Two Cases of Atopic Dermatitis Patients With Scleral Perforation After Recurrent Scleritis Induced by Scleral-Sutured Posterior Chamber Intraocular Lens Implantation

This report describes two cases of atopic dermatitis patients with scleral perforation after recurrent scleritis induced by suture exposure after scleral-sutured posterior chamber intraocular lens (PC-IOL) implantation. The first patient was a 41-year-old man (case 1), and the second was a 46-year-old man (case 2). Both had a history of atopic dermatitis and scleral-sutured intraocular lens (IOL) implantation. Scleritis recurred at the suture site after scleral-sutured IOL implantation in both patients. Although the scleritis was controlled by topical and/or systemic anti-inflammatory drugs, the sclera was perforated in both cases because of exposure of the suture knots (after seven years in case 1 and after 11 years in case 2). In case 1, the superotemporal IOL haptic was also exposed over the conjunctiva, and in case 2, the ciliary body was incarcerated in the scleral hole with deformation of the pupil superonasally. Considering that there were no signs of severe intraocular inflammation, surgical intervention was performed in both cases. In case 1, IOL repositioning was performed with oral prednisolone cover at a dosage of 15 mg/day, starting two weeks prior to the surgery. The steroid dosage was gradually tapered off until two months after the surgery. In case 2, the scleral patch underwent without IOL extraction, and no steroid or immunosuppression cover was administered. There was no recurrence of scleritis after surgery in either case, and visual acuity was preserved in both cases. The scleral perforation that occurred after scleral-sutured IOL implantation in these patients was thought to be the result of recurrent scleritis caused by suture exposure and chronic mechanical irritation by a suture knot. The scleritis subsided without removal of the IOL by moving the suture site of the IOL haptic and covering the suture with a scleral flap or patch graft.