Scleral Patch Graft In A Surgically Induced Necrotising Scleritis After Pterygium Excision

To report a case of surgically induced necrotising scleritis after pterygium surgery managed with a scleral patch graft.

Interventional case report.

A 53-year-old man presented with redness and pain in his left eye for the last 1 year. On examination focal thinning of the nasal sclera with uveal tissue prolapse was noted in the left eye. He had undergone pterygium excision with a conjunctival autograft at another facility 15 years back. Proper systemic and rheumatological workup was done and it was within normal limits. The patient was diagnosed with surgically induced necrotising scleritis(SINS). He was started on oral corticosteroids and due to severe scleral thinning he was planned for scleral patch grafting. 

The patient underwent a scleral patch grafting after 1 week of oral corticosteroid therapy. The scleral patch graft was well apposed and taken well by the host tissue and the patient's sclera was stable. The best corrected visual acuity of 6/9 was maintained after surgery.

Surgically induced necrotising scleritis (SINS) is a rare but potentially devastating complication of pterygium excision surgery. It can have delayed presentation several years after the primary surgery. Early recognition and prompt treatment are crucial in preventing further complications and preserving vision.