Autogenous lamellar scleral graft in the treatment of scleral melt after pterygium surgery

We report a case series of three patients who developed scleral melting 18-26 months after pterygium removal with beta-irradiation that refused to use any donor tissue. All patients presented with constant pain, redness and foreign body sensation on their eye. Initial evaluation revealed the presence of an area of scleral melt and epithelial defect with an underlying calcific plaque over the necrotic area in the nasal conjunctiva. Fluorescein staining and pooling was present at the base of the defect, indicating epithelial loss, in two patients. No signs of infection were present, and screening for associated systemic risk factors for melting was negative in all cases. The patients refused to use any kind of donor tissue to cover the area of melting. An autogenous lamellar scleral graft harvested from the superotemporal quadrant and an advancement of the nasal tenon was used. The use of autologous sclera and tenon has been described in the treatment of avulsive corneoscleral wounds and corneal fistulas. This case series describes the successful management of scleral melting with autogenous tissues.