Trabeculectomy with Mitomycin C in Refractory Glaucoma Associated with Nonnecrotizing Anterior Scleritis

Surgically induced necrotising scleritis (SINS) following sequential laser-assisted in situ keratomileusis (LASIK) and pterygium excision with conjunctival autograft. Purpose: To report a case of SINS occurring 1 month after uncomplicated pterygium excision with conjunctival autograft. Setting: Department of Ophthalmology, Singleton Hospital, Abertawe Bro Morgannwg University NHS trust, United Kingdom Method: A 70-year-old male presented with a 10 day history of redness and reduced vision in the right eye. Bilateral hyperopic LASIK and right eye pterygium excision with conjunctival autograft had been performed elsewhere, 6 months and 1 month prior to presentation. BCVA were 6/60 OD and 6/6 OS. A 2mm full thickness nasal corneal perforation with adjacent scleral melt (6.5x4mm) was evident. Tectonic full thickness corneal and scleral patch grafting with amniotic membrane graft overlay was performed with systemic immunosuppression (prednisolone 60mg od). Results: Recurrence of the corneascleral melt occurred one month postoperatively on reduction of prednisolone to 15mg od. This was initially managed successfully with cyclophosphamide 100mg and prednisolone 80mg. Two months postoperatively recurrent corneal perforation required the application of cyanoacrylate glue. At latest follow up four months postoperatively the corneal glue is insitu with no evidence of recurrent melt. Conclusions: SINS following pterygium excision with conjunctival autograft is rare with only 2 case reports in the literature. This is the first reported case of SINS occurring after pterygium excision with conjunctival autograft with preceeding LASIK.