ABSTRACT
Objective To summarize the clinical features and visual outcome of posterior scleritis presented with symptoms involving affected optic nerve.Methods Retrospective case series study.Twelve eyes of 12 female patients with posterior scleritis were included in this study.The average age was 35.2± 14.31 years old.The patients got diagnosed with an average of 24.75 ± 22.91 days.Ocular pain was complained in all patients,and blurred vision in 11 patients.The best corrected visual acuity (BCVA),intraocular pressure (IOP),slit lamp microscope examination,B-scan ultrasound,optical coherence tomography (OCT),fundus photography,fundus fluorescein angiography (FFA) and ocular wall thickness measurement were performed in all patients.Nine eyes received visual field examination.All patients received systemic corticosteroid and steroidal eye drops for 3 months.Clinical features and outcome were retrospectively studied.Results Before treatment,the BCVA was from ＜0.1 to ＞0.8.There were 3 eyes with scleral hyperemia,3 eyes with anterior chamber flares,12 eyes with papilledema and different degrees of retinal vein dilatation,3 eyes with star-shaped macular exudates and 2 eyes with macular retinal pigment epithelium detachment.B-scan ultrasound demonstrated that the ocular walls were thickening in all eyes with typical T-sign,and the average thickness was 2.76± 0.68 mm.OCT demonstrated optic disc swelling,and the macular retinal detachment in 2 eyes.In the FFA examination,the fluorescein leakage of the disc was enhanced with time.In the Humphrey test,the value of mean deviation (MD) was 12.56± 5.73 dB and pattern standard deviation (PSD) was 8.15±4.23 dB in 9 eyes before the treatment.After treatment for 3 months,the symptoms were attenuated and the visual acuity was obviously improved with BCVA＞0.1 in all eyes.Scleral hyperemia and anterior chamber flares were only found in 1 eye.The optic disc edema gradually faded away.The ocular wall thickness in the poster part of the eyeball decreased,and the T-sign disappeared in all eyes,the average thickness was 1.53±0.41 mm.Compared with parameters before the treatment,the difference was statistically significant (t=0.003 5,P＜0.05).OCT demonstrated the recovery of the macular retinal detachment.There was no abnormal leakage evidenced in FFA in the optic disc and macular.After treatment,the value of MD and PSD was 5.19±4.82 dB and (4.33 ±3.76) dB,respectively.The difference of MD value between before and after the treatment was significant (t=0.026,P＜0.05).Conclusions Posterior scleritis with an initial symptom of optic nerve was tend to affect middle-aged patients,with clinical manifestations of anterior segment signs in some patients and optic disc swelling with retinal vein dilatation in all patients.B ultrasound examination showed typical T sign.Systemic corticosteroid treatment always obtained remission of the ocular inflammatory activity,and could achieve favorable visual outcome.
ABSTRACT
ABSTRACT We describe an unusual case of Nocardia spp scleritis in a health girl resistant to topical fourth-generation fluoroquinolones. Clinically, there was only partial response of the scleritis to initial therapy. Treatment was changed to meropenem intravenously and topical amikacin. Following several weeks of antibiotic treatment, the patient's infection resolved but her vision was reduced to no light perception. Nocardia asteroides must be considered as a possible agent in cases of necrotizing scleritis in patients without a clear source. Antibiotic sensitivity testing has a definitive role in view of the resistance to these new medications.
RESUMO Nós descrevemos um raro caso de esclerite por Nocardia spp em uma criança sadia resistente a utilização tópica de fluorquinolona de quarta-geração. Clinicamente, a paciente apresentou apenas uma resposta parcial do quadro de esclerite a terapêutica inicial. O tratamento foi então modificado para meropenem intravenoso e amicacina tópica. Após várias semanas de tratamento com antibiótico, o quadro infeccioso regrediu porém a visao da pacientes evoluiu para perda da percepção luminosa. Em casos de esclerite necrotizante em pacientes sem fatores de risco aparente é necessário considerer a Nocardia Asteroides como possível agente causador. Os testes de sensibilidade medicamentosa apresentam importância significativa em virtude do aparecimento de resistência aos novos medicamentos.