Scleral flap necrosis and infectious endophthalmitis after cataract surgery with a scleral tunnel incision.
BACKGROUND
Long scleral tunnel dissection techniques have been developed for cataract surgery incisions. These incisions reduce postoperative astigmatism and keratorefractive instability. If fashioned correctly, the internal lip of the incision produces a tight seal to the anterior chamber, permissible of sutureless surgery. The behavior of such a wound during intraocular infection is unknown.


METHODS
The authors describe two elderly patients in whom postoperative bacterial endophthalmitis was accompanied by infectious scleritis, infectious sclerokeratitis or keratitis, and rapid scleral flap necrosis. One of the patients had a painless disease process.


RESULTS
Intraocular isolates of Staphylococcus aureus and Streptococcus equinus were recovered from the two patients, respectively. Management was complicated by loss of tectonic integrity that followed scleral flap necrosis, by impaired vitreoretinal visualization associated with rapidly progressive sclerokeratitis or keratitis, and by bacterial scleritis in the base of the scleral flap. No light perception was retained in either eye.


CONCLUSIONS
Scleral tunnel incisions create a potential abscess cavity. Although a rare occurrence, postoperative endophthalmitis in such an eye may present major surgical and therapeutic problems intrinsic to the wound design.
Ormerod
L D
LD
Kresge Eye Institute, Wayne State University, Detroit 48201-1423.
Puklin
J E
JE
McHenry
J G
JG
McDermott
M L
ML
D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000009:adverse effects*; D009877:Endophthalmitis / Q000209:etiology*; D015818:Eye Infections, Bacterial / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009336:Necrosis; D011183:Postoperative Complications; D012590:Sclera / Q000473:pathology* / Q000601:surgery; D015423:Scleritis / Q000382:microbiology; D013203:Staphylococcal Infections / Q000209:etiology; D013290:Streptococcal Infections / Q000209:etiology; D013524:Surgical Flaps; D013536:Suture Techniques