Risk factors and clinical outcomes of bacterial and fungal scleritis at a tertiary eye care hospital

Abstract

Purpose:The aim was to analyze demographics, risk factors, pathogenic organisms, and clinical outcome in cases with microbiologically proven bacterial or fungal scleritis.Materials and Methods:Retrospective review of all the medical records of patients with microbiologically proven infectious scleritis examined from March 2005 to December 2009 in the cornea services of L. V. Prasad Eye Institute, Hyderabad, India was done.Results:Forty-two eyes of 42 patients were included in this study. The mean age at presentation was 48.52 ± 14.10 years (range: 12-70). Surgery was the major risk factor seen in 24 eyes (58.5%). Scleral infection was noted after vitreoretinal surgery (with scleral buckle) in 15 eyes, cataract surgery in 3 eyes, pterygium surgery in 3 eyes, corneoscleral tear repair and scleral buckle surgery in 3 eyes. Sixteen eyes (39%) were on systemic or topical steroids at the time of presentation. History of injury was noted in 9 eyes (22%) and diabetes mellitus in 7 patients (17%). Associated keratitis was noted in 9 eyes (21.4%). The scleral abscess was unifocal in 33 eyes (78.5%), multifocal in 6 eyes (14.2%) and diffuse in 3 eyes (7.14%). The final follow-up ranged from 24 days to 37 months. The final visual acuity was better in 18 eyes (42.8%), stable in 13 (30.9%), and deteriorated in 7 eyes (16.6%). Recurrence was seen in 4 eyes (9.5%).Conclusions:Surgery is a major risk factor for infectious scleritis in our series. Fungus was the most common organism isolated. Thorough debridement and intensive use of medications have improved the outcome.

Scedosporium apiospermum infectious scleritis following posterior subtenon triamcinolone acetonide injection: a case report and literature review

“…Generally, bacterial scleritis develops within 1 month, while fungal scleritis develops after 2 to 3 months (Table 2 ). Since 4 out of the 9 reported cases exhibited recurrences after a transient improvement, this suggests that these types of infections require not only extensive but also prolonged systemic and topical medical treatment especially for fungal scleritis [ 26 ]. All of the gram-positive cocci cases recovered after antibiotic treatment and exhibited good visual outcome.…”

Interventions and Outcomes in Patients with Infectious Pseudomonas scleritis: A 10-Year Perspective

“…3, 7–9 It is commonly associated with prior ocular surgery, often following pterygium surgery, and can occur years after the inciting surgey, and this has been reported in large case series in both the developing and developed world. 7, 10, 11 Fewer studies have focused on outcomes after infectious scleritis compared to autoimmune scleritis. In general, older studies reported poor outcomes after infectious scleritis with 42–88% of patients ending up with severe vision loss (< 20/200) and 22–33% requiring enucleation or evisceration despite medical and surgical intervention.…”

Unorthodox ophthalmic preparations on the Ghanaian market: a potential risk for ocular and enteric infections

“…28 Clasdosporium spp. on the other hand, causes Clasdosporium Keratitis 29 while Cercosporium spp is also a known cause of ocular infections. Another potential means that could be contributing to the contaminations observed is poor storage practices.…”