Abstract
Purpose:To report a surgical approach combining scleral patch graft and tenonplasty for successful management of refractory Pseudomonas scleritis following pterygium removal with mitomycin C application.Case Report:A 75-year-old diabetic woman with a history of prior pterygium excision and mitomycin C application developed infectious necrotizing scleritis caused by Pseudomonas aeruginosa. Owing to progression of scleritis despite medical management, the patient underwent surgery. Intraoperatively, extensive scleral ischemia was noted. Therefore, debridement of the necrotic tissue, scleral graft, tenonplasty to bring blood vessels to the ischemic sclera, and amniotic membrane transplantation were performed. Postoperatively, no signs of ischemia or recurrence of infection were observed. During 6 months of follow-up, the patient achieved complete restoration of the globe integrity with a non-inflamed ocular surface.Conclusion:Through restoration of blood supply to the ischemic sclera, tenonplasty is an effective adjunctive procedure in addition to conventional scleral patch graft for the treatment of refractory Pseudomonas scleritis associated with ischemia.
Highlights
Infectious scleritis, which constitutes 5%–10% of scleritis cases, is a serious disease with devastating ocular complications.[1]
Scleral ischemia can be a complication of mitomycin C (MMC) application at the time of pterygium surgery,[5] which itself predisposes patients to the development of infectious scleritis.[6]
For patients with infectious scleritis who are refractory to medical management with antibiotics, a surgical procedure is required
Summary
Infectious scleritis, which constitutes 5%–10% of scleritis cases, is a serious disease with devastating ocular complications.[1]. Infectious scleritis, which constitutes 5%–10% of scleritis cases, is a serious disease with devastating ocular complications.[1] Pseudomonas aeruginosa, which is the most common causative microorganism,[2] causes an aggressive necrotizing scleral infection. Infectious process aggravates the pathogenesis by minimizing the penetration of antibiotics.[3,4] Scleral ischemia can be a complication of mitomycin C (MMC) application at the time of pterygium surgery,[5] which itself predisposes patients to the development of infectious scleritis.[6]
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