PMC9979078_01
Reported cases of surgically induced scleral necrosis with concomitant active tuberculosis
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T1
Slit-lamp evaluation of the RE revealed marked ciliary injection, a nasal corneal leucoma, and scleral necrosis at the pterygium excision site (Figure 1A (Fig. 1)). After one month of therapy, the scleral necrosis progressed, and inflammatory activity was observed at the nasal peripheral cornea (Figure 1B (Fig. 1)). MTX was increased to 25 mg/week, and 1 g of intravenous methylprednisolone was prescribed for three days (Figure 1B (Fig. 1)). Moreover, empirical management with natamycin 5% QID and oral valaciclovir (1 g TID) for fungal and herpetic coverage was initiated.
(A) At presentation. Anterior segment photograph of the right eye (RE) showing nasal marked ciliary injection, ischemic scleral necrosis and a corneal leukoma at the pterygium excision site. (B) At one month. Clinical photograph depicts progression of scleral necrosis, increased ciliary injection, and inflammatory activity was observed at the nasal peripheral cornea.
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F1
Unfortunately, the scleral necrosis continued progressing (Figure 2A (Fig. 2)); thus, a scleral biopsy, debridement, and a corneal tectonic graft with conjunctival autograft were performed due to impending corneal perforation (Figure 2B (Fig. 2)). One month later, the corneal tectonic graft lysed completely (Figure 2C (Fig. 2)).
(A) At two months. Progression of necrosis with uveal exposure. (B) Area of necrosis with a corneal tectonic graft with conjunctival autograft. (C) One month after surgery the patch completely lysed.
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F2
The patient is currently in her seventh month of treatment and an excellent therapeutic response with no pain and no further scleral inflammation or necrosis are observed (Figure 3 (Fig. 3)).