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.

Keywords: Tenon's membrane; pterygium; scleral necrosis; systemic immunosuppressive therapy.

Figure 1.

A defect area was covered with a Tenon's membrane flap from the surrounding site following removal of the devitalized tissue and surrounding inflamed conjunctiva. Then, the repaired sclera was covered with amniotic membrane.

Figure 2.

(A) A patient presented the moderate scleral thinning associated with corneal melting. (B) At the one month follow-up, the patient's scleral necrosis disappeared progressively accompanied with normalization of the sclera, and conjunctival and corneal reepithelialization.

Figure 3.

(A) A patient with rheumatoid arthritis, ~2 weeks after surgery, whose corneal margin of the graft began to melt (highlighted by the yellow circle) and the remainder of the graft appeared softened but intact over the defect without uveal exposure. (B) The area of scleral necrosis resolved after 8 weeks and the perforated area was sealed with vascularized epithelialization.