Scleral patch graft in the management of necrotising scleritis with inflammation. A case report

Parada-Vásquez, R.H.; Benítez-Castrillón, P.C.; de León-Ortega, J.E.; León-Roldán, C.R.

doi:10.1016/j.oftale.2015.11.004

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"apellidos" => "León-Roldán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Oftalmología, Escuela Superior de Oftalmología , Guatemala, Guatemala" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Escuela Superior de Oftalmología, Guatemala, Guatemala" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Parche escleral en manejo de escleritis necrosante con inflamación. Informe de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 693 "Ancho" => 953 "Tamanyo" => 159984 ] ] "descripcion" => array:1 [ "en" => "Necrotising scleritis with inflammation in left eye before surgery." ] ] ] "textoCompleto" => "Scleritis is a chronic granulomatous disease of the sclera, characterized by the destruction of collagen, cell infiltration and vascular alterations.<a class="elsevierStyleCrossRefs" href="#bib0020">1,2</a> It expresses more frequently in females during the 5th decade of life and is bilateral in 52% of cases. Approximately 25–50% of patients have a base disease that accounts for the inflammation.<a class="elsevierStyleCrossRef" href="#bib0025">2</a> Scleritis can be classified in 2 groups, i.e. anterior and posterior scleritis. The former is expressed as diffuse, nodular and necrotising with and without inflammation (perforating scleromalacia).<a class="elsevierStyleCrossRef" href="#bib0025">2</a> The etiology of infectious scleritis is multi-factorial, notably selfimmune diseases, vasculitis and multisystemic diseases. In addition, it can be associated with traumatisms such as pterygium surgery with or without the use of mitomycin C, filtrating surgery, cryotherapy or excessive use of cauterization in the sclera.<a class="elsevierStyleCrossRef" href="#bib0030">3</a>A case of necrotising scleritis with inflammation is presented, with scleral patch placement together with amniotic membrane, describing the evolution in the postoperative treatment. The case is a female patient, age 57, without known medical history. She referred that one year ago she underwent surgery in another hospital for left eye (LE) nasal pterygion surgery with mitomycin C.Physical examination revealed a visual acuity (far vision, uncorrected) in the right eye of 20/30 and 20/40 in the LE. Intraocular pressure in the RE was17mmHg; and in the LE of 17mmHg. RE did not exhibit alterations, while the LE exhibited ciliary injection, with a scleral thinning area, hyperemia, fluorescein staining in 80% of the lesion. Sentinel vessels observed surrounding the area, as well as whitish plate of approximately 1.5mm diameter in the nasal region of the corneoscleral limbus. The posterior pole did not exhibit alterations (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Lamellar scleral patch graft treatment was performed with placement of amniotic membrane in the LE. Two weeks after surgery the patient exhibited improvement in symptoms and good juxtaposition of the graft, with favorable evolution and clinical improvement. The patient remains in check-up visits with lubrication and analgesics (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Several authors have mentioned that conjunctival autotransplant is the procedure of choice for treating relapsed or primary advanced pterygium, as the recurrence rates are lower than with simple excision techniques.<a class="elsevierStyleCrossRef" href="#bib0025">2</a> It has been observed that 96% of necrotising scleritis cases were surgically induced<a class="elsevierStyleCrossRef" href="#bib0025">2</a> in patients. Similarly, the literature mentions that 75% of scleritis patients had 2 or more surgical procedures performed after the first one.<a class="elsevierStyleCrossRef" href="#bib0025">2</a> By way of conclusion, in this case it can be appreciated that the use of a scleral patch together with the placement of amniotic membrane was a very useful for resolving necrotising scleritis with inflammation when conventional medical therapy is not effective." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Parada-Vásquez RH, Benítez-Castrillón PC, de León-Ortega JE, León-Roldán CR. Parche escleral en manejo de escleritis necrosante con inflamación. Informe de un caso. Arch Soc Esp Oftalmol. 2016;91:353–354." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 693 "Ancho" => 953 "Tamanyo" => 159984 ] ] "descripcion" => array:1 [ "en" => "Necrotising scleritis with inflammation in left eye before surgery." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 695 "Ancho" => 953 "Tamanyo" => 132625 ] ] "descripcion" => array:1 [ "en" => "Postop, 2 weeks after scleral patch surgery and placement of amniotic membrane." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kanski oftalmología clínica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.J. Kanski" 1 => "B. Bowling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "7.ª edición" "fecha" => "2012" "paginaInicial" => "252" "paginaFinal" => "259" "editorial" => "Elsevier" "editorialLocalizacion" => "España" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scleritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Biber" 1 => "B.L. Schwam" 2 => "M.B. Raizman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Cornea" "paginaInicial" => "1343" "paginaFinal" => "1353" "edicion" => "2nd ed." "serieFecha" => "2005" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Yamazoe" 1 => "S. Shimazaki-Den" 2 => "I. Otaka" 3 => "K. Hotta" 4 => "J. Shimazaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/OPTH.S24885" "Revista" => array:6 [ "tituloSerie" => "Clin Ophthalmol" "fecha" => "2011" "volumen" => "5" "paginaInicial" => "1609" "paginaFinal" => "1611" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22140306" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009100000007/v1_201606230404/S2173579416300044/v1_201606230404/en/main.assets" "Apartado" => array:4 [ "identificador" => "5813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009100000007/v1_201606230404/S2173579416300044/v1_201606230404/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416300044?idApp=UINPBA00004N"]

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Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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Vol. 91. Issue 7.

Pages 353-354 (July 2016)

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