Surgically induced necrotising scleritis following three-port pars plana vitrectomy without scleral buckling: a series of three cases.
OBJECTIVE
To document the presentation, management, and prognosis of three cases of surgically induced necrotising scleritis (SINS) following three-port-pars plana vitrectomy (PPV) without scleral buckling. To discuss potential pathogeneses and treatments.


METHODS
An interventional case series of three patients presenting to a tertiary referral unit over a 6-month period.


RESULTS
All cases were male, presenting within 6 weeks of PPV, with scleral necrosis around a sclerotomy site. Wound microbiology and systemic vasculitis screens were negative. Two cases had underlying systemic disease and had undergone previous ocular surgery. The necrosis resolved in all with aggressive immunosuppression.


CONCLUSIONS
SINS following PPV is a rare occurrence requiring prompt and aggressive immunosuppression. Differentiation from an infective postoperative process is essential. The pathogenesis is poorly understood but may share features with classic SINS including hypersensitivity and ischaemia.
Morley
A M S
AM
Uveitis Service, Moorfields Eye Hospital, London, UK. Susie@morleys.net
Pavesio
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D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012590:Sclera / Q000473:pathology; D012591:Scleral Buckling; D015423:Scleritis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D014821:Vitrectomy / Q000009:adverse effects*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab