Scleral melting following scleral sutured intraocular lens using a polytetrafluoroethylene (Gore-Tex®) suture.

Abstract

Purpose: To report a case of scleral melting following implantation of a Gore-Tex^®-sutured scleral-fixated intraocular lens (SFIOL).

Methods: Single-case report.

Results: A 39-year-old man with a history of blunt trauma and crystalline lens subluxation presented with a 3-week history of left-eye pain, redness, and foreign-body sensation. He had undergone pars plana vitrectomy, and SFIOL using silk sutures one-year earlier; however, the intraocular lens (IOL) was unstable and was replaced with a Gore-Tex^® suture. On presentation, his best-corrected visual acuity was counting fingers near the face in the left eye. The left eye had episcleral and conjunctival injection, clear cornea, a deep anterior chamber with occasional cellular reaction, a peaked pupil inferonasally, and temporal subluxation of the IOL. A large area of active temporal scleral melt with prolapsed uveal tissue and an exposed Gore-Tex suture knot were noted. Systemic work-up was unremarkable. Oral prednisolone and methotrexate were initiated, and a scleral patch graft was performed to cover the exposed suture and enhance the structural integrity of the scleral wall. However, the scleral melt continued to involve the nasal side, and the patient underwent another scleral patch grafting over the nasal side. Rituximab was also administered, but the scleral melt persisted. Therefore, the Gore-Tex suture and IOL were removed. Five months later, the patient remained stable without further melting.

Conclusions: Although Gore-Tex suture-related complications are rare, further long-term studies are warranted. The early detection and treatment of suture-related complications can optimize visual outcomes and prevent devastating sequelae.