J Korean Ophthalmol Soc.  2013 Dec;54(12):1929-1934.

Efficacy of Autologous Tragal Perichondrium Graft after Proper Antifungal Treatment in Fungal Necrotizing Scleritis

• Moon JH
• Kim JC

Abstract

PURPOSE
To compare the efficacy of an autologous tragal perichondrium graft after proper antifungal treatment between 2 cases of fungal necrotizing scleritis.
CASE SUMMARY
A 58-year-old female was referred to our clinic with fungal necrotizing scleritis of the left eye which had occurred after pterygium removal. Scleral melting around calcification was observed. After proper treatment with antifungal agents, the authors performed autologous tragal perichondrium graft; however, 3 months after surgery, a necrosis of sclera recurred and the, patient underwent additional treatment with antifungal agents. No complication has been observed up to 3 months postoperatively. A 36-year-old male visited our clinic with ocular pain and decreased visual acuity associated with necrotizing scleritis which occurred after local conjunctival resection. After 4 weeks of antifungal treatments, scleral lesions were stabilized and the authors confirmed negative findings with repetitive fungus smear test. Therapeutic autologous tragal perichondrium graft was performed, and no complication was observed 3 months postoperatively.
CONCLUSIONS
When treating a patient with fungal necrotizing scleritis, preoperative antifungal therapy and confirmation of negative findings in repetitive fungus smear test are important. Autologus tragal perichondrium graft accompanied with proper antifungal therapy is an effective treatment of fungal necrotizing scleritis.

Keyword

Autologus tragal perichondrium; Fungal necrotizing scleritis; Proper antifungal therapy

MeSH Terms

Adult
Antifungal Agents
Female
Freezing
Fungi
Humans
Male
Middle Aged
Necrosis
Pterygium
Sclera
Scleritis*
Transplants*
Visual Acuity
Antifungal Agents

Figure

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  Figure 1. Preoperative and postoperative appearances of case 1. (A) Preoperatively, melted sclera and corneal ulcer with feath-ery-like fungal invasion are noted. (B) On hospital day 10th, anterior chamber irrigation and calcified material removal was performed. (C) After autologous tragal perichondrium graft, auto-tragal perichondrium graft is in place. (D) After 1 month of surgery, scleral lesions improved.

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  Figure 2. Preoperative and postoperative appearances of case 2. (A) Preoperatively, melted scleral lesions are noted. (B, C) Postoperatively, autologus tragal perichondrium is in place. (D) After 6 month of surgery, melted scleral lesions are improved and vascularization and conjunctivalization has started over the graft.

Reference

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