Purpose: 

The purpose of this study was to report a case of infective necrotizing scleritis following XEN Gel Stent with mitomycin-C.

Methods: 

Case report. This is a case report of a 68-year-old woman.

Results: 

XEN Gel Stent glaucoma surgery enhanced with mitomycin-C 0.04% and combined with cataract surgery was performed at a regional center to manage the patient’s primary open-angle glaucoma. Past medical history was significant for rheumatoid arthritis requiring treatment with methotrexate and adalimumab. Periocular pain and swelling developed 14 months after the initial operation, followed by a rapid deterioration of visual acuity to 20/60, intraocular pressure of 4 mm Hg, and worsening pain 5 months later. On initial presentation to Sydney Eye Hospital, 180 degrees of scleral necrosis was evident with a moderate anterior segment inflammatory reaction and a large temporal choroidal effusion due to hypotony. Empirical hourly topical ofloxacin and cephalothin 5% drops, with oral moxifloxacin, were initiated. Conjunctival swab grew Staphylococcus aureus and Staphylococcus lugdunensis. Significant clinical improvement occurred, but the XEN Gel Stent became exposed after 9 days of treatment with worsening hypotony. Urgent surgical revision was performed to remove the XEN Gel Stent and apply a tutoplast plug with overlying amniotic membrane graft. Intraocular pressure gradually improved over 6 weeks to 15 mm Hg with reversal of hypotonous changes, and visual acuity stabilized at 20/40.

Conclusions: 

To our knowledge, this is the first reported case of necrotizing scleritis following XEN Gel Stent insertion. It is a reminder that infection should always be the primary differential diagnosis in patients with surgical-induced necrotizing scleritis.

中文翻译：

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丝裂霉素-C XEN 凝胶支架术后感染性坏死性巩膜炎

目的： 

本研究的目的是报告一例使用丝裂霉素-C 的 XEN 凝胶支架后发生感染性坏死性巩膜炎的病例。

方法： 

案例报告。这是一名 68 岁女性的病例报告。

结果： 

在区域中心进行了使用 0.04% 丝裂霉素 C 增强的 XEN 凝胶支架青光眼手术并结合白内障手术，以治疗患者的原发性开角型青光眼。过去的病史对于需要甲氨蝶呤和阿达木单抗治疗的类风湿性关节炎来说很重要。初次手术后14个月出现眼周疼痛和肿胀，随后视力迅速下降至20/60，眼压为4毫米汞柱，5个月后疼痛加剧。初次到悉尼眼科医院就诊时，发现明显的 180 度巩膜坏死，伴有中度前段炎症反应和由于眼压过低导致的大量颞部脉络膜积液。开始经验性地每小时局部使用氧氟沙星和 5% 头孢噻吩滴剂，并口服莫西沙星。结膜拭子检出金黄色葡萄球菌和路邓葡萄球菌。临床出现显着改善，但治疗 9 天后 XEN 凝胶支架暴露，低张力恶化。进行了紧急手术翻修以移除 XEN 凝胶支架并应用带有羊膜移植物的 tutoplast 塞。6周内眼压逐渐改善至15毫米汞柱，低眼压变化逆转，视力稳定在20/40。

结论： 

据我们所知，这是首例报道 XEN 凝胶支架插入后出现坏死性巩膜炎的病例。这提醒我们，对于手术引起的坏死性巩膜炎患者，感染始终应该是主要的鉴别诊断。