July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Role of Circumferential Full Thickness Scleral Debridement in Fulminant Infective Ring Scleritis
Author Affiliations & Notes
  • Samendra Karkhur
    Retina & Uvea Service, Department of Ophthalmology, , Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
    Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, United States
  • Alok Sen
    Retina & Uvea Service, Department of Ophthalmology, , Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
  • Pratik Shenoy
    Retina & Uvea Service, Department of Ophthalmology, , Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
  • Muhammad Hassan
    Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, United States
  • Muhammad Sohail Halim
    Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, United States
  • Murat Hasanreisoglu
    Department of Ophthalmology, Gazi University, Ankara, Ankara, Turkey
  • Rubbia Afridi
    Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, United States
  • Yasir Jamal Sepah
    Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, United States
  • Diana V Do
    Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, United States
  • Quan Dong Nguyen
    Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, United States
  • Vishali Gupta
    Department of Ophthalmology, Post Graduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
  • Footnotes
    Commercial Relationships   Samendra Karkhur, None; Alok Sen, None; Pratik Shenoy, None; Muhammad Hassan, None; Muhammad Sohail Halim, None; Murat Hasanreisoglu, None; Rubbia Afridi, None; Yasir Jamal Sepah, None; Diana Do, None; Quan Nguyen, None; Vishali Gupta, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 870. doi:https://doi.org/
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      Samendra Karkhur, Alok Sen, Pratik Shenoy, Muhammad Hassan, Muhammad Sohail Halim, Murat Hasanreisoglu, Rubbia Afridi, Yasir Jamal Sepah, Diana V Do, Quan Dong Nguyen, Vishali Gupta; Role of Circumferential Full Thickness Scleral Debridement in Fulminant Infective Ring Scleritis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):870. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To illustrate the role of 360o surgical debridement in the management of infectious scleritis complicated by the administration of corticosteroids, especially if the infection is extensive and unresponsive to medical therapy.

Methods : We present a series of 4 cases with infectious scleritis, who were exposed to oral steroids during their management resulting in fulminant ring scleritis. Corticosteroids, along with antibiotics [Case 1 & 2], were given in 2 cases as part of routine management. In the third case, the patient developed infectious scleritis at the site of cataract surgery incision with coexisting endophthalmitis. Hence, steroids (oral and topical) were used in conjunction with intraocular antibiotics in its management [Case 3]. The fourth case was misdiagnosed as autoimmune scleritis and initially treated with high dose steroids. In all four cases, initial presentation of focal scleritis had turned into fulminant diffuse anterior necrotizing annular/ring scleritis with multi-focal abscesses. The cases were non-responsive to conservative treatment with anti-microbials and localized surgical debridement. Muscle involvement and posterior extension of scleritis was not present in any of the cases. Therefore, extensive full thickness 360o annular scleral debridement was performed; corticosteroids (oral and topical) were withdrawn.

Results : All four patients responded well to 360o annular scleral debridement. One case showed fungal elements, while the other three were non-revealing for any organism. The eyes remained healthy with normal intraocular pressure; no recurrence of scleritis or development of ciliary staphyloma was observed during the last follow-up of 1 year. None of the cases developed corneal involvement or posterior extension of scleritis. The progression of necrotizing scleritis and development of abscesses were annular and limited anteriorly by the limbus and posteriorly by the spiral of Tillaux.

Conclusions : In steroid exposed cases of fulminant infectious scleritis, prompt and extensive surgical debridement can be undertaken to halt progression. Annular debridement created a complete structural disconnection of perilimbal sclera from posterior edge of healthy sclera and did not affect the structural integrity of the eyeball. Hence, circumferential debridement may be considered as an adjunctive intervention in non-responsive/progressive infectious scleritis.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

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