Management of infectious scleritis after pterygium excision

Purpose. We sought to describe the clinical features, responsible pathogens , management, and prognosis of infectious scleritis after pterygium excisio n. Methods. A retrospective study through review of medical records of pati ents diagnosed with infectious scleritis after pterygium excision over a 10 -year period at our institution. Results. A total of 16 cases of infectious scleritis after pterygium excision was identified. Among them, eight were associated with sclerokeratitis. and six had multifocal scleral nodules wit h subconjunctival abscesses, Culture results were positive in 15 (93.8%) ca ses. Pseudomonas was isolated in 13 (81.3%) patients, fungus in three (18.8 %), and two had a mixed growth (12.5%). Based on the in vitro susceptibilit y test, four (31%) Pseudomonas isolates were resistant to gentamicin, where as all isolates were sensitive to amikacin. During the course of treatment, eight casts were complicated by vitreous opacity, four developed glaucoma, four had serous retinal or choroidal detachment, and two had secondary cat aract. Scleral infection recurred in two patients after cessation of therap y. Among the nine patients treated with medical therapy, two eyes were enuc leated, whereas only two attained a visual acuity of greater than or equal to 2/200 at the end of the follow-up period. On the other hand, seven patie nts had combined antibiotic therapy and surgical debridement. The number of surgical debridement ranged from one to three, with an average of 1.4. In this combined-treatment group, only one patient required enucleation, and f ive cases attained a visual acuity of greater than or equal to 2/200. The d uration of hospitalization for patients with combined treatment was 21.2 +/ - 4.8 days compared with the 28.4 +/- 5.0 days for those with medical treat ment alone (p = 0.035). Conclusion. Surgical debridement in combination wit h appropriate antimicrobial therapy shortens the course of treatment and im proves the visual outcome of severe infectious scleritis after pterygium ex cision.