A R ANAND
To study the clinical features, causative factors and treatment outcomes in patients with infectious scleritis.
Retrospective study of all patients with infectious scleritis examined at a tertiary care centre in India between August 2012 and March 2022.
Fifty-eight patients (58 eyes) with infectious scleritis were included. Mean age was 53.5 ±16.6 years. Mean duration of symptoms was 3.5± 4.9 months. Inciting factors for scleritis were found in 58.7%, including injury in 32.8% and ocular surgery in 25.9%. Clinical features included fifty-seven anterior and one posterior scleritis with multifocal lesions in 41.1%, unifocal lesions in 32.1% and diffuse lesions in 26.8%. Associated features were uveitis, keratitis, endophthalmitis, subretinal abscess and exudative retinal detachment. The causative organisms were bacteria (51.7%), fungi (36.2%) and herpes virus (12%). All patients were treated with topical and/or systemic antimicrobials. Surgical treatment included scleral debridement and patch graft. Complete resolution of scleritis was seen in 47 eyes (87%) with median duration of antimicrobial therapy as 3 months. The mean follow-up was 7.2±12.4 months. However, 50% (n=28) patients lost functional vision (visual acuity <1 logMAR). Causes of decreased vision were corneal scar, cataract, macular scar, glaucomatous optic atrophy & phthisis bulbi. On univariate analysis, poor visual acuity at presentation resulted in a worse visual outcome (P=0.019). Other factors associated with poor visual outcomes were necrotizing scleritis, multifocal scleritis, scleritis associated with keratitis and uveitis.
Early diagnosis & antimicrobial treatment can result in complete resolution of infectious scleritis but visual prognosis depends on other complications.