Posterior Rotational Tenon Flaps for Corneal and Scleral Sterile Stromalysis After Pterygium Surgery: A Case Report.

Abstract

Purpose: To report the management of progressive corneal and scleral stromalysis in a monocular patient after pterygium surgery with beta irradiation and highlight the effectiveness of posterior rotational Tenon flaps in restoring ocular integrity.

Methods: Single-case report conducted in Mexico.

Results: A 55-year-old man with a history of pterygium surgery and beta irradiation developed corneal and scleral stromalysis that was unresponsive to initial treatment, including oral steroids and intravenous rituximab. After confirming the avascular etiology, the patient underwent a corneal lamellar patch and posterior rotational Tenon flaps combined with conjunctival autografts. The follow-up evaluations included best-corrected visual acuity, intraocular pressure, and posterior segment optical coherence tomography.

Conclusions: Posterior rotational Tenon flaps successfully managed sterile scleral and corneal stromalysis associated with prior beta irradiation by reestablishing the vascular supply and restoring functional vision. Early recognition of the avascular etiology and avoidance of inappropriate immunosuppression are crucial for preventing further ocular damage.