Suture Loosening After Penetrating Keratoplasty Associated With Scleral Atrophy Following Orbital Radiotherapy: A Case Report
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR113 | Type: Case Report | DOI: 10.82333/mrsz-yd82
Authors: Dr Neslihan Öztürk* 1
1Cliniques universitaires Saint Luc ,Brussels,Belgium
Purpose
To describe corneal suture loosening occurring one month after penetrating keratoplasty in the context of underlying scleral pathology. In this case, the oncologic history and prior radiotherapy were contributing factors to the development of scleral atrophy.
Setting
A 77-year-old patient with long-standing pseudophakic decompensation and significant stromal fibrosis following complicated cataract surgery 10 years earlier was followed at a tertiary referral center (Cliniques universitaires Saint-Luc, Brussels) for grade I MALT lymphoma of the lower eyelid.
Report of case
The patient presented with chronic pseudophakic corneal decompensation and stromal fibrosis, notably related to the presence of an anterior chamber intraocular lens. He was subsequently diagnosed with grade I MALT lymphoma of the ipsilateral lower eyelid and treated with local radiotherapy (24 Gy).
Nine months after radiotherapy, intraocular lens explantation and penetrating keratoplasty were scheduled. Intraoperatively, a highly localized area of scleral atrophy was observed, requiring placement of a scleral patch graft. The anterior chamber intraocular lens was explanted, and penetrating keratoplasty was performed. Given the marked iris atrophy, secondary scleral fixation was deferred to a later stage. The penetrating keratoplasty was completed without intraoperative complications. Due to the history of irradiation, an overlay amniotic membrane graft was also performed. Corneal suturing consisted of eight interrupted 10-0 nylon sutures and one continuous 10-0 nylon suture.
On postoperative day 1, the sutures were tight and no Seidel sign was observed. At the 1-month follow-up, progressive suture loosening occurred, initially involving the continuous suture and subsequently the interrupted sutures, in association with circumferential (360°) scleral atrophy.
Conclusion/Take home message
Suture loosening occurring one month after penetrating keratoplasty should raise suspicion for an underlying anatomical change. Scleral atrophy that develops without pain or inflammatory scleritis in the context of prior penetrating keratoplasty and orbital irradiation is a rare but potentially serious complication.