Rapid Regression of Scleral Melting Associated with Tumor Necrosis Factor-α in a Case of Surgically Induced Necrotizing Scleritis

Purpose: To report a case with rapid regression of scleral melting associated with tumor necrosis factor-α (TNF-α) in a surgically induced necrotizing scleritis (SINS) patient treated with local steroid therapy. Case Presentation: An 85-year-old male patient presented with conjunctival tumor in his right eye. Complete resection of the tumor lesion and conjunctival re-construction were performed. Local steroid drops were administered until 1 month after surgery, and a good clinical course was achieved. However, after stopping the local steroid, scleral melting to the uvea occurred on the center of the tumor-resected sclera. After diagnosing SINS, we immediately restarted his local steroid. After 2 weeks, there was a complete and rapid regression of the scleral melting. Following this episode, only local steroid therapy was continued for the treatment of SINS, with no recurrence observed after 6 months. Histopathological analysis revealed the infiltration of inflammatory cells during the acute phase, with TNF-α immune reactivity observed in the center of the melting site near the resected conjunctiva. Conclusion: We speculate that the observed changes were associated with the TNF-α that was present during the pathological state of SINS. Local steroid therapy may play a key role in the local immune balance in SINS.

Scleral thinning after eye-whitening surgery

We report the case of a 32-year-old male patient who presented with conjunctival redness after multiple bilateral eye-whitening surgeries. Slit-lamp examination revealed scleral melting, avascular areas, and demarcation lines in both eyes. Considering the treatment history and the clinical findings of the patient, we conclude that the removal of the conjunctiva and Tenon’s layer and use of mitomycin C is not desirable for a healthy ocular surface.