Flipped scleral flap surgery for reduction of ocular pigmentation in oculodermal melanosis

Abstract

PURPOSE: To report on surgical reduction of oculodermal melanosis in 6 patients presenting with severe episcleral pigmentation. METHODS: After informed consent was obtained, surgical reduction of ocular pigmentation with ocular dermal melanosis was performed on 3 children, 2 girls and 1 boy male, who were cosmetically handicapped. After conjunctival peritomy, rectangular scleral free flaps were created using lamellar dissection, usually in the nasal or temporal quadrants. The rectangles extended from just posterior to the rectus muscle insertion. These free flaps were flipped over and reattached to the scleral bed, hiding the episcleral pigmentation internally and resulting in a less pigmented surface being visible. The superficial scleral nevus and the nevus adjacent to the limbus were peeled using a blade. RESULTS: In all cases, episcleral pigmentation was reduced with satisfactory cosmetic improvement, but mild scleral pigmentation and conjunctival scarring remained. During the 37-month mean follow-up period, no complications were observed. CONCLUSIONS: Patients with oculodermal melanosis often complain of globe pigmentation as well as face pigmentation. Serial follow-up was needed because some reports indicate development of choroidal melanoma occurs in oculodermal melanosis. To the best of our knowledge, this is the first report of successful surgical reduction of ocular pigmentation in oculodermal melanosis.