[Sequestrating senile scleral plaque simulating "necrotizing scleritis". Surgical management]

Presentation and surgical treatment of a sequestrating senile scleral plaque, a rare clinical disorder.

A 76 year-old-female patient presented with foreign body sensation and epiphora. Half a year before, she had first noticed a "black spot" in her eye which had now progressed to a painless yellow-greyish plaque.

The patient had previously undergone a steroid-treatment elsewhere with a diagnosis "necrotizing scleritis" without any improvement. We found a yellow-greyish degenerative plaque sequestrating from the surrounding scleral tissue. In order to prevent superinfection and to secure the tissue defect we surgically removed the plaque and covered the remaining thin inner scleral tissue layers with autologous sclera and conjunctiva. The clinical diagnosis of a calcified senile scleral plaque was histologically confirmed. The patient has been free from any symptoms since the operation. To our knowledge this is the first description of surgical removal of a deeply sequestrating senile sceral plaque.

Calcified sequesters represent a very rare complication of the otherwise frequent senile scleral plaques. Surgical intervention may be required to prevent superinfection and to cover the deep sceral defect. The clinical picture can be distinguished from necrotizing scleritis or scleromalacia perforans. Sequestrating senile scleraplaques do not tend to perforate. They are, however, a risk for infection and chronic inflammation.