Rose Bengal photodynamic antimicrobial therapy as an adjunct treatment for Pseudomonas aeruginosa infectious necrotizing scleritis

Purpose To report the utility of Rose Bengal Photodynamic Antimicrobial Therapy (RB-PDAT) as an adjunct treatment in rapidly progressing Infectious Necrotizing Scleritis (INS) secondary to Pseudomonas aeruginosa. Methods Retrospective chart review was conducted on consecutive patients with scleritis and culture-proven Pseudomonas aeruginosa who underwent RB-PDAT. Results Six patients with Pseudomonas aeruginosa INS were included. All patients achieved complete resolution of the infection. The mean time to resolution after RB-PDAT was 17 days (range; 6-30 days), with a total treatment course average of 36 days (range; 22-60 days). One patient with pan-resistant Pseudomonas sclerokeratitis required two RB-PDAT treatments due to persistent stromal melting. All patients received a standardized regimen of oral fluoroquinolone, topical tobramycin, and ciprofloxacin/moxifloxacin. The patient with pan-resistant Pseudomonas aeruginosa required treatment with topical imipenem as well. None of the patients required enucleation. Conclusion RB-PDAT is a feasible option to halt the progression of infectious necrotizing scleritis caused by Pseudomonas aeruginosa, especially in cases of impending perforation.