Surgically Induced Focal Scleral Necrosis – A Rare Outcome

Abstract

Purpose: To present a rare case of surgically induced scleral necrosis (SISN) following vitreoretinal surgery and discuss its clinical presentation, potential etiological factors, and management strategies.
Methods: A 71-year-old male with a history of hypertension and type 2 diabetes mellitus presented with progressive vision loss in the right eye for six months and ocular discomfort with redness for two months. Two months prior, he had undergone pars plana vitrectomy, scleral buckling, and epiretinal membrane peeling for retinal detachment. Clinical examination revealed reduced visual acuity (1/60 in OD), conjunctival congestion, scleral thinning with uveal exposure, and prominent episcleral vessels. Fundus findings included a pale, tilted optic disc with vessel shifting in the right eye, and hypertensive changes in the left eye. Autoimmune markers (ANA, RA factor) were negative. A diagnosis of post-retinal surgery-induced scleral necrosis was made.
Results: Management included topical fortified vitamin C, antibiotics, corticosteroids, and oral doxycycline. Surgical intervention with scleral patch graft and buckle readjustment was advised. The pathogenesis was attributed to possible scleral ischemia induced by excessive buckle tension or trocar-related trauma, compounded by systemic comorbidities impairing healing.
Conclusion: SISN, though rare, is a serious complication of ocular surgery. Risk factors include multiple surgeries, adjunctive therapies, surgical trauma, and systemic diseases. Early recognition and a multidisciplinary approach are critical for preserving ocular integrity. Surgeons must exercise caution during scleral manipulations and conduct thorough systemic evaluations prior to surgery.