1
|
Chen X, Lv X, Yang L, Bai F, Liu X. Etiology, Pathogens, Clinical Features and Treatment of Bacterial Scleritis. Semin Ophthalmol 2023:1-8. [PMID: 36794923 DOI: 10.1080/08820538.2023.2177117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We retrospectively reviewed literature reports on pathogens, clinical features, diagnosis, treatment, and clinical and visual outcomes in patients with bacterial scleritis over the past decade. Eye surgery and trauma are the most common causes of bacterial infections. Subtenon triamcinolone acetonide injection, intravitreal ranibizumab, and wearing contact lenses are also causes of bacterial scleritis. Pseudomonas aeruginosa is the most common pathogenic microorganism causing bacterial scleritis. Mycobacterium tuberculosis ranks second. The main symptoms of bacterial scleritis are red and painful eyes. The patient's visual acuity decreased significantly. Bacterial scleritis caused by Pseudomonas aeruginosa often manifests as necrotizing scleritis, tuberculous scleritis and syphilitic scleritis are mostly nodular scleritis. Bacterial scleritis often involves the cornea, and approximately 37.6% (32 eyes) of patients had corneal bacterial infection. Hyphema was present in 18.8% (16 eyes). Elevated intraocular pressure was observed in 36.5% (31 eyes) of patients. Bacterial culture was an effective method of diagnosis. Most bacterial scleritis cases require both aggressive medical and surgical treatment, and the drug choice must be based on antibiotic susceptibility testing.
Collapse
Affiliation(s)
- Xiangtong Chen
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China.,Clinical College, Jilin University, Changchun, P.R. China
| | - Xueman Lv
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, P.R. China
| | - Li Yang
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Feng Bai
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Xiaoli Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| |
Collapse
|
2
|
Kumar DA, Agarwal A, Chandrasekar R, Chinnappan RM. Semilunar sign of cornea: A multimodal analysis of the posterior corneal opacity in non-infectious anterior scleritis. Indian J Ophthalmol 2022; 70:1197-1202. [PMID: 35326015 PMCID: PMC9240560 DOI: 10.4103/ijo.ijo_2073_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: To analyze the morphological outcomes of the posterior corneal opacity or “semilunar sign” in noninfectious anterior scleritis using multimodal imaging. Methods: This was a prospective observational case series. Patients with anterior scleritis from January 2018 to January 2019 were included. Clinical and demographic data were collected. Posterior cornea was visualized using the digital slit lamp photography (Elite, mega digital vision), spectral domain optical coherence tomography (MS39), and specular count analyzer (EM-3000). “Semilunar sign” was defined by the (1) presence of posterior corneal opacity, (2) concave semilunar pattern, (3) absence of blood vessels, and (4) normal anterior cornea. Incidence, clinical characteristics and significance, correlation with Mantoux sensitivity, and role of multimodal valuation were assessed. Results: Overall 76 eyes of 72 patients were recruited with anterior scleritis. Fifteen eyes of 11 patients (15.3%) presented with semilunar sign. The scleritis was both nonnecrotizing (n = 8) and necrotizing (n = 7). The semilunar configuration appeared as isolated (n = 9) and continuous lesion (n = 6). The extent was directly related to the scleral disease extent (P = 0.002). The mean thickness measured 212.5 ± 129.3 mm. The mean central endothelial cell density (ECD) was 2540.8 ± 351.7 cells/mm2, which was significantly higher than the involved peripheral cornea (P = 0.05). The mean surface area of the semilunar sign was 7.7 ± 5.2 mm2. There was no significant correlation between the opacity thickness and the best-corrected visual acuity (P = 0.895, r = −0.39), ECD (P = 0.52, r = −0.188), and Mantoux (P = 0.696, r =− 0.142) Conclusion: Corneal semilunar sign of scleritis affected the peripheral cornea and caused no functional abnormality in early presentation. Multimodal analysis can aid in clinical assessment and severity.
Collapse
Affiliation(s)
- Dhivya Ashok Kumar
- Department of Uvea, Oculolasty and Oncology, Dr Agarwal Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
| | - Amar Agarwal
- Department of Uvea, Oculolasty and Oncology, Dr Agarwal Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
| | - Radhika Chandrasekar
- Department of Uvea, Oculolasty and Oncology, Dr Agarwal Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
| | - Raja M Chinnappan
- Department of Uvea, Oculolasty and Oncology, Dr Agarwal Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
| |
Collapse
|
3
|
Ksiaa I, Abroug N, Mahmoud A, Ben Amor H, Attia S, Khochtali S, Khairallah M. Hypopyon: Is-it Infective or Noninfective? Ocul Immunol Inflamm 2021; 29:817-829. [PMID: 34255602 DOI: 10.1080/09273948.2021.1922708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypopyon usually corresponds to the sedimentation of white blood cells, and it signifies severe intraocular inflammation. This key clinical sign may occur in association with a wide variety of infectious, inflammatory, and neoplastic conditions that may be sight- and, occasionally, life-threatening. A careful history and thorough clinical examination are the cornerstones for orienting the differential diagnosis, identifying the causative agent, and initiating prompt and appropriate treatment. This review outlines the clinical characteristics and management of hypopyon in relation with the underlying causative infectious or noninfectious ocular or systemic diseases.
Collapse
Affiliation(s)
- Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Anis Mahmoud
- Department of Ophthalmology, Taher Sfar University Hospital of Mahdia, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| |
Collapse
|
4
|
Agarwal M, Patnaik G, Agarwal S, Iyer G, Anand AR, Ar G, Biswas J, Zierhut M. Tuberculous Scleritis and Multidrug Resistance. Ocul Immunol Inflamm 2021; 30:915-924. [PMID: 33416427 DOI: 10.1080/09273948.2020.1853176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To present a case of necrotizing sclerokeratitis in a patient with multidrug-resistant tuberculosis and study the challenges in diagnosis and management of anterior tuberculous scleritis.Methods: Retrospective observational case report and review of anterior tuberculous scleritis.Results: A 28-year-old woman, previously diagnosed as presumed tubercular panuveitis, presented with necrotizing sclerokeratitis and progressed to develop panophthalmitis. Laboratory investigations revealed multidrug-resistant Mycobacterium tuberculosis as the etiological agent. We reviewed cases of anterior tuberculous scleritis published in the literature, with regards to clinical features, microbiological investigations, treatment, and outcomes. Treatment includes standard antitubercular therapy, with or without systemic corticosteroids. Poor response to treatment is seen either due to delayed diagnosis or drug resistance, and the significance of the same is highlighted in our case.Conclusion: Diagnosis of tuberculous scleritis is a challenge. Therapeutic failure must alert the clinician for drug resistance which is diagnosed early, can prevent the devastating outcomes.
Collapse
Affiliation(s)
- Mamta Agarwal
- Uveitis & Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Gazal Patnaik
- Uveitis Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Shweta Agarwal
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Geetha Iyer
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - A R Anand
- L & T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Gayathri Ar
- Pulmonologist, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Uveitis & Ocular Pathology Department, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Manfred Zierhut
- Department of Ophthalmology, University of Tubingen, Tubingen, Germany
| |
Collapse
|
5
|
Dutta Majumder P, Agrawal R, McCluskey P, Biswas J. Current Approach for the Diagnosis and Management of Noninfective Scleritis. Asia Pac J Ophthalmol (Phila) 2020; 10:212-223. [PMID: 33290287 DOI: 10.1097/apo.0000000000000341] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACT Scleritis is a rare, vision-threatening inflammation of the sclera that is often associated with life-threatening systemic illnesses. Rheumatoid arthritis remains the most common associated systemic rheumatic disease and the commonest systemic association of scleritis. Granulomatosis with polyangiitis is the most common cause of vasculitis-associated scleritis. The etiopathogenesis of scleritis remains unclear, but can be immune complex-mediated or due to a local delayed hypersensitivity reaction. Scleritis can involve either the anterior or posterior sclera, and has a wide spectrum of clinical presentations. Among the subtypes of scleritis, necrotizing scleritis has an increased risk of complications and is more commonly associated with anterior uveitis and peripheral ulcerative keratitis. Posterior scleritis is often not diagnosed or missed due to its subtle clinical signs and protean manifestations. Meticulous history taking, detailed ocular examination, and a targeted array of investigations with a multi-disciplinary approach to find any underlying systemic disease are crucial for the management of a case of scleritis. Corticosteroids remain the mainstay of short-term treatment of scleritis; mild to moderate scleral inflammation may respond well to treatment with nonsteroidal antiinflammatory drug or topical corticosteroid. Corticosteroid-sparing immunosuppressive therapies are useful in cases with an inadequate response or failure to provide long-term control of inflammation, and to prevent recurrence of scleritis. Biologic agents are increasingly used in the management of scleritis, not responding to the conventional therapies. This review provides an overview of the various subtypes of scleritis and its systemic associations and evaluates current trends in the diagnosis and management of noninfective scleritis.
Collapse
Affiliation(s)
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Peter McCluskey
- Ocular Infections and Antimicrobials Research Group, Singapore Eye Research Institute, Singapore
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
| |
Collapse
|
6
|
Latiff N, Lakshmipathy M, Janani MK, Dutta Majumder P. Tuberculous corneal ulcer with hypopyon: A case report. Indian J Ophthalmol 2020; 68:922-924. [PMID: 32317491 PMCID: PMC7350481 DOI: 10.4103/ijo.ijo_1368_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This case report represents an unusual presentation of Mycobacterium tuberculosis-associated corneal ulcer with hypopyon. A 64-year-old man presented with a hypopyon corneal ulcer in the right eye. His corneal scrapings were negative, and the ulcer was not responding to empirical antimicrobial therapy. A real-time polymerase chain reaction from an aqueous aspirate of the right eye detected 422 copies of M. tuberculosis. Subsequent investigations revealed positive Mantoux and interferon-gamma release assay, supportive radiology. The patient was successfully treated with a course of antitubercular therapy and topical steroids. Hypopyon corneal ulcer, though a rare manifestation of ocular tuberculosis, should be considered in cases not responding to standard antimicrobial therapy.
Collapse
Affiliation(s)
- Neethu Latiff
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Meena Lakshmipathy
- Department of Cornea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - M K Janani
- Sankara Nethralaya Referral Laboratory, Chennai, Tamil Nadu, India
| | | |
Collapse
|