Gone through a rough patch: Fixing a large overhanging intercalary staphylomain lepromatous leprosy

Background: Lepromatous scleritis is usually a recurrent entity, rarely leading to structural complications like outpouching of uveal tissue through a hanging intercalary staphyloma. The scleral deroofing procedure and tectonic patch graft under anti‑leprosy drugs may be an effective treatment alternative. Purpose: To describe surgical management of a large intercalary staphyloma in an inadequately treated systemic Hansen’s disease. Synopsis: A 55‑year‑old male with treatment naïve leprosy for 10 years presented with sclerouveitis. He was started on anti‑leprosy treatment with oral steroids, leading to the resolution of scleral inflammation. He discontinued medications a month later and was lost to follow up for 8 months when he presented with scleritis and intercalary staphyloma. Under cover of topical steroids, cycloplegia, and restarting anti‑leprosy drugs, the patient underwent scleral deroofing with a scleral patch graft procedure. An overhanging intercalary staphyloma was dealt with by excising the overlying conjunctiva and anomalous scleral complex. Double freeze‑thaw cryotherapy for minimizing bleeding during the excision maneuver was used. The scleral defect was approximated with double breasting of tissue with ragged edges using absorbable 7–0 polyglactin sutures. An additional overlying scleral patch graft of size 5 × 4 mm was sutured to the sclera to maintain tectonic integrity of the globe. A bandage contact lens over the cornea and adjacent limbus was placed. During subsequent visits, the scleral patch graft was intact and well‑integrated along with a formed anterior chamber. Highlights: 1. Inadequately treated leprosy can present with vision‑hampering, overhanging intercalary staphylomas, a complication of scleritis. 2. Systemic management of leprosy is the cornerstone of therapy; however, surgical correction of such lesions may be required. 3. An overhanging intercalary staphyloma can be managed by excision of anomalous sclera with scleral patch grafts to offer tectonic support.