The clinical and pathogenic spectrum of surgically-induced scleral necrosis: A review

Ruiz-Lozano, Raúl E.; Garza-Garza, Lucas A.; Dávila-Cavazos, Osvaldo; Foster, C. Stephen; Rodríguez-García, Alejandro

doi:10.1016/j.survophthal.2020.12.008

Cited by 31 publications

(31 citation statements)

References 143 publications

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“…Surgery-induced necrotizing scleritis (SINS) can be triggered by any type of ocular surgical intervention, and the latency period is highly variable, ranging from rst postoperative day to years after surgery 1 .…”

Section: Discussionmentioning

confidence: 99%

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Surgery-induced necrotizing scleritis after vitrectomy with removal of dislocated intraocular lens and secondary iris-claw IOL implantation

Mártires,

Pérez,

Bujanda

et al. 2023

Preprint

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Purpose To report a surgical-induced necrotizing scleritis, as well as its medical and surgical management.Methods Case-reportResults An 88 year-old patient with a three-day severe single-left-eye ocular pain. One-time surgery involving PPV with removal of dislocated intraocular lens and secondary implantation of iris-claw Artisan® lens was performed six months earlier. Visual acuity of 20/100. Slit-lamp examination revealed a 5x2 mm non-suppurative superior scleral defect. Empirical topical antibiotic treatment with dexamethasone, as well as oral doxycycline was started. Infectious and autoimmune diseases were ruled out. Non-infectious scleritis treatment was conducted with intravenous Methylprednisolone three day pulses, followed by weekly tapered Prednisone and intramuscular Methotrexate. However, one month after the diagnosis, the defect was worsened; hence, a heterologous scleral patch graft was performed and, days after the intervention, Adalimumab was initiated. To date, six months later, remains with proper scleral patch, a diary low-dose Prednisone, and spacing Adalimumab treatment.Conclusion: Surgery-induced necrotizing scleritis is a severe condition that compromise the ocular and visual integrity. Proper diagnosis, as well as early treatment is required to achieve remission, prevent relapses, and avoid structural complications. In refractory cases, anti-TNF-α immunotherapy associated with surgical tectonic graft interventions can achieve promising results.

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Section: Discussionmentioning

confidence: 99%

“…Surgery-induced necrotizing scleritis (SINS) is a rare local autoimmune reaction of the sclera adjacent to previous surgical incisions, which has been reported following cataract surgery, trabeculectomy, scleral buckling, as well as pterygium and strabismus surgery [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

Surgery-induced necrotizing scleritis after vitrectomy with removal of dislocated intraocular lens and secondary iris-claw IOL implantation

Mártires,

Pérez,

Bujanda

et al. 2023

Preprint

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“…7 Surgically induced scleritis occurs most commonly after pterygium removal, where the sclera experiences trauma and is exposed to pathogens and toxins. 7,10 The most common risk factors include a past history of autoimmune disease and multiple ocular surgeries. 7 An infectious cause should be carefully considered following ocular surgery that incorporates antifibrotic agents, such as MMC and 5-fluorouracil, use of cryotherapy, radiotherapy, and excessive scleral cauterization.…”

Section: Discussionmentioning

confidence: 99%

Infective Necrotizing Scleritis After XEN Gel Stent With Mitomycin-C

Kingston

Zagora

Symes

et al. 2021

Journal of Glaucoma

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The purpose of this study was to report a case of infective necrotizing scleritis following XEN Gel Stent with mitomycin-C.Methods: Case report. This is a case report of a 68-year-old woman.Results: XEN Gel Stent glaucoma surgery enhanced with mitomycin-C 0.04% and combined with cataract surgery was performed at a regional center to manage the patient's primary open-angle glaucoma. Past medical history was significant for rheumatoid arthritis requiring treatment with methotrexate and adalimumab. Periocular pain and swelling developed 14 months after the initial operation, followed by a rapid deterioration of visual acuity to 20/60, intraocular pressure of 4 mm Hg, and worsening pain 5 months later. On initial presentation to Sydney Eye Hospital, 180 degrees of scleral necrosis was evident with a moderate anterior segment inflammatory reaction and a large temporal choroidal effusion due to hypotony. Empirical hourly topical ofloxacin and cephalothin 5% drops, with oral moxifloxacin, were initiated. Conjunctival swab grew Staphylococcus aureus and Staphylococcus lugdunensis. Significant clinical improvement occurred, but the XEN Gel Stent became exposed after 9 days of treatment with worsening hypotony. Urgent surgical revision was performed to remove the XEN Gel Stent and apply a tutoplast plug with overlying amniotic membrane graft. Intraocular pressure gradually improved over 6 weeks to 15 mm Hg with reversal of hypotonous changes, and visual acuity stabilized at 20/40.Conclusions: To our knowledge, this is the first reported case of necrotizing scleritis following XEN Gel Stent insertion. It is a reminder that infection should always be the primary differential diagnosis in patients with surgical-induced necrotizing scleritis.

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“…The onset time ranges from one day to more than 50 years after surgery. The most frequent SISN associated surgeries are pterygium excision and cataract extraction [ 1 ], [ 2 ]. While the former is mostly related to an infectious etiology, the latter is more probably associated with an underlying autoimmune disease [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Surgically induced scleral necrosis associated with concomitant tuberculosis infection: a diagnostic challenge

Ruiz-Lozano

Rodríguez-García

Colorado-Zavala

et al. 2023

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The clinical and pathogenic spectrum of surgically-induced scleral necrosis: A review

Cited by 31 publications

References 143 publications

Surgery-induced necrotizing scleritis after vitrectomy with removal of dislocated intraocular lens and secondary iris-claw IOL implantation

Surgery-induced necrotizing scleritis after vitrectomy with removal of dislocated intraocular lens and secondary iris-claw IOL implantation

Infective Necrotizing Scleritis After XEN Gel Stent With Mitomycin-C

Surgically induced scleral necrosis associated with concomitant tuberculosis infection: a diagnostic challenge

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