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Successful management of Aspergillus scleritis by medical and surgical treatment

W Bernauer1, B D Allan, J K Dart

  • 1University of Zurich, Department of Ophthalmology, Switzerland.

Eye (London, England)
|July 31, 1998
PubMed
Abstract

Insights

Successful management of Aspergillus scleritis, a rare fungal eye infection, requires prompt diagnosis, often via scleral biopsy. Combination therapy including antifungal medications and surgical intervention improves outcomes for this serious post-operative complication.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Scleral inflammatory diseases are often linked to autoimmune conditions, with infectious causes being infrequent.
  • Fungal infections of the sclera are rare and typically associated with poor prognoses.
  • This study focuses on post-operative Aspergillus scleritis, a challenging clinical presentation.

Observation:

  • Three patients presented with Aspergillus scleritis following ocular surgery (cataract extraction and trabeculectomy).
  • Diagnosis was delayed, with Aspergillus infection confirmed only via scleral biopsy in all cases, as initial swabs were inconclusive.
  • Patients' ages ranged from 54 to 82, with one patient being diabetic.

Findings:

  • Successful elimination of Aspergillus infection was achieved in all three patients.
  • One patient was treated with systemic and topical amphotericin B.
  • Two patients required surgical intervention, including scleral excision and patch grafts, alongside systemic and topical antifungal therapy (itraconazole, econazole, amphotericin B).

Implications:

  • Fungal scleritis, particularly Aspergillus scleritis, can present with diagnostic delays.
  • Scleral biopsy is a crucial diagnostic tool for suspected fungal scleritis.
  • Combined medical and surgical treatment strategies are essential for effectively managing fungal scleritis and improving patient outcomes.

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