Purchase this article with an account.
P.P. Nazemi, B.D. Fouraker, J.J. Rowsey, M.A. Meallet; Subpalpebral Lavage for the treatment of Pseudomonal Keratoscleritis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4980.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose:We report on the use of the subpalpebral lavage technique in the treatment of four cases of Pseudomonas scleritis and keratitis. Methods:The subpalpebral lavage technique was used in four cases of Pseudomonas keratitis and scleritis. Two patients had Pseudomonas infections following pteryium surgery with adjunctive beta–irradiation (patient 1) and adjunctive mitomycin C (patient 2), one patient had Pseudomonas keratitis in relation to contact lens wear (patient 3), and one patient had Pseudomonas keratitis in a blind neurotrophic eye (patient 4). All had placement of the subpalpebral lavage system. This consisted of passing a small caliber IV tube through the superior fornix to emerge full–thickness through the upper eyelid inferior to the lateral eyebrow. The irrigating end of the tubing was secured into the superior fornix and an infusion line was connected to the exposed end at the eyebrow. An continuous antibiotic solution was delivered with an infusion pump to bathe the surface of the eye. The antibiotic concentrations were chosen to exceed the MICs for the suspected organisms. Patients 1 and 2 were initially started on a Levofloxacin lavage, then switched to Tobramycin upon diagnosis of Pseudomonas. Patients 3 and 4 were initially diagnosed with Pseudomonas and were started on a Tobramycin lavage on admission. Results:All four patients underwent an average of 8 days of treatment (range 3–12 days) with the subpalpebral lavage system. They were then switched to fortified tobramycin and were also started on topical steroid drops. The infections resolved completely, with remaining scleral thinning and cataract development in one patient. Cataract extraction followed by intraocular lens implantation was performed in patient 1, with improvement of vision from 20/200 to 20/40. Conclusions: Severe cases of Pseudomonas scleritis and keratitis have been reported to lead to more than 50% rate of enucleation and evisceration in some series and they present one of the most difficult management challenges to the anterior segment specialist. We believe that the subpalpebral lavage technique allows greater tissue penetration of the antibiotics and the continuous lavage also allows for the washing of inflammatory debris and exudate from the eye, minimizing collagenase and cytokine activity as well as clearing the infection. This technique also obviates the need for intensive frequent fortified antibiotic application, thus lessening the burden of nursing care and eliminating the issue of compliance. This technique broadens the arsenal of treatments that ophthalmologists have in management of severe infections of the ocular surface.
This PDF is available to Subscribers Only