Table 1
Report of four cases with necrotising scleritis after bare sclera excision of pterygium
| Case no | Age/sex/race | Presenting symptoms | Clinical findings | Investigations | Treatment | Outcome |
| 1 | 69/F/Ch | RE pain and red for 6 months RE nasal pterygium excision 18 months ago |
RE sclera melt 10 × 3.5 mm inferonasally with sequestrum (Fig 1) Inflamed nodule inferotemporally Anterior chamber cells and
flare Exudates in inferonasal retina away from posterior pole |
CH50: 51 U/ml (13–37 U/ml) IgG: 15.9 g/l (7.3–15.4 g/l) ESR: 60 mm/h (3–15 mm/h) Positive ANA |
Oral indomethacin 25 mg three times daily, topical dexamethazone 0.1% two hourly, topical homatropine 2% twice daily Scleral necrosis progressed. Large tectonic lamellar keratoplasty (using corneal tissue) extending beyond medial rectus insertion done with preoperative intravenous methylprednisolone 1 g given Postoperative oral prednisolone 60 mg daily for 2 weeks Inferotemporal scleral nodule melted when steroids stopped. Oral prednisolone 40 mg daily recommenced and tapered over 6 weeks |
No recurrence after 2 years Vision at 6/12 |
| 2 | 61/M/Ch | LE blurred vision LE pterygium excision 20 and 40 years ago | LE area of scleral melt nasally with inflammation covered by conjunctival epithelium Cornea shows signs of limbal stem cell deficiency | IgA: 6.08 g/l (0.7–3.76 g/l) Active tuberculosis |
Limbal autograft transplant done for cornea problem only | Scleral melt remained stable without treatment after 3.5 years Vision at 6/12 |
| 3 | 79/M/Ch | LE blurred vision RE pterygium excision 20 years ago | RE nasal scleral melt with overlying staining plaque | Gout in the past Uric acid 644 μmol/l (232–494 μmol/l) Positive ANA |
Lamellar patch graft done with removal of plaque | No recurrence for 2.5 years |
| 4 | 74/F/Ch | LE red and pain for 3 months LE nasal pterygium excision 4.5 years ago LE cataract surgery 2.5 years ago |
Scleral melt with inflammation superonasally with intact overlying conjunctiva (Fig2) | CRP: 14.3 mg/l (1–10 mg/l) | Tapering oral prednisolone 80 mg daily, maintaining at 10 mg daily for 2.5 years Reactivates when prednisolone lower than 10 mg daily |
Scleral melt stable with prednisolone at maintenance dose for 2.5 years Vision at 6/18 |
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CH50 = total haemolytic complement; ESR = erythrocyte sedimentation rate; IgG, IgA = immunoglobulin G and A; ANA = antinuclear antibody; CRP = C reactive protein.
