The spectrum of postoperative scleral necrosis

Rishi R. Doshi, George J. Harocopos, Ivan R. Schwab, Emmett T. Cunningham

Research output: Contribution to journalReview articlepeer-review

36 Scopus citations

Abstract

An otherwise healthy 62-year-old woman developed necrotizing scleritis 23 years following pterygium excision with adjunctive beta-radiation. Surgically induced necrotizing scleritis (SINS) was diagnosed, but the scleritis progressed despite anti-inflammatory therapy, and 10 weeks after presentation the patient developed a hypopyon and decreased vision. After cultures revealed no growth at 72 hours, immunosuppressive therapy was escalated, with a subsequent deterioration in the patient's clinical course. Scedosporium superinfection was eventually cultured and found on histological examination of the enucleated globe. In reported cases, infectious scleral necrosis occurs most commonly following pterygium (71.4%) and scleral buckling (97.2%) surgery. Hypopyon is uncommon (10.0%) in patients with postoperative scleral necrosis, but when present is a strong predictor of infection (odds ratio,21.2; 95% confidence interval, 2.9-157.5). Rates of underlying autoimmune disease are generally low (0.0-12.5%) except following cataract and lens procedures, where the occurence of SINS heralds systemic illness in 42.9% of cases.

Original languageEnglish
Pages (from-to)620-633
Number of pages14
JournalSurvey of ophthalmology
Volume58
Issue number6
DOIs
StatePublished - Nov 2013

Keywords

  • Beta-radiation
  • Fungal scleritis
  • Pterygium
  • Scleral necrosis
  • Surgically induced necrotizing scleritis

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