Surgically induced necrotizing scleritis after pterygium excision and conjunctival autograft.
OBJECTIVE
To report a case of surgically induced necrotizing scleritis (SINS) after pterygium excision and conjunctival autograft.


METHODS
A 55-year-old man presented 2 weeks after excision of primary pterygium with conjunctival autograft in the right eye with severe pain in that eye. He had undergone cataract surgery in that eye 8 months before. The graft was pale and white. The underlying sclera was white and avascular. There was marked inflammation adjacent to the site of surgery and graft. A scraping from the graft surface revealed no organisms in smears, and culture revealed no growth. The conjunctival graft was removed. Amniotic membrane transplantation was performed. After surgery, the amniotic membrane was avascular and pale. Systemic steroid therapy was initiated.


RESULTS
Three days after initiation of systemic steroid therapy, the graft became vascularized. Over the next 10 days, the eye quietened, conjunctival and scleral inflammation lessened, and the graft was well accepted.


CONCLUSIONS
Surgically induced necrotizing scleritis is a rare complication of pterygium excision with conjunctival autograft. A pale graft with underlying avascular sclera and surrounding inflammation should arouse suspicion of this complication.
Sridhar
M S
MS
Cornea Service, L.V. Prasad Eye Institute, Hyderabad, India. mss@lvpeye.stph.net
Bansal
Aashish K
AK
Rao
Gullapalli N
GN
D000650:Amnion / Q000637:transplantation; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000637:transplantation*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011625:Pterygium / Q000601:surgery*; D015423:Scleritis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D014182:Transplantation, Autologous
D005938:Glucocorticoids