Purchase this article with an account.
Mamta Agarwal, Jyotirmay Biswas, Lily K Therese; Infectious scleritis – Clinical features, diagnosis and treatment outcome in Indian population.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4169. doi: https://doi.org/.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To study the inciting factors, clinical features, diagnosis and treatment outcome in patients with infectious scleritis.
Retrospective study between 2012 and 2017 at a tertiary care center in South India.
23 patients (23 eyes). All except 1 were immunocompetent. Mean age was 50.78 years (±16.35). Mean duration of symptoms was 53.14±35.66 days presenting as redness (100%), pain (86.96%) and decreased vision (39.13%). Risk factors included previous surgery in 6 eyes (26%) (Vitrectomy 4, scleral buckle 1, cataract surgery 1) and injury in 7 eyes (30.4%). Pre treatment mean visual acuity was 1.57 logmar(±1.22). Clinical presentation included 22 anterior and 1 posterior scleritis with multifocal lesions in 10 eyes (43.5%), unifocal in 10 eyes (43.5%) and diffuse in 3 eyes (13%). Associated uveitis was seen in 7 eyes (30.4%), keratitis in 6 eyes (26%) and exudative retinal detachment in 1 eye. The causative organisms included bacteria in 52%, fungus in 39%, herpes virus in 4.3%, and mixed in 4.3%. Bacterial pathogens were Nocardia (3), Mycobacterium tuberculosis (5), Streptococcus viridans, Pseudomonas aeruginosa, Burkholderia and Treponema pallidum each. Fungal pathogens were Aspergillus fumigatus (2), Penicillium, Paecilomyces and Candida albicans each. Average duration of symptoms was longer in fungal (55.22 ±39.93 days) than bacterial scleritis (44.73 ±29.36 days). All patients were treated with antimicrobials. Surgical treatment included scleral debridement & patch graft. Average time of healing was longer in fungal (80.87± 53.4 days) than bacterial scleritis (62±46.32 days). Follow up range was 6 weeks to 4.5 years. 21(91.3%) eyes had complete resolution. 1 eye each required enucleation and evisceration. Mean post treatment visual acuity was 1.32 logmar(±1.28). Causes of decreased vision were corneal scar, glaucoma, macular scar and phthisis bulbi. On univariate analysis, poor visual acuity at presentation resulted in a worse visual outcome (P=0.062). The visual outcome was independent of the causative organism (P=0.802) or presence of multifocal abscesses (P=0.073). Surgical intervention did not result in better visual outcome than medical therapy alone (P=0.006).
Early diagnosis and antimicrobial treatment can result in complete resolution of infectious scleritis but visual prognosis depends on other complications.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
This PDF is available to Subscribers Only