Postoperative Rhizopus scleritis in a diabetic man

Abstract

A 50-year-old diabetic man developed necrotizing scleritis with adjacent keratitis 4 weeks after uncomplicated cataract extraction and intraocular lens implantation through a scleral tunnel incision. Cultures of the necrotic sclera grew Rizopus species. Severe destruction of the globe ensued despite topical, subconjunctival, and intravenous amphotericin B, in combination with hyperbaric oxygen therapy. Histopathological examination of the enucleated globe was consistent with Rhizopus infection. One year later, the patient was well without signs of recurrence.

Current Perspectives on Ophthalmic Mycoses

“…Rhizopus spp. are reported as a cause of scleritis (221), but evidence is not convincing (fungus was not seen in tissues, only 1 colony grown in culture). (Table 4; Fig.…”

“…Fungal scleritis has been reported to occur in at least 13 patients (Table 21) following various ophthalmic surgical procedures, including excision of pterygium (a fleshy conjunctival growth) without (379) or with beta irradiation (202,230,254,370) or cataract extraction (31,51,221), and after trabeculectomy (filtering surgery for glaucoma). For management of fungal scleritis, early debridement and culture, close microbiologic assistance, systemic antimicrobials for a prolonged period, and penetrating keratoplasty for perforation or incipient perforation are the measures that have been advocated (254).…”

“…in the remaining patient is contentious, since fungal hyphae were not visualized in the samples collected and since just one colony of a Rhizopus spp. was recovered in culture (221). Of the 13 patients, 8 required some form of surgical intervention, such as scleral debridement or resection or removal of plaque, to ensure resolution of the infection; the fungi involved were A. flavus and Aspergillus sp.…”

Novel use of adjunctive hyperbaric therapy for fungal scleritis

“…2 We report a case of the novel use of HBOT as an adjunct to treat Cladosporium fungal scleritis secondary to pterygium removal with topical mitomycin C. This is only the second reported case of HBOT use in fungal scleritis and the first case where it was used with resolution of the infection. 3 A 45-year-old female presented 1 month following excision of a right nasal pterygium with mitomycin C. Visual acuity was 6/15 in the right eye. On slit-lamp examination, the sclera was avascular with an overlying conjunctival defect and corneal thinning around the nasal limbus.…”

Spectrum of clear corneal incision cataract wound infection

“…2 To our knowledge, there are only 4 series regarding cases of this nature [3][4][5][6] and 5 isolated case reports. [7][8][9][10][11] Our report is the first case series from Australia and the United Kingdom.…”