Related Experiment Videos
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.
Background:
Inflammatory scleral disease is frequently associated with autoimmune disorders and only occasionally caused directly by an infective agent. Fungal infections primarily involving the sclera are rare, and the outcome is generally poor. Here we report three patients with post-operative Aspergillus scleritis who were successfully managed by medical therapy and surgical intervention.
Patients:
Scleral infection with Aspergillus sp. was diagnosed 6 and 5 months after cataract extraction in a 76-year-old diabetic and an 82-year-old woman respectively, and in a 54-year-old man 3 months after trabeculectomy. Swabs and/or scrapings had not been conclusive and the diagnosis of Aspergillus infection was established in all cases only after scleral biopsy.
Results:
The infection was eliminated in all cases. This was achieved in one eye by treatment with systemic and topical amphotericin B. The two patients with fungal scleritis after cataract extraction required in addition to the medical therapy (oral itraconazole, topical econazole and amphotericin B) scleral excisions and patch grafts to control infection.
Conclusion:
Fungal scleritis may remain undiagnosed for months. A scleral biopsy may be necessary to establish this diagnosis. Prolonged systemic antifungal therapy alone may not eradicate fungal infection. Surgical excision improves the outcome of fungal scleritis.
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.