# Surgically-Induced Necrotizing Scleritis After Pars Plana Vitrectomy: A Case Report

## TL;DR

A rare case of eye inflammation following vitrectomy surgery is reported, highlighting the challenges in diagnosis and treatment.

## Contribution

This case report adds to the limited literature on surgically-induced necrotizing scleritis after vitreoretinal procedures.

## Key findings

- A 61-year-old diabetic male developed scleral melting two months after vitrectomy.
- The patient's condition did not respond well to medical and surgical interventions.
- Uncontrolled diabetes may have contributed to delayed healing and immune issues.

## Abstract

Surgically induced necrotizing scleritis (SINS) is a rare delayed hypersensitivity reaction following ocular surgeries, characterized by pain and redness at the surgical site. While commonly reported in various ocular surgeries, its occurrence after vitreoretinal procedures remains infrequent. We present a case of a 61-year-old diabetic male who developed progressive scleral melting and uveal exposure two months after an uneventful 23-gauge vitrectomy for retinal detachment. The infectious and immunologic profile was negative. Despite aggressive medical and surgical interventions, the patient exhibited advancing scleral melting. The diagnostic challenge lies in determining the relative contributions of trauma, epithelial breakdown, immune activation, and infection in these patients. Our patient's uncontrolled diabetes potentially aggravated vascular disruption, contributing to delayed wound healing and immune complex deposition. The treatment involved topical steroids with broad-spectrum antibiotics, followed by conjunctival flap and oral corticosteroids. This case underscores the importance of early diagnosis, cautious immunosuppression, and thorough infection evaluation in managing postoperative scleritis. The limitations include a single culture test and the patient being lost to follow-up.