Emergency Keratoplasty Research Articles

Ultraviolet A/Riboflavin Corneal Cross-linking for Infectious Keratitis Associated With Corneal Melts

To evaluate the efficacy of ultraviolet-corneal cross-linking (CXL) for treating infectious melting keratitis. Five patients with infectious keratitis associated with corneal melting were treated with CXL at the outpatient departments of the Institut für Refraktive und Ophthalmo-Chirurgie and the eye hospital at the University of Zurich. CXL was performed when the infection did not respond to systemic and topical antibiotic therapy. Follow-up after cross-linking ranged from 1 to 9 months. In all cases, the progression of corneal melting was halted after CXL treatment. Emergency keratoplasty was not necessary in any of the 5 cases presented. CXL is a promising option for treating patients with therapy-refractory infectious keratitis to avoid emergency keratoplasty.

Acanthamoeba and Fungal Keratitis in a Woman With a History of Intacs Corneal Implants

To report a case of corneal perforation secondary to Acanthamoeba and fungal keratitis in a patient with a history of Intacs corneal implants. The patient's history, clinical presentation, and pathologic analysis were reviewed. A 56-year-old woman with keratoconus was referred to the university eye center for a corneal perforation secondary to a chronic corneal ulcer initially diagnosed as herpes simplex keratitis. The patient had Intacs inserted in the same eye 14 months earlier, but had them removed approximately 1 month before her visit. After emergency keratoplasty, the patient's corneal tissue was sent for histopathologic examination, which showed an Acanthamoeba and fungal coinfection. Atypical sources of keratitis should be considered in patients with a chronic corneal ulcer and a history of Intacs corneal implants.

Contact Lens-Associated Fusarium Keratitis in Switzerland

Fusarium has been an exceptionally rare cause of infectious keratitis. A recent outbreak of Fusarium keratitis in contact lens wearers in North America and Asia has been associated with the multipurpose disinfection solution ReNu with MoistureLoc (Bausch&Lomb). We report a series of Fusarium keratitis in Swiss contact lens wearers. A multicentre retrospective case review of patients with corneal ulceration and a positive microbiological identification of Fusarium species was undertaken. Between September 2005 and August 2007, six cases of Fusarium keratitis were identified. Patients were 39 to 63 years of age. All patients were using disposable soft contact lenses for at least two years. Four patients used daily wear disposable lenses. Two patients were wearing 1-monthly disposable lenses and used ReNu with MoistureLoc solution. Due to multiresistant Fusarium, enucleation was required in two cases and an emergency keratoplasty was performed in three cases. An optical keratoplasty was undertaken in one case that developed corneal scarring. Final visual acuity in patients with preserved eyes ranged from light perception to 8 / 20. Exposure to ReNu with MoistureLoc is not the only risk factor for Fusarium keratitis. In addition to antifungal therapy, an early keratoplasty with excision of the infected tissue seems mandatory to improve prognosis.

Clear graft survival and immune reactions following emergency keratoplasty

Emergency penetrating keratoplasty is said to have a poorer outcome than conventional keratoplasty. We performed a retrospective analysis of 272 cases of emergency keratoplasty to evaluate this hypothesis. We analysed 272 cases of emergency keratoplasty and compared the results with a control group of 1,257 scheduled normal-risk keratoplasties and 407 scheduled high-risk keratoplasties. Kaplan-Meier estimations were performed to estimate the percentage of clear graft survival and development of immune reactions. Indications for emergency keratoplasty were microbial diseases (n=109, acanthamoeba, bacteria, fungi), herpes simplex virus infections (n=83), ulcers due to immunological diseases (n=63), and 17 cases of ulcers of unknown origin. Within 1,500 postoperative days, grafts following emergency keratoplasty suffered statistically significantly more graft failures (clear graft survival, 67.9 vs. 86.9%, P<0.01) and immune reactions (grafts free from immune reactions, 62.8 vs. 78.6%, P<0.01) than grafts following scheduled, normal-risk keratoplasty. There was no statistically significant difference between emergency and scheduled high-risk keratoplasties (clear graft survival, 67.9 vs. 70.2%, and grafts free from immune reactions, 62.8 vs. 66.8%). For emergency keratoplasties, systemic immunosuppression (with cyclosporin A and/or mycophenolatmophetil) had a statistically significant positive effect on clear graft survival (77.4 vs. 63.5%, P=0.01), but not on the development of immune reactions (62.8 vs. 62.3%). A sub-group analysis showed that the effect on clear graft survival was mainly an effect on the underlying systemic immunological disease that had lead to emergency keratoplasty. This retrospective analysis revealed that clear graft survival is limited following emergency keratoplasty. As in high-risk situations, systemic immunosuppression may be the key to improving prognosis following emergency keratoplasty in the long run.

Kératites stromales amibiennes : épidémiologie et facteurs pronostiques

Early treatment of amebic stromal keratitis can change patients' final visual and esthetic prognosis. The aim of this study was to review all proven Acanthamoeba stromal keratitis cases presenting at our ophthalmology emergency department over the past 3 years, in order to delineate the incidence and the factors still leading to this serious complication.and methods: All cases of Acanthamoeba stromal keratitis confirmed with a parasitology examination and treated between January 2000 and December 2002 were recorded. During this period of time, eight patients were identified with this condition. Their charts, as well as biomicroscopic, therapeutic, and outcome data were analyzed.All patients were referred in a second or third intention. Only one patient did not usually wear contact lenses. Six patients had an associated bacterial abscess. The typical amebic annular infiltrate was only observed in one patient. Three patients received an effective antiamebic treatment in the 15 days following the first symptoms and five patients 1 month or more after. An emergency keratoplasty was carried out in one patient. Finally, visual acuity was lower than 5/10 in all cases. The patients treated in the first 15 days had the best final visual acuity.Soft contact lenses are still responsible for the majority of serious amebic corneal complications. Late diagnosis remains the main cause of Acanthamoeba stromal keratitis development, particularly in the absence of contact lens history, because of the delay in treatment.The catastrophic consequences of this complication justify a systematic treatment against ameba in each case of suspected diagnosis. An early and effective treatment of the stromal amebic keratitis can increase the final visual prognosis.

Indications for emergency keratoplasty at the University Eye Hospital of the Martin-Luther-University Halle-Wittenberg

Indications for emergency keratoplasty at the University Eye Hospital of the Martin-Luther-University Halle-Wittenberg

Gemella haemolysans keratitis and consecutive endophthalmitis

PURPOSE: To report a case of Gemella hemolysans keratitis with consecutive endophthalmitis.METHODS: Interventional case report. A 47-year-old woman with a history of sarcoidosis treated chronically with systemic prednisone developed bacterial keratitis and consecutive endophthalmitis in the left eye.RESULTS: Corneal, aqueous, and vitreous cultures yielded G. hemolysans. Emergent keratoplasty, pars plana vitrectomy, and injection of intravitreal antibiotics led to resolution of the infection and improved vision. Five months after surgery, the corneal graft has remained clear since cessation of antibiotics.CONCLUSION: This is the first report, to our knowledge, of ocular G. hemolysans infection, an uncommon gram-positive pathogen often confused with viridans-type streptococci.

Intraocular surgery following penetrating keratoplasty: The risks and advantages

Graft survival has been evaluated for patients who underwent subsequent intraocular surgery (extra-capsular cataract surgery or trabeculectomy) between 1983 and 1989. The patients were different from the majority of keratoplasty patients as evidenced by the indications for keratoplasty; corneal perforation was the indication in 24% of cases. Perforated and inflamed eyes were treated aggressively at the time of the acute event, including emergency keratoplasty and intensive topical steroids. Visco-elastic fluids were routinely used during secondary surgery and topical steroids were administered intensively post-operatively. The incidence of post-operative graft rejection was low (less than 14%). Rejection episodes were diagnosed early, prior to the appearance of a Khodadoust line, and were treated aggressively with intensive topical steroids. Glaucoma which was not controlled by topical therapy was surgically managed by trabeculectomy in the first instance. If this failed, tube drainage was performed and long-term topical steroids were administered. The only risk factor identified was uncontrolled glaucoma, P = 0.1. The probability of graft survival (at five years) was 0.83 after cataract surgery and 0.62 after trabeculectomy, but wide confidence limits indicate the difference is not significant.

Emergency Keratoplasty in Corneal Lacerations

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The Use of Corneas from Frozen Whole Eyes : For emergency keratoplasty

The Use of Corneas from Frozen Whole Eyes : For emergency keratoplasty