Management of Infectious Scleritis with Combined Medical and Surgical Interventions

Abstract

Purpose: Infectious scleritis is one of the most devastating external eye diseases. Previously, with topical medication as the only treatment, the clinical outcome was usually poor, and most cases required enucleation or evisceration. We retrospectively analyzed the outcome of patients with infectious scleritis who received surgical interventions with systemic and topical antibiotics. Patients and methods: Eight patients (M:F = 1:7, mean age = 66.0 ± 12.6 y/o) with culture-proven infectious scleritis were treated with standardized combined systemic antibiotic, surgical debridement (conjunctival recession with cryotherapy) in addition to topical antibiotic treatment. Low dose oral steroid was used in later stage to reduce inflammation. Moreover, amniotic membrane (AM) graft was performed in four of them with persist scleral melting to promote epithelial wound healing. Results: All the eyes were salvaged, and maintained useful vision that was 20/400 or better, and these patients receiving AM grafts showed a more rapid re-epithe- lialization and reduction of inflammation after grafting. Conclusion: Surgical debridement in combination with systemic and topical antibiotics can treat infectious scleritis efficiently. In conditions with extensive stromal melting, inflammation, and impending perforation, AM graft may be considered an adjunctive therapy to promote wound healing once sufficient antibiotic therapy has been administered.