TY - JOUR
T1 - The spectrum of postoperative scleral necrosis
AU - Doshi, Rishi R.
AU - Harocopos, George J.
AU - Schwab, Ivan R.
AU - Cunningham, Emmett T.
N1 - Funding Information:
The authors report no proprietary or commercial interest in any product mentioned or concept discussed in the article. Funding was provided by the Pacific Vision Foundation, San Francisco, CA, and by an unrestricted grant from Research to Prevent Blindness.
PY - 2013/11
Y1 - 2013/11
N2 - 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.
AB - 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.
KW - Beta-radiation
KW - Fungal scleritis
KW - Pterygium
KW - Scleral necrosis
KW - Surgically induced necrotizing scleritis
UR - http://www.scopus.com/inward/record.url?scp=84886264325&partnerID=8YFLogxK
U2 - 10.1016/j.survophthal.2012.11.002
DO - 10.1016/j.survophthal.2012.11.002
M3 - Review article
C2 - 23410842
AN - SCOPUS:84886264325
SN - 0039-6257
VL - 58
SP - 620
EP - 633
JO - Survey of Ophthalmology
JF - Survey of Ophthalmology
IS - 6
ER -