Clinico-Microbiological Profile and Treatment Outcome of Infectious Scleritis: Experience from a Tertiary Eye Care Center of India

Abstract

Medical and microbiology records of seventeen patients (17 eyes), diagnosed as scleritis of infectious origin were reviewed; to study clinical features, predisposing risk factors, microbiologic profile and treatment outcome of infectious scleritis. The mean patient age was 52.3 ± 19.75 years. Twelve patients (70.6%) had history of trauma/prior surgery. Isolated organisms included Staphylococcus species (spp) (n = 5), Fungus (n = 4), Nocardia spp (n = 3), two each of atypical Mycobacterium spp and Streptococcus pneumoniae and one Pseudomonas aeruginosa. Treatment included intensive topical antimicrobial in all eyes and systemic medication in 15 (88.2%) patients; surgical exploration was needed for 13 (76.5%) patients and scleral patch graft was done in four (23.5%) patients. Lesions resolved in all patients and none required evisceration. The presenting log MAR visual acuity of 1.77 ± 1.40 and improved to 0.99 ± 0.91. (P ≤ 0.039) after treatment with a mean follow up of 22.57 ± 19.53 weeks. A microbiological confirmation, appropriate medical and/or surgical intervention has a good tectonic and visual outcome.

Occult Fungal Scleritis

“…20/50 in the affected eye). 34-80% of patients with infectious scleritis present with or develop impaired central acuity in contrast to only 3-12% with immune-mediated disease [1,11,12,13]. Sainz de la Maza et al [14] found patients with infectious scleritis have over four times the risk of presenting with or developing reduced vision versus those with other forms of scleritis [14].…”

Modern treatments for purulent corneal ulcers

“…Гнойный склерит трудно поддается лече-нию вследствие плохого проникновения антими-кробных средств в некротически измененную скле-ру. Слабо васкуляризированная склера довольно быстро подвергается гнойному расплавлению, что существенно повышает риск развития эндофталь-мита [66,67].…”

Infectious Scleritis

“…The median age of patients at the time of diagnosis has been reported more commonly in the elderly population [9 •• , 14,17], suggesting a possibility of relative immunosuppression in elderly individuals. However, post-traumatic infection can be noted in any age group and would be expected to be more common in a younger, active population.…”

“…P. aeruginosa is usually sensitive to ciprofloxacin, and its use both topically and systemically has shown good results [1 • , 10 •• , 17]. The use of topical steroids in conjunction with antibiotics always remained controversial in spite of reports showing some benefit [9 •• , 10 •• , 17,50,64]. Pseudomonas exacerbates tissue destruction by upregulating multiple host cytokines and chemokines [82] and by decreasing the ocular defense mechanism and increasing the lytic enzyme activity [63].…”

“…There was mixed response to various antibiotics and hence was thought that Mycobacterium is resistant to many antibiotics, but the recent literature of in vitro susceptibility shows that Mycobacterium is sensitive to amikacin, azithromycin, and clarithromycin [17,20,50,67]. Topical amikacin (bactericidal drug) in combination with oral clarithromycin or azithromycin (bacteriostatic) is the best treatment option for nontuberculous mycobacterial ocular infections [81].…”