Satisfaction from improved alignment may occasionally be overshadowed by unsightly scarring of the conjunctiva and the Tenon capsule. The tissues remain hyperemic and salmon pink instead of returning to their usual whiteness. This complication may occur as a result of the following:
Advancement of thickened Tenon capsule too close to the limbus. In resection procedures, pulling the muscle forward may advance the Tenon capsule. The undesirable result is exaggerated in reoperations, when the Tenon capsule may be hypertrophied.
Advancement of the plica semilunaris. During surgery on the medial rectus muscle using the limbal approach, the surgeon may mistake the plica semilunaris for a conjunctival edge and incorporate it into the closure. Though not strictly a conjunctival scar, the advanced plica, now pulled forward and hypertrophied, retains its fleshy color (Fig 14-6).
Figure 14-6 Hypertrophy involving the plica semilunaris.
(Courtesy of Scott Olitsky, MD.)
Treatment options include conjunctivoplasty with resection of scarred conjunctiva and transposition of adjacent conjunctiva, resection of subconjunctival fibrous tissue, recession of scarred conjunctiva, and amniotic membrane grafting.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.