G
authors.initials: DG
authors.lastname: Gregory
authors.forename: Vikram D
authors.initials: VD
authors.lastname: Durairaj
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications; D003228:Conjunctiva / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015423:Scleritis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012720:Severity of Illness Index; D013524:Surgical Flaps; D013536:Suture Techniques