Supplementary Material for: A Severe Case of Infectious Necrotizing Anterior Scleritis Caused by Pseudomonas aeruginosa After Vitreoretinal Surgery

Abstract
Introduction: This report describes a case of necrotizing scleritis caused by Pseudomonas aeruginosa infection soon after vitreous surgery, which caused severe scleral melting and rapidly progressive necrosis that led to scleral perforation and bacterial endophthalmitis.
Case presentation: The patient was an 86-year-old man with a history of type 2 diabetes mellitus who underwent pars plana vitrectomy for vitreous hemorrhage in his right eye. On postoperative day 10, he complained of severe ocular pain and was found to have conjunctival edema and eyelid swelling, which was treated by topical and general systemic antibiotics. His ocular symptoms improved but subsequently worsened. On postoperative day 25, hypopyon and a fibrinous exudative membrane were observed in the anterior chamber, and the fundus could not be visualized. Pars plana vitrectomy was repeated with addition of silicone oil tamponade. During the surgery, the retina was found to be completely detached with severe anterior scleral melting, perforation, and necrosis, as well as abscess formation. Culture of an eye discharge specimen detected P. aeruginosa. After surgery, antibiotics were administered and the eye was washed with polyvinyl alcohol-iodine solution daily. Ten days later, there was significantly improved eye pain or eyelid swelling. The scleral inflammation gradually resolved without recurrence.
Conclusion: In this case, rapidly progressive necrotizing scleritis caused by P. aeruginosa infection was controlled by a combination of antibiotics, removal of necrotic tissue, and daily eye washing with polyvinyl alcohol-iodine solution.

摘要
引言：本报告描述1例玻璃体手术后不久因铜绿假单胞菌（Pseudomonas aeruginosa）感染引发坏死性巩膜炎（necrotizing scleritis）的病例，该病症造成严重巩膜融解及快速进展性坏死，最终导致巩膜穿孔与细菌性眼内炎（bacterial endophthalmitis）。
病例介绍：患者为86岁男性，有2型糖尿病病史，因右眼玻璃体积血接受经睫状体平坦部玻璃体切除术（pars plana vitrectomy）。术后第10天，患者主诉剧烈眼痛，检查发现结膜水肿与眼睑肿胀，予局部及全身抗生素治疗。患者眼部症状一度好转，但随后再次加重。术后第25天，前房可见前房积脓（hypopyon）与纤维素性渗出膜，无法窥见眼底。遂再次行经睫状体平坦部玻璃体切除术，并联合硅油填充术（silicone oil tamponade）。术中发现视网膜完全脱离，伴严重前部巩膜融解、穿孔、坏死及脓肿形成。眼部分泌物标本培养检出铜绿假单胞菌。术后予抗生素治疗，每日以聚乙烯醇-碘溶液（polyvinyl alcohol-iodine solution）冲洗眼部。10天后，眼痛与眼睑肿胀症状显著改善。巩膜炎症逐渐消退，未见复发。
结论：本病例中，联合抗生素治疗、清除坏死组织以及每日以聚乙烯醇-碘溶液冲洗眼部，成功控制了铜绿假单胞菌感染引发的快速进展性坏死性巩膜炎。