Corneal Dellen and Scleral Melt Induced following Phacoemulsification Surgery and Bare Sclera Pterygium Excision: A Case Report

Document Type : Case Reports


1 Department of Ophthalmology, Muzaffarnagar Medical College, Atal Bihari Vajpayee Medical University, Lucknow, India

2 Department of Pathology, Venkatashwara Institute of Medical Sciences, Shri Venkateshwara University, Gajraula, India


Scleral thinning and delayed conjunctival regeneration can be found after bare sclera pterygium excision. A 63-year-old male was admitted in our department for left eye cataract and grade II nasal pterygium surgery in the same sitting. Pterygium excision was done without putting graft or adjuvant treatment. After two weeks of surgery, the patient presented with scleral thinning and corneal dellen at the site of the pterygium excision. The scleral thinning was deep enough to show the uveal tissue through its base. Successful management was done with topical and oral medications for six weeks. Bare sclera pterygium excision should not be practiced along with cataract surgery. It should be performed in two different sittings, or conjunctival autograft or amniotic membrane graft should cover the bare area. Steroid drops may also slow healing and induce iatrogenic scleral necrosis leading to dreaded consequences.


Main Subjects

[1] Madanagopalan VG, Shivananda N, Krishnan T. Surgically induced necrotizing scleritis after retinal detachment surgery masquerading as scleral abscess. GMS Ophthalmology Cases. 2019;9.
[2] Doshi RR, Harocopos GJ, Schwab IR, Cunningham Jr ET. The spectrum of postoperative scleral necrosis. Survey of ophthalmology. 2013;58(6):620-33.
[3] Yamada T, Mochizuki H, Ue T, Kiuchi Y, Takahashi Y, Oinaka M. Comparative study of different β-radiation doses for preventing pterygium recurrence. International Journal of Radiation Oncology* Biology* Physics. 2011;81(5):1394-8.
[4] Hovanesian JA, Starr CE, Vroman DT, Mah FS, Gomes JA, Farid M, Shamie N, Davidson RS, John T, Holland EJ, Kim T. Surgical techniques and adjuvants for the management of primary and recurrent pterygia. Journal of Cataract & Refractive Surgery. 2017;43(3):405-19.
[5] Kodavoor SK, Preethi V, Dandapani R. Profile of complications in pterygium surgery-A retrospective analysis. Indian Journal of Ophthalmology. 2021;69(7):1697-1701.
[6] Sultan D, Alnema O, Sultan MN, Zahlouk N, Kayyali A. A case of resistant scleral thinning following uneventful pterygium surgery: A case report and a literature review. International Journal of Surgery Case Reports. 2022;95:107223.
[7] Alrawashdeh HM, Al-Habahbeh O. Bilateral surgically induced necrotizing scleritis after pterygium excision with conjunctival autograft: a case report. Oman Medical Journal. 2022;37(4):e399.
[8] Okita S, Ishikawa H, Abe A, Ito S, Nakazono K, Murasawa A, Nishida K, Ozaki T. Risk factors of postoperative delayed wound healing in patients with rheumatoid arthritis treated with a biological agent. Modern rheumatology. 2021;31(3):587-92.
[9] Kadota Y, Nishida K, Hashizume K, Nasu Y, Nakahara R, Kanazawa T, Ozawa M, Harada R, Machida T, Ozaki T. Risk factors for surgical site infection and delayed wound healing after orthopedic surgery in rheumatoid arthritis patients. Modern Rheumatology. 2016;26(1):68-74.
[10] Accorinti M, Gilardi M, Giubilei M, De Geronimo D, Iannetti L. Corneal and scleral dellen after an uneventful pterygium surgery and a febrile episode. Case Reports in Ophthalmology. 2014;5(1):111-5.
[11] Linaburg T, Choi D, Bunya VY, Massaro-Giordano M, Briceno CA. Systematic Review: The Effects of Pterygium and Pingueculum on The Ocular Surface and the Efficacy of Surgical Excision. Cornea. 2021;40(2):258-67.
[12] Fu-Shin XY, Lee PS, Yang L, Gao N, Zhang Y, Ljubimov AV, Yang E, Zhou Q, Xie L. The impact of sensory neuropathy and inflammation on epithelial wound healing in diabetic corneas. Progress in Retinal and Eye Research. 2022:101039.
[13] Chavhan P, Stephen M, Babu KR, Pragathi S. An unusual case of scleral thinning with uveal exposure following pterygium surgery and its management. Kerala Journal of Ophthalmology. 2021;33(1):75-7.
[14] Sharma B, Bajoria SK, Patnaik A, Barbhaya R. Resolution of corneal dellen after an uneventful pterygium surgery with punctal cautery. Cureus. 2020;12(5):e8250.
Volume 5, Issue 1
March 2023
Pages 57-60
  • Receive Date: 19 January 2023
  • Revise Date: 27 February 2023
  • Accept Date: 02 March 2023
  • First Publish Date: 06 March 2023