IMMUNOLOGICAL AND CLINICAL-EVALUATION OF POSTSURGICAL NECROTIZING SCLEROCORNEAL ULCERATION

Purpose. To perform a clinical, laboratory and pathologic evaluation i n patients who had developed a postsurgical necrotizing sclerocorneal ulceration to detect a serious associated autoimmune disorder and to t reat the ocular disease early Methods. Nine patients with postsurgical necrotizing sclerocorneal ulceration after uneventful cataract extrac tion were studied by means of immunohistochemical techniques on conjun ctival resections, immunologic serologic studies, sind rheumatologic e valuation. Nine healthy subjects who underwent uneventful cataract sur gery were used as controls. Results. The pathologic studies showed a l ocal immunoglobulin M (IgM) and IgG deposition, increased human leukoc yte antigen (HLA-DR) expression, and a significant T-helper cell parti cipation in conjunctival biopsies in the most severe ulcerations, whic h were detected in four patients with underlying autoimmune systemic d isorder (rheumatoid arthritis, 45%) and only a macrophagic infiltratio n in the mildest ulcers in patients (55%) without immune disorders. Se rologic features included high titers of rheumatoid factor in the four (45%) patients with rheumatoid arthritis, nonspecific serologic immun e alteration in three (33%) patients, and were unremarkable in two (22 %) patients. The medical and immunologic evaluations were negative in the control cases. Topically administered cyclosporin A healed the ocu lar disease. Conclusion. A surgically induced local autoimmune reactio n could occur in the incision area in patients with systemic vasculiti c disease. There was no underlying systemic disorder in the mildest ul cers, and these ulcers could be due to a defect in the surgical techni que. Our results suggest the need for a detailed systemic evaluation i n patients with severe postsurgical necrotizing ulceration. Early diag nosis and aggressive medical treatment of the ocular disorder improves the visual outcome.