J Korean Ophthalmol Soc.  2021 Mar;62(3):400-404. 10.3341/jkos.2021.62.3.400.

Infectious Scleritis Featuring Kissing Choroidal Detachment and Serous Retinal Detachment

• Kim SJ
• Kim SH
• Choi Y
• Choi SK
• Park SW
• Byon IS
• Lee JJ

• KMID: 2514256
• DOI: http://doi.org/10.3341/jkos.2021.62.3.400

Abstract

Purpose
We report a case of infectious scleritis featuring kissing choroidal detachment and serous retinal detachment.
Case summary
A 65-year-old female presented with ocular pain and hyperemia of the right eye 1 week in duration. Anterior chamber inflammation was evident. After pterygium excision, a thinned sclera and loss of conjunctiva around a necrotic lesion were observed. Necrotizing scleritis with anterior uveitis was diagnosed and topical and systemic steroids commenced. After 1 week, the scleral thickness increased, but conjunctival injection and choroidal detachment were newly noticed. Infectious scleritis was suspected and the pterygium excision site cultured. Although empirical antibiotics (fortified ceftazidime and tobramycin) were prescribed, the choroidal and serous retinal detachments became aggravated. Pseudomonas aeruginosa was identified on scleral culture, and topical piperacillin/tazobactam and systemic cefepime (2 g) commenced. Although the antibiotics were appropriate, the choroidal and serous retinal detachments became further aggravated. Necrotic tissue was subjected to surgical debridement. Two days later, the infectious signs had diminished and a systemic steroid was added. Over the next few weeks, all of the choroidal and serous retinal detachments, and the infectious signs, improved.
Conclusions
Patients with infectious scleritis featuring severe choroidal detachment and serous retinal detachment resistant to appropriate antibiotics may require surgical debridement of necrotic tissue. After controlling the infectious signs, systemic steroids should be considered to ensure a good prognosis.

Keyword

Choroidal detachment, Debridement, Pseudomonas aeruginosa, Retinal detachment, Scleritis