A case of necrotizing scleritis resulting from Pseudomonas aeruginosa.

PURPOSE: The purpose of this study was to report a case of necrotizing scleritis resulting from Pseudomonas aeruginosa with no corneal infiltrate. RESULTS: A 75-year-old man presented with pain and redness in his left eye accompanied by fever of 3 days' duration. He was receiving chemotherapy for hepatic metastasis of an unknown origin. He presented a necrotizing scleritis with no corneal infiltrate. Scleral cell culture and blood culture were positive for P. aeruginosa. He was treated with oral imipenem and topical fortified ceftazidime. The response was good, but a scleral patch graft was needed to stabilize scleral thinning. CONCLUSION: This is the first case report of infectious scleritis in the context of P. aeruginosa sepsis in the absence of corneal infiltration.

Conjunctival healing after amniotic membrane graft over ischemic sclera.

PURPOSE: To present a case of chemical injury associated with calcification and severe conjunctival and scleral ischemia, in which tissue regeneration was achieved using an amniotic membrane graft. METHODS: A 65-year-old man presented to our department 8 weeks after suffering a chemical injury of his left eye with sulfuric acid. There was extensive calcification of the cornea and conjunctiva, associated with severe ischemia of the adjacent sclera. After resection of the calcified tissue and nonviable tissue, amniotic membrane was grafted to cover the extensive zone of scleral ischemia. RESULTS: In the weeks following grafting, slow epithelialization and revascularization was observed over the amniotic membrane, stemming from the surrounding healthy conjunctiva. CONCLUSION: Although the presence of ischemia at the base of the graft has been considered a contraindication for amniotic membrane transplantation, this case demonstrates that, provided that the surrounding tissue is not affected, a graft may be useful. In such cases an amniotic membrane graft could be attempted before other alternatives, such as conjuntival or oral mucosal autografts.

Amniotic membrane implantation as a therapeutic contact lens for the treatment of epithelial disorders.

PURPOSE: To evaluate the efficacy and safety of amniotic membrane implantation as a therapeutic contact lens in the treatment of different epithelial defects without stromal ulceration. METHODS: We used amniotic membrane implantation as a therapeutic contact lens in 20 consecutive patients with epithelial defects. Group 1 included 10 patients with persistent epithelial defects that did not respond to medical treatment. Group 2 included 10 patients with surgically induced epithelial defects. RESULTS: No intra- or postoperative complications were observed. The amniotic membrane implant remained in place for a mean of 12.5 days (range, 3-34). In 11 of the 20 patients, the amniotic membrane implant became detached within the first 8 days. When the corneal implant was postoperatively covered with a soft contact lens, this time increased. In group 1, complete epithelialization was achieved in three of the four cases in which the amniotic membrane remained in place for 2 or more weeks. There were no cases of complete epithelialization in which the implant remained in place for less than 1 week. In group 2, epithelialization was achieved in all cases, regardless of the time that the implant remained in place. CONCLUSION: Amniotic membrane implanted as a therapeutic contact lens can be an effective and safe option for the treatment of different epithelial defects. In patients with persistent epithelial defects, the number of cases with complete postoperative epithelialization was higher when the amniotic membrane remained in place longer. The early detachment of the amniotic membrane implant remains a major problem, even with the use of multiple fixation sutures.