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Nocardia scleritis-clinical presentation and management: a report of three cases and review of literature.

Sahu SK, Sharma S, Das S - J Ophthalmic Inflamm Infect (2011)

Bottom Line: The medical management was based on the antibiotic sensitivity.All three patients resolved with a good visual and tectonic outcome.The literature review also suggests a good outcome with prolonged medical management though the preferred antibiotic has changed over the years.

View Article: PubMed Central - PubMed

Affiliation: Cornea and Anterior segment Services, Proff Brien Holden Eye Research Center, L V Prasad Eye Institute, Bhubaneswar, Patia, Bhubaneswar, Orissa, 751024, India, srikant_sahu1@yahoo.co.in.

ABSTRACT

Aim: This study aims to describe the clinical features and management of Nocardia scleritis.

Methods: The authors retrospectively reviewed medical charts of three patients with microbiologically proven Nocardia scleritis and reviewed literature.

Results: All the patients presented with areas of well-demarcated, circumscribed abscess. No specific clinical feature could be attributed to the causative organism. Nocardia was identified by smear and culture from the scleral exudates. The medical management was based on the antibiotic sensitivity. Surgical exploration of the suppurated area along with the healthy margins was done on all patients. Two patients required multiple explorations. All three patients resolved with a good visual and tectonic outcome. The literature review also suggests a good outcome with prolonged medical management though the preferred antibiotic has changed over the years.

Conclusion: Though the prevalence of a disease like Nocardia scleritis is low, the results suggest that specific diagnosis and appropriate management can lead to a good outcome.

No MeSH data available.


Related in: MedlinePlus

Patient no. 2. a Slit lamp picture showing an area of circumscribed scleral abscess. A scleral ulcer is situated inferior to the abscess. b Scleral scraping showing thin, branching, acid fast filaments (arrow) suggestive of Nocardia species (Kinyoun’s acid fast stain using 1% H2SO4, ×1,000). c Three weeks after treatment decipitating uveal show. d Healthy and vascularized graft 4 months after scleral patch graft
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Fig1: Patient no. 2. a Slit lamp picture showing an area of circumscribed scleral abscess. A scleral ulcer is situated inferior to the abscess. b Scleral scraping showing thin, branching, acid fast filaments (arrow) suggestive of Nocardia species (Kinyoun’s acid fast stain using 1% H2SO4, ×1,000). c Three weeks after treatment decipitating uveal show. d Healthy and vascularized graft 4 months after scleral patch graft

Mentions: A 50-year-old lady with history of injury to the right eye with some plant material 2 1/2 months ago developed pain, redness and watering. She was on topical levofloxacin and lubricant. Her vision was 20/30 in right eye and 20/20 in left eye. The right eye showed a well-localized, circumscribed abscess and a scleral ulcer discharging purulent material in the inferior bulbar conjunctival area (Fig. 1a).The abscess was drained and the surrounding necrotic tissue was removed. Smear and culture of the exudates were positive for Nocardia species (Fig. 1b). Topical amikacin 2.5% every hour, ciprofloxacin 0.3% every hour, homatropine twice daily, and oral ciprofloxacin 500 mg twice daily was given. After 3 weeks of treatment there was no area of scleral suppuration or ulcer, conjunctiva was mildly congested, and there was an area of uveal show (Fig. 1c) under the conjunctiva. A donor scleral patch graft with amniotic membrane graft over it was done. Postoperatively we advised topical prednisolone acetate eight times a day, ciprofloxacin 0.3% every hour, and oral ciprofloxacin 500 two times a day. The systemic medication was discontinued after a week, topical corticosteroids were tapered, and antibiotic was continued for 2 months. Four months postoperatively her best corrected visual acuity was 20/20 with a healthy graft.Fig. 1


Nocardia scleritis-clinical presentation and management: a report of three cases and review of literature.

Sahu SK, Sharma S, Das S - J Ophthalmic Inflamm Infect (2011)

Patient no. 2. a Slit lamp picture showing an area of circumscribed scleral abscess. A scleral ulcer is situated inferior to the abscess. b Scleral scraping showing thin, branching, acid fast filaments (arrow) suggestive of Nocardia species (Kinyoun’s acid fast stain using 1% H2SO4, ×1,000). c Three weeks after treatment decipitating uveal show. d Healthy and vascularized graft 4 months after scleral patch graft
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3303001&req=5

Fig1: Patient no. 2. a Slit lamp picture showing an area of circumscribed scleral abscess. A scleral ulcer is situated inferior to the abscess. b Scleral scraping showing thin, branching, acid fast filaments (arrow) suggestive of Nocardia species (Kinyoun’s acid fast stain using 1% H2SO4, ×1,000). c Three weeks after treatment decipitating uveal show. d Healthy and vascularized graft 4 months after scleral patch graft
Mentions: A 50-year-old lady with history of injury to the right eye with some plant material 2 1/2 months ago developed pain, redness and watering. She was on topical levofloxacin and lubricant. Her vision was 20/30 in right eye and 20/20 in left eye. The right eye showed a well-localized, circumscribed abscess and a scleral ulcer discharging purulent material in the inferior bulbar conjunctival area (Fig. 1a).The abscess was drained and the surrounding necrotic tissue was removed. Smear and culture of the exudates were positive for Nocardia species (Fig. 1b). Topical amikacin 2.5% every hour, ciprofloxacin 0.3% every hour, homatropine twice daily, and oral ciprofloxacin 500 mg twice daily was given. After 3 weeks of treatment there was no area of scleral suppuration or ulcer, conjunctiva was mildly congested, and there was an area of uveal show (Fig. 1c) under the conjunctiva. A donor scleral patch graft with amniotic membrane graft over it was done. Postoperatively we advised topical prednisolone acetate eight times a day, ciprofloxacin 0.3% every hour, and oral ciprofloxacin 500 two times a day. The systemic medication was discontinued after a week, topical corticosteroids were tapered, and antibiotic was continued for 2 months. Four months postoperatively her best corrected visual acuity was 20/20 with a healthy graft.Fig. 1

Bottom Line: The medical management was based on the antibiotic sensitivity.All three patients resolved with a good visual and tectonic outcome.The literature review also suggests a good outcome with prolonged medical management though the preferred antibiotic has changed over the years.

View Article: PubMed Central - PubMed

Affiliation: Cornea and Anterior segment Services, Proff Brien Holden Eye Research Center, L V Prasad Eye Institute, Bhubaneswar, Patia, Bhubaneswar, Orissa, 751024, India, srikant_sahu1@yahoo.co.in.

ABSTRACT

Aim: This study aims to describe the clinical features and management of Nocardia scleritis.

Methods: The authors retrospectively reviewed medical charts of three patients with microbiologically proven Nocardia scleritis and reviewed literature.

Results: All the patients presented with areas of well-demarcated, circumscribed abscess. No specific clinical feature could be attributed to the causative organism. Nocardia was identified by smear and culture from the scleral exudates. The medical management was based on the antibiotic sensitivity. Surgical exploration of the suppurated area along with the healthy margins was done on all patients. Two patients required multiple explorations. All three patients resolved with a good visual and tectonic outcome. The literature review also suggests a good outcome with prolonged medical management though the preferred antibiotic has changed over the years.

Conclusion: Though the prevalence of a disease like Nocardia scleritis is low, the results suggest that specific diagnosis and appropriate management can lead to a good outcome.

No MeSH data available.


Related in: MedlinePlus