ESCRS - PO333 - Scleral Necrosis After Pterygium Surgery

Scleral Necrosis After Pterygium Surgery

Published 2022 - 40th Congress of the ESCRS

Reference: PO333 | Type: ESCRS 2022 - Posters | DOI: 10.82333/yz4n-8z38

Authors: Francesc March March De Ribot* 1 , Anna March de Ribot 1 , Teresa Torrent Solans 2 , Luis Alfonso Hernández 3

1University Hospital,la bisbal,Spain, 2University Hospital,terrassa,Spain, 3University Hospital,mexico,Mexico

Purpose

Necrotizing scleritis is an inflammatory disorder that affects the sclera. It is commonly associated with systemic collagen vascular diseases, vasculitis, or autoimmune disease, being rheumatoid arthritis the most frequent. It is rarely associated with ocular surgeries, receiving the name of surgically induced necrotizing scleritis. The pathophysiology is a granulomatous inflammation with fibrinoid necrosis affecting the sclera related to ischemia.

Setting

University hospital

Methods

A 50-year-old male patient complained of discomfort and vision loss in the right eye ten days after pterygium excision with Mitomycin C (MMC). 
The patient had a nasal pterygium in the right eye for eight years. He received a pterygium excision with Mitomycin C (MMC) and 10-0 nylon sutures in another center. The patient had diabetes mellitus for 12 years, with panphotocoagulation for proliferative diabetic retinopathy. 

Results

Visual acuity was 20/100 in the right eye and 20/30 in the left eye, and intraocular pressure was 14 mmHg. Examination of the right eye showed a violaceous hue area in the perilimbal nasal part, and a porcelain white sclera in the nasal region, with inflamed conjunctiva and scleral vessels. We diagnosed Surgically induced necrotizing scleritis. We treated with topical chloramphenicol six times a day to avoid the risk of infection, topical steroids eight times a day, and oral steroids 60 mg a day to decrease the inflammation. We did an early surgery with an amniotic membrane and a scleral graft. Upon follow-up, the patient improved visual acuity to 20/80, obtaining complete eye restoration. 

 

Conclusions

Scleral necrosis following pterygium surgery is a rare complication related to postoperative infection and the application of adjunctive antimetabolites. Scleral necrosis may appear from weeks to years after pterygium surgery, with a longer latency in infectious than noninfectious cases. It is essential to consider the high infection rates; as a presentation or in progress for an adequate treatment. Surgical management is usually the recommended approach. Systemic investigations for systemic autoimmune conditions are unproductive because the correlation is exceptional.