Surgically induced scleritis after pars plana vitrectomy or scleral buckling surgery: a 12-year audit

Surgically induced scleritis is a recognised adverse consequence of retinal surgery but its incidence, clinical features and outcomes are poorly defined.

This retrospective case series included all cases of surgically induced scleritis following pars plana vitrectomy (PPV) or scleral buckling surgery (SB) identified at Moorfields Eye Hospital, London, UK between September 2012 and June 2024. Those with a previous history of scleritis were excluded. The incidence was estimated using identified cases and the total number of PPV and SB performed during the same period. Clinical characteristics, management and outcomes were described.

Forty cases of surgically induced scleritis were identified: 23 post-PPV and 17 post-SB. The estimated annual incidence was 5.0 cases (95% CI: 3.4-7.5) per 100,000 PPV and 45.0 cases (95% CI: 24.4-82.5) per 100,000 SB. Scleritis was non-necrotising in 62.5% cases and developed following multiple retinal surgeries in 45% cases. Post-PPV scleritis presented earlier (3.6 weeks vs. 33.4 weeks, p = 0.013), but appeared less likely to be necrotising (26% vs. 47%, p = 0.20) than SB scleritis. Oral NSAIDs were sufficient to control scleritis in 33 (82.5%) cases. Systemic steroids or immunomodulatory therapy were used more frequently in SB scleritis than post-PPV scleritis (29.4% vs. 8.7%, p = 0.11). The scleral explant was removed in 59% cases of SB scleritis. A scleral patch graft was applied in 5% cases. With treatment, visual acuity at presentation was maintained in 80% of the cases and the globe preserved in all.

Surgically induced scleritis following retinal surgery is rare. Scleritis associated with scleral buckling appears to require more aggressive medical and surgical intervention than scleritis following pars plana vitrectomy.