Raharja Antony, Shah Neil, Ahmed Syed, Wagner Siegfried Karl, Okhravi Narciss, Bainbridge James
Moorfields Eye Hospital, London, UK.
UCL Institute of Ophthalmology, London, UK.
Eye (Lond). 2025 Apr 16. doi: 10.1038/s41433-025-03803-4.
Surgically induced scleritis is a recognised adverse consequence of retinal surgery but its incidence, clinical features and outcomes are poorly defined.
This retrospective case series included all cases of surgically induced scleritis following pars plana vitrectomy (PPV) or scleral buckling surgery (SB) identified at Moorfields Eye Hospital, London, UK between September 2012 and June 2024. Those with a previous history of scleritis were excluded. The incidence was estimated using identified cases and the total number of PPV and SB performed during the same period. Clinical characteristics, management and outcomes were described.
Forty cases of surgically induced scleritis were identified: 23 post-PPV and 17 post-SB. The estimated annual incidence was 5.0 cases (95% CI: 3.4-7.5) per 100,000 PPV and 45.0 cases (95% CI: 24.4-82.5) per 100,000 SB. Scleritis was non-necrotising in 62.5% cases and developed following multiple retinal surgeries in 45% cases. Post-PPV scleritis presented earlier (3.6 weeks vs. 33.4 weeks, p = 0.013), but appeared less likely to be necrotising (26% vs. 47%, p = 0.20) than SB scleritis. Oral NSAIDs were sufficient to control scleritis in 33 (82.5%) cases. Systemic steroids or immunomodulatory therapy were used more frequently in SB scleritis than post-PPV scleritis (29.4% vs. 8.7%, p = 0.11). The scleral explant was removed in 59% cases of SB scleritis. A scleral patch graft was applied in 5% cases. With treatment, visual acuity at presentation was maintained in 80% of the cases and the globe preserved in all.
Surgically induced scleritis following retinal surgery is rare. Scleritis associated with scleral buckling appears to require more aggressive medical and surgical intervention than scleritis following pars plana vitrectomy.
手术诱发的巩膜炎是视网膜手术公认的不良后果，但其发病率、临床特征和预后尚不明确。
本回顾性病例系列纳入了2012年9月至2024年6月期间在英国伦敦摩尔菲尔德眼科医院确诊的所有玻璃体切割术（PPV）或巩膜扣带术（SB）后手术诱发巩膜炎的病例。排除既往有巩膜炎病史的患者。通过已确诊病例和同期进行的PPV及SB总数估算发病率。描述临床特征、治疗及预后情况。
共确诊40例手术诱发的巩膜炎病例：PPV术后23例，SB术后17例。PPV的估计年发病率为每10万例中有5.0例（95%CI：3.4 - 7.5），SB的估计年发病率为每10万例中有45.0例（95%CI：24.4 - 82.5）。62.5%的病例为非坏死性巩膜炎，45%的病例在多次视网膜手术后发生。PPV术后巩膜炎出现时间更早（3.6周对33.4周，p = 0.013），但与SB术后巩膜炎相比，坏死性巩膜炎的可能性似乎更小（26%对47%，p = 0.20）。33例（82.5%）患者口服非甾体抗炎药足以控制巩膜炎。SB术后巩膜炎比PPV术后巩膜炎更频繁使用全身类固醇或免疫调节疗法（29.4%对8.7%，p = 0.11）。59%的SB术后巩膜炎病例切除了巩膜外植体。5%的病例应用了巩膜补片移植术。经治疗，80%的患者就诊时视力得以维持，所有患者眼球均得以保留。
视网膜手术后手术诱发的巩膜炎较为罕见。与巩膜扣带术相关的巩膜炎似乎比玻璃体切割术后巩膜炎需要更积极的药物和手术干预。
