Methicillin-resistant Staphylococcus aureus sclerokeratitis after pterygium excision

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Pterygium excision is a common ophthalmic procedure.
• Infectious scleritis is a rare but serious complication following ocular surgery.

Observation:

• A 72-year-old woman presented with severe pain and decreased visual acuity six months post-pterygium excision.
• Initial clinical diagnosis of Pseudomonas scleritis with broad-spectrum antibiotics showed no improvement.

Findings:

• Cultures confirmed methicillin-resistant Staphylococcus aureus (MRSA) as the causative agent.
• Topical and systemic vancomycin effectively resolved the corneoscleral inflammation.
• Surgical reconstruction with scleral patch graft and conjunctival flap was successful, with no recurrence at 14 months.

Implications:

• MRSA should be considered in infectious scleritis cases post-pterygium excision, particularly when initial treatments fail.
• Early identification and appropriate antibiotic therapy (e.g., vancomycin) are crucial for managing MRSA sclerokeratitis.
• This case highlights the importance of microbiological diagnosis in refractory infectious scleritis.