Abstract
Purpose :
Culture negative (CN) infectious scleritis is not a well described entity in ophthalmic literature. We conducted a retrospective comparative clinical study of culture positive (CP) and culture negative infectious scleritis to ascertain the risk factors and clinical outcomes of culture negative infectious scleritis.
Methods :
We reviewed medical records of infectious scleritis. Scleral lesions were deemed as infectious on clinical appearance of boggy, purulent exudates, with or without ulceration, scleral abscess, and presence of hypopyon. Scleral debridement and microbiologic evaluation were done. Scrapings were repeated if the initial sample was negative. Treatment was started with empirical antibiotics, change to specific class of drugs, depending on type of organisms isolated. Topical or oral steroids were prescribed on case-to-case basis. Scleritis was resolved if there were no symptoms, lack of ocular inflammation, quiet eye with or without scleral thinning and uveal show. Mann-Whitney U test and Wilcoxon signed rank test was used to compare continuous variables within two groups. Logistic regression was used to calculate crude odds ratio (crude OR). P value < 0.05 was considered statistically significant.
Results :
We included 147 eyes of 147 patients of infectious scleritis between Jan 2006 to December 2022 of which 98 eyes were CP and 49 eyes were CN. Gram negative bacteria were the most common isolated organisms (n=27/98). Baseline demographics of age, gender, agriculture work, ocular trauma, and prior ocular surgeries between two groups were comparable. Diabetics were 2.85 times more likely to be CP (crude OR= 2.85; 95% CI: 1.02 to 8.02). Treatment with prior steroids were 68% less likely to be CP (crude OR= 0.32; 95% CI: 0.13 to 0.76). Median presenting and final visual acuity was significantly lower in CP as compared to CN scleritis (p<0.001). There was no difference in duration of symptoms, treatment and time to resolution between two groups. Odds of recurrence were 94.9% lesser in CP as compared to CN scleritis (crude OR= 0.051; 95% CI: 0.003 to 0.974).
Conclusions :
Culture negative scleritis accounted for a third of infectious scleritis. Nondiabetics and treatment with prior steroids were risk factors. Visual acuity was better in CN but clinical outcomes was comparable between two groups. Chance of recurrence was more in CN scleritis.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.