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Elsa Maria Flores Reyes, Vanessa Valderrama Albino, Miguel Pedroza-Seres; Infectious scleritis. Clinical characteristics and ethiology. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1575.
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To describe the clinical and epidemiological features, pathogenic organisms and the outcomes in cases of infectious scleritis
Retrospective chart review of all patients with infectious scleritis examined from 2009 to 2013 in the Uveitis and Ocular Inmunology Department of Institute of Ophthalmology, “Conde de Valenciana,” Mexico City, Mexico. Information including epidemiological and clinico-microbiological data were abstracted from the records
A total of 362 patients were included, seventy nine had episcleritis (23,1%) and two hundred and sixty three had scleritis (76,9%). Infectious scleritis was found in thirteen cases (12 anterior and 1 posterior scleritis). Among them, mean age was 48.15 years (±17,8), with no sex predominance (6 males and 7 females). Mean time since onset was 45 days (±31), with clinical features characterized by hiperemia (92,3%), ocular pain (84,6%) and decrease in vision (53,8%). Average visual acuity was 0,43 logMAR ±0,79 and 0,54 logMAR ± after full treatment We found four patients with herpetic scleritis, 3 of them had also skin, corneal and uveal involvement. All of these patients received medical treatment with oral Aciclovir during 2,75 months in average with fully recovery. Three patients were clasified as having mycobacterial scleritis, two of them with associated uveítis; in all cases diagnosis was confirmed by a PPD ≥10mm and clinical cure after antifimic therapy. Six patients presented a scleral infection caused by normal bacterial flora Grampositive cocci (5) and one by Pseudomonas spp. Risks factors for bacterial infection were identified in three of them, such as previous pterigyum surgery, inmunosupression, and a previous periocular injection treatment. None of them had keratitis or endophtalmitis associated and responded well to medical treatment guided by antibiogram results. Surgical exploration or biosy was not necessary in any of the patients. Main complications were cataracts (3), retinal detachment(1) and secondary glaucoma(1)
Infectious scleritis represents a diagnostic challenge. Prior ocular surgery or trauma and inmunosupresion treatment for sistemic conditions must be considered as risk factors for an infectious origin. Early recognition and appropriate treatment improve visual outcome
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