Ocular Microbiology and Immunology Group
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2011 OMIG Abstract 28

Management and outcome of Pseudomonas aerugionosa keratoscleritis and scleritis
L.H. Suh, G. Amescua, N. Stanciu, T.A. Albini, D. Miller, R.K. Forster
Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL

Purpose: To describe the clinical presentation and course of patients with culture proven Pseudomonas aeruginosa scleritis and keratoscleritis at our institution.

Methods: A retrospective case series review from January 2006 through December 2010 was performed, identifying all patients managed by the authors with culture proven Pseudomonas aeruginosa keratoscleritis and scleritis. Clinical findings, therapeutic interventions, visual outcomes and complications were reviewed.

Results: A total of seven cases are included in this study. The Pseudomonas infections included four cases of keratoscleritis and three cases of scleritis with five male and two female patients, and a mean age of 69.5 +/- 11.  Prior pterygium surgery with radiation or mitomycin C was the most common risk factor, followed by soft contact lens use, prior glaucoma surgery, and organic trauma. Systemic fluoroquinolones were used in all patients. Topical steroids were used in all patients once cultures were positive for P. aeruginosa. Systemic steroids were used in three patients. All patients received aggressive medical management with topical fortified tobramycin, a topical 4th generation fluoroquinolone, and systemic antibiotics of the fluoroquinolone family. Four patients had acute surgical intervention consisting of conjunctival resection, antibiotic irrigation and cryotherapy. One patient required a scleral patch graft after cryotherapy due to significant scleral thinning. Retinal detachment occurred in one patient and required a scleral buckle, pars plana vitrectomy and penetrating keratplasty. After treatment, all patients improved without evisceration or enucleation. The mean final visual acuity was 0.95 logMAR +/- 0.3.

Conclusions: The visual prognosis of Pseudomonas aeruginosa keratoscleritis and scleritis remains poor. Aggressive medical treatment and, when possible, acute surgical intervention is necessary. The availability of systemic fluoroquinolones may be the reason for better outcomes in these patients compared to historical reports. The role of systemic and/or topical steroids remains controversial. 

Disclosures: N

2011 Abstract List | < Previous