Purpose: The aim of this study was to investigate long-term clinical outcomes of conjunctival flap surgery for calcified scleromalacia after periocular surgery. Methods: We examined 73 surgical sites (nasal and/or temporal area) in 60 eyes from 43 patients who underwent conjunctival flap surgery for calcified scleromalacia arising from cosmetic wide conjunctivectomy or pterygium excision. Clinical outcomes, including the need for reoperation and development of complications, were evaluated over a long-term follow-up period. Morphological evaluations of the surgical area at final follow-up were performed using a total score for injection severity, ocular surface smoothness, and choroid visibility, and patients subjectively evaluated their cosmetic outcome using a scale of 0 (very poor) to 4 (excellent). Results: The mean follow-up duration after final conjunctival flap surgery was 26.5 ± 6.8 months (range, 15-52 months). There were no cases of progressive scleral thinning or serious complications such as flap necrosis or scleral perforation. Only 3 surgical areas with an inferior flap required additional flap placement because of avascular sclera exposure. Minor complications such as conjunctival cyst, edematous flap, vessel engorgement, and flap hypertrophy were easily treated or spontaneously improved. Mean morphological score was 2.2 and cosmetic outcome score was 2.9, indicating almost "good" outcomes. Conclusions: Based on our long-term experience, we propose that conjunctival flap surgery may be a safe and satisfactory treatment for complicated calcified scleromalacia after periocular surgery.
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