A Case of Scleromalacia Perforance That Developing after Surgery for Excision of the Pterygium in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

The ocular manifestations of rheumatoid arthritis (RA) are common and they can vary from patient to patient. However, necrotizing anterior scleritis without inflammation (scleromalacia perforans) is a rare and serious opthalmic complication, and it is typically associated with long-standing RA. Although the etiology and pathogenesis of scleromalacia perforans are diverse and they are not completely understood, ophthalmic surgery is one of the well known causes of scleromalacia perforans. Patients with systemic autoimmune disease such as RA have an especially higher risk of scleromalacia perforans after opthalmic surgery. Because scleromalacia perforans is a potential threat not just to eyesight, but to life as well, early diagnosis and prompt treatment are required for its successful management. We experienced a case of scleromalacia perforans that developed after scleral excision of pterygium in a 58 year old woman who had a 7 year history of RA, and this was well treated with an early screral graft. We report here on this case along with a review of the relevant literature.

A Case of Enucleation due to Extensive necrotizing Scleritis after Pterygium Excision in a Rheumatoid Arthritis Patient

The scleritis is developed after taruma, infection or associated with systemic disease in 505 such as connective tissue disease, granulomatous disease & metabolic disease, in which the most common disease is rheumatoid arthritis[RA]. Scleromalacia perforans characterized by progressive thinning of the sclera in the absence of symtoms and with minimal inflammatory signs is a typical type of scleritis in rhematoid arthritis patient. And necrotizing scleritis is associated with long-standing and severe RA in 4-10%. However, there has been no effective method for preventing those diseases. In order to prevent recurrence of pterygium, anti-metabolic agent or radioactive material has been applied to excision site. However, in case of RA, excessive application of above method or aggressive excision of pterygeal mass is rather avoided to prevent postoperative necrotizing scleritis. In this study, we reported a case of enucleation with histology due to severe necrotizing scleritis with extensive exposure of choroid in a 67-year-old man having a past history of RA for 20 years and pterygium excision[OS] 15 years ago.