Surgery-induced necrotizing scleritis after vitrectomy with removal of dislocated intraocular lens and secondary iris-claw IOL implantation

Abstract

Abstract Purpose To report a surgical-induced necrotizing scleritis, as well as its medical and surgical management.Methods Case-reportResults An 88 year-old patient with a three-day severe single-left-eye ocular pain. One-time surgery involving PPV with removal of dislocated intraocular lens and secondary implantation of iris-claw Artisan® lens was performed six months earlier. Visual acuity of 20/100. Slit-lamp examination revealed a 5x2 mm non-suppurative superior scleral defect. Empirical topical antibiotic treatment with dexamethasone, as well as oral doxycycline was started. Infectious and autoimmune diseases were ruled out. Non-infectious scleritis treatment was conducted with intravenous Methylprednisolone three day pulses, followed by weekly tapered Prednisone and intramuscular Methotrexate. However, one month after the diagnosis, the defect was worsened; hence, a heterologous scleral patch graft was performed and, days after the intervention, Adalimumab was initiated. To date, six months later, remains with proper scleral patch, a diary low-dose Prednisone, and spacing Adalimumab treatment.Conclusion: Surgery-induced necrotizing scleritis is a severe condition that compromise the ocular and visual integrity. Proper diagnosis, as well as early treatment is required to achieve remission, prevent relapses, and avoid structural complications. In refractory cases, anti-TNF-α immunotherapy associated with surgical tectonic graft interventions can achieve promising results.