Surgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft

Abstract

Background: Although pterygium excision with conjunctival autograft is a widely performed surgical procedure, surgically induced necrotizing scleritis (SINS) following such surgery is extremely rare.

Methods: A 68-year-old man underwent nasal pterygium excision with conjunctival autograft uneventfully. On postoperative day 17, the conjunctival graft was avascular, with epithelial defect. Although topical steroid and antibacterial treatments were continued, the graft and sclera melted, with the ischemic sclera showing gradual thinning. The thinning area spread to the adjoining cornea, and active inflammation with epithelial defect was observed adjacent to the site of thinning.

Results: Systemic and microbiological examination was noncontributory. The patient was suspected of having SINS, and administration of oral prednisolone was started. Although the necrotic area was reduced temporarily, medication was discontinued due to nausea, and the area of thinning increased. Conjunctival flap surgery was later performed, and the graft was well accepted.

Conclusions: SINS must be considered in the differential diagnosis of patients with scleritis following pterygium surgery, especially if radiation or mitomycin C has not been used.

Keywords: SINS; conjunctival autograft; pterygium; pterygium surgery; scleritis.

Figure 1

Slit-lamp photograph of surgically induced necrotizing scleritis on postoperative day 29. Although the scleral bed was covered by keratinized conjunctival epithelium, active inflammation and epithelial defect were observed adjacent to the site of thinning.

Figure 2

Slit-lamp photograph and anterior optical coherence tomography after discontinuing systemic steroid treatment. (A) Scleral and corneal bed at the site of pterygium excision showing substantial thinning and active surrounding conjunctival inflammation. (B) Anterior optical coherence tomography also showed major corneoscleral thinning.