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Electronic Poster No.   FP1559

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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Electronic Poster No.   FP1559

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  1. 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

  2. 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

  3. 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

  4. Results Risk factors

  5. Results Microbiology profile

  6. Results Fungus: 10 cases (23.8%) Aspergillus flavus in two cases Dematacious fungi in two cases Cladosporium Sp Colletotrichum dematium Aspergillus tereus Paecelomyces lilacinus

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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 

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