title: Intrascleral dissemination of infectious scleritis following pterygium excision.
abstract: OBJECTIVE
  To assess the clinical pictures, possible pathogenesis, management, and therapy of patients with infectious scleritis associated with multifocal scleral abscesses following pterygium excision.
  
  
  METHODS
  The records of patients with infectious scleritis after pterygium excision who developed multifocal scleral abscesses presenting from 1988 to the end of 1995 were reviewed. Early culture of abscesses was performed, and topical, systemic antimicrobials, or both were given to all patients. Fourteen eyes were operated on in addition to antimicrobial treatment.
  
  
  RESULTS
  The initial culture reports of scleral ulcers identified Pseudomonas species in 12 of these 18 patients, Aspergillus in one, Mycobacterium fortuitum in one, and mixed organisms in four. Subsequent abscess cultures were taken from 15 of the infected eyes, and revealed the same organism as the initial culture in 12. Associated complications included four serous retinal detachments, three choroidal detachments, two double detachments, five complicated cataracts, and four recurrences of the initial infection. Four eyes required eventual enucleation and 11 eyes regained useful vision.
  
  
  CONCLUSIONS
  With subsequent abscess cultures proving to be the same organism as found in the initial ulcer, the abscess formation appears to represent intrascleral dissemination. Early diagnosis and appropriate, prolonged topical plus systemic antimicrobial treatment are essential to halt the progression of such severe infections.
authors.affiliation: Department of Ophthalmology, Chang-Gung Memorial Hospital, Taipei, Taiwan, ROC.
authors.forename: C H
authors.initials: CH
authors.lastname: Hsiao
authors.forename: J J
authors.initials: JJ
authors.lastname: Chen
authors.forename: S C
authors.initials: SC
authors.lastname: Huang
authors.forename: H K
authors.initials: HK
authors.lastname: Ma
authors.forename: P Y
authors.initials: PY
authors.lastname: Chen
authors.forename: R J
authors.initials: RJ
authors.lastname: Tsai
mesh_terms: D000038:Abscess / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D015818:Eye Infections, Bacterial / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000009:adverse effects; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000382:microbiology*; D019907:Mycobacterium fortuitum / Q000302:isolation & purification; D011183:Postoperative Complications / Q000382:microbiology*; D011552:Pseudomonas Infections / Q000150:complications / Q000382:microbiology*; D011625:Pterygium / Q000601:surgery*; D012008:Recurrence; D015422:Scleral Diseases / Q000382:microbiology*; D015423:Scleritis / Q000382:microbiology; D014456:Ulcer / Q000382:microbiology
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin