Necrotizing scleritis is an uncommon but most severe form in scleritis both in terms of pain and scleral destruction. It occasionally associated with systemic connective tissue diseases or idiopathic in orgin. Adequate diagnosis and therapy are essential to every ophthalmologist because it takes disastrous clinical course frequently. Histopathologically, localized granulomatous vasculitis was found and in pathogenesis, immunologic mechanism is suggested. We treated two cases of necrotizing scleritis which developed after pars plana vitrectomy, with topical or systemic corticosteroids and in one case, whose sclera was extensively melted, grafting with fascia lata was made with sucessful result. Two eyes became quiet after months of treatment without sequelae by scleritis itself We thought that this conditions occured by electrical low current diathermy which was given for hemostasis around sclerotomy incisions and by diabetic microcirculatory disturbances although not proven histologically.
Adrenal Cortex Hormones ; Connective Tissue Diseases ; Diagnosis ; Diathermy ; Fascia Lata ; Hemostasis ; Sclera ; Scleritis* ; Transplants ; Vasculitis ; Vitrectomy*

Twelve eyeys of retinal detachment with full thickness macular hole without(Group 1:6 eyes) and with(Group II:6 eyes) peripheral retinal tears were treated by pars plana vitrectomy and partial or full fluid gas exchange at our hospital from 1987 to 1990. Five showed high myopia, four had trauma histories and in the remammg three were of unknown cause. Other procedures included were; internal drainage of subretinal fluid through macular hole(6 eyes), transscleral drainage(one eye), membrane peeling(one eye), encirclement(7 eyes) and segmental buckle(6 eyes) for peripheral retinal tears and silicone oil injection(one eye). No direct attempts to seal macular hole using photocoagulation or posterior pole buckles were made. During the follow-up period ranging from 6 to 25 months, retinal reattachments were achieved in eleven eyes(92%) and visual acuities improved in seven eyes(58%), were unchanged in three(25%), worsened in two(17%). The causes of worse vision included a redetachment and a macular slantng by high buckle for the tears elsewhere posterior to equator. Among several causative factors, a method releaving the vitreal traction component and a temporary internal tamponade with gas is thought to be the best way to treat this disease.
Drainage ; Follow-Up Studies ; Light Coagulation ; Membranes ; Myopia ; Retinal Detachment* ; Retinal Perforations* ; Retinaldehyde* ; Silicone Oils ; Subretinal Fluid ; Traction ; Visual Acuity ; Vitrectomy*