Scedosporium scleritis or keratitis or both: case series.
OBJECTIVE
To report case series of infectious scleritis or keratitis or both caused by Scedosporium fungal species.


METHODS
Medical records of patients presenting with infectious scleritis or keratitis or both caused by Scedosporium were retrospectively reviewed at a tertiary care hospital. Nine culture-proven cases of Scedosporium corneal and scleral infection that were treated medically or surgically or both were enrolled for the study. The main parameters evaluated were the predisposing factors, clinical presentation, and the success of various treatment modalities.


RESULTS
The most common mode of presentation was scleritis (six cases, 67%), followed by sclerokeratitis (two cases, 22%) and keratitis (one cases, 11%). The risk factors included a previous pterygium excision with or without beta-radiation (six cases, 67%) and trauma (two cases, 22%). One patient had no identifiable risk factor. Mean duration between the time of pterygium excision and onset of infectious scleritis or keratitis or both was 7.6 +/- 3.3 years (range, 5-12 years). Voriconazole was the most commonly used antifungal medication in the form of drops (five cases, 56%) or tablets (five cases, 56%). Medical therapy alone could successfully resolve infection in six cases. Penetrating keratoplasty was performed in one eye, and two eyes were enucleated.


CONCLUSIONS
Corneal and scleral infection caused by Scedosporium may occur many years after pterygium surgery. Although newer antifungal agents like voriconazole are effective in management of such cases, severe infections may result in the loss of eye.
Jhanji
Vishal
V
Royal Victorian Eye and Ear Hospital, Centre for Eye Research Australia, University of Melbourne, Australia.
Yohendran
Jay
J
Constantinou
Marios
M
Sheorey
Harsha
H
Vajpayee
Rasik B
RB
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D015353:Eye Enucleation; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000382:microbiology*; D015948:Keratoplasty, Penetrating; D008297:Male; D008499:Medical Records; D009883:Ophthalmic Solutions; D011183:Postoperative Complications; D011625:Pterygium / Q000601:surgery; D011743:Pyrimidines / Q000008:administration & dosage; D021681:Scedosporium; D015423:Scleritis / Q000382:microbiology*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage; D065819:Voriconazole
D000935:Antifungal Agents; D009883:Ophthalmic Solutions; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole