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
169/F/ChRE 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
261/M/ChLE 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 deficiencyIgA: 6.08 g/l (0.7–3.76 g/l)
Active tuberculosis
Limbal autograft transplant done for cornea problem onlyScleral melt remained stable without treatment after 3.5 years
Vision at 6/12
379/M/ChLE blurred vision RE pterygium excision 20 years agoRE nasal scleral melt with overlying staining plaqueGout in the past
Uric acid 644 μmol/l (232–494 μmol/l) Positive ANA
Lamellar patch graft done with removal of plaqueNo recurrence for 2.5 years
474/F/ChLE 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
  • CH50 = total haemolytic complement; ESR = erythrocyte sedimentation rate; IgG, IgA = immunoglobulin G and A; ANA = antinuclear antibody; CRP = C reactive protein.