Cataract surgery in a patient with bilateral necrotising scleritis and peripheral ulcerative keratitis associated with granulomatosis with polyangiitis (Wegener's granulomatosis)

Abstract

Introduction. We report a rare case of cataract surgery in a patient with an extreme, widespread anterior staphyloma fol-lowing severe bilateral necrotising anterior scleritis associated with granulomatosis with polyangiitis (GPA). Case report. A 61-year-old man with a history of GPA developed bilateral, rapidly progressive necrotising scleritis and peripheral ulcera-tive keratitis (PUK). Inflammation compromised the entire anterior globe and peripheral cornea in both eyes. More than 90% of the surface area healed within 8 weeks, following the treatment with 3 pulsed doses of methylprednisolone in addi-tion to the cyclophosphamide treatment. Systemic steroid therapy was slowly tapered over a period of 6 months. Ex-traordinary scleral loss with a uveal bulge developed, follow-ing severe necrotising anterior scleritis associated with PUK. Once the full remission had been achieved after 6 months, uncomplicated phacoemulsification was performed in his left eye, the only functional one. Conclusion. Preoperative and postoperative control of inflammation, careful surgical plan-ning, and meticulous surgical techniques are critically im-portant for optimal surgical outcome in such patients. To our knowledge, phacoemulsification in a patient with coexisting uveitic cataract and severe anterior staphyloma has not been previously reported. © 2021 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.