Scleral Necrosis Following Pterygium Excision: A Case Report

International Journal of Research and Scientific Innovation (IJRSI) | Volume VIII, Issue VI, June 2021 | ISSN 2321–2705

Scleral Necrosis Following Pterygium Excision: A Case Report

Bade Ogundipe¹, Olubusayo O.Adejumo²,³, Benedictus G.K Ajayi², Izuka A.Okwudishu1
Omodele O.A Jagun⁴, Caroline O.Adeoti^3
1Department of Ophthalmology, UCH, Ibadan, Nigeria.
²Eleta Eye Institute, Ibadan, Nigeria.
³Ophthalmology Department, Osun State University Teaching Hospital, Osogbo, Nigeria.
⁴Ophthalmology unit, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.

Abstract

Purpose: To report a case of scleral necrosis after pterygium excision and the management.
Method: Case report of a healthy young woman who presented with poor vision and scleral necrosis following nasal recurrent pterygium excision with adjunct beta irradiation in October 2020 at Eleta Eye Institute, Ibadan, Nigeria.
Results: Marked improvement in visual recovery by two months post-operative with corneo-scleral patch.
Conclusion: Prompt treatment with corneo-scleral patch and topical steroid can help avert the vision loss and possible loss of eye integrity that can follow surgically induced scleral necrosis.

Keywords: Pterygium, scleral necrosis, corneo-scleral graft, visual recovery.

I.INTRODUCTION

A pterygium is a wing-shaped, fibrovascular growth on the conjunctiva; which could extend across the limbus, invading the corneal surface. It is postulated to result from actinic damage to the limbal stem cells, hence, considered a focal limbal stem cell deficiency (Ronald, 2018). The most challenging aspect of pterygium excision is the high incidence of recurrence, as high as 88% with simple excision involving an uncovered bare sclera (Ronald, 2018; Noureddin G, &Yeung, S, 2016). The management options for prevention of pterygium recurrence are conjunctival autografting, amniotic membrane grafting and the use of adjuvant therapies including mitomycin C( MMC), 5-fluorouracil, anti-vascular endothelial growth factor (anti-VEGF) agents, and beta-irradiation (Noureddin G, &Yeung, S, 2016).

Complications following pterygium excision includes infection, diplopia, cornea perforation, cornea scarring and granuloma, rarely, globe perforation, scleral necrosis, vitreous hemorrhage and retinal detachment. Scleral necrosis or melting is a rare complication that may develop following pterygium surgery and it can lead to blindness (Linna, LU et al, 2017). Infection, ischemia and hypersensitivity response are possible pathological mechanisms underlying scleral necrosis following pterygium surgery (Linna, et al, 2017). The use of adjunctive MMC and beta- irradiation may increase the likelihood of scleral necrosis following pterygium excision (Linna, et al, 2017).

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