Sharma Bharti, Bajoria Sushil Kumar, Patnaik Abhishek, Barbhaya Ravi
Ophthalmology, Tata Main Hospital, Jamshedpur, IND.
Ophthalmology, RDB Eye Care, Jamshedpur, IND.
Cureus. 2020 May 23;12(5):e8250. doi: 10.7759/cureus.8250.
Corneal dellen are a rare and serious complication after primary pterygium surgery with conjunctival limbal autograft (CLAG) with fibrin glue without antimetabolites. Dellen are caused by interruptions of the tear film and local dehydration of the cornea. If untreated, they may lead to corneal perforation. We describe the case of a patient who developed corneal dellen 15 days after uneventful pterygium excision with CLAG with fibrin glue without the use of antimetabolites. There was no satisfactory response to lubricants and patching, and the patient had no associated systemic risk factors. As the thinning increased, cyanoacrylate glue with bandage contact lens was applied, but the dellen reappeared seven days after glue removal. Dellen finally resolved with thermal punctal cautery applied to both puncta. Dellen most commonly respond to artificial tears, antibiotic ointment, and patch application. However, in refractory cases, punctal cauterization can be considered as a good option to increase tear pooling in the area of dellen, thereby promoting healing.
角膜小凹是原发性翼状胬肉手术联合结膜角膜缘自体移植术（CLAG）并使用纤维蛋白胶且未使用抗代谢药物后罕见且严重的并发症。角膜小凹由泪膜中断和角膜局部脱水引起。若不治疗，可能导致角膜穿孔。我们描述了一例患者的病例，该患者在接受使用纤维蛋白胶且未使用抗代谢药物的CLAG进行翼状胬肉切除术后15天出现角膜小凹。使用润滑剂和眼罩治疗效果不佳，且患者无相关全身危险因素。随着角膜变薄加剧，应用了氰基丙烯酸酯胶和绷带式隐形眼镜，但在去除胶水7天后角膜小凹再次出现。最终通过对双眼泪小点进行热烧灼，角膜小凹得以消退。角膜小凹最常见的应对方法是使用人工泪液、抗生素眼膏和眼罩。然而，在难治性病例中，泪小点烧灼可被视为增加角膜小凹区域泪液积聚从而促进愈合的良好选择。
