Clinical experiences of infectious scleral ulceration: a complication of pterygium operation

Abstract

Aims-To report the special clinical manifestations and determine the appropriate management of infectious scleral ulceration. Methods-A retrospective study was performed on 30 eyes with infectious scleral ulceration. Information was recorded on patients' age, onset and course of disease, pathogenic organism, clinical presentations, methods of diagnosis, treatment, and outcome. Results-10 cases (33.3%) were accompanied by corneal involvement. Subconjunctival abscess was noted in 16 cases (53.3%). 17 cases (56.7%) gave positive results of pathogen culture and all were Pseudomonas aeruginosa. Two cases had combined bacterial infections and one case was complicated by fungal infection. A total of 26 cases had surgical debridement in this series. Extensive involvement of the sclera with the presence of a 'tunnel lesion' or a 'satellite subconjunctival abscess' were found during debridement. All of the eyeballs involved were salvaged except one. Conclusion-The results of this study were contrary to the poor prognosis presented in previous reports. Early and repetitive surgical debridement is believed to be mandatory in the intractable cases to shorten the admission period and to save these eyes. (Br J Ophthalmol 1997;81:980-983)

Microbial scleritis—experience from a developing country

“…Huang et al reported 16 cases of infective scleritis, of which three were fungal (18%). Lin et al 6 reported 30 patients of infectious scleritis of which only one had fungal keratitis (3%). In a series by Hsio et al, 7 only one case had fungal etiology (5%) out of Clinical experiences of infectious scleritis from a developing country V Jain et al…”

“…[4][5][6][7][8] Fungal scleritis was a rare entity. Huang et al reported 16 cases of infective scleritis, of which three were fungal (18%).…”

“…5 Although a variety of organisms have been identified as the cause of infective scleritis, Pseudomonas aeruginosa has been the most commonly reported causative agent in various series. [6][7][8] In the earlier series, the clinical outcomes were reported to be poor and most cases required enucleation or evisceration. A review of more recent reports clearly suggests that infectious scleritis can be managed successfully with preservation of vision as a result of combined antibiotic therapy and early surgical intervention.…”

“…A review of more recent reports clearly suggests that infectious scleritis can be managed successfully with preservation of vision as a result of combined antibiotic therapy and early surgical intervention. [6][7][8] Surgical debridement not only facilitates the penetration of antibiotics but also debulks the infected scleral tissue. Since most of these reports are from countries where bacterial infections of eye are otherwise common, we hypothesized that based on the experience with microbial keratitis; etiological agents may be different in geographic regions with tropical climate.…”

“…[6][7][8][20][21][22] Huang et al reported 16 cases of infective scleritis, of which three were fungal, two of these cases required enucleation, and the last one developed recurrence in a patch graft. Similar poor outcome of fungal scleritis was reported by Lin et al 6 and Hsio et al 7 Numerous factors could be responsible for progressive worsening in fungal scleritis; these are poor penetration of antifungal agents in avascular sclera, nonavailability of fungicidal agent, and the ability of organisms to persist in the avascular interstitial scleral lamellae for prolonged periods without inciting an inflammatory response, leading to progressive worsening. Moriarty et al 23 reported presence of fungal hyphae in enucleated specimens from two patients, in spite of the prolonged treatment.…”