Tsai Yi-Yu, Lin Jane-Ming, Shy Jium-Dar
Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan.
Cornea. 2002 Mar;21(2):227-9. doi: 10.1097/00003226-200203000-00022.
To describe a patient with scleral dellen after pterygium excision with intraoperative mitomycin C.
Case report and MEDLINE review of the medical literature on scleral dellen after bare sclera technique.
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.
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.
描述1例翼状胬肉切除术中使用丝裂霉素C后发生巩膜变薄区的患者。
病例报告及对巩膜裸露技术后巩膜变薄区的医学文献进行MEDLINE检索。
一名48岁男性采用巩膜裸露技术并在术中使用丝裂霉素C切除左侧鼻侧翼状胬肉。术后8天，患者注意到巩膜裸露区有一个小黑点，伴有轻度刺激感。裂隙灯检查发现一个局限性极度变薄区域，以未上皮化的巩膜裸露区为中心，周围是水肿的结膜。通过薄而干燥的巩膜病变可看到睫状体。局部应用润滑剂治疗3天后，巩膜病变厚度恢复正常且颜色变白。持续治疗直至巩膜上皮化。
巩膜变薄区是巩膜裸露技术术后的早期并发症，是由于结膜伤口闭合延迟所致。变薄巩膜的水化会使其迅速增厚。然而，应持续药物治疗直至周围结膜变平且巩膜上皮化。手术缝合伤口是另一种处理方法，可能是预防巩膜裸露技术后巩膜变薄区形成的方法。所有巩膜裸露手术后的患者都应随访至结膜伤口愈合。如果发现愈合延迟，需要频繁使用人工泪液、眼部包扎或手术干预。
