Within the eyes, neoplastic lymphocytes had expanded and effaced the iris leaflets, ciliary body, and the choroid (Fig 2) infiltrating the sclera and episclera
near the optic nerve, with additional multifocal regions of conjunctival involvement.
There is usually an area of inflammation of the conjunctiva, episclera
or sclera adjacent to the area of crescent-shaped peripheral corneal ulceration and thinning.
As the sclera was absent due to penetrating sclerectomy, the fibroblasts migrated from the choroid and the episclera
(Figure 2B) to the choroidal and conjunctival faces, respectively, through a fibrin net.
The graft was sutured using 8-0 vicryl interrupted sutures with the bites incorporating the episclera
at limbal side.
1) The episclera
is a fibroelastic structure covering the sclera and is formed of two layers loosely joined together by connecting fibres.
Ocular/Oculodermal melanocytosis: Ocular or oculodermal melanocytosis is a condition characterized by hyperpigmentation of the episclera
, uvea and skin, and is more common in black, Hispanic and Asian populations.
5% of cases due to inadvertent trauma to conjunctival vessels and inadequate hemostasis, tenon's granuloma in 5% of patients due to inadvertent removal of tenon's along with graft and suturing of graft only to adjacent conjunctiva not with episclera
and graft rejection in 5% of cases.
b) The radial nature of the blood vessels indicates that the condition affects the episclera
Both grafts were sutured to the surrounding conjunctiva with a shallow pass through the episclera
using 8/0 vicryl (Figure 2).
It might be due to inadvertent removal of tenon's tissue along with graft and suturing of graft only to adjacent conjunctiva not with episclera
It represents melanocytes that migrate into the sclera, the episclera
or the substantia propria but do not reach the epithelium.
The medial edge of the graft was sutured with 2-4 additional sutures, preferably including episclera