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Fungal scleral keratitis and endophthalmitis following pterygium excision
Vasileios Peponis1, Pinchas Rosenberg, Spyridon E Chalkiadakis
1Athens Eye Hospital, 2nd Eye Clinic, Athens, Greece. pepbas@yahoo.com
Purpose:
The authors report a case of fungal scleral keratitis and endophthalmitis as a complication of pterygium surgery.
Methods:
Case presentation.
Results:
A 46-year old woman underwent pterygium excision with topical use of intraoperative mitomycin C. By day 21 after excision, scleral melting was followed by fungal keratitis. Endophthalmitis ensued, which rapidly progressed, despite surgical and medical interventions. The eye was finally enucleated to prevent fungaemia. Pathology revealed a highly disorganized eye with disruption of scleral collagen in the area of scleral melting.
Conclusions:
Fungal keratitis and scleral melting are rare but devastating complications of pterygium surgery with adjuvant use of mitomycin C.
Insights
Fungal keratitis and scleral melting are rare but severe complications following pterygium surgery, especially when mitomycin C is used. Prompt intervention is crucial to prevent further vision loss.
Area of Science:
- Ophthalmology
- Surgical Complications
- Mycology
Background:
- Pterygium surgery is a common procedure.
- Mitomycin C is sometimes used as an adjuvant to prevent recurrence.
Observation:
- A case of fungal scleral keratitis and endophthalmitis occurred 21 days post-pterygium excision.
- The patient had received topical intraoperative mitomycin C.
- Scleral melting preceded the fungal keratitis and endophthalmitis.
Findings:
- Despite aggressive medical and surgical management, the infection progressed.
- The eye was enucleated to prevent systemic spread of the fungus (fungaemia).
- Pathology confirmed scleral collagen disruption.
Implications:
- This case highlights the potential for rare but devastating fungal infections after pterygium surgery.
- Adjuvant mitomycin C may increase the risk of such complications.
- Ophthalmologists should maintain a high index of suspicion for fungal keratitis in post-operative pterygium patients, particularly those treated with mitomycin C.
