To evaluate the efficacy of topical erythropoietin for chemical burn induced scleral necrosis.
This study included 18 eyes of 16 patients with chemical burn induced scleral necrosis who presented within 6 weeks of the injury. In the prospective arm, 11 eyes received topical erythropoietin, 3000 IU/mL every 6 h, along with standard medical treatment. Retrospectively, we included 7 consecutive eyes of 7 patients who were managed with conventional treatment as historical control group. The main outcome measure was healing of avascular scleral lesions. The secondary outcome measure was complete re-epithelization of cornea.
Mean patient age was 39.8 ± 16.2 years in the erythropoietin group, and they presented 16.6 ± 15.2 days after acute chemical injury. Scleral necrosis improved in all eyes after 30.7 ± 23.2 days of treatment with topical erythropoietin. Corneal epithelial defects were completely healed in 10 eyes 61.9 ± 50.7 days after the start of the medication. In comparison, standard medical treatment alone did not improve scleral necrosis in the historical control group, necessitating ocular surface reconstruction including conjunctival advancement (1 eye) and tenonplasty (6 eyes).
The results of our study showed that topical erythropoietin was effective in the management of chemical burn induced scleral necrosis. This treatment could avoid ocular surface reconstruction procedures in inflamed eyes.

Topical erythropoietin has been recently introduced for the treatment of avascular conjunctival and scleral lesions. Before this treatment can be routinely used, however, its safety profile and contraindications should be determined. Herein, we report a case of recurrent conjunctival squamous cell carcinoma (SCC) and intraocular tumor extension after treatment with topical erythropoietin for excisional biopsy-induced scleral necrosis. An 87-year-old man underwent excisional biopsy for a conjunctival leukoplakic mass. Histological examination showed a well-differentiated SCC on the postoperative day 10. All borders of the specimen were reported to be involved with tumoral cells. The patient did not receive further surgical intervention or topical mitomycin since he developed surgically induced scleral necrosis on the postoperative day 14. Topical erythropoietin 3,000 IU/mL was started every 6 h, and avascular scleral lesion healed over 21 days of treatment with topical erythropoietin. However, 4 months after complete improvement, the tumor recurred with extension into the anterior chamber. Ultrasound biomicroscopy showed the involvement of sclera, iris root, and ciliary body with blunting of the anterior chamber angle. Orbital extension was not detected in magnetic resonance imaging. Topical erythropoietin administered in eyes with a history of conjunctival SCC could be linked to tumor recurrence and intraocular invasion. We recommend avoiding topical erythropoietin in eyes with existing conjunctival SCC or a previous history of conjunctival SCC that was incompletely removed.

UNASSIGNED: To investigate the safety and efficacy of topical erythropoietin for the treatment of scleral necrosis.
UNASSIGNED: This study enrolled eight consecutive patients with scleral necrosis due to previous ocular surgery, rheumatoid arthritis-associated necrotizing anterior scleritis, and thermal and chemical burns. Conventional treatments failed to heal avascular scleral lesions in all eyes. Patients were treated with topical erythropoietin (3000 IU/mL) four times a day.
UNASSIGNED: The mean patient age was 37.6 ± 15.5 years. The interval between the development of scleral necrosis and initiation of topical erythropoietin was 25.6 ± 12.0 days. The necrotic sclera completely healed within 31.9 ± 16.9 days in all patients. The avascular lesions did not recur, and there was no evidence of side effects during the study.
UNASSIGNED: Our results showed that topical erythropoietin could be safely used to manage scleral necrosis. Randomized clinical trials are needed to further explore the efficacy of this intervention in patients with avascular scleral lesions.