First Author: M.Jhingan INDIA
Co Author(s): R. Narayanan
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Case report describing presenting features of a rare variant of posterior scleritis with management of associated complications
L.V. Prasad Eye Institute, Hyderabad
A 40 year old male labourer presented with complaints of decreased vision in right eye associated with pain since 1 week. At presentation vision in right eye was CF 1m and the fundus showed subretinal fluid at the posterior pole with inferior exudative retinal detachment. B scan of the right eye showied choroidal thickening locally with subtenon's fluid. A subretinal abscess was suspected with a differential diagnosis of infective scleritis or choroidal abscess in mind. On investigating the mantoux was found to be strongly positive with x-ray chest showing hilar prominence. Thus the patient was started on ATT. At his 1 week review, vision in left eye had dropped from 20/25 to 20/50. Fundus showed subretinal fluid at the posterior pole with disc edema in both eyes. B scan of both eyes showed subtenon's fluid now. The patient was instituted on a three day couse of intravenous methylprednisolone along with his ATT. Within three days dramatic reduction of subretinal fluid was noted and visual acuity in both eyes improved to 20/32 and 20/25 respectively. The patient was then started on tapering dose of oral steroids and continued on ATT.
Patient recovered fully within a month and was kept on oral ATT. At his last visit 3 months later visual acuity in both eyes was maintained at 20/25 but right eye had developed a peripapillary CNVM, for which he was promptly advised intravitreal Avastin®.
The clinical features and management of infectious posterior scleritis along with the management of its complications requires long term follow up with long term immunosuppresion along with anti-infective therapy and detailed clinical evaluation at each visit.