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Demographic profile,risk factors and clinical outcome of infectious scleritis at a tertiary eye care hospital. Authors: Jagadesh C Reddy, MS, Somasheila I Murthy, MS, Suma Nalamada MD Prashant Garg MS, Pravin K Vaddavalli , MS,

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Demographic profile,risk factors and clinical outcome of infectious scleritis at a tertiary eye care hospital

Authors: Jagadesh C Reddy, MS, Somasheila I Murthy,MS, Suma Nalamada MD PrashantGargMS, Pravin K Vaddavalli, MS,

R Muralidhar, MS, SunitaChourasia, MS, VarshaRathi, DO and Virender S Sangwan, MS

Affiliation: Cornea And Anterior Segment Service,

Jhaveri Microbiology Centre

L. V. Prasad Eye Institute, KallamAnji Reddy Campus, Hyderabad, India

Electronic Poster No.  FP1559

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Purpose and Methods

  • To analyse the demographics, risk factors, pathogenic organisms, and the clinical outcome in cases of infectious scleritis
  • Retrospective review of all the medical records of patients with microbiologically-proven infectious scleritis examined from march 2005 to Dec 2009 in the cornea services of L.V. Prasad Eye Institute, Hyderabad, India
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Results

  • Demographics
  • 42 eyes of 42 patients
  • 34 were males and 8 females.
  • Right eye was involved in 23 cases and left eye in 19 cases
  • The mean age at presentation was 48.52±14.10 (Range:12-70) years
  • The mean duration of symptoms before presentation was 31.79±34.52 (Range: 2-180) days
  • Cornea was involved in 9(21.42%) cases
  • The final follow-up ranged from 24 days to 37 months
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Results

Risk factors

slide5

Results

Microbiology profile

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Results

Fungus: 10 cases (23.8%)

Aspergillus flavus in two cases

Dematacious fungi in two cases

Cladosporium Sp

Colletotrichum dematium

Aspergillus tereus

Paecelomyces lilacinus

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Results

  • Topical 5% Natamycin and Systemic Ketoconozole. Topical Itraconozole was added in case of recurrence.
  • Mean duration of treatment was 92 days (range 20 days-1 year)
  • Complete resolution of scleritis was seen in all the cases
  • Recurrent scleritis was seen in 3 cases
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Results

  • Staphylococcus Species was Isolated in 7 cases(17.66%)
  • One case was treated with topical fortified cefazolin and oral ciprofloxacin, five cases were treated with only topical fortified cefazolineyedrops
  • Scleritis was resolved in all the eyes
  • Pseudomonas aeruginosawas the cause of scleritis in 6 cases(14.2%)
  • complete resolution was seen in all the cases with topical and systemic ciprofloxacin
  • One case was sensitive to only Ceftazidime ,which showed complete resolution with topical and systemic ceftazidime
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Results

  • Nocardia asteroids was the etiological agent in 6 cases (14.2%),
  • All cases were treated with topical 2.5% amikacin
  • Five cases were treated with systemic amikacin for a period of 7-14 days depending on the response
  • Complete resolution of infection was seen in 5 cases but recurrence was seen in one case which was lost to follow-up
  • Streptococcus species was isolated in 4 cases (9.52%)
  • 3 cases were treated with only topical cephazolin eye drops but one case was on systemic ciprofloxacin eye drops
  • Resolution of scleritis was seen in all the cases with duration of treatment ranging from 16 to 50 days
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Results

  • Mycobacterium Chelonaewas isolated in four cases (9.52%)
  • All the patients was treated with topical amikacin
  • Complete resolution was seen in all the three cases
  • Corynebacterium Species was isolated in two cases
  • Risk factors were pterygium excision and use of Mitomycin C and sclera buckling for retinal detachment 2 years back
  • Complete resolution was seen in both the cases with topical ciprofloxacinin
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Results

  • Brevibacterium was isolated in one patient 7 years after buckle surgery
  • scleritis was successfully treated by buckle explantationand topical cephazolin eye drops for 15 days
  • Mixed infection was seen in 53 year old female with 7 years history of scleral buckling in her right eye
  • Staphylococcus epidermidis and Mycobacterium chelonae were isolated from cultures
  • complete resolution of scleritis was seen with topical ciprofloxacin eye drops
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Conclusion

  • Surgical debridement in conjunction with appropriate antimicrobials is a viable option for patients with severe infectious scleritis
  • A timely surgical debridement not only shortens the course of treatment but also improves the final visual outcome of infectious scleritis