Late-onset intrascleral dissemination of Pseudomonas aeruginosa scleritis following pterygium excision

Somsanguan  Ausayakhun; Chulaluck Tangmonkongvoragul; Winai Chaidaroon; Napaporn Tananuvat; Muanploy Niparugs; Sumet Supalaset

Authors

Somsanguan Ausayakhun Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand
Chulaluck Tangmonkongvoragul Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand
Winai Chaidaroon Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand
Napaporn Tananuvat Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand
Muanploy Niparugs Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand
Sumet Supalaset Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand

Keywords:

pterygium excision, scleritis, Pseudomonas aeroginosa, late-onset

Abstract

Objective To report on two cases of late-onset intrascleral dissemination of Pseudomonas aeruginosa
scleritis following pterygium excision.

Methods Case reports.

Results Two women, one 67 years old, the second 74 years old, were referred to Chiang Mai University
Hospital for treatment of Pseudomonas aeruginosa scleritis 5 years after pterygium excision. In both cases, after admission appropriate antibiotics were extensively administered, both topically and systematically. That therapy was combined with surgical debridement in the second case. After being admitted for 20 and 48 days, the patients’ best corrected visual acuity were 6/6-2, and 6/18+2, respectively.

Conclusion Regular follow-up and early diagnosis combined with prompt and intensive treatment
may save vision in cases Pseudomonas aeruginosa scleritis following pterygium excision.

References

1. McCarty CA, Fu CL, Taylor HR. Epidemiology of pterygium in Victoria, Australia. Br J Ophthalmol. 2000;84:289–92.
2. Wong TY, Foster PJ, Johnson GJ, Seah SK, Tan DT. The prevalence and risk factors for pterygium in an adult Chinese population in Singapore: the Tanjong Pagar survey. Am J Ophthalmol. 2001; 131:176–83.
3. Gazzard G, Saw SM, Farook M, Koh D, Widjaja D, Chia SE et al. Pterygium in Indonesia: prevalence, severity and risk factors. Br J Ophthalmol. 2002;86:1341–46.
4. Hirst LW. The treatment of pterygium. Surv Ophthalmol. 2003;48:145–80.
5. Chaidaroon W, Thongkhao-Orn M, Wiwatwongwana D, Wiwatwongwana A. A survey of pterygium in Thailand 2010. J Med Assoc Thai. 2013; 96:64-8.
6. Kositphipat K, Tananuvat N, Choovuthayakorn J. Results of pterygium excision adjunct with conjunctival autograft transplantation for primary pterygium by ophthalmology trainees. Int Ophthalmol. 2016. doi:10.1007/s10792-016-0175-x.
7. Huang FC, Huang SP, Tseng SH. Management of infectious scleritis after pterygium excision. Cornea. 2000;19:34-9.
8. Lee JE, Oum BS, Choi HY, Lee JS. Methicillin-resistant Staphylococcus aureus sclerokeratitis after pterygium excision. Cornea. 2007;26:744-6.
9. Alsagoff Z, Tan DTH, Chee S-P. Necrotising scleritis after bare sclera excision of pterygium. Br J Ophthalmol. 2000;84:1050-2.
10. Sridhar MS, Bansal AK, Rao GN. Surgically induced necrotizing scleritis after pterygium excision and conjunctival autograft. Cornea. 2002; 21:305-7.
11. Jain V, Shome D, Natarajan S, Naverkar R. Surgically induced necrotizing scleritis after pterygium surgery with conjunctival autograft. Cornea. 2008; 27:720-1. doi: 10.1097/QAI.0b013e31815d2f27.
12. Lin HC, Ma DH, Chen yf, Yeh LK, Hsiao CH. Late-onset intrascleral dissemination of Stenotrophomonas maltophilia scleritis after pterygium excision. Cornea. 2011;30:712-5.
13. Paula JS, Simão ML, Rocha EM, Romão E, Velasco Cruz AA. Atypical pneumococcal scleritis after pterygium excision: case report and literature review. Cornea. 2006;25:115-7.
14. Hsiao CH, Chen JJ, Huang SC, Ma HK, Chen PY, Tsai RJ. Intrascleral dissemination of infectious scleritis following pterygium excision. Br J Ophthalmol. 1998;82:29-34.
15. Huang SC, Lai HC, Lai IC. The treatment of Pseudomonas keratoscleritis after pterygium excision. Cornea. 1999;18:608-11.
16. Fahim K, Houghton O, Dastjerdi M, Mian SI. Posterior scleritis secondary to Pseudomonas aeruginosa keratitis. Cornea. 2005;24:879-881.
17. Raber IM, Laibson PR, Kurz GH, Bernardino VB. Pseudomonas corneoscleral ulcers. Am J Ophthalmol. 1981;91:706-10.
18. Codère F, Brownstein S, Jackson WB. Pseudomonas aeruginosa scleritis. Am J Ophthalmol. 1981;92:353-62.
19. Su CY, Tsai JJ, Chang YC, Lin CP. Immunologic and clinical manifestations of infectious scleritis after pterygium excision. Cornea. 2006;25:663-6.
20. Lindquist TP, Lee W. Mitomycin C-associated
scleral stromalysis after pterygium surgery. Cornea. 2015;34: 398-401. doi: 10.1097/ICO.000000 0000000384.
21. Dougherty PJ, Hardten DR, Lindstrom RL. Corneoscleral melt after pterygium surgery using a single intraoperative application of mitomycin-C. Cornea. 1996;15:537-40.
22. Wan Norliza WM, Raihan IS, Azwa JA, Ibrahim M. Scleral melting 16 years after pterygium excision with topical Mitomycin C adjuvant therapy. Cont Lens Anterior Eye. 2006;29:165-7.
23. Safianik B, Ben-Zion I, Garzozi HJ. Serious corneoscleral complications after pterygium excision with mitomycin C. Br J Ophthalmol. 2002;86:357-8.
24. Dadeya S, Fatima S. Comeoscleral perforation after pterygium excision and intraoperative mitomycin C. Ophthalmic Surg Lasers Imaging. 2003; 34:146-8.
25. Rubinfeld RS, Pfister RR, Stein RM, Foster CS, Martin NF, Stoleru S, Talley AR, Speaker MG. Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology. 1994;99: 1647-54.
26. Tsai YY, Lin JM, Shy JD. Acute scleral thinning after pterygium excision with intraoperative mitomycin C: a case report of scleral dellen after bare sclera technique and review of the literature. Cornea. 2002;21:227-9.