Dellen and corneal perforation after bilateral pterygium excision in a patient with no risk factors

Abstract

Corneal perforation associated with dellen is a rare but serious complication of a primary pterygium excision. In this case report, we describe a 60-year-old man who underwent a corneal perforation in the centre of corneal dellen in his right eye and corneal dellen in his left eye after the surgical treatment of a bilateral pterygium with a bare sclera technique without adjunctive therapy. He was successfully treated with lamellar keratoplasty in his right eye and a conservative approach in his left eye, consisting of the use of artificial tears, antibiotic ointment and a patch. The clinical evidence from this brief interventional case report indicates that topical lubricants are proper therapy for corneal dellen. However, if corneal perforation is observed, lamellar keratoplasty is a good option.

Figure 1

Lamellar keratoplasty as a treatment of corneal perforation associated with dellen after primary pterygium excision. (A) Slit-lamp examination of the right eye reveals a focal area of extreme thinning in the nasal region of the cornea (dellen) surrounded by an oedematous area. In the centre of the dellen, a corneal perforation with a uveal prolapse is noted. (B) The corneal perforation was resolved with lamellar keratoplasty using 10–0 nylon sutures. Good graft survival was noted 6 months after surgery.