Case Of Infectious Crystalline Keratopathy Research Articles

Corneal snowflake - a case of infectious crystalline keratopathy after penetrating keratoplasty.

Corneal snowflake - a case of infectious crystalline keratopathy after penetrating keratoplasty.

Crosslinking as a treatment for infectious crystalline keratopathy

Infectious crystalline keratopathy (ICK) is a rare cornea disease, manifested by gray-and-white tree-like or needle-like stromal opacities with minimal signs of inflammation. The disease is caused by the colonization of microorganisms on the corneal stroma and their formation of biofilms, making them extremely resistant to treatment with antibiotics and to the immune response of the patient. Typically, the most important risk factor for ICK development is the presence of an immunodeficiency cornea condition with long-term topical steroid therapy, which is normally prescribed after keratoplasty. Two clinical cases of ICK are discussed in which the reduction of topical glucocorticoids and the intensive use of antibiotics did not result in positive clinical changes. Only after an accelerated crosslinking procedure (PACK-CXL), needlelike opacities disappeared in the area of microbial invasion and signs of infiltration appeared, indicating the restoration of the local immune response. This phenomenon is likely due to the destruction of the biofilm and the microbial agents themselves, which afterwards contributed to a more effective impact of the antibacterial drug. This combined treatment led to resorption of the inflammatory focus with the formation of local opacification. The effectiveness of PACK-CXL in infectious processes is explained by the effects of both riboflavin and ultraviolet radiation. No literature references on the use of cross-linking in the treatment of ICK are available. In our opinion, cross-linking in early ICK patients after keratoplasty is justified by the inability, in some cases, to completely discontinue glucocorticosteroid therapy, as this will greatly increase the chances of rejection and graft jailure. PACK-CXL can be an effective way of destroying the biofilm in the corneal stroma.

A rare case of infectious crystalline keratopathy caused by Burkholderia cepacia

We report a unique case of infectious crystalline keratopathy (ICK) caused by Burkholderia cepacia in a 47-year-old patient with history of multiple penetrating keratoplasties (PKPs). Slit-lamp examination revealed a white nonsuppurative needle-like branching anterior stromal infiltrate. Microscopic examination of the Gram-stained smear showed gram-negative bacilli. Cultures revealed Burkholderia cepacia, which was multidrug resistant and sensitive to piperacillin/tazobactam. Based on antibiotic sensitivity report, patient was started fortified piperacillin-tazobactam (0.32%) eye drop on an hourly basis. After 8 weeks of aggressive therapy, the infiltrate resolved with subsequent corneal scarring and vascularization. To our knowledge, this is the first reported case of Burkholderia-related ICK. ICK, first described by Gorovoy et al.[1] in 1983, is an indolent keratitis with characteristic needle-like branching opacities in the absence of corneal or anterior segment inflammation.[2] The presence of an immunocompromised corneal state, such as chronic topical steroid use post PKP, is a known risk factor for the development of ICK. Other risk factors include surgical procedures such as lamellar keratoplasty, corneal cross-linking, laser-assisted in situ keratomileusis, pterygium excision, and trabeculectomy with 5- FU. Topical anaesthetic abuse as a risk factor has also been described.[3] Burkholderia is a group of Gram-negative bacteria, composed of at least 20 different species. We describe a case of Burkholderia keratitis presenting as ICK in a patient who underwent multiple PKPs and a history of long-term topical steroid therapy.

Unusual Course of Crystalline Keratopathy in a Patient with Graft-Versus-Host Disease.

We present a case of infectious crystalline keratopathy in a patient with Graft-versus-Host disease (GVHD) who developed satellite fungal keratitis. A 51-year-old man was referred for bilateral total persistent corneal epithelial defects with severe dry eye. Although persistent epithelial defect healed with medical therapy, he developed stromal keratitis with satellite lesions confirmed to be secondary to Candida albicans. After three months of antifungal treatment and debridement, improvement of the infiltrates was obtained. Crystalline keratopathy is an important clinical entity which may develop due to several causes. The microbial causes include not only bacteria but fungi as well. Careful investigation must be performed, especially for immune-compromised patients, in order to provide appropriate and timely treatment.

Infectious crystalline keratopathy in dogs and cats: clinical, in vivo confocal microscopic, histopathologic, and microbiologic features of eight cases.

To describe clinical, in vivo confocal microscopic, histopathologic, and microbiologic features of canine and feline cases of infectious crystalline keratopathy (ICK). Six dogs and two cats with naturally acquired ICK. Medical records of dogs and cats with a clinical diagnosis of ICK were reviewed. Signalment, medical history, clinical findings, and diagnostic evaluations were retrieved, including corneal cytology, histopathology, in vivo confocal microscopy, and microbiology results. All animals presented with fine, needle-like, and branching white crystalline anterior stromal opacities emanating from corneal facets or corneal epithelial defects. Mild conjunctival hyperemia and anterior uveitis were frequently present. Concurrent ocular and systemic diseases were common, including keratoconjunctivitis sicca, corneal sequestrum, diabetes mellitus, hyperadrenocorticism, and malignant neoplasia. Bacteria, with minimal or absent leukocytes, were identified by cytology and histopathology. Histopathologically, the crystalline corneal opacities corresponded with dense accumulations of bacteria present in the interlamellar stromal spaces and forming cord-like projections within the stroma. In vivo confocal microscopy demonstrated deposits of reflective crystalline or amorphous structures within the stroma with a paucity of associated inflammatory changes. The most frequently cultured bacteria were alpha-hemolytic Streptococcus and Staphylococcus species. Resolution of clinical lesions was achieved in most cases with long-term medical or surgical therapy; however, the initiation of medical treatment was associated with an acute, dramatic onset of severe keratitis and anterior uveitis in some animals. Infectious crystalline keratopathy in dogs and cats shares many features with this condition in human patients. Prolonged medical therapy, or surgical intervention, is required for resolution.

Infectious Crystalline Keratopathy Caused by Pseudomonas fluorescens

To demonstrate a case of infectious crystalline keratopathy (ICK) caused by Pseudomonas fluoresecens (PF). Case report description. A 15-year-old female contact lens wearer presented complaining of eye pain and redness in the left eye. The patient reported that she had suffered a corneal scratch a few months earlier, which was treated by her family physician, and that she had felt some discomfort since then. The biomicroscopy showed a central corneal abscess with a crystalline appearance, stromal edema, the Tyndall effect, and abundant fibrin in the anterior chamber. A diagnosis of ICK was made. The culture was positive for gram-negative PF. Pseudomonas fluoresecens was sensitive to cephalosporins, quinolones, and tobramycin. No cases of ICK caused by PF have been reported previously. Two previous studies reported that the gram-negative Pseudomonas aeruginosa caused ICK. Unlike other ICK cases in which there is minimal stromal inflammation, the patient presented with an intense inflammatory reaction in the anterior chamber.

Abiotrophia defectiva causing infectious crystalline keratopathy and corneal ulcer after penetrating keratoplasty: a case report

BackgroundInfectious crystalline keratopathy is commonly caused by Streptococcus viridans and other gram positive organisms. We present the first case of infectious crystalline keratopathy that developed into a corneal ulcer and grew Abiotrophia defectiva which responded well to topical and systemic antimicrobial therapy and did not require re-grafting. A 78-year-old man underwent penetrating keratoplasty for pseudophakic bullous keratopathy. He presented 1.5 years later with infectious crystalline keratopathy which progressed to a corneal ulcer. The patient received topical fortified vancomycin and moxifloxacin, as well as oral moxifloxacin.FindingsThe corneal ulcer base was cultured and grew A. defectiva, or nutritionally deficient streptococcus. Complete resolution of the corneal infiltrates was obtained within three months.ConclusionsNutritionally deficient streptococcus has been implicated in numerous human diseases, including endocarditis, and is increasingly being recognized as an important pathogen. This represents the second reported case of A. defectiva causing infectious crystalline keratopathy in humans and the first case of A. defectiva successfully treated with antibiotics. This case shows that aggressive antibiotic therapy can be effective in A. defectiva-associated infectious crystalline keratopathy.

Infectious crystalline keratopathy and its management

Abstract Purpose Infectious crystalline keratopathy (ICK) is defined as microbial infection of the cornea in the absence of the host inflammatory response. It presents as slowly progressive crystalline opacities resembling needles, snowflakes or ferns and are filamentous or branching in pattern within the cornea stroma. Methods Pathogenesis: Streptococcus viridans is the most common cause of ICK but a range of fungi and bacteria have been isolated from cases of ICK. They are located within the corneal stroma within the interlamellar planes. The pattern of spread of bacteria within corneal tissue is determined by the compactness of the corneal stroma. Another common feature is reduced corneal sensation, abrogating the triple response reflex at the limbus and hence the lack of the host response. The diagnosis of ICK is made on history and examination as microbiological diagnosis by culture of scrapes is difficult. Histology of biopsy specimen confirms diagnosis. Results Medical treatment with broad spectrum topical anti‐microbial agents is initiated. Any concomitant use of topical steroids should be discontinued. If no resolution of infection occurs, surgery in the form of lamellar or penetrating keratoplasty or superficial keratectomy is required. The successful use of excimer laser therapeutic keratectomy and Nd:YAG laser in the treatment of ICK has been demonstrated in single case reports but these techniques need further evaluation. Conclusion The diagnosis of ICK is largely clinical. It is difficult to treat medically often requiring surgical intervention. Poor corenal sensation and steroid use are important predisposing factors.

Gemella haemolysans Infectious Crystalline Keratopathy

Purpose To report a case of infectious crystalline keratopathy caused by Gemella haemolysans. Methods Observational case report. A 65-year-old woman underwent penetrating keratoplasty for contact lens-related Acanthamoeba keratitis and developed a nonhealing epithelial defect. Despite continued prophylaxis with topical gatifloxacin, small superficial stromal opacities were noted and cultured 6 months after penetrating keratoplasty. The opacities coalesced into a fine, crystalline keratopathy in the superficial stroma with persistent overlying epithelial defect. Results Culture results from corneal scraping showed more than 100 colonies of G. haemolysans. Topical vancomycin was instituted, with complete resolution of the crystalline keratopathy and epithelial defect over the next 2 months. Conclusions G. haemolysans can be a causative organism of infectious crystalline keratopathy. This infection can arise in a postkeratoplasty patient despite prophylaxis with a fourth-generation fluoroquinolone.

Infectious Crystalline Keratopathy Caused by Gemella haemolysans

To report a novel case of infectious crystalline keratopathy after penetrating keratoplasty caused by Gemella haemolysans. Observational case report. Patient notes and literature review. A 51-year-old woman presented with the clinical picture of infectious crystalline keratopathy 18 months after a second penetrating keratoplasty was performed for corneal decompensation secondary to recurrent herpes simplex infection. Corneal biopsy yielded a heavy growth of G. haemolysans. Initial treatment was made up of frequent topical vancomycin 0.5% and was later changed to topical cefuroxime 5% and ofloxacin 0.3%. Snellen visual acuity after complete resolution of the keratitis was 6/60 as a result of a residual corneal scar. Gemella haemolysans may be an etiologic agent in infectious crystalline keratopathy. A corneal biopsy may be diagnostic but may also promote healing by allowing direct access of antibiotics to deep-seated infected tissue and by altering the growth environment of the organism.

Gemella haemolysans Infectious Crystalline Keratopathy

To report a case of infectious crystalline keratopathy caused by Gemella haemolysans. Observational case report. A 65-year-old woman underwent penetrating keratoplasty for contact lens-related Acanthamoeba keratitis and developed a nonhealing epithelial defect. Despite continued prophylaxis with topical gatifloxacin, small superficial stromal opacities were noted and cultured 6 months after penetrating keratoplasty. The opacities coalesced into a fine, crystalline keratopathy in the superficial stroma with persistent overlying epithelial defect. Culture results from corneal scraping showed more than 100 colonies of G. haemolysans. Topical vancomycin was instituted, with complete resolution of the crystalline keratopathy and epithelial defect over the next 2 months. G. haemolysans can be a causative organism of infectious crystalline keratopathy. This infection can arise in a postkeratoplasty patient despite prophylaxis with a fourth-generation fluoroquinolone.

Post-LASIK Infectious Crystalline Keratopathy Caused by Alternaria

To describe a case of infectious crystalline keratopathy (ICK) after laser in situ keratomileusis (LASIK) caused by Alternaria species. A case report of a 29-year-old woman who presented with clinical features of ICK 3 weeks after LASIK surgery. Medical therapy failed to control and resolve the corneal infection. Penetrating keratoplasty was performed, which controlled the infection and aided in visual recovery of 20/30. The culture of the corneal button revealed the presence of Alternaria species fungus. Alternaria species fungus may cause ICK after LASIK.

Infectious Crystalline Keratopathy and Endophthalmitis Caused by a Slime Producing <I>Staphylococcus epidermidis</I> Strain

A case of infectious crystalline keratopathy with secondary endophthalmitis, caused by a slime producing Staphylococcus epidermidis in a patient with pseudophakic bullous keratopathy. Histopathology of the corneal button, after penetrating keratoplasty failed to exhibit cells of the causative organism. S. epidermidis, though generally of low pathogenicity, may become an important pathogen affecting the intraocular tissues in compromised corneas.

Biofilm Formation in Infectious Crystalline Keratopathy Due to Candida albicans

Infectious crystalline keratopathy (ICK) is an uncommon, indolent corneal infection in which the slow clinical course contrasts with the rapid laboratory growth and microbiological sensitivities of the infecting organism. This prospective study aimed to determine whether biofilm production was the cause of this disparity. A case of failed medical management of ICK in a patient with Stevens-Johnson syndrome is presented. A penetrating keratoplasty yielded corneal tissue that was freshly fixed for electron microscopy using 0.05% ruthenium red and 2.5% gluteraldehyde. Candida albicans was grown from 3/3 broths, and fungi with morphology consistent with Candida were seen on histological examination. Electron microscopy revealed microorganisms morphologically typical of Candida surrounded by a polysaccharide-rich glycocalyx consistent with a biofilm. We concluded that Candida albicans is capable of producing a biofilm and is a known cause of ICK. This case is supportive evidence that biofilm production is associated with cases of ICK and may explain the chronic, pauciinflammatory features of ICK and its relative resistance to antibiotic treatment.

Infectious Crystalline Keratopathy Occurring in an Eye Subsequent to Glaucoma Filtering Surgery With Postoperative Subconjunctival 5-Fluorouracil

We present a case of infectious crystalline keratopathy occurring after 5-fluorouracil filtering surgery. The patient had discrete, branching, white crystalline lesions in the anterior corneal stroma. Cultures grew Streptococcus viridans, and gram-positive cocci were demonstrated in corneal tissue biopsy specimens. Toxic and immunosuppressive properties of 5-fluorouracil may have participated in the pathogenesis of the infectious crystalline keratitis.

Infectious crystalline keratopathy

A 76-year-old patient was found to have a crystalline keratopathy with no evidence of acute inflammation in her right corneal graft. The patient had been on long-term topical steroids. Subsequent microscopy of the graft demonstrated pockets of Gram-positive cocci with a paucity of inflammatory cells. This is the tenth reported case of infectious crystalline keratopathy, first reported by Gorovoy in 1983. It does not always occur in corneal grafts, but the use of long-term topical steroids, together with an epithelial defect, allows the microorganism, usually Streptococcus viridans, to invade the corneal stroma and replicate along the lamellar planes, unhindered by the usual inflammatory response. Retrospective analysis of this patient's history suggests that she has suffered the same keratopathy in previous corneal grafts. Treatment involves cessation of steroids, antibiotic cover and often a repeat penetrating keratoplasty. If this is required, the lowest possible dose of steroid cover should be used with prolonged use of topical antibiotics. To the best of our knowledge this is the first reported case of infectious crystalline keratopathy in Australia.