Microbial scleritis-experience from a developing country

Abstract

Purpose: The purpose of this article was to study the clinical features, pathogenic organisms, and the outcome in cases of infectious scleritis.

Method: Retrospective chart review of all patients of infectious scleritis examined from January 2000 to February 2005 in the cornea services of L.V. Prasad Eye Institute, Hyderabad, India was done. Information including patient's age, predisposing factors, clinical presentation, pathogenic organism, methods of diagnosis, treatment, and outcome were abstracted from the medical records.

Results: A total of 21 eyes of infectious scleritis were identified. All except three eyes had preceding predisposing factors, prior cataract surgery (6 eyes) (30%) and pterygium surgery (5 eyes) (23.8%) were the most common predisposing factors. Fungus (8 eyes) (38%), either alone (5 eyes) (24%) or as mixed infection (3 eyes) (14%), was the most common offending organism. Nocardia was identified in five eyes (24%) and Pseudomonas aeruginosa in two eyes (10%). Seven eyes (33%) had accompanying corneal infiltration. Multifocal scleral abscess was seen in three eyes (14%) and endophthalmitis was seen in three eyes (14%). During the course of treatment, five eyes (24%) were complicated by serous retinal or choroidal detachment and five eyes (24%) with progression of cataract. Surgical debridement was carried out in 14 eyes (67%). Four eyes (19%) were eviscerated. Useful vision, defined as visual acuity > or = 20/200, could be preserved with treatment in seven eyes (33%).

Conclusion: Although predisposing factors were similar, fungi and Nocardia were the most common etiological agents in this series and the clinical outcomes were poorer.