Abstract
RATIONALE: Necrotic scleral melting presents a significant therapeutic challenge, especially when complicated by concurrent conditions like refractory glaucoma. Conventional repair materials often have limitations. This case report aimed to evaluate the long-term efficacy and safety of a novel approach: utilizing an allogeneic corneal intrastromal lenticule (typically discarded after small incision refractive lenticule extraction surgery) combined with an autologous conjunctival graft for repairing necrotic scleral melting in a complex patient with glaucoma. We specifically investigated the lenticule's potential for structural integration and its surprising role in aqueous humor drainage. PATIENT CONCERNS: A 29-year-old male with a history of congenital cataract surgery and multiple surgeries for retinal detachment and secondary glaucoma presented with necrotic scleral melting at the filtration site of a previous glaucoma surgery. The intraocular pressure was low due to the damage to the integrity of the eyeball. DIAGNOSIS AND INTERVENTION: Necrotic scleral melting is diagnosed. Surgical repair was performed using an allogeneic corneal intrastromal lenticule, extracted during small incision refractive lenticule extraction surgery, combined with an autologous conjunctival graft. OUTCOMES: At the 36-month follow-up, the globe remained structurally intact. Intraocular pressure stabilized within the normal range (9-14 mm Hg) without any hypotensive medication, significantly improved from the preoperative hypotony (5 mm Hg). Visual acuity improved from light perception to counting fingers. Imaging (optical coherence tomography, ultrasound biomicroscopy) demonstrated successful fusion of the lenticular graft with the surrounding scleral tissue and revealed the formation of a functional aqueous drainage channel within the supraciliary space. No rejection, infection, or graft melting occurred during the entire follow-up period. LESSONS: Corneal intrastromal lenticules may represent a novel and accessible solution for the treatment of scleral melting, offering not only effective structural repair but also functioning as a filtration pathway. This material demonstrated good long-term safety and efficacy, making it a promising option for managing complex scleral conditions.