The Development of Scleromalacia after Regional Conjunctivectomy with the Postoperative Application of Mitomycin C as an Adjuvant Therapy
A healthy 40-year-old woman visited our clinic with complaints of ocular discomfort in both eyes. There was no documented history suggestive of connective tissue disease or any systemic disease. Six months prior to this presentation, she had undergone a bilateral regional conjunctivectomy to treat a chronic hyperemic conjunctiva. Following this procedure, she was started on a regimen of 0.2 mg/mL (0.02%) MMC eye drops four times daily for 5 days. The patient's best-corrected visual acuity was 20 / 25 in both eyes. Based on the results from the slit-lamp examination, the conjunctiva and Tenon's capsule on the nasal and lateral bulbar area were excised. Slit-lamp examination also revealed marked scleral thinning and a bluish hue due to seeing the underlying choroid layer which measured 8 × 4 mm in the temporal portion of her right eye and 8 × 3 mm in the temporal portion of her left eye (). There were a 3 × 1.7 mm sized yellowish-white calcified plaque on the nasal bulbar conjunctiva of her right eye and a 1.5 × 0.5 mm sized yellowish-white calcified plaque on the nasal bulbar conjunctiva of her left eye (). In addition, we found that the bare sclera was covered with a thin abnormal membranous tissue. There were no fluorescence stained lesions overlying the membranous tissue in either of her eyes (). She began conservative treatment with antibiotics and artificial eye drops. The condition of the calcified plaque seemed to stabilize over the course of the next several weeks, and the area of scleral melting did not show any further deterioration. However, there was a newly developed fluorescence stained lesion on the calcified plaques (). Fifteen months later, the thinned scleral area and fluorescence stained lesions showed no significant interval change (). Because the scleral melting did not show any further deterioration during the following fifteen months, and aggressive surgical intervention might not have been helpful for improving her lesions, we decided to continue regular follow-ups and non-surgical treatment.