Surgically induced necrotising scleritis: report of a case presenting 51 years following strabismus surgery

Mahmood, S; Suresh, P S; Carley, Fiona; Bruce, Ian N.; Tullo, A B

doi:10.1038/sj.eye.6700033

Cited by 23 publications

(11 citation statements)

References 3 publications

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“…6 Therapy of scleral necrosis involves suppression of inflammation and prevention of further scleral necrosis. [2][3][4][5]7 Systemic nonsteroidal anti-inflammatory agents are rarely sufficient such that high-dose corticosteroids or cytotoxic agents should be started promptly and tapered to a maintenance dose when healing occurs to ensure a successful visual outcome. 3 Low-dose maintenance corticosteroid therapy was required for 2 months to 6 years in 40 patients treated by Donoghue et al 3 Various surgical techniques have been described for refractory cases, including lamellar patch graft, 1 tectonic lamellar keratoplasty, 1 limbal autograft transplants for corneal involvement, 1 scleral grafting, 4 and tarsoconjunctival pedicle flap for large areas of scleral melt.…”

Section: Discussionmentioning

confidence: 99%

Excision of Granulation Tissue and Free Conjunctival Autograft in the Management of Necrotizing Scleritis

Gregory¹,

Weir²,

Ramaesh³

2010

Cornea

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The pathogenesis of surgically induced scleral necrosis not associated with autoimmune conditions may be the result of the products of inflammation and lytic enzymes released by the surrounding conjunctival tissue initiating the scleral melting process. This type of surgically induced scleral necrosis may be successfully managed by excision of the surrounding inflamed conjunctiva, thus removing a potential source of collagenases, and covering the exposed sclera by a conjunctival transplant obviating the need for prolonged high-dose immunosuppression.

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Section: Discussionmentioning

confidence: 99%

Excision of Granulation Tissue and Free Conjunctival Autograft in the Management of Necrotizing Scleritis

Gregory¹,

Weir²,

Ramaesh³

2010

Cornea

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“…In SINS there is a variable latent period between surgery and presentation, which may vary from 1 day to 51 years 7. The area of scleral melt tends to develop adjacent to the surgical wound16 and may extend to involve the cornea and whole anterior segment.…”

Section: Discussionmentioning

confidence: 99%

“…It typically occurs postoperatively as intense scleral necrosis adjacent to the site of previous scleral or limbal incision 16. It may or may not be associated with serious ocular complications such as peripheral ulcerative keratitis (PUK), which is always present adjacent to the SINS site 7. This may progress to perforation with poor visual prognosis.…”

Section: Introductionmentioning

confidence: 99%

Amniotic membrane transplantation in surgically induced necrotizing scleritis with peripheral ulcerative keratitis

Thatte

Gupta

2012

Middle East Afr J Ophthalmol

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A case of surgically induced necrotizing scleritis (SINS) after manual small incision cataract surgery that was associated with peripheral ulcerative keratitis (PUK) at a different site. Neither pathology responded to systemic steroids and progressed to become sight threatening, which is unusual. Progression of SINS was aggressive enough to cause a limbal wound gape, similarly PUK extended up to Descemet's membrane and emergency amniotic membrane transplantation (AMT) was required to save the globe. AMT may regress the scleral and corneal melting successfully. It is not common to observe SINS with PUK at a different site that is unresponsive to systemic steroids. AMT, though palliative treatment, was effective at treating this condition successfully.

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“…Therefore, the post-operative monitoring of patients at risk should not be delayed for more than one week, to avoid possible corneal perforation and perhaps other extremely serious corneal or scleral complications. 7 Obviously, the different percentages of post-operative corneal complications (dellen) with the different surgical procedures have no bearing on pre-operative indications. The awareness of the possibility of dellen development simply suggests a close post-operative follow-up of the cornea.…”

Section: Discussionmentioning

confidence: 99%

Corneal ‘Dellen’ as a complication of strabismus surgery

Fresina

Campos

2007

Eye

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Purpose This paper presents results of an analysis on patients operated on for strabismus in order to evaluate frequency and clinical characteristics of corneal alterations. In our experience, this kind of complication occurs more frequently after reoperation and/ or after surgery for esotropia in sixth nerve palsy using transposition procedures. Methods A retrospective analysis was made of 655 consecutive patients operated on for strabismus on the recti muscles with a limbal approach from January 2001 to July 2003 (30 months). Results We found 30 corneal dellen out of the 184 eyes (16.30%) reoperated on medial rectus muscles, 7 corneal dellen out of the 37 eyes (18.92%) operated on using transposition procedures, 4 corneal dellen out of the 101 eyes (3.96%) operated of lateral rectus muscle recession combined with medial rectus muscle resection and no corneal dellen in the other 976 eyes operated of using different surgical procedures on the recti muscles. All patients had been operated on using a conjunctival limbal approach. All corneal dellen disappeared in about 10-15 days, using topical antibiotics and a firm bandage applied to the eye at night, leaving permanent alterations in corneal homogeneity in 8 eyes (19.51%). Conclusion This study showed that this kind of complication is relatively frequent after reoperations and/or transposition procedures, thus indicating that it is possible to identify surgical procedures which might play a role in the development of corneal dellen. Therefore, the post-operative monitoring of patients at risk should not be delayed for more than one week, in order to avoid possible corneal perforation.

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Surgically induced necrotising scleritis: report of a case presenting 51 years following strabismus surgery

Abstract: Surgically induced necrotising scleritis S Mahmood et al 503 References

Cited by 23 publications

References 3 publications

Excision of Granulation Tissue and Free Conjunctival Autograft in the Management of Necrotizing Scleritis

Excision of Granulation Tissue and Free Conjunctival Autograft in the Management of Necrotizing Scleritis

Amniotic membrane transplantation in surgically induced necrotizing scleritis with peripheral ulcerative keratitis

Corneal ‘Dellen’ as a complication of strabismus surgery

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