Case report on managing glaucoma with refractory scleritis: iStent complications and challenges

Area of Science:

• Ophthalmology
• Glaucoma Research
• Scleritis Management

Background:

• Scleritis, an inflammation of the sclera, can lead to secondary glaucoma, a condition that is rare but difficult to manage.
• Refractory idiopathic scleritis presents significant challenges in treatment, often requiring multiple interventions.
• Secondary glaucoma in the context of scleritis poses unique management difficulties.

Observation:

• A case of a 56-year-old female with refractory scleritis and secondary glaucoma is presented.
• The patient underwent multiple glaucoma surgeries, including iStent insertion, after which the iStent migrated.
• Examination revealed severe scleral thinning and uveal prolapse, with significantly elevated intraocular pressure (IOP).

Findings:

• The iStent migrated into the subconjunctival space postoperatively, causing elevated IOP.
• Severe scleral thinning and chronic inflammation were identified as factors compromising iStent anchoring.
• Medical management involved systemic immunosuppressants and ocular hypotensive agents.

Implications:

• This case highlights the risk of iStent migration in patients with severe scleral thinning due to chronic inflammation.
• Meticulous surgical technique and rigorous postoperative follow-up are crucial in managing secondary glaucoma associated with scleritis.
• Careful surgical planning is essential to mitigate complications like iStent migration in complex cases.