Posterior Scleritis Following Uneventful Small-Incision Cataract Surgery

Posterior scleritis following routine, uncomplicated cataract surgery in a patient without underlying systemic disease is an exceedingly rare and potentially sight-threatening clinical entity.

A 55-year-old female with no systemic medical history presented three weeks after uneventful small-incision cataract surgery (SICS) in the right eye with sudden vision loss, redness, and severe ocular pain exacerbated by eye movements. Her best-corrected visual acuity (BCVA) had deteriorated from 6/9 to finger counting close to her face. Dilated fundus examination revealed multiple dull yellow subretinal lesions across the posterior pole. Optical coherence tomography (OCT) showed hyperreflective vitreous cells, subretinal fluid (SRF), and choroidal undulations. B-scan ultrasonography confirmed diffuse posterior scleritis, demonstrating localized sclerochoroidal thickening and fluid accumulation in the sub-Tenon's space. Comprehensive laboratory testing and imaging ruled out infectious and autoimmune etiologies.

The patient was treated with high-dose intravenous pulse methylprednisolone (1 g/day for three days) followed by an oral prednisolone taper, which led to immediate pain relief and anatomical resolution. At six months, the scleritis had completely resolved with a BCVA improvement to 6/12, limited by persistent localized disruption of the foveal ellipsoid zone on OCT. The patient remained recurrence-free at six months.

Diffuse posterior scleritis can occur as a postoperative inflammatory phenomenon following uneventful cataract surgery. Clinicians must maintain a high index of suspicion, utilize B-scan ultrasonography for diagnosis, and initiate prompt systemic corticosteroid therapy to optimize anatomical and visual outcomes.