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Self-retained, cryopreserved amniotic membrane for a scleral defect caused by mitomycin C: A case report
Brett Bielory1,2,3,4
1New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
Purpose:
To report a case of scleral melting noted within weeks after symblepharon release and pterygium excision with peri-operative adjuvant topical Mitomycin C (MMC) that was salvaged with in-office cryopreserved membrane.
Observations:
A 61-year-old Hispanic gentleman with history of pterygium excision many years prior underwent right nasal pterygium excision and symblepharon release using bare sclera technique followed by topical MMC 0.1 % for a week, 16 years ago. He was noted to have a right nasal scleral thinning. He was successfully treated conservatively with in-office cryopreserved amniotic membrane without further progression of the scleral melting or surgical intervention required.
Conclusions And Importance:
Short-term complication of pterygium excision with adjuvant topical MMC may occur. This case shows that early detection and recognition of the complication can be sight-saving with in-office cryopreserved amniotic membrane.
Insights
Scleral melting, a rare complication after pterygium excision with Mitomycin C (MMC), can be effectively treated with amniotic membrane. Early intervention with this method can save sight and prevent further surgical needs.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Ocular Surface Disease
Background:
- Pterygium excision with symblepharon release using the bare sclera technique is a common ophthalmic procedure.
- Adjuvant topical Mitomycin C (MMC) is frequently used to reduce recurrence rates after pterygium surgery.
- While generally safe, MMC can be associated with potential complications, including scleral thinning or melting.
Observation:
- A 61-year-old gentleman developed significant scleral thinning weeks after undergoing pterygium excision and symblepharon release with peri-operative topical Mitomycin C (MMC).
- The patient had a history of prior pterygium surgery.
- The scleral thinning was noted in the nasal quadrant of the right eye.
Findings:
- The scleral melting was successfully managed conservatively using an in-office application of cryopreserved amniotic membrane.
- No further progression of the scleral melting was observed post-treatment.
- The patient did not require additional surgical intervention.
Implications:
- This case highlights a rare but serious short-term complication of pterygium excision with adjuvant topical MMC.
- Early detection and prompt management are crucial for salvaging vision in cases of scleral melting.
- In-office cryopreserved amniotic membrane serves as an effective, non-surgical treatment option for this sight-threatening complication.
