Etiology, surgical management, and outcomes of patients with scleral thinning

This study aimed to analyze the etiological spectrum, surgical management strategies, and clinical outcomes of patients with scleral thinning and summarize individualized treatment principles based on lesion characteristics and systemic conditions. In this retrospective observational case series of 14 patients (16 eyes) diagnosed with scleral thinning, patient data on demographics, etiology, clinical presentation, surgical details, and outcomes were collected. Treatment strategies were individualized based on lesion location, extent, corneal involvement, and conjunctival status. Etiologies were congenital (18.75%), surgery/trauma-related (43.75%), immune-mediated (18.75%), inflammatory (12.5%), and idiopathic (6.25%), with four cases involving multiple factors. Surgical repair was performed in 11 eyes using scleral patch grafts (18.2%), anterior lamellar corneal grafts (45.4%), or double lamellar keratoplasty (36.4%), with adjunctive procedures (conjunctival flap or amniotic membrane transplantation) performed in 6 cases. Globe integrity was successfully restored in all surgical cases with normal intraocular pressure. Final best-corrected visual acuity improved or remained stable in 9 of the 11 cases. Four cases developed postoperative graft rejection or melting, which was associated with systemic autoimmune activity or poor medication adherence, with two requiring surgical reintervention. Management of scleral thinning requires a comprehensive etiological assessment and an individualized surgical plan based on lesion characteristics. Postoperative outcomes appear to be influenced by systemic immune status and patient compliance.