Tailored treatment for the management of scleral necrosis following pterygium excision

Abstract

The present study aimed to investigate the efficacy of tailored treatment for the management of scleral necrosis following pterygium surgery. A series of nine cases of scleral necrosis following pterygium excision between September 2009 and September 2012 were included. In cases where ischemia was the cause of scleral necrosis, Tenon's membrane covering (TMC) surgery was performed. For cases with surgically-induced necrotizing scleritis (SINS), systemic immunosuppressive therapy following surgical repair of the scleral defect was administered in the form of oral prednisolone (starting dose, 30–60 mg/day). Five patients with ischemic scleral necrosis received TMC postoperatively. Four patients with SINS received various doses of oral prednisolone according to their systematic immune state. All patients had successful postoperative results except one with rheumatoid arthritis, who postoperatively developed scleral patch graft melting within 2 weeks. Following aggressive immunosuppressive treatment, the scleral patch graft was saved. In conclusion, patients achieved positive results using tailored treatment according to the pathogenesis of their scleral necrosis.

Diffuse anterior and posterior scleritis with multiple iris granular deposits following pterygium excision

“…Deposition of the immune complex in the scleral vessels may be stimulated by surgical trauma. However, scleral necrosis and melting can occur following pterygium surgery from the use of MMC, infection, adjunctive irradiation, or by excessive cauterization of the sclera [ 4 , 9 ].…”

“…Lu et al retrospectively assessed treatment of 9 cases of scleral necrosis following pterygium excision [ 4 ]. None of the potential causes of scleritis, such as MMC application, irradiation, or infection, were present; therefore, a diagnosis of SINS was proposed.…”

“…In the review of literature, more than half of SINS cases are associated with systemic disease, [3], while patients with SINS who undergo pterygium surgery have rarely exhibited a history of systemic disease [4][5][6][7][8]. If the etiology of SINS is hypersensitivity to an immune complex from systemic disease or a previous history of ocular surgery, and is common to pterygium and other surgeries, there should be no difference between pterygium and other cases.…”

“…However, only a few cases have been reported after primary pterygium excision. To the best of our knowledge, posterior scleritis associated with pterygium surgery has not been reported [ 4 - 8 ]. We reported such a case of anterior diffuse scleritis accompanied with posterior scleritis, following primary pterygium excision.…”

Delayed Onset Scleromalacia and Conjunctival Bleb Formation Following Intraoperative Mitomycin C Application during Conjunctival Melanoma Excision

“…These complications were also limited to pterygium excision with adjunctive MMC [ 12 , 13 , 14 ]. Necrotizing anterior scleritis is also reported after regional conjunctivectomy with postoperative topical MMC [ 15 ], which may be due to epithelial breakdown and fibroblast damage owing to the use of MMC, as well as vascular compromise owing to extensive conjunctivectomy [ 16 , 17 ]. In a recent study by Ji et al [ 15 ], the average time of presentation with necrotizing scleritis following cosmetic conjunctivectomy in Korea were 51 months.…”