Related Experiment Videos
Management of infectious scleritis after pterygium excision
F C Huang1, S P Huang, S H Tseng
1Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.
Purpose:
We sought to describe the clinical features, responsible pathogens, management, and prognosis of infectious scleritis after pterygium excision.
Methods:
A retrospective study through review of medical records of patients diagnosed with infectious scleritis after pterygium excision over a 10-year period at our institution.
Results:
A total of 16 cases of infectious scleritis after pterygium excision was identified. Among them, eight were associated with sclerokeratitis, and six had multifocal scleral nodules with subconjunctival abscesses. Culture results were positive in 15 (93.8%) cases. Pseudomonas was isolated in 13 (81.3%) patients, fungus in three (18.8%), and two had a mixed growth (12.5%). Based on the in vitro susceptibility test, four (31%) Pseudomonas isolates were resistant to gentamicin, whereas all isolates were sensitive to amikacin. During the course of treatment, eight cases were complicated by vitreous opacity, four developed glaucoma, four had serous retinal or choroidal detachment, and two had secondary cataract. Scleral infection recurred in two patients after cessation of therapy. Among the nine patients treated with medical therapy, two eyes were enucleated, whereas only two attained a visual acuity of > or =2/200 at the end of the follow-up period. On the other hand, seven patients had combined antibiotic therapy and surgical debridement. The number of surgical debridement ranged from one to three, with an average of 1.4. In this combined-treatment group, only one patient required enucleation, and five cases attained a visual acuity of > or =2/200. The duration of hospitalization for patients with combined treatment was 21.2+/-4.8 days compared with the 28.4+/-5.0 days for those with medical treatment alone (p = 0.035).
Conclusion:
Surgical debridement in combination with appropriate antimicrobial therapy shortens the course of treatment and improves the visual outcome of severe infectious scleritis after pterygium excision.
Insights
Infectious scleritis after pterygium excision requires prompt management. Combined surgical debridement and antimicrobial therapy improve outcomes and reduce hospitalization compared to medical treatment alone.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Pterygium excision is a common ophthalmic procedure.
- Infectious scleritis is a rare but serious complication following pterygium excision.
Purpose of the Study:
- To describe the clinical features, pathogens, management, and prognosis of infectious scleritis post-pterygium excision.
- To evaluate the effectiveness of different treatment modalities.
Main Methods:
- Retrospective review of 16 patients diagnosed with infectious scleritis after pterygium excision over a 10-year period.
- Analysis of clinical data, microbiological cultures, in vitro susceptibility testing, and treatment outcomes.
Main Results:
- Pseudomonas was the most common pathogen (81.3%).
- Combined antibiotic therapy and surgical debridement resulted in better visual acuity and shorter hospitalization (21.2 days) compared to medical therapy alone (28.4 days).
- Complications included vitreous opacity, glaucoma, and retinal detachment.
Conclusions:
- Surgical debridement combined with antimicrobial therapy is superior to medical management alone for severe infectious scleritis after pterygium excision.
- This combined approach improves visual outcomes and shortens treatment duration.