Ocular Microbiology and Immunology Group
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2015 OMIG Abstract 16

The Role of Scleral Debridement in Infectious Scleritis
Laura A. Vickers, John A. Irvine, Hugo Y. Hsu, Olivia L. Lee
Doheny Eye Center of UCLA.  UCLA Department of Ophthalmology, Los Angeles, CA

Purpose: To demonstrate the role of scleral debridement in a series of cases of infectious scleritis, and its potential usefulness in avoiding poor outcomes.

Methods: The medical records of patients with culture-proven infectious scleritis were reviewed retrospectively. Microbial culture results, therapeutic approach, time to scleral debridement if performed, anatomic outcomes including development of scleral perforation, choroidal detachment, need for enucleation, and final visual outcome were compared. Early scleral debridement was defined as being carried out before scleral perforation, and late debridement when done after perforation occurred.

Results: Six eyes of 6 patients were identified as having infectious scleritis. Most patients had prior surgery as a risk factor, with 3 patients having undergone prior pterygium surgery with mitomycin-C (MMC), one trabeculectomy/Ex-Press shunt with MMC, one with exposure keratopathy leading to a sclerokeratitis and one with autoimmune scleral melt with secondary infection. Cultures were positive for Pseudomonas in three eyes, Aspergillus in one eye, Streptococcus in one eye and Staphylococcus in one eye. In addition to antibiotic treatment, scleral debridement was done in 5 eyes, 4 eyes with early debridement and one eye with late debridement after a small perforation. Three eyes with Pseudomonas scleritis developed choroidal detachments and one eye with Streptococcus scleritis developed a serous retinal detachment. Three of these eyes underwent early debridement with subsequent resolution of the choroidals and retinal detachment, but without significant final visual improvement and final visual acuities ranging from counting fingers to 20/150. The third eye underwent late debridement and was eventually enucleated. All eyes that underwent early debridement did not require enucleation.

Conclusions: Infectious scleritis is a rare and eye-threatening condition frequently associated with poor outcomes. In addition to antibiotic use, scleral debridement performed prior to scleral perforation may have a role in avoiding enucleation. However, complications such as choroidal or retinal detachment can prohibit visual recovery even in cases of anatomic recovery.

Funding: None
Financial Disclosures: LV (N), JI (N), HH (N), OL (S, C)

2015 Agenda and Abstracts | < Previous | Next >