The Clinical and Pathogenic Spectrum of Surgically-Induced Scleral Necrosis. A Review

Citation:

Ruiz-Lozano RE, Garza-Garza LA, Cavazos-Davila O, Foster SC, Rodriguez-Garcia A. The Clinical and Pathogenic Spectrum of Surgically-Induced Scleral Necrosis. A Review. Surv Ophthalmol 2021;

Date Published:

2021 Jan 07

Abstract:

The onset of scleral necrosis after ocular surgery can have catastrophic ocular and systemic consequences. The two most frequent surgeries causing surgically-induced scleral necrosis (SISN) are pterygium excision and cataract extraction. Several pathogenic mechanisms are involved in SISN. All of them are poorly understood. Ocular trauma increasing lytic action of collagenases with subsequent collagen degradation, vascular disruption leading to local ischemia, and immune complex deposition activating the complement system represents some of the events that lead to scleral necrosis. The complex cascade of events involving different pathogenic mechanisms and the patient's abnormal immune response frequently leads to delayed wound healing that predisposes the development of scleral necrosis. The management of SISN ranges from short-term systemic anti-inflammatory drugs to aggressive immunosuppressive therapy and surgical repair. Therefore, before performing any ocular surgery involving the sclera, a thorough ophthalmic and systemic evaluation must be done to identify high-risk patients that may develop SISN.

Last updated on 01/31/2021