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Epidemiology and Visual Outcomes in Patients With Infectious Scleritis

Hodson, Kelly L. MD; Galor, Anat MD; Karp, Carol L. MD; Davis, Janet L. MD; Albini, Thomas A. MD; Perez, Victor L. MD; Miller, Darlene DHSc, MPH; Forster, Richard K. MD

doi: 10.1097/ICO.0b013e318259c952
Clinical Science
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Purpose: To describe the epidemiology of patients with infectious scleritis and identify factors associated with poor visual prognosis.

Methods: Retrospective review of inciting factors, causative organisms, and visual outcomes of patients with infectious scleritis.

Results: Fifty-five patients (56 eyes) with confirmed infectious scleritis were included. The median time from inciting event to scleritis symptoms was 1.9 months. Eyes with a history of pterygium surgery had a longer time from surgery to development of scleritis (median 49 months, range 0–183) compared to those with a history of glaucoma, cataract, and retina surgery (median 1.0–1.6 months; P = 0.001). Fungal, nocardial, and mycobacterial infections (median 17–45 days) had a longer interval between symptoms and diagnosis than eyes with non–acid-fast gram-positive and gram-negative bacteria (median 7 days; P = 0.04). Patients were followed for a median of 11.1 months (0.5–47 months). Approximately 50% of eyes lost functional vision (worse than 20/200). Presenting VA of worse than 20/200 and concomitant keratitis or endophthalmitis were associated with poorer VA outcomes.

Conclusions: Infectious scleritis can occur days to years after ocular surgery, with infection occurring after a longer interval in eyes with a history of pterygium surgery. Approximately 50% of eyes lost functional VA after infection with poor presenting VA being the strongest predictor for subsequent severe vision loss.

*Ophthalmology Department, Bascom Palmer Eye Institute, University of Miami, Miami, FL

Ophthalmology Department, Miami Veterans Administration Medical Center, Miami, FL.

Reprints: Anat Galor, Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St, Miami, FL 33136, (e-mail: agalor@med.miami.edu).

Supported by NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant, Department of Defense (DOD grant W81XWH-09-1-0675) (institutional grants).

The authors have no conflicts of interest to disclose.

Received October 5, 2011

Accepted April 8, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.