Anterior segment ischemia following pterygium surgery

A 60-year-old woman developed anterior segment ischemia 1 week after an uneventful pterygium excision in the left eye. Corrected visual acuity fell from 20/20 to 20/200. Ophthalmic examination found keratic precipitates on the corneal endothelium, ++ cells in the aqueous humor, and necrosis of the lower half of the iris with posterior synechiae resulting in a fixed and distorted pupil. On therapy of topical corticosteroid eyedrops hourly and atropine eyedrops three times a day, the iridocyclitis resolved in 2 weeks. At the final examination 3 months after the surgery, the corrected visual acuity was 20/20. The atrophy of the lower half of the iris and posterior synechiae in the lower half of the pupil, giving the fixed and distorted pupil, were noted as sequelae. Iris fluorescein angiography revealed filling defects in the lower half of the iris but no leakage from iris vessels. Systemic evaluation was unremarkable except for mild hypertension. Doppler studies of carotid, ophthalmic, and central retinal arteries were normal. Mitomycin C, beta-irradiation and rectus muscle fixation sutures were not used. Only conjunctival dissection or episcleral cauterization were seen as possible causes of interference with the anterior segment blood supply. We believe this is the first report of anterior segment ischemia following pterygium surgery.