Surgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft

Abstract

Background: Although pterygium excision with conjunctival autograft is a widely performedsurgical procedure, surgically induced necrotizing scleritis (SINS) following such surgery isextremely rare.Methods: A 68-year-old man underwent nasal pterygium excision with conjunctival autograftuneventfully. On postoperative day 17, the conjunctival graft was avascular, with epithelialdefect. Although topical steroid and antibacterial treatments were continued, the graft andsclera melted, with the ischemic sclera showing gradual thinning. The thinning area spread tothe adjoining cornea, and active inflammation with epithelial defect was observed adjacent tothe site of thinning.Results: Systemic and microbiological examination was noncontributory. The patient wassuspected of having SINS, and administration of oral prednisolone was started. Although thenecrotic area was reduced temporarily, medication was discontinued due to nausea, and thearea of thinning increased. Conjunctival flap surgery was later performed, and the graft waswell accepted.Conclusions: SINS must be considered in the differential diagnosis of patients with scleritisfollowing pterygium surgery, especially if radiation or mitomycin C has not been used. © 2011 Yamazoe et al, publisher and licensee Dove Medical Press Ltd.