Infectious scleritis with multiple scleral abscesses
| Case/ age (y)/ sex/eye | Adjuncts to pterygium excision | Latency period | Organisms | Cinical features | Treatment | Final VA | Complication(s) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Medical | Surgical | |||||||||||||||
| 1/68/F/R | NA | 11 y | 1 Enterobacterium cloacae; Pseudomonas aeruginosa | Scleral abscesses; calcific plaque; ant uveitis; corneal infiltrate | Topical and systemic cefazolin sodium and amikacin | Debridement; enucleation | — | None | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 2/72/M/R | NA | 3 m | 1 P aeruginosa | Scleral abscesses; ant uveitis; corneal infiltrate; limited EOM | Topical cefazolin sodium and amikacin | Enucleation | — | None | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 3/73/F/R | NA | 10 y | 1Aspergillus | One scleral abscess in the first episode; calcific plaque; ant uveitis | Topical cefazolin sodium and gentamicin, then amphotericin B§ | Debridement; enucleation | — | Recurrence | ||||||||
| 4/40/F/R | NA | 8 y | 1 P aeruginosa | Scleral abscesses; calcific plaque; ant uveitis; limited EOM | Topical cefazolin sodium and gentamicin and systemic gentamicin | None | 20/30 | None | ||||||||
| 2 No growth | ||||||||||||||||
| 5/71/F/R | Mitomycin C soaking | 21 d | 1 P aeruginosa; Lactobacillus; N subflava; Stomatococcus | Scleral abscesses; calcific plaque | Topical cefazolin sodium and gentamicin and systemic gentamicin | Cryotherapy | 20/200 | Recurrence; complicated cataract | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 6/63/F/R | NA | 12 y | 1 P aeruginosa | One scleral abscess in the first episode; ant uveitis; limited EOM | Topical and sytemic gentamicin | Conjunctival flap | 20/200 | Recurrence; complicated cataract; inferior retinal detachment | ||||||||
| 2 No growth | ||||||||||||||||
| 7/65/M/R | None | 8 y | 1 Bacillus; Staphylococcus epidermidis; Escherichia cloacae | Scleral abscesses; ant uveitis | Topical and systemic gentamicin | None | 20/200 | Total retinal detachment; complicated cataract | ||||||||
| 8/74/M/R | NA | 32 y | 1 P aeruginosa | Scleral abscesses; calcific plaque | Topical and systemic gentamicin | Conjunctival flap | 20/400 | Inferior retinal detachment; complicated cataract | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 9/78/F/R | Topical thiotepa | 7 d | 1 P aeruginosa | Scleral abscesses; ant uveitis | Topical cefazolin sodium and amikacin; systemic ticarcillin and amikacin | Debridement | 20/50 | None | ||||||||
| 2 No growth | ||||||||||||||||
| 3 P aeruginosa | ||||||||||||||||
| 10/61/F/L | NA | 1 m | 1 S epidermis; P aeruginosa | Scleral abscesses; ant uveitis | Topical and systemic cefazolin sodium and gentamicin | Debridement | HM | None | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 11/61/M/L | Mitomycin C soaking | 21 d | 1 P aeruginosa | Scleral abscesses | Topical cefazolin sodium and gentamicin systemic gentamicin and amikacin | Cryotherapy; conjunctival flap | 20/50 | None | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 12/79/F/R | NA | 32 y | 1 P aeruginosa | Scleral abscesses; calcific plaque | Topical cefazolin sodium and gentamicin; systemic gentamicin | Conjunctival flap | CF | Inferior retinal detachment | ||||||||
| 13/62/F/L | Topical mitomycin C | 3.5 y | 1 P aeruginosa | Scleral abscesses; calcific plaque; ant uveitis; corneal infiltrate and perforation | Topical cefazolin sodium and gentamicin; systemic gentamicin | Glue; conjunctival flap; enucleation | — | Choroidal and total retinal detachment; complicated cataract | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 3 P aeruginosa | ||||||||||||||||
| 14/70/M/R | NA | 1.5 y | 1 P aeruginosa | Scleral abscesses; calcific plaque; ant uveitis | Topical cefazolin sodium and amikacin; systemic amikacin | Debridement | LP | Choroidal detachment | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 15/63/F/R | NA | 3 y | 1 M fortuitum | Scleral abscesses | Topical cefazolin sodium and amikacin; systemic amikacin | None | 20/100 | Recurrence | ||||||||
| 2 No growth | ||||||||||||||||
| 3 No growth | ||||||||||||||||
| 16/72/F/R | None | 3 y | 1 P aeruginosa | Scleral abscesses; calcific plaque; ant uveitis | Topical cefazolin sodium and amikacin; systemic amikacin | None | 20/200 | Choroidal detachment | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 17/76/F/L | NA | 25 y | 1 P aeruginosa | Scleral abscesses; calcific plaque; ant uveitis | Topical cefazolin sodium and amikacin; systemic amikacin | Debridement; conjunctival flap | 20/200 | Choroidal detachment | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 18/68/F/L | NA | 10 y | 1 P aeruginosa | Scleral abscesses; ant uveitis | Topical cefazolin sodium and gentamicin; systemic gentamicin | Conjunctival flap | 20/100 | Choroidal and retinal detachments | ||||||||
| 2 P aeruginosa | ||||||||||||||||
| 3 P aeruginosa | ||||||||||||||||
↵Modifed from Moriarty et al.11
↵1 = Result of first culture from initial scleral ulcer; 2, 3 = second and third culture result of subsequent abscesses.
↵VA after extracapsular cataract extraction and intraocular lens implantation; § after the return of the culture reports.
NA=not available; y=year; m=month; d=day; ant=anterior; EOM=extraocular movements; VA=visual acuity; HM=hand movement; CF=counting fingers.