Method of surgical treatment of purulent scleritis with scleral abscess

Relevance Purulent scleritis mediated by bacterial flora is an extremely rare postoperative complication requiring urgent treatment. In this situation, conservative therapy according to clinical recommendations is usually ineffective or is accompanied by a short-term improvement in the clinical picture with subsequent relapse, which determines the need for surgical treatment, the tactics of which are currently not clearly defined. Objective To analyze the effectiveness of surgical treatment of purulent scleritis with the development of a scleral abscess based on a clinical case. Material and methods A clinical case of purulent scleritis after penetrating keratoplasty for acanthamoeba keratitis. The patient was diagnosed with the development of acanthamoeba keratitis in the left eye against the background of the use of orthokeratological lenses for the correction of myopia. Results The use of contact methods for correcting various types of ametropia is associated with the development of acanthamoeba keratitis, the diagnosis of which is complicated by clinical similarities with keratitis of other etiologies, which leads to late administration of empirical therapy and the development of severe complications. Often, to restore the visual function of the affected eye as a result of acanthamoeba keratitis affecting the optical zone of the cornea, keratoplasty is required after stopping the infectious process and forming a stable corneal infiltrate. Keratoplasty carries a risk of infection with the possible development of purulent scleritis or the formation of a scleral abscess. The development of acanthamoeba keratitis of the left eye in a patient using orthokeratological lenses for the correction of myopia led to penetrating keratoplasty followed by rekeratoplasty complicated by a scleral abscess of coccobacillary etiology. The absence of positive dynamics against the background of conservative therapy, penetration of purulent contents of the abscess into the anterior chamber determined the need for revision of the abscess cavity by separation of the conjunctiva parallel to the limbus and a U-shaped incision of the sclera with further evacuation of purulent exudate, formation of subconjunctival drainage of the intrascleral cavity and sanitation of the anterior chamber with BSS solution. Then, postoperative systemic antibacterial and antifungal therapy was prescribed. Over the next 4 months, the transplant remained transparent, and there were no signs of inflammation in the scleral abscess area. Conclusion Purulent scleritis is a rare but extremely severe postoperative complication, in which conservative therapy is often ineffective, especially when a scleral abscess is formed, therefore, surgical treatment is possible, the tactics of which are currently not determined by clinical recommendations. The above-described surgical treatment in combination with intensive antibacterial therapy in the postoperative period gives a good result and helps to avoid relapse of purulent scleritis. Keywords: purulent scleritis; scleral abscess; acanthamoeba keratitis; penetrating keratoplasty