Moriarty et al1 failed to address the importance of surgical treatment in patients with infectious keratoscleritis. In an article published in 1991,2 we examined 28 patients with cultureproven infectious scleritis and keratoscleritis. Three patients had developed keratoscleritis following pterygium removal and application of beta radiation. An additional patient had pterygium removal alone, without the application of beta radiation. Seven of eight patients who were treated with antibiotics alone and two of 11 patients who received surgical intervention and antibiotics eventually required evisceration or enucleation of the eye. Our results suggest that cryotherapy, lamellar or penetrating corneoscleral grafts, in addition to intensive antibiotic therapy may improve the outcome of patients with infectious keratoscleritis. In infectious scleritis alone, five patients were treated with conjunctival recession and cryotherapy in addition to an intensive regimen of antibiotics, and four patients were treated with antibiotics alone. The infections of these nine patients resolved.
Alfonso E. Surgical Intervention in Infectious Keratoscleritis. Arch Ophthalmol. 1994;112(8):1017. doi:10.1001/archopht.1994.01090200019005