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Surv Ophthalmol. 2013 Nov-Dec;58(6):620-33. doi: 10.1016/j.survophthal.2012.11.002. Epub 2013 Feb 12.

The spectrum of postoperative scleral necrosis.

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  • 1The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.


An otherwise healthy 62-year-old woman developed necrotizing scleritis 23 years following pterygium excision with adjunctive beta-radiation. Surgically induced necrotizing scleritis (SINS) was diagnosed, but the scleritis progressed despite anti-inflammatory therapy, and 10 weeks after presentation the patient developed a hypopyon and decreased vision. After cultures revealed no growth at 72 hours, immunosuppressive therapy was escalated, with a subsequent deterioration in the patient's clinical course. Scedosporium superinfection was eventually cultured and found on histological examination of the enucleated globe. In reported cases, infectious scleral necrosis occurs most commonly following pterygium (71.4%) and scleral buckling (97.2%) surgery. Hypopyon is uncommon (10.0%) in patients with postoperative scleral necrosis, but when present is a strong predictor of infection (odds ratio, 21.2; 95% confidence interval, 2.9-157.5). Rates of underlying autoimmune disease are generally low (0.0-12.5%) except following cataract and lens procedures, where the occurence of SINS heralds systemic illness in 42.9% of cases.

Copyright © 2013 Elsevier Inc. All rights reserved.


beta-radiation; fungal scleritis; pterygium; scleral necrosis; surgically induced necrotizing scleritis

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