Clinical experiences of infectious scleral ulceration: a complication of pterygium operation

Abstract

Aims—To report the special clinical mani-festations and determine the appropriate management of infectious scleral ulcera-tion. Methods—A retrospective study was per-formed on 30 eyes with infectious scleral ulceration. Information was recorded on patients ’ age, onset and course of disease, pathogenic organism, clinical presenta-tions, methods of diagnosis, treatment, and outcome. Results—10 cases (33.3%) were accompa-nied by corneal involvement. Subconjunc-tival abscess was noted in 16 cases (53.3%). 17 cases (56.7%) gave positive results of pathogen culture and all were Pseudomonas aeruginosa. Two cases had combined bacterial infections and one case was complicated by fungal infection. A total of 26 cases had surgical debride-ment in this series. Extensive involvement of the sclera with the presence of a ‘tunnel lesion ’ or a ‘satellite subconjunctival ab-scess ’ were found during debridement. All of the eyeballs involved were salvaged except one. Conclusion—The results of this study were contrary to the poor prognosis presented in previous reports. Early and repetitive surgical debridement is be-lieved to be mandatory in the intractable cases to shorten the admission period and to save these eyes. (Br J Ophthalmol 1997;81:980–983) Infectious scleral ulceration has not been reported commonly in the USA and Europe. Most reported infectious scleral ulcers are associated with systemic infection1 including tuberculosis2 3 and syphilis,4 5 severe infectious endophthalmitis,6 7 keratitis,8–10 scleral buckling surgery for retinal detachment,11–13 or unsu-tured small incision cataract surgery.14 15 How-ever, reports from the areas where pterygium has a high prevalence—for example, Australia