Conjunctival Necrosis following Ahmed Valve Implantation and Subtenon Triamcinolone Injection

PURPOSE: We report a case of conjunctival necrosis in a glaucoma patient who underwent Ahmed valve implantation and subtenon triamcinolone injection. CASE SUMMARY: subconjunctival injections of mitomycin C in her right eye. Ahmed valve implantation and subtenon triamcinolone injection were performed in the right eye. Four weeks later, conjunctival necrosis was observed. After debridement of necrotic tissue, an additional conjunctival autograft was needed because of recurrence of the conjunctival necrosis. After amniotic membrane transplantation was performed for one more recurrent conjunctival necrosis, conjunctival epithelialization was completed. CONCLUSIONS: Although conjunctival necrosis after periocular injection of triamcinolone is a rare complication, previous multiple usage of antimetabolites such as mitomycin C might be associated with a higher risk of developing conjunctival necrosis. In such cases, aggressive surgical intervention may be helpful in the reconstruction of the conjunctival epithelium.

Necrotizing Conjunctival Ulceration following Subconjunctival Atropine Depot Injection

PURPOSE: To report a case of severe conjunctival necrosis associated with scleral melting following subconjunctival atropine depot injection in treating posterior synechiae associated with uveitis. METHODS: A 31-year-old male patient visited our clinic after subconjunctival injection of 1% atropine, 0.4 ml, in treating circular posterior synechiae associated with uveitis in his left eye. The marked conjunctival injection and chemosis around the limbus were noted. Three days after first visit to our clinic, remarkable necrosis had developed around the whole limbus, and newly developed whitish necrotic tissue was noted over sclera and episclera. We debrided the necrotic conjunctiva and episclera, and the exposed sclera was grafted with amniotic membrane. REUSLTS: After 4 weeks, the complete re-epithelization of necrotized defect was shown and there were no evidence of inflammation, symblepharon, or scleral melting. CONCLUSIONS: In usage of atropine, especially to eyes locally, subconjunctival injection should be avoided due to direct toxicity to the conjunctiva and sclera to form necrosis and melting. The damaged lesions of conjunctiva and sclera due to usage of this drug generally cause chronic inflammation and persistent surface defect. In order to restore and re-epithelize the necrotic defect, more aggressive treatment such as an amniotic membrane transplantation would be needed.