Cases Of Infectious Keratitis Research Articles

Different modalities for management of peripheral corneal ulcer

Background The peripheral cornea has unique features, which make it more vulnerable to inflammatory reactions and necrosis. Peripheral corneal ulcer is caused by various infectious and noninfectious ocular and systemic diseases. It may impair vision by inducing astigmatism and ulcer progression to the center or threaten the eyeball integrity by spontaneous perforation. So, early diagnosis and proper treatment prevent blindness. Aim To evaluate different modalities for management of peripheral corneal ulcer. Patients and methods In this prospective study, 30 eyes of 29 patients having peripheral corneal ulcer were evaluated and treated with medical treatment and surgical intervention as adjunctive therapy in resistant cases. The duration of the study was 6 months with a follow-up period of 3 months. Results Of 30 eyes, 14 responded to medical treatment, with complete epithelial healing ranging from 2 to 6 weeks, with a mean of 3.36 ± 1.34 weeks. On the contrary, 16 of 30 eyes were resistant within 2 weeks and underwent surgical interference. A total of seven eyes were managed by amniotic membrane transplantation, and nine eyes were treated with tectonic keratoplasty. Time of healing ranged from 4 to 14 weeks, with a mean of 9.38 ± 3.91. All eyes showed anatomically successful outcomes. Conclusion Mild infectious peripheral keratitis heals on medical treatment. Cases of moderate infectious peripheral keratitis with history of diabetes mellitus or exposure keratitis need amniotic membrane transplantation as adjunctive therapy. Severe noninfectious cases with history of rheumatoid arthritis or Mooren’s ulcer need systemic treatment and tectonic keratoplasty.

Infectious Keratitis in Patients with Ocular Sjögren's Syndrome.

PurposeTo investigate the incidence, characteristics, risk factors, and treatment outcomes for infectious keratitis in patients with ocular Sjögren’s syndrome (SS).MethodsWe performed a retrospective chart review of patients who had been followed up for ocular SS in Seoul National University Hospital from 2010 to 2020 and identified cases where infectious keratitis developed. The incidence, demographical and clinical characteristics, risk factors, microbiological profiles, and treatment outcome were investigated, some of which were compared with infectious keratitis cases in the non-SS group.ResultsOut of 929 patients with ocular SS, infectious keratitis occurred in 18 eyes (1.94%). All 18 patients were female in the ocular SS group, while 48 out of 100 infectious keratitis patients (48%) were female in the non-SS group (p < 0.01). The mean age at diagnosis of infectious keratitis was 66.1 years in the ocular SS group, which was not different from the non-SS group (57.2 years, p = 0.12). Of risk factors analyzed, the use of therapeutic contact lens was more frequently used in the ocular SS patients, compared to the non-SS patients (67% vs. 11%, p < 0.01). Culture-positivity rate was 50% in the ocular SS group. All culture-proven cases were bacterial infection, one of which was bacterial-fungal coinfection. Infection resolved in all eyes after the mean 29 days of medical treatment, except one that additionally required penetrating keratoplasty with vitrectomy. The visual acuity improved in 15 eyes (83%) after resolution. Infectious keratitis recurred in three patients (17%) during the mean 55.7 months of follow-up.ConclusionsThe incidence of infectious keratitis was 1.94% in patients with ocular SS. Most were bacterial infections and resolved by medical treatment. Therapeutic and visual outcomes were favorable, but recurrence occurred in 17%.

An overview of microbiological profile in chronic microbial keratitis at a tertiary care center

Abstract Aims: Clinical feature and microbiological investigation help in reaching the diagnosis in cases of microbial keratitis. But in cases where a patient is already on polytopical therapy, clinical features are altered so dependency on microbiological investigation is more by the time cases reached to the referred hospital. The present study aimed to overview the profile of microbial investigation in microbial corneal ulcer cases that were already on polytherapy referred to the ophthalmic department of tertiary care center. Materials and Methods: This is a retrospective hospital record-based study where microbiological reports of 58 infective keratitis cases of moderate-to-severe nature were analyzed. Statistical analysis was calculated with confidence intervals (CIs) using “Medcalc” statistical software online. Results: Following are the results of the study: 52% patients were males; 18.97% cases were positive for Gram stain. Aerobic culture was positive in 10.34%; potassium hydroxide (KOH) mount was positive in 9.62% cases; sabouraud dextrose agar culture was positive in 7.69% cases. Sensitivity of Gram stain was 33.3% (95% CI: 4.33%–77.72%), whereas specificity was 82.7% (95% CI: 69.67%–91.77%); positive predictive value (PPV) was 18.18% (95% CI: 2.28%–51.78%) and negative predictive value (NPV) was 91.49% (95% CI: 79.62%–97.63%). Sensitivity of KOH mount was 25% (95% CI: 0.63%–80.59%), whereas specificity was 91.67% (95% CI: 80.02%–97.68%); PPV was 20.20% (95% CI: 0.51%–71.64%) and NPV was 93.62% (95% CI: 82.46%–98.66%). Pseudomonas aeruginosa and Staphylococcus aureus were the most common bacterial isolates. Conclusions: Basic microbiological investigations have a low yield in chronic infectious keratitis cases that are on prior cocktail long-term therapy. Therefore, advanced tests such as polymerase chain reaction, confocal microscopy, and corneal biopsy may be helpful in managing such challenging cases.

Reverse graft suturing to avoid Descemet's membrane detachment of glycerol-preserved donor cornea used for therapeutic penetrating keratoplasty during COVID-19 to overcome the tissue shortage - A novel surgical technique.

To overcome tissue shortage during pandemic, we switched to 100% glycerol preservation of the donor cornea, which is economical and provides longer duration of storage than the short and intermediate storage mediums we normally use like McCAREY Kaufman (MK) or cornisol. During our initial few cases of therapeutic penetrating keratoplasty using glycerol preserved donor cornea, we faced spontaneous Descemet’s detachments resistant to air tamponade. We tried reverse graft suturing and successfully reinforced Descemet’s attachment along with air tamponade, in one of the cases after multiple failed air injections. In the subsequent two cases of infective keratitis needing therapeutic penetrating Keratoplasty, we took eight reverse sutures in between the eight cardinals, to anchor the Descemet’s membrane of the graft. Both the grafts showed attached Descemet’s and maintained good graft clarity. The reverse corneal suturing technique has not been described to the best of our knowledge and hope this helps our corneal fraternity.

Increased Rate of Infectious Keratitis After PRK in the COVID-19 Era: The Possible Role of Face Masks.

To evaluate the rate of infectious keratitis after photorefractive keratectomy (PRK) before and during the coronavirus disease 2019 (COVID-19) pandemic. A retrospective chart review was performed on patients who were diagnosed as having infectious keratitis after PRK between January 2015 and January 2021. The study period was divided into the pre-COVID-19 era (between January 2015 and February 2020) and the COVID-19 era (between February 2020 and January 2021). A total of 47 patients were diagnosed as having infectious keratitis after PRK: 22 were diagnosed in the pre-COVID-19 era and 25 were diagnosed in the COVID-19 era. The rate ratio for infectious keratitis after PRK was 5.68 during the COVID-19 pandemic (CI: 3.20 to 10.07, P < .001). The odds ratio for the ratio of cases of infectious keratitis after PRK to all cases of infectious keratitis was 9.00 during the COVID-19 pandemic (CI: 5.05 to 16.05, P < .001). To better understand the change in the rate of infectious keratitis after PRK during the COVID-19 pandemic, the analysis was narrowed to the patients with infectious keratitis who had their procedure in Farabi Eye Hospital. Of the 8 patients who were diagnosed as having infectious keratitis after PRK, 4 were diagnosed in the pre-COVID-19 era and 4 were diagnosed in the COVID-19 era. The risk ratio of infectious keratitis after PRK was 9.11 in our department in the COVID-19 era (95% CI limit: 2.28 to 36.46, P = .005). The rate of infectious keratitis after PRK increased during the COVID-19 pandemic. This may be due to the increased use of face masks in this era. [J Refract Surg. 2022;38(2):78-81.].

Infectious keratitis in Vietnam: etiology, organisms, and management at Vietnam National Eye Hospital.

To report the etiologies, risk factors, treatments, and outcomes of infectious keratitis (IK) at a major Vietnamese eye hospital. This is a retrospective review of all cases of IK at Vietnam National Eye Hospital (VNEH) in Hanoi, Vietnam. Medical histories, demographics, clinical features, microbiological results, and treatment outcomes were reviewed. IK was diagnosed in 1974 eyes of 1952 patients, with ocular trauma being the greatest risk factor for IK (34.2%), frequently resulting from an agriculture-related injury (53.3%). The mean duration between symptom onset and presentation to VNEH was 19.3±14.4d, and 98.7% of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH. Based on smear results of 1706 samples, the most common organisms identified were bacteria (n=1107, 64.9%) and fungi (n=1092, 64.0%), with identification of both bacteria and fungi in 614 (36.0%) eyes. Fifty-five of 374 bacterial cultures (14.7%) and 426 of 838 fungal cultures (50.8%) were positive, with the most commonly cultured pathogens being Pseudomonas aeruginosa, Streptococcus pneumonia, Fusarium spp., and Aspergillus spp. Corneal perforation and descemetocele developed in 391 (19.8%) and 93 (4.7%) eyes, respectively. Medical treatment was successful in resolving IK in 50.4% eyes, while 337 (17.1%) eyes underwent penetrating or anterior lamellar keratoplasty. Evisceration was performed in 7.1% of eyes, most commonly in the setting of fungal keratitis. Ocular trauma is a major risk factor for IK in Vietnam, which is diagnosed in almost 400 patients each year at VNEH. Given this, and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration, greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.

Brevundimonas Species Keratitis in a Patient without Underlying Disease

Purpose: To report a case of keratitis caused by Brevundimonas diminuta/vesicularis.Case summary: A 20-year-old man presented with decreased visual acuity and glare in his right eye from 2 days earlier. At the first visit, slit lamp examination revealed a 1.5 × 1.5 mm2-sized stromal infiltration, an edematous cornea and endothelial deposits in the center of the right eye. Microbiological examinations were performed from corneal scrapings. Treatment was started with topical eye drops (fortified cefazolin, fortified tobramycin) as empirical antibiotics. After several days, the cultures revealed Brevundimonas diminuta/vesicularis. After treatment with empirical antibiotic eye drops, the symptoms and visual acuity improved.Conclusions: We report a case of infectious keratitis caused by Brevundimonas diminuta/vesicularis, which has never previously been reported in the Republic of Korea.

Exserohilum rostratum keratitis: report of a case from South Africa

We report a case of infectious keratitis caused by the fungal pathogen Exserohilum rostratum in an immune-competent patient in South Africa. A 67-year-old man with hypertension presented with a painful red left eye two weeks after trauma with an organic foreign body. Slit-lamp biomicroscopy revealed a corneal ulcer with underlying stromal infiltrates, feathery margins and a hypopyon. Exserohilum rostratum was identified using fungal PCR testing on culture grown from a corneal scrape, and the patient responded to topical 5% natamycin eye drops. Corneal scarring limited final visual outcomes to Counting Fingers at 50cm. In conclusion, E. rostratum keratitis was previously rare, but is now considered an emerging corneal pathogen which can occur in temperate climates.

Microbial profile of infectious corneal ulcer in a remote Himalayan teaching hospital in Himachal Pradesh (India)

Purpose: To study the microbiological profile of clinically diagnosed infectious keratitis cases in tertiary care hospitals in Solan, HP (India). Design: The study design involves prospective cross-sectional study. Materials and Methods: It was a prospective cross-sectional study that included clinically diagnosed corneal ulcer patients from September 1, 2018 to September 1, 2019. The demographic data, predisposing risk factors, clinical details, previous treatment history, investigations, treatment, and visual outcomes were analyzed. Results: A total of 36 patients were included in the study, and no significant difference between the number of males and females was noted (P = 0.74). The most common etiology of ulcer was corneal trauma in 25 (69%) patients. Injury with vegetative material was the most common mode of injury (18 of 25, 72%), followed by injury during construction work (3 of 25, 12%). Twelve of 36 (33%) cases were fungal, 6 (16%) were found to be bacterial and 2 (5%) cases had mixed organisms. The most common organism isolated was Fusarium spp. in 8 (40%) cases. The most common bacterial isolate was Staphylococcus aureus in 4 (20%) cases, followed by one each of Streptococcus pneumonia (5%) and Pseudomonas spp. (5%). Thirteen patients (36%) reached outpatient department between 7 and 14 days and 15 (42%) patients 2 weeks after the start of symptoms with no significant difference in the two genders (P = 0.97). Conclusion: Majority of infectious corneal ulcers in our region are fungal due to injuries during predominantly agriculture-based lifestyles and need urgent management.

Karakteristik Pasien Corneal Cross-Linking Di Pusat Mata Nasional Rumah Sakit Mata Cicendo

Introduction: Corneal cross-linking (CXL) is a minimally invasive procedure aiming to haltering corneal ectasia progressivity. Corneal cross-linking are part of a management of keratoconus, infectious keratitis, and bullous keratopathy cases. Purpose: To describe characteristics of patients that underwent corneal cross-linking procedure in National Eye Center - Cicendo Eye Hospital, Bandung. Method: This is a retrospective descriptive study. The data were collected from medical records within the period of October 2019 – August 2020 in Cicendo Eye Hospital. Subjects of the study were patients who underwent corneal cross-linking procedure, divided in three main group CXL keratoconus, PACKCXL, and CXL bullous keratopathy. Results: Forty-six corneal cross-linking procedure was done during the period of this study. Corneal cross-linking was done on 16 eyes of 13 patients with keratoconus, 28 patients with infectious keratitis and on one patient with pseudophakic bullous keratopathy (PBK). The mean age of keratoconus patients was 21.77 ± 4.66, the majority of the patients was mild keratoconus 9 patients (56.25%), 7 patients (43.75%) visual acuity with correction ? 6/18. In infectious keratitis the mean age of the patients was 48.07 ± 17.40, the main risk factor was trauma in 19 patients (67.85%), the most common pathogen was fungus in 15 patients (53.57%) and had blindness visual acuity in 26 patients (92.86%). Patients with PBK experienced a reduction in symptoms. Conclusion: The keratoconus patients are young adults with mild keratoconus requiring correction for visual acuity and the infectious keratitis patients with majority of the pathogens are fungus with blindness visual acuity.

Population-based study on the prevalence, clinical characteristics and vision-related quality of life in patients with corneal opacity resulting from infectious keratitis: results from the Corneal Opacity Rural Epidemiological study

AimTo estimate prevalence and characterise clinical features and vision-related quality of life (VR-QoL) of corneal opacities (COs) resulting from infectious keratitis in a rural North Indian population.MethodsThe Corneal Opacity Rural...

Infectious Keratitis Isolates and Susceptibility in Southern California.

The purpose of this study was to determine longitudinal trends in prevalence and resistance profiles for infectious keratitis at referral centers in Southern California. Cultured infectious keratitis cases from January 1, 2006, through December 31, 2009, and January 1, 2016, through December 31, 2019, at the University of California, Los Angeles, were evaluated. Outcome measures included microbial isolate prevalence and antibiotic/antifungal susceptibility and resistance patterns. One hundred thirty-nine and 315 culture-positive isolates were obtained between 2006-2009 and 2016-2019, respectively. Gram-positive organisms accounted for 65% (2006-2009) and 74% (2016-2019) of bacterial isolates ( P = 0.076). Staphylococcus infections, the most common gram-positive and bacterial isolate in both study epochs, demonstrated increased prevalence from 2006-2009 to 2016-2019 (41% vs. 53%, P = 0.019). Although coagulase-negative Staphylococcus (CoNS) increased from 40% to 58% ( P = 0.0012), the prevalence of methicillin-resistant Staphylococcus aureus was unchanged (28% vs. 28%, P = 0.99). Pseudomonas aeruginosa , the most common gram-negative organism, demonstrated decreased prevalence from 18% to 10% ( P = 0.027). Candida species comprised 3.5% of culture-positive isolates in both epochs. All gram-positive isolates were susceptible to vancomycin, and all Staphylococcus isolates were susceptible to linezolid. Pseudomonas aeruginosa remained susceptible to tested fluoroquinolones (>93%) and aminoglycosides (100%) over time. In southern California between 2006 and 2019, there was a shift toward Staphylococcus species, with increased CoNS, decreased methicillin-sensitive Staphylococcus aureus , and decreased prevalence of P. aeruginosa . Empiric therapy of vancomycin and a fluoroquinolone or aminoglycoside provides effective antibacterial coverage for predominant bacterial species when culture sensitivities are pending.

Corneal Cross-linking for Infectious Keratitis at the Slit Lamp in Wheelchair Users

PURPOSE: To present a case of infectious keratitis in a wheel-chair user who was treated twice with high-fluence accelerated photoactivated chromophore for infectious keratitis–corneal cross-linking (PACK-CXL) at the slit lamp. METHODS: Case report. RESULTS: A 39-year-old man with progressive Duchenne muscular dystrophy presented with pain, deep corneal infection, and tearing in his left eye. Ophthalmological examination revealed a 3 × 3.5 mm corneal ulcer in the presence of a 2.5-mm hypopyon. Following a corneal scrape, antimicrobial treatment was initiated. Two consecutive adjuvant high-fluence PACK-CXL procedures (10.8 J/cm 2 each) were performed within 5 days. To avoid cardiopulmonary difficulties associated with the patient lying supine to receive PACK-CXL, the procedure was performed in the sitting (upright) position at the slit lamp. Full reepithelialization occurred 6 days after the second PACK-CXL procedure. CONCLUSIONS: In patients with reduced mobility or difficulties breathing in the supine position, CXL at the slit lamp significantly simplifies treatment. [ Journal of Refractive Surgery Case Reports. 2021;1(3):e36–e39.]

Thermokeratoplasty for Keratoconus: A More Than 30-Year Follow-Up Study.

Purpose:The aim of this study was to investigate the long-term outcomes of thermokeratoplasty (TKP) surgery in patients with keratoconus (KC).Methods:We retrospectively reviewed our clinical database of 2949 patients with KC seen at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan, between April 1979 and December 1991. Patients with KC who underwent TKP with a greater-than 30-year postoperative follow-up were included. The occurrence of adverse events including infectious keratitis, corneal perforation, corneal melting, bullous keratopathy, consistency of contact lenses (CL) wear at the final visit, and a history of corneal transplantation post-TKP was assessed.Results:Forty-two patients (29 male and 13 female patients) with a mean age at initial visit of 23.4 years (range: 13.9–39.5 yrs) were included, and TKP was performed unilaterally in all cases. The mean follow-up period was 35.2 years (range: 30.1–41.6 yrs). As for adverse events/complications, no cases of infectious keratitis, corneal perforation, corneal melting, and/or BK were observed. However, 11 eyes received corneal transplants at an average of 24.9 years postoperatively because of the inability to wear CL continuously. At the last visit, 31 eyes were able to continue wearing CL without corneal transplantation, and the remaining 11 eyes were able to continue wearing contact lenses in all cases after corneal transplantation.Conclusions:TKP for KC resulted in relatively favorable surgical outcomes over the long-term postoperative period.

Infectious keratitis after corneal crosslinking for keratoconus caused by levofloxacin-resistant microorganisms

IntroductionWe present seven cases of infectious keratitis after corneal crosslinking (CXL) to attenuate keratoconus progression.MethodsOf 524 consecutive patients who underwent CXL, 7 cases (4 males and 3 females; 21.5 ± 7.1 years) developed postoperative infectious keratitis were retrospectively reviewed. CXL was performed using the Dresden protocol or an accelerated protocol involving epithelial removal.ResultsAll cases appeared normal on the day after surgery, but subsequently developed eye pain, blurred vision, corneal infiltration, inflammation of the anterior chamber, and ciliary injection on day 2 or 3. Methicillin-resistant Staphylococcus aureus was cultured from two eyes, methicillin-sensitive Staphylococcus aureus from two eyes, and Streptococcus pneumoniae from one eye. All detected bacteria were resistant to levofloxacin (LVFX). Five of the seven cases, especially four of the five severe cases with hypopyon, had a history of atopic dermatitis. All cases were observed after 2015.ConclusionsInfectious keratitis after CXL caused by microbes resistant to LVFX is increasing. In addition to careful postoperative observation of the cornea, preoperative evaluation of bacteria within the conjunctival sac evident on nasal swab cultures may be useful to identify potentially problematic microbes and inform the selection of appropriate antibiotics.

Clinical aspects and prognosis of polymicrobial keratitis caused by different microbial combinations: a retrospective comparative case study

The purpose of this study is to compare the predisposing factors, clinical findings, treatment results, and prognosis for polymicrobial keratitis. In this retrospective comparative case study, we identified the cases of polymicrobial keratitis from the microbiological records (n = 649) at Balcalı Hospital, Çukurova University (Adana, Turkey; October 2010-2018). We included all the cases of infectious keratitis with two different types of microbial agents and grouped them as follows: group 1 (n = 25), bacterium-fungus coexistence; group 2 (n = 12), herpes simplex virus (HSV) or Acanthamoeba with bacterial infection; and group 3 (n = 7), HSV or Acanthamoeba with fungal infection. We compared the clinical and microbiological characteristics, and treatment outcomes among the groups. In our study, we found that 44 infectious keratitis cases (6.7%) were of polymicrobial nature. The mean follow-up period was 11.4 ± 17.8months. In total, 17 different bacteria along with 3 different fungi, HSV, and Acanthamoeba were isolated. The most common bacterium was Staphylococcus epidermidis (25%). Most of the fungal pathogens were filamentous. Patients with initial treatment failure and requiring surgical intervention had larger infiltrates (p = 0.023, p = 0.003, respectively) than other patients. Older age was associated with delayed recovery and poor visual prognosis. Bacterial-fungus coexistence is the most common combination among patients, but other combinations should also be considered for suspected polymicrobial etiology. The corneal infiltrate size may be an important indicator of the course of disease and response to treatment. A closer and longer follow-up period should be planned for older patients.

Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis

Infectious keratitis (IK) is the 5th leading cause of blindness globally. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though adjuvant treatment or surgeries are often required in refractory cases of IK. This systematic review aimed to examine the effectiveness and safety of adjuvant amniotic membrane transplantation (AMT) for treating IK. Electronic databases, including MEDLINE, EMBASE and Cochrane Central, were searched for relevant articles. All clinical studies, including randomized controlled trials (RCTs), non-randomized controlled studies and case series (n > 5), were included. Primary outcome measure was time to complete corneal healing and secondary outcome measures included corrected-distance-visual-acuity (CDVA), uncorrected-distance-visual-acuity (UDVA), corneal vascularization and adverse events. A total of twenty-eight studies (including four RCTs) with 861 eyes were included. When compared to standard antimicrobial treatment alone, adjuvant AMT resulted in shorter mean time to complete corneal healing (− 4.08 days; 95% CI − 6.27 to − 1.88; p < 0.001) and better UDVA (− 0.26 logMAR; − 0.50 to − 0.02; p = 0.04) at 1 month follow-up in moderate-to-severe bacterial and fungal keratitis, with no significant difference in the risk of adverse events (risk ratio 0.80; 0.46–1.38; p = 0.42). One RCT demonstrated that adjuvant AMT resulted in better CDVA and less corneal vascularization at 6 months follow-up (both p < 0.001). None of the RCTs examined the use of adjuvant AMT in herpetic or Acanthamoeba keratitis, though the benefit was supported by a number of case series. In conclusion, AMT serves as a useful adjuvant therapy in improving corneal healing and visual outcome in bacterial and fungal keratitis (low-quality evidence). Further adequately powered, high-quality RCTs are required to ascertain its therapeutic potential, particularly for herpetic and Acanthamoeba keratitis. Future standardization of the core outcome set in IK-related trials would be invaluable.

Adjunctive Green Thermal Laser Photocoagulation for Treatment of Resistant Infectious Keratitis.

PurposeTo investigate the safety and efficacy of green thermal laser as an adjunctive therapy for the treatment of resistant infectious keratitis (IK) in the Delta region of Egypt.MethodsA retrospective case series of 150 patients, within a 4 year duration, with resistant IK, who failed to respond to specific medical treatment alone for 7 days, were included. They all received green thermal laser photocoagulation treatment to the cornea as an adjunctive to medical treatment.ResultsForty-eight women and 102 men were included in this study with a mean age of 46.2 ± 7.7 years. Common risk factors associated with IK included trauma by material of plant origin and contact lens wear. The mean duration of healing was 2.87 ± 0.7 weeks. A single session of green thermal laser application was adequate in 138 IK cases (92%), while 12 cases (8%) required an additional session a week later. Supplementary amniotic membrane transplantation (AMT) was required in 26 cases (17.3%). Two patients (1.3%) required tectonic keratoplasty for corneal perforation. The final corrected distance visual acuity (CDVA) was counting fingers (CF) or better in 78 patients (52%). No decrease of CDVA was reported throughout the study.ConclusionGreen thermal laser is a safe and effective adjunctive therapy for the treatment of resistant infectious keratitis.

Large-Diameter Penetrating Keratoplasties are Mostly Due to Very Severe Infectious Keratitis and Cannot Always Prevent Secondary Enucleation.

To report the indications and outcomes of penetrating keratoplasties with a graft diameter > 8.5 mm in severe corneal diseases at the Department of Ophthalmology at Saarland University Medical Centre. Retrospective (6 years), descriptive, and observational. Thirty-five large-diameter penetrating keratoplasties (LDPKPs) in 27 patients (mean age, 62 ± 22 years) were performed from March 2010 to December 2016. The indication for surgery, number of previous corneal transplantations, best-corrected visual acuity (BCVA) before surgery, intraocular pressure, graft status, and BCVA at last follow-up were recorded. Infectious keratitis represented 83% of the indications (of those, 45% fungal). The mean corneal graft diameter was 10.8 ± 1.7 (min 8.75, max 15.0) mm. Twenty-three eyes (65% absolute) had at least one previous penetrating keratoplasty (mean graft size, 9.2 ± 1.6 mm). The mean pre-surgery BCVA was 1.96 ± 0.23 logMAR. With a mean follow-up period of 20.2 ± 13.4 months, the mean BCVA was 1.57 ± 0.57 logMAR at last follow-up. Overall, 12 grafts (35%) remained clear until the last follow-up, and in 23 grafts (65%), the primary disease recurred, or corneal decompensation developed. Up to the last follow-up, 6 eyes (17%) had to be enucleated. In complex cases of infectious keratitis requiring a LDPKP to remove the complete pathology and preserve eye integrity, the visual outcomes are generally expected to be poor, not only because of the well-known risks of LDPKP but also because of the consequences of the infectious disease itself. This knowledge is important for adequate counselling of the patient preoperatively.

Infectious Keratitis After Boston Type 1 Keratoprosthesis Implantation.

To identify the incidence, risk factors, and outcomes of infectious keratitis after Boston type 1 keratoprosthesis (kpro) implantation. Retrospective case series of kpro procedures at the Stein Eye Institute and the Centre Hospitalier de l'Université de Montréal between May 1, 2004, and December 31, 2018. Data were collected regarding ocular history, operative details, postoperative management, microbiologic profile, treatment, and outcomes. Log-rank test and Cox proportional hazard ratio (HR) were used to evaluate for an association between risk factors and outcomes. A total of 349 kpro procedures were performed in 295 eyes of 268 patients. Fifty-seven cases of presumed infectious keratitis were identified after 53 procedures (15.2%) in 50 eyes (16.9%) of 49 patients (18.3%). The incidences of culture-positive bacterial and fungal keratitis were 0.014 and 0.004 per eye-year, respectively. Persistent corneal epithelial defect formation (P < 0.001) and cicatricial disease (HR: 1.98, 95% confidence interval, 1.02-3.83) were associated with a significantly higher incidence of infectious keratitis. For the 53 cases with a known outcome, medical therapy achieved resolution of infection in 34 cases (64.2%), whereas kpro explantation was required in 19 cases (35.8%). Infectious keratitis was associated with an increased risk for kpro explantation (HR: 3.09, 95% confidence interval, 1.92-4.79). Infectious keratitis develops in approximately 17% of eyes after kpro implantation, with a higher rate of culture-positive bacterial than fungal keratitis. The observed rate of microbial keratitis suggests the need for additional topical antimicrobial prophylaxis in eyes at higher risk, such as those with preexisting cicatricial disease or postoperative persistent corneal epithelial defect formation.