Infective Necrotizing Scleritis After XEN Gel Stent With Mitomycin-C
| Autor: | Sophia Zagora, Ezekiel J Kingston, Jed Lusthaus, Richard Symes, Pushpa Raman, Peter McCluskey |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Intraocular pressure Visual acuity Mitomycin medicine.medical_treatment Glaucoma Staphylococcus lugdunensis medicine Glaucoma surgery Humans Glaucoma Drainage Implants Intraocular Pressure Aged Past medical history biology business.industry Stent Cataract surgery biology.organism_classification medicine.disease Surgery Ophthalmology Treatment Outcome Female Stents medicine.symptom business Glaucoma Open-Angle Scleritis |
| Zdroj: | Journal of Glaucoma. 31:129-132 |
| ISSN: | 1057-0829 |
| Popis: | Purpose The purpose of this study was to report a case of infective necrotizing scleritis following XEN Gel Stent with mitomycin-C. Methods Case report. This is a case report of a 68-year-old woman. Results XEN Gel Stent glaucoma surgery enhanced with mitomycin-C 0.04% and combined with cataract surgery was performed at a regional center to manage the patient's primary open-angle glaucoma. Past medical history was significant for rheumatoid arthritis requiring treatment with methotrexate and adalimumab. Periocular pain and swelling developed 14 months after the initial operation, followed by a rapid deterioration of visual acuity to 20/60, intraocular pressure of 4 mm Hg, and worsening pain 5 months later. On initial presentation to Sydney Eye Hospital, 180 degrees of scleral necrosis was evident with a moderate anterior segment inflammatory reaction and a large temporal choroidal effusion due to hypotony. Empirical hourly topical ofloxacin and cephalothin 5% drops, with oral moxifloxacin, were initiated. Conjunctival swab grew Staphylococcus aureus and Staphylococcus lugdunensis. Significant clinical improvement occurred, but the XEN Gel Stent became exposed after 9 days of treatment with worsening hypotony. Urgent surgical revision was performed to remove the XEN Gel Stent and apply a tutoplast plug with overlying amniotic membrane graft. Intraocular pressure gradually improved over 6 weeks to 15 mm Hg with reversal of hypotonous changes, and visual acuity stabilized at 20/40. Conclusions To our knowledge, this is the first reported case of necrotizing scleritis following XEN Gel Stent insertion. It is a reminder that infection should always be the primary differential diagnosis in patients with surgical-induced necrotizing scleritis. |
| Databáze: | OpenAIRE |
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