[Necrotizing sclerokeratitis following cataract extraction]

A number of cases of necrotic sclerokeratitis following eye surgery have been reported in recently published literature. The condition was presumably triggered by surgical inflammation and caused by localized occlusive vasculitis: in one case deposits of immune complexes in vessel walls were demonstrated. The authors report on three cases of necrotic sclerokeratitis which developed five to 16 months after uncomplicated cataract extraction. Clinical examination showed disappearance of vessels in affected sclera, together with tissue necrosis. None of the patients had any systemic immune disease and no immune complexes were found in biopsy material obtained from two eyes (of which one was enucleated and the other two healed under steroid treatment). In all three affected eyes cataract extraction was performed via a corneoscleral incision. In two of the three cases communicated here cataract extraction was performed in the fellow eye without any postoperative complications. Since postsurgical sclerokeratitis is presumably triggered by vascula inflammation, clear corneal incisions may be preferable to corneoscleral incisions in cases where immune reactions are anticipated.