Tailored treatment for the management of scleral necrosis following pterygium excision

Lu,Linna; Xu,Shiqiong; Ge,Shengfang; Shao,Chunyi; Wang,Zi; Weng,Xuyang; Lu,Wenjuan; Wu,Xinhua; Fu,Yao; Fan,Xianqun

doi:10.3892/etm.2017.4038

March-2017 Volume 13 Issue 3

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March-2017 Volume 13 Issue 3

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Article Open Access

Tailored treatment for the management of scleral necrosis following pterygium excision

Authors:
- Linna Lu
- Shiqiong Xu
- Shengfang Ge
- Chunyi Shao
- Zi Wang
- Xuyang Weng
- Wenjuan Lu
- Xinhua Wu
- Yao Fu
- Xianqun Fan
View Affiliations / Copyright

Affiliations: Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, P.R. China

Copyright: © Lu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Pages: 845-850
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Published online on: January 12, 2017

https://doi.org/10.3892/etm.2017.4038
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Abstract

The present study aimed to investigate the efficacy of tailored treatment for the management of scleral necrosis following pterygium surgery. A series of nine cases of scleral necrosis following pterygium excision between September 2009 and September 2012 were included. In cases where ischemia was the cause of scleral necrosis, Tenon's membrane covering (TMC) surgery was performed. For cases with surgically‑induced necrotizing scleritis (SINS), systemic immunosuppressive therapy following surgical repair of the scleral defect was administered in the form of oral prednisolone (starting dose, 30‑60 mg/day). Five patients with ischemic scleral necrosis received TMC postoperatively. Four patients with SINS received various doses of oral prednisolone according to their systematic immune state. All patients had successful postoperative results except one with rheumatoid arthritis, who postoperatively developed scleral patch graft melting within 2 weeks. Following aggressive immunosuppressive treatment, the scleral patch graft was saved. In conclusion, patients achieved positive results using tailored treatment according to the pathogenesis of their scleral necrosis.

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1	Kheirkhah A, Hashemi H, Adelpour M, Nikdel M, Rajabi MB and Behrouz MJ: Randomized trial of pterygium surgery with mitomycin C application using conjunctival autograft versus conjunctival-limbal autograft. Ophthalmology. 119:227–232. 2012. View Article : Google Scholar : PubMed/NCBI
2	Díaz L, Villegas VM, Emanuelli A and Izquierdo NJ: Efficacy and safety of intraoperative mitomycin C as adjunct therapy for pterygium surgery. Cornea. 27:1119–1121. 2008. View Article : Google Scholar : PubMed/NCBI
3	Fernandes M, Sangwan VS, Bansal AK, Gangopadhyay N, Sridhar MS, Garg P, Aasuri MK, Nutheti R and Rao GN: Outcome of pterygium surgery: Analysis over 14 years. Eye (Lond). 19:1182–1190. 2005. View Article : Google Scholar : PubMed/NCBI
4	Jain V, Shome D, Natarajan S and Narverkar R: Surgically induced necrotizing scleritis after pterygium surgery with conjunctival autograft. Cornea. 27:720–721. 2008. View Article : Google Scholar : PubMed/NCBI
5	Morley AM and Pavesio C: Surgically induced necrotising scleritis following three-port pars plana vitrectomy without scleral buckling: A series of three cases. Eye (Lond). 22:162–164. 2008. View Article : Google Scholar : PubMed/NCBI
6	de la Maza M Sainz, Molina N, Gonzalez-Gonzalez LA, Doctor PP, Tauber J and Foster CS: Scleritis therapy. Ophthalmology. 119:51–58. 2012. View Article : Google Scholar : PubMed/NCBI
7	Young AL, Wong SM, Leung AT, Leung GY, Cheng LL and Lam DS: Successful treatment of surgically induced necrotizing scleritis with tacrolimus. Clin Experiment Ophthalmol. 33:98–99. 2005. View Article : Google Scholar : PubMed/NCBI
8	Yamazoe K, Shimazaki-Den S, Otaka I, Hotta K and Shimazaki J: Surgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft. Clin Ophthalmol. 5:1609–1611. 2011. View Article : Google Scholar : PubMed/NCBI
9	Sangwan VS, Jain V and Gupta P: Structural and functional outcome of scleral patch graft. Eye (Lond). 21:930–935. 2007. View Article : Google Scholar : PubMed/NCBI
10	Gregory ME, Weir CR and Ramaesh K: Excision of granulation tissue and free conjunctival autograft in the management of necrotizing scleritis. Cornea. 29:577–579. 2010. View Article : Google Scholar : PubMed/NCBI
11	Rachitskaya A, Mandelcorn ED and Albini TA: An update on the cause and treatment of scleritis. Curr Opin Ophthalmo. 21:463–467. 2010. View Article : Google Scholar
12	Davidson RS, Erlanger M, Taravella M, Gregory DG and Durairaj VD: Tarsoconjunctival pedicle flap for the management of a severe scleral melt. Cornea. 26:235–237. 2007. View Article : Google Scholar : PubMed/NCBI
13	Dadeya S and Fatima S: Comeoscleral perforation after pterygium excision and intraoperative mitomycin C. Ophthalmic Surg Lasers Imaging. 34:146–148. 2003.PubMed/NCBI
14	Solomon A, Kaiserman I, Raiskup FD, Landau D and Frucht-Pery J: Long-term effects of mitomycin C in pterygium surgery on scleral thickness and the conjunctival epithelium. Ophthalmology. 111:1522–1527. 2004. View Article : Google Scholar : PubMed/NCBI
15	Yazici B: Use of conjunctiva-Müller muscle pedicle flap in surgical treatment of necrotizing scleritis. Ophthal Plast Reconstr Surg. 24:19–23. 2008. View Article : Google Scholar : PubMed/NCBI
16	Kim BH: Surgical treatment of necrotic scleral calcification using combined conjunctival autografting and an amniotic membrane inlay filling technique. Eye (Lond). 25:1484–1490. 2011. View Article : Google Scholar : PubMed/NCBI
17	Díaz-Valle D, Benítez del Castillo JM, Castillo A, Sayagués O, Bañares A and García-Sánchez J: Immunologic and clinical evaluation of postsurgical necrotizing sclerocorneal ulceration. Cornea. 17:371–375. 1998. View Article : Google Scholar : PubMed/NCBI
18	O'Donoghue E, Lightman S, Tuft S and Watson P: Surgically induced necrotising sclerokeratitis (SINS)-precipitating factors and response to treatment. Br J Ophthalmol. 76:17–21. 1992. View Article : Google Scholar : PubMed/NCBI
19	Fong LP, de la Maza M Sainz, Rice BA, Kupferman AE and Foster CS: Immunopathology of scleritis. Ophthalmology. 98:472–479. 1991. View Article : Google Scholar : PubMed/NCBI
20	Singh RP and McCluskey P: Scedosporium prolificans sclerokeratitis 10 years after pterygium excision with adjunctive mitomycin C. Clin Experiment Ophthalmol. 33:433–434. 2005. View Article : Google Scholar : PubMed/NCBI
21	Lai T, Leibovitch I, Zadeh R, Chehade M, Tamblyn D and Selva D: Surgically induced necrotizing scleritis occurring 48 years after strabismus surgery. J Pediatr Ophthalmol Strabismus. 42:180–182. 2005.PubMed/NCBI
22	Akpek EK, Thorne JE, Qazi FA, Do DV and Jabs DA: Evaluation of patients with scleritis for systemic disease. Ophthalmology. 111:501–506. 2004. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Tailored treatment for the management of scleral necrosis following pterygium excision

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