Bacterial Corneal Ulcers Research Articles

Efficiency and Safety of the Domestic Device KERATOLINK for the Treatment of Patients with Bacterial Corneal Ulcers

Efficiency and Safety of the Domestic Device KERATOLINK for the Treatment of Patients with Bacterial Corneal Ulcers

The Pattern of Corneal Diseases in North Kordofan State

Background: All corneal diseases cause ocular morbidity and decrease vision, or even blindness, so early management intervention is critical. This study sought to evaluate several corneal disorders, including corneal foreign bodies, corneal tears, and ruptured globes. Methodology: This retrospective descriptive study was undertaken in El-Obeid Teaching Hospital's Ophthalmology Emergency Department in North Kordofan State, Sudan, as well as Dr. Khalil's Ophthalmology Center. This study sample, which represents the entire corneal illness, was obtained from 1000 patient files for various eye conditions. Results: This study examines 205 patients with corneal disorders to assess the prevalence of corneal diseases in North Kordofan State. The study found that the disease is more common in males, with 48 out of 78 patients (62%) being male and 38% being female. The male-to-female ratio is 1.6:1. The age group that is most affected is the group of individuals younger than 9 years, accounting for 34% of the affected population. This is followed by the age groups of 10–20 years, 21–32 years, 33–53 years, and >54 years, which account for 24%, 18%, 14%, and 9%, respectively. Regarding the classification of corneal disorders, the most prevalent form is foreign body corneal disease, accounting for 38% of cases. This is followed by corneal tear (16%), corneal opacity (15%), corneal tear with iris prolapses (10%), bacterial corneal ulcer (7%), and rupture globe (6%). The incidence rates of viral corneal ulcers, chemical trauma, burn trauma, and keratoconus are 3%, 3%, 1%, and 1%, respectively. Conclusion: Eye trauma is prevalent in north Kordofan, leading to an upsurge in corneal illnesses including foreign body cornea, corneal tear, and ruptured globe.

Study of demographic profile, risk factor, clinical profile and microbiological profile of corneal ulcer

: To study the demographic factors, risk factors, microbiological profile and clinical course of patients with corneal ulcer presenting to Minto Regional institute of ophthalmology Bangalore.: A total of 876 patients diagnosed with infective corneal ulcer from January 2018 to January 2020 were retrospectively reviewed and analyzed for demographic profile, risk factors, clinico-microbiological profile at Minto Regional institute of ophthalmology Bengaluru. Among the 876 patients, 596 (68.04%) were male and 280 (31.96%) were females. 613(69.97%) were in the age group of 51-60 years. 85.04% belonged to low socioeconomic class. History of injury from vegetative matter was the leading cause and was seen in 264(30.14%) patients. Among the 613 (69.98%) culture positive patients, 410 (46.81%) were positive for fungi, while 203 (23.17%) were positive for bacteria. 674(76.94%) out of 876 responded to conservative management alone, while 202 (23.06%) patients required therapeutic penetrating keratoplasty. Fungal corneal ulcers caused by Aspergillus were the most common type, followed by bacterial corneal ulcers due to Staphylococcus aureus. Incidence of fungal corneal ulcer is very high among agricultural and industrial workers. Lack of awareness and delayed treatment leads to corneal blindness. This emphasizes the need for awareness among at risk population and also shall guide clinicians in decision making regarding empirical treatment.

Locality is the strongest predictor of expert performance in image-based differentiation of bacterial and fungal corneal ulcers from India.

This study sought to identify the sources of differential performance and misclassification error among local (Indian) and external (non-Indian) corneal specialists in identifying bacterial and fungal keratitis based on corneal photography. This study is a secondary analysis of survey data assessing the ability of corneal specialists to identify acute bacterial versus fungal keratitis by using corneal photography. One-hundred images of 100 eyes from 100 patients with acute bacterial or fungal keratitis in South India were previously presented to an international cohort of cornea specialists for interpretation over the span of April to July 2021. Each expert provided a predicted probability that the ulcer was either bacterial or fungal. Using these data, we performed multivariable linear regression to identify factors predictive of expert performance, accounting for primary practice location and surrogate measures to infer local fungal ulcer prevalence, including locality, latitude, and dew point. In addition, Brier score decomposition was used to determine experts' reliability ("calibration") and resolution ("boldness") and were compared between local (Indian) and external (non-Indian) experts. Sixty-six experts from 16 countries participated. Indian practice location was the only independently significant predictor of performance in multivariable linear regression. Resolution among Indian experts was significantly better (0.08) than among non-Indian experts (0.01; P < 0.001), indicating greater confidence in their predictions. There was no significant difference in reliability between the two groups ( P = 0.40). Local cornea experts outperformed their international counterparts independent of regional variability in tropical risk factors for fungal keratitis. This may be explained by regional characteristics of infectious ulcers with which local corneal specialists are familiar.

STUDY OF CLINICAL PROFILE AND RISK FACTORS OF INFECTED CORNEAL ULCERS AT RURAL TERTIARY CARE HOSPITAL

Introduction: A corneal ulcer is a discontinuation in normal epithelial surface of cornea associated with necrosis of the surrounding corneal tissue. It is a major worldwide cause of preventable corneal blindness that is mostly under-reported but can be responsible every year for 1.5–2.0 million new cases of monocular blindness. Detailed studies of severe sight-threatening infectious keratitis are therefore important as they provide valuable information on the detection of etiology, predisposing factors, and visual outcomes to form the development of management strategies and protocols. Aims and Objectives: To study the clinical profile and known risk factors of infected corneal ulcers at rural tertiary care hospital. Materials and Methods: An Observational, Descriptive Cross-Sectional Hospital-based study was conducted after Institutional Ethical Committee (IEC) at the Department of Ophthalmology, DVPRMC, Loni. A total of 70 patients with infected corneal ulcers were screened and evaluated from June 2022 to May 2023 for a duration of 1 year. We studied the infected corneal ulcer patients above 18 years old attending to our hospital OPD. Results: 57% of patients were male and 43% were female. 66% of patients gave a history of trauma. The most common clinically diagnosed ulcer was fungal, representing 53% of all ulcers, followed by bacterial (27%) and viral (13%). There were also 2 cases each of acanthamoeba (3%) and pythium (3%) ulcers. 62.8% of cases were above 50 years old. In our study 73% of suspected fungal corneal ulcers were KOH smear-positive and 70% of suspected bacterial corneal ulcers were gram-positive. All cases were advised medical management. Out of those 43% were also advised therapeutic penetrating keratoplasty. Conclusion: Corneal ulcers are commonly seen in adult male farmers and laborers with ocular trauma in rural areas and fungal ulcer is the most common type of ulcer. Late presentation with corneal perforation requires therapeutic penetrating keratoplasty.

MANAGEMENT OF CORNEAL ULCER PRESENTED WITH RARE PATHOGEN : STREPTOCOCCUS MITIS

Introduction : Corneal ulcers can arise from various corneal diseases, including infections, inflammation, and autoimmune disease. Staphylococcus aureus is the most common bacterial pathogen, but lesser- known bacteria like Streptococcus mitis can also cause corneal ulcers. Accurate diagnosis and treatment are essential to prevent vision loss and complications.&#x0D; Case Illustration : A 19-year-old female patient presented with a chief complaint of white spots on her right eye for three months. Previously, her right eye was hit by a foreign object and subsequently, the patient experienced redness and pain in the affected eye. One week later, white spot appeared in the patient's eye and reported to enlarge in the last month. The patient also complained of pain, blurry vision with visual acuity of 1/300, redness, glare, and a foreign body sensation. Corneal swab culture discovered Streptococcus mitis to be the causative agent. The patients was given hourly drop of topical levofloxacin. One month after initial treatment, patient’s symptoms was improving with visual acuity of 6/60 on her affected eye and the ulcer was healed.&#x0D; Discussion : Streptococcus mitis is a commensal pathogen in oral cavity and not normally cause infection of ocular tissue. It may cause ulcer due to prolonged use of topical steroid and previous ocular trauma, since Streptococcus mitis had low virulence rate.&#x0D; Conclusion : Corneal scraping culture should be carried out before treatment of infectious corneal ulcer. Streptococcus mitis is considered rare for corneal ulcer pathogen. Topical quinolones are the first- line drug for bacterial corneal ulcer and worked exceptional for wide range of bacteria.

A Case of Allergic Reaction to 0.5% Moxifloxacin Eye Drops

Purpose: We report a rare case of allergic contact dermatitis after the use of a non-preservative 0.5% moxifloxacin ophthalmic solution.Case summary: A 60-year-old male presented with bacterial corneal ulceration of the right eye. He was treated with 50 mg/mL of fortified cefazolin and 14 mg/mL of tobramycin that were tapered as the corneal lesion improved after 1 month, and 0.5% moxifloxacin application was started. After 2 weeks of moxifloxacin treatment, the patient developed conjunctival injection, lid swelling, redness, and itching in the right eye. An allergic reaction was suspected and moxifloxacin administration was immediately stopped. The symptoms improved after the administration of oral antihistamines, 0.5% loteprednol eye drops, and steroid combination ointment.Conclusions: Patients treated with 0.5% topical moxifloxacin should be monitored for allergic contact dermatitis, even if preservative-free eye drops are used.

Tactics of Managing Patients with Bacterial Corneal Ulcers in a Multidisciplinary Hospital (Series of Clinical Cases)

Bacterial corneal ulcers in patients with comorbid pathology are a complex clinical situation with a high risk of complications — corneal perforation. The article presents four clinical cases of bacterial corneal ulcers in patients with chronic latent sinusitis. The publication discusses the issues of diagnostic tactics, provides an analysis of the results of instrumental and laboratory tests in each case. The results of corneal ulcer therapy are presented taking into account antibioticograms.

The Utility of Corneal Cultures in Bacterial Keratitis.

To determine the utility and use of corneal cultures in bacterial keratitis. Retrospective single-center chart review of patients with bacterial keratitis who showed a positive corneal culture result from January 2017 to December 2021. Seventy-four cases of bacterial keratitis in 73 patients with positive cultures were identified. The most common organisms were Pseudomonas, Staphylococcus, and Streptococcus species. In total, 87.8% of cases were started on fortified antibiotics initially. All organisms isolated were susceptible to empiric antibiotics used (n=54). In 47.3% of cases, an antibiotic was discontinued once culture results became available, most often fortified vancomycin. Within the 27 Pseudomonas cases, consisting of predominantly contact lens wearers, at least one fortified antibiotic was discontinued in 66.7% of cases after a positive culture result. Multidrug resistance was infrequent in the study population. Empiric antibiotic therapy is still effective in bacterial corneal ulcers. Corneal cultures may have utility in antibiotic de-escalation.

MICROBIAL PROFILE OF ULCERATIVE KERATITIS AT TERTIARY LEVEL HOSPITAL

Background: Keratitis is the term applied for inammations of the cornea. Ulcerative keratitis is a common potentially sight threatening ocular infection that may be caused by bacteria, fungi, viruses or parasites. Corneal ulcer is an ocular emergency that requires prompt management to ensure the best visual outcome for the patient. Otherwise, it can result in scarring and blindness. Aim and objectives: To study Microbial causes and to identify risk factors, and corelation of clinical features of ulcerative keratitis with etiological agents Materials and methods: Total 325 corneal ulcer cases were studied. Corneal scrapings were collected and subjected for examination by Gram's stain, 10% KOH, bacterial and fungal culture. Antibiotic susceptibility of the bacterial pathogens was performed by Kirby Bauer disc diffusion method as per CLSI guidelines with various groups of antibiotics. MIC for vancomycin were determined for study isolates by Epsilometer test. Results: Totally 325 infectious corneal ulcers were studied in detail. Aetiological agents were isolated in 115 (35.38%) cases. Majority of the isolates were fungal agents (44.18%), belonging to the Aspergillus (21.05%), Fusarium (14.47%). Bacterial corneal ulcer was less common (25.49%). The predominant bacterial pathogen isolated was Staphylococcus epidermidis, followed by Pseudomonas aeruginosa. no Acanthamoeba were identied. The sensitivity of potassium hydroxide staining was almost 100% in culture-proven fungal cases. Trauma is the leading cause for the corneal ulcers. Majority of the bacterial isolates were susceptible to amikacin. Conclusion: Ulcerative keratitis being a sight threatening disorder, early suspicion, rational use of laboratory diagnostic procedures, identication of the causative organisms and timely institution of appropriate antimicrobial therapy based on the prevailing sensitivity pattern of the isolates could save the eye from this preventable cause of blindness

Comparison of Culture Results between Specimens from Corneal Scraping with Microhomogenization and Corneal Swab in Moderate and Severe Bacterial Corneal Ulcers.

The purpose of this study was to compare the bacterial culture results from corneal infiltrate specimens collected using two different methods, corneal scraping followed by microhomogenization and corneal swab. This is a comparative crosssectional study, with 18 participants undergoing corneal specimen collection using each of the 2 sampling techniques. The results from the scraping and swab methods were separated and then compared using data analysis. The proportion of Gram stain results that matched the culture results for the scraping-microhomogenization technique was 6/13 (46.2%), and the proportion of Gram stain results that matched the culture results for the swab technique was 5/13 (38.5%) (McNemar test P value, 1.000; P > 0.05). The proportion of positive cultures obtained using the scraping-microhomogenization technique was 13/18 (72.2%), and the proportion of positive cultures obtained using the swab technique was 9/18 (50%) (McNemar test P value, 0.219; P > 0.05). The Kappa suitability test value for comparison of the scraping-microhomogenization technique to the corneal swab was 0.333. The specimens collected by corneal scraping followed by microhomogenization had a higher positive bacterial culture rate than those collected by corneal swab, but the results were not statistically significant. IMPORTANCE This study aimed to compare the culture results between scraping specimens with microhomogenization and corneal smears in patients with moderate to severe bacterial corneal ulcers. This study could be a guideline for treating bacterial corneal ulcers.

Susceptibility pattern of bacterial isolates in equine ulcerative keratitis: Implications for empirical treatment at a university teaching hospital in Sydney.

Corneal ulceration is a common ophthalmic condition in horses. It is frequently caused by trauma to the corneal surface, followed by secondary infection by commensal or pathogenic organisms including Streptococcus equi subspecies zooepidemicus, Pseudomonas aeruginosa and Staphylococcus spp. Emerging antimicrobial resistance amongst these organisms has raised the need for appropriate antimicrobial therapy selection, to optimise treatment efficacy while minimising further antimicrobial resistance. Medical records of 38 horses presented at the University Veterinary Teaching Hospital Camden for ulcerative keratitis between 2010 and 2020 were reviewed to identify those with positive bacterial cultures and antimicrobial susceptibility profiles (13/38). Common susceptibility patterns were identified and used to guide the empirical treatment of equine bacterial corneal ulcers. Pseudomonas spp. (64.3%), Streptococcus equi subspecies zooepidemicus (14.3%) and Actinobacillus spp. (14.3%) were most commonly identified. Susceptibility to amikacin, gentamicin and ciprofloxacin was observed in 100%, 66.7% and 85.7% Pseudomonas spp. isolates respectively. Resistance to polymyxin B and neomycin occurred in 85.7% and 71.4% of Pseudomonas spp., respectively. All Streptococcus equi subspecies zooepidemicus organisms in this study were susceptible to ceftiofur, cephalexin, penicillin and ampicillin, while they were all resistant to gentamicin, neomycin, enrofloxacin and marbofloxacin. Predominating in this study, Pseudomonas spp. maintained overall aminoglycoside susceptibility despite some emerging resistance, and good fluoroquinolone susceptibility. High resistance to Polymyxin B could have arisen from its common use as first-line therapy for bacterial corneal ulcers. Although further research is required, these new findings about predominant bacteria in equine corneal ulceration in the Camden region and their antimicrobial susceptibility patterns can be used to guide the empirical treatment of bacterial corneal ulcers in horses.

Autologous platelet-rich plasma eye drop for moderate-to-severe bacterial corneal ulcers: Changes in interleukin-6 tear concentration and clinical outcomes.

The objective of this study was to evaluate interleukin-6 (IL-6) tear concentration and clinical outcome in patients with moderate-to-severe bacterial corneal ulcers post autologous platelet-rich plasma (PRP) eye drop therapy. This was a pre-post designed study involving 21 moderate-severe corneal ulcer patients who got autologous PRP eye drop. Subjects were got autologous PRP eye drop as adjuvant therapy. Patients with moderate-to-severe infectious bacterial corneal ulcers were included in this study. Tear sampling was performed before therapy using sterile Schirmer paper from conjunctival inferior fornix. PRP therapy was performed for 7 days. Data recording and tear sampling were then performed at day 0 (pre-PRP), day 7 (D+7), and day 14 (D+14) after PRP therapy. Data recording included presence of pericorneal injection, blepharospasm, size of corneal defects, and hypopyon. There was a decrease in IL-6 tear concentration by day 14 after PRP therapy (P < 0.001). IL-6 concentration at day 7 after therapy (7525.67 ± 7092 pg/mL) tended to be lower before therapy (10,599 ± 6158 pg/mL), but not statistically significant (P = 0.156). The size of corneal defects decreased significantly post PRP at day 7 (P = 0.035) and at day 14 (P = 0.001). There was a significant blepharospasm at day 7 (P = 0.012) and day 14 (P < 0.001). There was a significant pericorneal injection only at day 14 (P = 0.002). There was no significant decreased hypopyon. There was a significant reduction in IL-6 tear concentration and clinical improvement in moderate-to-severe bacterial corneal ulcers which got autologous PRP eye drop as adjuvant therapy.

Profile of Pseudomonas aeruginosa Antibiotic Sensitivity Test Results from Corneal Scrapings Specimens of Keratitis Patients with Contact Lens Users and Non-Contact Lenses Users at Dr. Soetomo Hospital Surabaya

Background: Pseudomonas aeruginosa have a significant proportion of the causes of bacterial keratitis. Corneal ulcers infected with P. aeruginosa are more severe than other bacterial corneal ulcers. P. aeruginosa is often associated with keratitis that results from wearing contact lenses, which eventually leads to corneal ulcers. This study aims to determine the differences in the results of the antibiotic sensitivity test of P. aeruginosa from corneal scraping specimens of keratitis patients using contact lenses and non-contact lens users at RSUD dr. Soetomo. Methods: This study is an observational analytic study of secondary data from corneal scraping cultures of patients with keratitis infected with P. aeruginosa at Dr. Soetomo Hospital period January 2017-December 2020. Results: The total number of samples included in the inclusion criteria was 46 samples. Of the total sample, 8 (17.40%) were contact lens users and 38 (82.60%) were non-contact lenses. The male sex and female sex each as much as 50%. The distribution of sample age categories for 0-20 years was 21.74%, 21-40 years was 13.04%, 41-60 years was 41.30%, and >60 years was 23.91%. Based on samples from 8 contact lens patients, antibiotics were found to be 100% sensitive, namely Amikacin, Cefepime, Ciprofloxacin, Imipenem, Levofloxacin, Meropenem, and Piperacillin tazobactam, Aztreonam and Gentamicin 87.5%, Ceftazidime 75%, Tobramycin 37.5% and Piperacillin 25%. Meanwhile, from a sample of 38 patients who did not wear contact lenses, the sensitive antibiotics were Cefepime 100%, Meropenem 94.8%, Amikacin 92.1% Imipenem 86.9%, Piperacillin-tazobactam 76.3%, Ciprofloxacin 73.8%, Gentamicin 73.8%, Aztreonam 68.4%, Levofloxacin 68.4%, Piperacillin 50%, Ceftazidime 44.7%, and Tobramycin 28.9%. Conclusion: The results of the antibiotic sensitivity test against P. aeruginosa from keratitis patients with a history of contact lens use showed that 8/8 (100%) of the active antibiotics were Amikacin, Cefepime, Ciprofloxacin, Imipenem, Levofloxacin, Meropenem, and Piperacillin tazobactam. Then followed by Aztreonam and Gentamicin (7/8). The results of the antibiotic sensitivity test against P. aeruginosa from keratitis patients who had no history of using contact lenses showed that the active antibiotics were above 50%, namely Cefepime 38/38 (100%), Meropenem 36/38 (94.8%), Amikacin 35 /38 (92.1%), Imipenem 33/38 (86.9%), Piperacillin-tazobactam 29/38 (76.3%), Ciprofloxacin 28/38 (73.8%), Gentamicin 28/38 (73 .8%), Aztreonam 26/38 (68.4%), and Levofloxacin 26/38 (68.4%). Keywords: Antibiotic sensitivity, Pseudomonas aeruginosa, keratitis, contact lenses

Image-Based Differentiation of Bacterial and Fungal Keratitis Using Deep Convolutional Neural Networks.

PurposeDevelop computer vision models for image-based differentiation of bacterial and fungal corneal ulcers and compare their performance against human experts.DesignCross-sectional comparison of diagnostic performance.ParticipantsPatients with acute, culture-proven bacterial or fungal keratitis from 4 centers in South India.MethodsFive convolutional neural networks (CNNs) were trained using images from handheld cameras collected from patients with culture-proven corneal ulcers in South India recruited as part of clinical trials conducted between 2006 and 2015. Their performance was evaluated on 2 hold-out test sets (1 single center and 1 multicenter) from South India. Twelve local expert cornea specialists performed remote interpretation of the images in the multicenter test set to enable direct comparison against CNN performance.Main Outcome MeasuresArea under the receiver operating characteristic curve (AUC) individually and for each group collectively (i.e., CNN ensemble and human ensemble).ResultsThe best-performing CNN architecture was MobileNet, which attained an AUC of 0.86 on the single-center test set (other CNNs range, 0.68–0.84) and 0.83 on the multicenter test set (other CNNs range, 0.75–0.83). Expert human AUCs on the multicenter test set ranged from 0.42 to 0.79. The CNN ensemble achieved a statistically significantly higher AUC (0.84) than the human ensemble (0.76; P < 0.01). CNNs showed relatively higher accuracy for fungal (81%) versus bacterial (75%) ulcers, whereas humans showed relatively higher accuracy for bacterial (88%) versus fungal (56%) ulcers. An ensemble of the best-performing CNN and best-performing human achieved the highest AUC of 0.87, although this was not statistically significantly higher than the best CNN (0.83; P = 0.17) or best human (0.79; P = 0.09).ConclusionsComputer vision models achieved superhuman performance in identifying the underlying infectious cause of corneal ulcers compared with cornea specialists. The best-performing model, MobileNet, attained an AUC of 0.83 to 0.86 without any additional clinical or historical information. These findings suggest the potential for future implementation of these models to enable earlier directed antimicrobial therapy in the management of infectious keratitis, which may improve visual outcomes. Additional studies are ongoing to incorporate clinical history and expert opinion into predictive models.

Baricitinib treatment of severe chronic hand eczema: Two case reports

Baricitinib treatment of severe chronic hand eczema: Two case reports

Epstein-Barr viral corneal stromal keratitis occurring during rheumatoid arthritis treatment: a case report

BackgroundA case of Epstein-Barr viral (EBV) corneal stromal keratitis during rheumatoid arthritis (RA) treatment is presented.Case presentationA 74-year-old female undergoing RA treatment was previously treated for bacterial corneal ulcer and herpetic keratitis and healed with antibiotic eye drops and topical anti-herpes ointment. At the first visit to our hospital, she presented with findings of monocular posterior interstitial keratitis with neovascularization mostly located in the inferior cornea with a corneal epithelial defect. The right eye showed no thinning of the corneal periphery and anterior uveitis. Her RA had subsided with oral steroid treatment, and infectious mononucleosis (IM) had not developed. EBV DNA could be detected in her corneal sample. After an extended but ineffective period to antibiotic treatment the corneal infiltrate responded rapidly to topical corticosteroids.ConclusionEBV can cause stromal keratitis without IM during treatment for RA.

Bacterial corneal ulcers in pediatric patients. Algorithms of pharmacotherapy. Part II

Part I of the article presents a review of publications highlighting current exogenous and endogenous risk factors contributing to the occurrence of bacterial corneal ulcers, laboratory diagnostic methods, clinical differential diagnostic features of bacterial corneal ulcers.&#x0D; A wide variety of objective symptoms characterizes the clinical picture of bacterial corneal ulcers. Still, objective differential diagnostic signs make it possible with a high degree of probability to assume the etiology of the disease during the first biomicroscopy and immediately begin etiotropic therapy, on the timing of which the outcome of the disease depends.&#x0D; Standard laboratory examination of patients with bacterial corneal ulcers includes the bacterioscopic and cultural examination of the contents of the conjunctival sac. However, the absence of etiotropic therapy while waiting for the results of microbiological research methods, which takes from 3 to 7 days, contributes to the rapid progression of the disease, the development of endophthalmitis, and corneal perforation, up to the loss of an eye in children. In this regard, treatment must be started immediately. Therefore, the choice of a drug is determined not only by the causative agent, proven laboratory but, first of all, based on clinical differential diagnostic signs of the disease.&#x0D; The traditional, undeniable approach to the conservative treatment of bacterial corneal ulcers is conventional etiotropic therapy using local and systemic antibacterial drugs. In addition, timely intensive specific drug therapy prevents the destruction of all layers of the cornea, and the use of metabolic drugs that improve regeneration and trophism promotes epithelialization of corneal ulcers.&#x0D; Attention should be given to the necessity and validity of the choice of antibacterial drugs for various etiological forms of bacterial corneal ulcers in children. An individual approach is a basis for effective antibiotic therapy in pediatric ophthalmology.&#x0D; The article presents an up-to-date review of publications and modern algorithms for treating bacterial corneal ulcers in children, the main causative agents of which are: Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Neisseria gonorrhoeae.

Bacterial corneal ulcers in pediatric patients: Clinical and laboratory diagnostics. Part I

Bacterial corneal ulcer is the second most common complication of herpetic ulcer, but it is the most severe complication and has the highest progression rate. The main causative agents of bacterial corneal ulcers are Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Neisseria gonorrhoeae. The frequency of the detection of corneal ulcers caused by gram-negative Pseudomonas aeruginosa has increased, which is characterized by a lightning-fast course and a high frequency of complications and adverse outcomes. Gonococcal corneal ulcer caused by Neisseria gonorrhoeae is less common in pediatric patients than in adult patients, but it has the most aggressive disease course, which does not change with age. Bacterial corneal ulcers are one of the main causes of corneal blindness and can lead to endophthalmitis, corneal perforation, and eye loss within a short time. Clinical differential diagnostic signs allow us to assume, with a high degree of probability, the etiology at the first biomicroscopy and immediately begin etiotropic therapy, which is crucial for the outcomes of bacterial corneal ulcer. The standard laboratory examination of patients with bacterial corneal ulcer includes bacterioscopic and culture examinations of the contents of the conjunctival sac. This paper presents an up-to-date review of publications, clinical features, differential diagnostic criteria, laboratory diagnostic methods of bacterial corneal ulcers in pediatric patients

Management Approach in Patient with Type 2 Diabetes Mellitus with Bacterial Corneal Ulcer Associated with Diabetic Keratopathy : A Case Report

Introduction: Diabetes with long standing hyperglycemia commonly causing peripheral neuropathy including corneal nerves. It may lead to delayed diagnosis or underdiagnosed because of asymptomatic due to decreased corneal sensation. Objective: To report a case of secondary bacterial infection of corneal ulcer due to diabetic keratopathy. Case Presentation: A female 63 years old came to ER with a major complaint of pain in her right eye since 2 weeks prior admission. The patient has medical history of long standing diabetes mellitus. She worked as a farmer on rice paddy field. Physical examination in the ER found in the right eye region, positive light perception visual examination, conjunctival hyperemia, subconjunctival abscess, corneal ulcer, hypopyon were found in the anterior chamber of the eye, positive fluorescence test with iris, pupil and lens which is difficult to evaluate. Laboratory result showed mild anemia (10,6), random blood glucose 188 mg/dL, Diabetes Neuropathy Symptom score 2. Discussion: Therapy glycemic control switch from oral to insulin basal bolus subcutan, diet 1800 kkcal per day, gabapentin, antibiotic subconjunctival injection and eye drops, planned for elective cryo-surgery. Patient showed clinical improvement with decreased signs of infection and ocular pain, glucose undercontrolled with insulin. Conclusion: Diabetes mellitus with long standing hyperglycemia should be screened for symptoms of neuropathy. Early diagnosis and treatment could help prevent progressive complications.