Adjunct Rose Bengal Photodynamic Antimicrobial Therapy for Refractory Pseudomonas aeruginosa Infectious Necrotizing Scleritis After Scleral Buckling: A Case Report.

A 34-year-old man developed rapidly progressive infectious necrotizing scleritis following blunt ocular trauma and subsequent scleral buckle placement for rhegmatogenous retinal detachment. At presentation, best-corrected visual acuity was light perception, with conjunctival lysis, multifocal scleral thinning with uveal exposure, purulent discharge, and marked ocular inflammation. Microbiologic cultures grew Pseudomonas aeruginosa. Despite targeted topical and systemic antimicrobial therapy and surgical debridement with partial buckle removal and tectonic reconstruction, scleral necrosis continued to progress. RB-PDAT was performed as adjuvant therapy, resulting in rapid clinical improvement, stabilization of scleral thinning, resolution of purulence and active inflammation, and no further tissue loss during follow-up. RB-PDAT may be a useful adjunctive option for refractory infectious necrotizing scleritis, particularly in aggressive Pseudomonas infections when conventional medical and surgical measures fail to halt scleral melt.