Tarsoconjunctival flap for scleromalacia related to treatments for conjunctival melanoma

Paul T Finger; Harsha S Reddy; Abhilasha Maheshwari

doi:10.1016/j.ajoc.2023.101805

Tarsoconjunctival flap for scleromalacia related to treatments for conjunctival melanoma

Am J Ophthalmol Case Rep. 2023 Jan 18:29:101805. doi: 10.1016/j.ajoc.2023.101805. eCollection 2023 Mar.

Authors

Paul T Finger^{1

2}, Harsha S Reddy², Abhilasha Maheshwari¹

Affiliations

¹ Department of Ocular Tumor, Orbital Disease and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York City, New York, USA.
² The Divisions of Ophthalmic Plastic Surgery and Ocular Oncology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.

Abstract

Purpose: To describe the use of a tarsoconjunctival pedicle flap for the repair of scleral melt secondary to treatment of conjunctival melanoma.

Observation: A 67-year-old woman developed progressive scleromalacia after multiple treatments for an American Joint Committee on Cancer cT2d category conjunctival melanoma. Prior to referral, she underwent synchronous topical chemotherapy (interferon, 5-fluorouracil, mitomycin). Then, incomplete tumor regression led to excision with adjuvant cryotherapy. Lastly, systemic metastasis treated with systemic immunotherapy provided durable remission. However, her multiple treatments (e.g., topical chemotherapy, resection, cryotherapy) were associated with progressive nasal bulbar scleromalacia treated by conjunctival advancement and amniotic membrane grafts. Sclera reinforcement was achieved after a tarsoconjunctival flap was affixed to the eye to cover, and thus vascularize the scleral defect. The tarsoconjunctival flap provided 5 years of tectonic support.

Conclusions and importance: Tarsoconjunctival pedicle flaps can provide scleral integrity for a patient with progressive scleral melting.

Keywords: Flap; Ocular surface surgery; Scleromalacia; Tectonic.

Publication types

Case Reports