Yamazoe Katsuya, Shimazaki-Den Seika, Otaka Isao, Hotta Kazuki, Shimazaki Jun
Department of Ophthalmology, Tokyo Dental College, Ichikawa.
Clin Ophthalmol. 2011;5:1609-11. doi: 10.2147/OPTH.S24885. Epub 2011 Nov 10.
Although pterygium excision with conjunctival autograft is a widely performed surgical procedure, surgically induced necrotizing scleritis (SINS) following such surgery is extremely rare.
A 68-year-old man underwent nasal pterygium excision with conjunctival autograft uneventfully. On postoperative day 17, the conjunctival graft was avascular, with epithelial defect. Although topical steroid and antibacterial treatments were continued, the graft and sclera melted, with the ischemic sclera showing gradual thinning. The thinning area spread to the adjoining cornea, and active inflammation with epithelial defect was observed adjacent to the site of thinning.
Systemic and microbiological examination was noncontributory. The patient was suspected of having SINS, and administration of oral prednisolone was started. Although the necrotic area was reduced temporarily, medication was discontinued due to nausea, and the area of thinning increased. Conjunctival flap surgery was later performed, and the graft was well accepted.
SINS must be considered in the differential diagnosis of patients with scleritis following pterygium surgery, especially if radiation or mitomycin C has not been used.
尽管自体结膜移植翼状胬肉切除术是一种广泛开展的外科手术，但该手术后发生手术性坏死性巩膜炎（SINS）极为罕见。
一名68岁男性顺利接受了鼻侧翼状胬肉自体结膜移植切除术。术后第17天，结膜移植片无血管，伴有上皮缺损。尽管继续使用局部类固醇和抗菌治疗，但移植片和巩膜发生溶解，缺血性巩膜逐渐变薄。变薄区域蔓延至相邻角膜，在变薄部位附近观察到伴有上皮缺损的活动性炎症。
全身检查和微生物学检查均无异常发现。该患者被怀疑患有SINS，并开始口服泼尼松龙治疗。尽管坏死区域暂时缩小，但由于恶心而停药，变薄区域增大。后来进行了结膜瓣手术，移植片被良好接受。
在翼状胬肉手术后巩膜炎患者的鉴别诊断中必须考虑SINS，尤其是在未使用放射治疗或丝裂霉素C的情况下。
