Panophthalmitis associated with scleral necrosis in dengue hemorrhagic fever

Dengue is a mosquito-borne flavivirus disease affecting humans. The Aedes aegypti mosquito spreads it. Ophthalmic manifestations of dengue range from subconjunctival hemorrhage to optic neuropathy. Panophthalmitis in dengue fever is a rare finding. We report a case of a 22-year-old male having dengue fever, who presented with pain, redness, swelling and loss of vision in his right eye. He was diagnosed as panophthalmitis with subretinal hemorrhage and required right eye evisceration.

Use of Gore-Tex in Bleb Revision after Trabeculectomy with Mitomycin

Trabeculectomy, as a surgical intervention in the treatment of glaucoma, has become most popular. The most common cause of filtration failure is obstruction of aqueous outflow due to bleb fibrosis. Adjunctive intraoperative mitomycin-C has been reported to improve the success of filtration surgery in eyes of high risk for failure. But its use increases the rate of complications after filtering surgery: especially postoperative hypotony, wound leakage, and scleral necrosis. We have experienced two patients whose scleral flaps were necrotized after trabeculectomy with mitomycin-C in uncomplicated glaucoma. We report successful results in revision of filtering bleb by using Gore-Tex as a patch graft.

Surgical Management of Scleral Necrosis

Scleral necrosis is a focal thinning of the sclera, and causes an exposure of underlying uveal tissue, endophthalmitis, and eyeball perforation. The authors experienced 16 cases of scleral necrosis after pterygium excision and performed combined lamellar scleral grafting and conjunctival flap for 13 cases, and simple conjunctival flap for 3 cases. After 12 months of follow-up period, all of the scleral grafts healed well except one case of graft melting. Six cases associated with endophthalmitis showed three lines of mean visual acuity improvement with Snellen chart after postoperative healing of inflammation. Postoperative complications included temporary corneal erosion(6 cases), conjunctival cyst formation(2 cases), scleral graft melting(1 case), and partial absorption of conjuctival flap(1 case).

Temporalis Fascia Grafting in Scleral Necrosis after Pterygium Excision

We performed scleral grafting with autogenous temporalis fascia and autogenous conjunctiva in 32 patients (32 eyes) in scleral necrosis after pterygium excision. The average age of patients was 54.3 years (range, 38 to 74 years). Nine of them were male and twenty-three were female. The intervals between pterygium excision and scleral necrosis were from 2 months to 23 years (mean, 6.2 years). After the mean follow-up 6.6 months, in 29 eyes graft was stably adhered but in three eyes graft was melted. Conjunctival wound dehiscence and conjunctival necrosis were noticed in three eyes and one eye respectively. There were no cases showing significant difference between the preoperative and the postoperative visual acuity and intraocular pressure. Autogenous temporalis fascia appears to be a good alternative to homologous sclera for scleral reinforcement.