Keratitis Patients Research Articles

The Role of Biofilms in Contact Lens Associated Fungal Keratitis.

Biofilm formation is an important microbial strategy for fungal pathogens, such as Fusarium, Aspergillus, and Candida, to establish keratitis in patients wearing soft contact lenses. Despite the well-documented 2006 outbreak of Fusarium keratitis that eventually led to the withdrawal of the Bausch & Lomb multipurpose lens care solution ReNu with MoistureLoc ("MoistureLoc") from the global market, contact lens care systems and solutions currently available on the market do not specifically target fungal biofilms. This is partially due to the lack of recognition and understanding of important roles that fungal biofilms play in contact lens associated fungal keratitis (CLAFK). This review aims to reemphasize the link between fungal biofilms and CLAFK, and deepen our comprehension of its importance in pathogenesis and persistence of this medical device-related infection.

Ocular microbial dysbiosis and its linkage with infectious keratitis patients in Northwest China: A cross-sectional study

ObjectivesTo evaluate the alteration of ocular surface microbiome of patients with infectious keratitis in northwest of China. MethodsThe corneal scrapings, eyelid margin and conjunctiva samples were collected from 57 participants, who were divided into bacterial keratitis, fungal keratitis, viral keratitis and control group. The V3–V4 region of bacterial 16S rDNA in each sample was amplified and sequenced on the Illumina HiSeq 2500 sequencing platform, and the differences among different groups were compared bioinformatically. ResultsSignificant alterations of the microbiome were observed in alpha-diversity and beta-diversity analysis between the keratitis groups and the control group (p < 0.05). There was no significant differences between eyelid margin and conjunctiva samples in Alpha-Diversity analysis, but a significant difference between eyelid margin and corneal scraping samples in the keratitis group (p < 0.05, independent t-test). The abundances of Bacillus, Megamonas, Acinetobacter, and Rhodococcu were significantly elevated, while the abundance of Staphylococcus was decreased in the keratitis group compared to the control group. ConclusionsThe abundance of the ocular microbiome in patients with bacterial keratitis, fungal keratitis, or viral keratitis was significantly higher than those in the control group. Keratitis patients may have ecological disorder on ocular surface microbiome compared with controls. We believe that the conjunctiva and eyelid margin microbiome combined analysis can more comprehensively reflect the composition and abundance of ocular surface microbiome.

The Epidemiological Profile and Predisposing Factors of Microbial Keratitis Over a 10-Year Period at a Tertiary Hospital in Central Saudi Arabia.

To evaluate the demographic and predisposing factors and clinical presentation of microbial keratitis (MK) patients over 10 years at a tertiary hospital in central Saudi Arabia. In 2020, a retrospective review of data from clinical and pathology departments from 2010 to 2019 was conducted. Demography includes age, gender, residence, and the risk factor of microbial keratitis, clinical features, and organism profile as number and percentage. We reviewed 181 eyes of 179 patients with microbial keratitis. The mean age was 40.1 years. Contact lens usage(55; 30%), ocular trauma (30; 16.5%), and ocular surface diseases(42; 23.2%) were the main predisposing factors. Hypopyon was noted in 60 (33%) eyes, impaired vision at presentation was observed in 78 (43%) eyes, and endophthalmitis with microbial keratitis was noted in eight (4.4%) eyes at presentation. Ninety-eight (54,1%) cases were culture positive, while gram-positive organisms were seen in 50 (27.6%) eyes, gram-negative organisms in 35 (19.3%) patients, and fungi in 13 (7.2%) patients. Microbial keratitis was central in 67 (37%), paracentral in 94 (52%), and peripheral in 20 (11.3%) patients. All instances of fungal keratitis occurred in the eyes of men who work in the agriculture field. Standard operating procedures to manage microbial keratitis at primary and secondary eye care levels are recommended. Health promotion to prevent trauma, appropriate useof contact lens, and early treatmentcould prevent the incidence ofmicrobial keratitis.

Herpes simplex virus keratitis: electronic medical records driven big data analytics report from a tertiary eye institute of South India.

To describe the demographics and clinical profile of Herpes Simplex Virus (HSV) Keratitis in patients presenting to a multi-tier ophthalmology hospital network in South India. We have reviewed the medical records of all patients having a clinical diagnosis of any form of HSV keratitis, seen between May 2012 and August 2020 across the L V Prasad Eye Institute network. All the further analyses of the groups were performed using the keywords used for making the diagnosis of HSV keratitis and the data were collected from the electronic medical record system. There were a total of 8308 (N = 8897 eyes) patients. Male: female ratio was 5368 (64.61%):2940 (35.39%). Unilateral involvement was in 7719 (92.91%) patients. The most common age group affected was between the third to fifth decades of life with 1544 (18.58%). 3708 (1.68%) eyes had mild visual impairment (< 20/70) while the rest of them had moderate to severe visual impairment as observed mainly (p ≤ 0.01) in Necrotizing stromal keratitis. 7314 (82.21%) eyes had normal intraocular pressure (10-21mm Hg) while raised most commonly in keratouveitis (P ≤ 0.01). Epithelial Keratitis, Immune Stromal Keratitis, Endotheliitis, Neurotrophic keratopathy and Keratouveitis were observed in 1875 (17.22%) eyes, 5430 (61.03%) eyes, in 129(1.45%) eyes, 1188 (13.35%) eyes, 148 (1.66%) eyes and 256 (2.88%) eyes respectively. Based on our institute-based data, the most common type of HSV keratitis is Immune stromal keratitis followed by epithelial keratitis. Although not representative of the general population, this data provide useful insights related to HSV keratitis from India.

Clinical Spectrum of Herpes Simplex Keratitis in a Tertiary Eye Hospital, Nepal

Background: Ocular manifestations of herpes simplex virus infection range from benign blepharitis, conjunctivitis, and epithelial keratitis to vision-threatening stromal keratitis and uveitis. This study aims to find out the demographic profile, clinical manifestations of herpes simplex virus keratitis and to assess associated visual impairment in Nepalese population. Method: The retrospective study was conducted from January 2020 – February 2022. The medical records were reviewed where visual acuity at presentation and at one month follow-up, clinical details on examination and, diagnosis of the stage of disease were noted. Results: Of 112 herpes simplex keratitis patients, mean age was 47.19±19.14 years. Patients of herpes simplex keratiris presented with different types of clinical manifestations namely 25 (22.31%) cases were dendritic and 13 (11.6%) geographic ulcers, 38 (33.9%) cases presented with purely stromal lesions, 19 (16.9%) cases with epithelial plus stromal lesions, 11 (9.8%) cases with stromal plus endothelial lesions and six (5.3%) cases with endothelitis. At presentation, 33 (29.4) had visual acuity of 6/6–6/18, 50 (44.6%) had 6/18–6/60, 6 (5.3%) had 6/60–3/60 and 23 (20.5%) had &lt;3/60. At one month follow up 71 (63.3%) had visual acuity of 6/6–6/18, 30 (26.7%) had 6/18–6/60, 5 (4.4%) had &lt;6/60–3/60 and 6 (5.35%) had &lt;3/60. Conclusion: Herpes simplex keratitis has diverse presentation and can cause significant vision impairment. Early clinical diagnosis and management may prevent disease progression and visual impairment.

A Case Series of Infectious Keratitis After Corneal Cross-linking.

To present the 7-year experience of a tertiary eye hospital while exploring possible risk factors and incidence of infectious keratitis in patients undergoing standard corneal cross-linking (CXL). This retrospective cohort study included patients with progressive keratoconus undergoing standard CXL in the Farabi Eye Hospital and all other patients who had undergone CXL in other facilities and were diagnosed as having infectious keratitis in the 7-year period of the study. Among the total of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, yielding an incidence rate of 0.12%. Additionally, 13 eyes from 10 patients with a CXL history in other facilities who developed infectious keratitis were included. The mean age was 23.75 years, and 75% of patients were men and 25% were women. Gram-positive bacteria and Staphylococcus aureus were the most prevalent pathogens. Meibomian gland dysfunction, dry eye disease, or blepharitis were present in 12 patients. Medical treatment did not arrest the disease progress in 5 patients, which eventually required cases to undergo keratoplasty. This study supports the need for proper patient selection by using a comprehensive medical history. It also highlights the imperative role of rigorous patient education and follow-up, particularly in the first postoperative week. Finally, the study emphasizes aggressive early therapy for patients with suspicious findings. [J Refract Surg. 2023;39(8):564-572.].

Investigation of Altered Spontaneous Brain Activity Patterns in Herpes Zoster Keratitis Using the Percent Amplitude of Fluctuation Method: A Resting-State Functional Magnetic Resonance Imaging Study.

The purpose of this study was to use the percent amplitude of fluctuation (PerAF) to study the changes in brain activity and nerve function of herpes zoster keratitis (HZK) patients. We recruited 20 HZK patients and 20 healthy controls (HCs). Each of these groups included ten males and ten females and were matched in weight and age. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI). The percent amplitude of fluctuation (PerAF) method was used for analysis and detected differences between the two groups in the neurological function of brain areas. We also applied the receiver operating characteristic (ROC) curve to analyze the two groups and did a correlation analysis between the PerAF value, anxiety and depression score, and visual acuity. The PerAF signal at the right putamen and right precentral gyrus was significantly higher in patients than in HCs. However, the PerAF value of the left inferior temporal was lower in patients than in HCs. In addition, the HZK patients' anxiety and depression score (HADS) and visual acuity (V.A.) Log MAR negatively correlated with the PerAF value at the left inferior temporal gyrus. HZK patients had some changes in brain regions, and the changes were also related to their mood and visual acuity. These findings might contribute to other studies on the potential pathological mechanism, disease development, prognosis, and brain function in HZK patients.

Clinical comparative analysis of bacterial keratitis according to contact lens use: a retrospective study in a tertiary referral center of South Korea.

To compare the clinical aspects and treatment outcomes of contact lens-related bacterial keratitis (CLBK) and non-CLBK patients. Altogether 217 patients of bacterial keratitis (CLBK; 62, non-CLBK; 155) hospitalized between January 2012 and December 2020 were retrospectively analyzed for epidemiology, microbiological profiles, predisposing factors, clinical characteristics, and treatment outcomes. Poor treatment outcomes (PTO) were defined as a final BCVA < 0.3 (Snellen), a decreased visual acuity after treatment, complications, or surgical intervention. Relative importance of the initial clinical features leading to PTO was assessed using the random forest model and two-proportion Z-test. The most common predisposing factors were sleeping with wearing CL (51.6%) in the CLBK group and trauma (55.5%) in the non-CLBK group. There were significant differences between the two groups in mean age (35.1:55.1years, p < 0.001), female sex (56.5:34.8%, p = 0.003), symptom duration (6.2:6.9days, p = 0.019), gram-negative organisms (83.3:48.3%, p = 0.008), epithelial healing time (8.5:14.1days, p = 0.004), final BCVA (0.15:0.46 logMAR, p = 0.015), and PTO (9.7:21.9%, p = 0.035). For the entire group, the initial BCVA < 0.1 (27.9%), symptom duration ≥ 5days (19.4%), age ≥ 60years (16.4%), and hypopyon (14.0%) were important initial clinical features leading to PTO in the random forest model. In CLBK group, the type of CL or CL-related history was not significantly related to PTO. CLBK patients had a higher proportion of females, younger age, gram-negative bacteria, and better treatment outcomes than those of non-CLBK patients. There were no significant risk factors leading to PTO in either the type of CL or CL-related history.

Draft genomes of Aspergillus nomiae and Aspergillus tamarii isolates from human eye infections.

Fungal species within the genus Aspergillus are an important cause of human diseases, including aspergillosis and keratitis. We present draft genomes of Aspergillus tamarii and A. nomiae isolated from keratitis patients in a U.S. tertiary care hospital.

Diabetes Exacerbates Pseudomonas aeruginosa Keratitis in Streptozotocin-Induced and db/db Mice via Altering Programmed Cell Death Pathways.

Patients with diabetes have a higher incidence of infections, which are often more severe. This study aimed to investigate the impact of hyperglycemia on bacterial keratitis caused by Pseudomonas aeruginosa (Pa) in two mouse models of diabetes, streptozotocin-induced type 1 diabetes mellitus (T1DM) and db/db type 2 diabetes mellitus. The susceptibility of corneas to Pa was assessed by determining the inocula required to cause infectious keratitis. Dead or dying cells were identified using TUNEL staining or immunohistochemistry. Specific inhibitors were used to evaluate the role of cell death modulators in Pa keratitis. Cytokines and Treml4 expressions were analyzed using quantitative PCR, and the role of Treml4 in keratitis was determined using small interfering RNA technology. DM corneas required significantly fewer inocula to develop Pa keratitis, with T1DM corneas requiring 750 inocula and type 2 diabetes mellitus corneas requiring 2000 inocula, compared with 10,000 inocula required for normal (NL) mice. T1DM corneas had more TUNEL-positive and fewer F4/80-positive cells than NL corneas. Phospho-caspase 8 (apoptosis) and -RIPK3 (necroptosis) staining was more intense in the epithelial and stromal layers of NL and T1DM corneas, respectively. Pa keratitis was augmented by targeting caspase-8 and prevented by RIPK3 inhibition in both NL and T1DM mice. Hyperglycemia suppressed IL-17A/F and augmented IL-17C, IL-1β, IL-1Ra, and TREML4, the downregulation of which protected T1DM corneas from Pa infection by suppressing necroptosis. RIPK3 inhibition blocked Pa infection in db/+ mice and significantly decreased the severity of keratitis in db/db mice. Hyperglycemia exacerbates bacterial keratitis in B6 mice by skewing apoptosis toward necroptosis. Preventing or reversing this transition may serve as an adjunct therapy for treating microbial keratitis in patients with diabetes.

Isolation and identification Streptococcus pneumonia from contact lenses of conjunctivitis and keratitis patients with bacteria resistance to antibiotics

There are different methods for identification bacteria,we used culture methods,biochemical tests and molecular method,the aim of this study to decide the measure of efficient select gene for the recognition of the S. pneumonia by molecular tests -specific polymerase chain reaction(PCR),the assay targeting lytA gene from keratitis and conjunctivitis in patients and clients wearing contact lenses in several centers in Erbil city, the results showed that out of 12 investigated S.pneumoniae isolates by culture methods and biochemical testes ,lytA gene is found in 6(50%).all 6 of the positive lytA isolates encapsulated ,Norfloxacin and Seftazidime were the best antibiotics (100% ,83.3%) respectively, most infections was keratitis(cornal infections),in addition the majority of patients and clients were among females 78(60%),32(24.6)of patients and clients in the average age ranging from(15-20)years ,80(61.5%) of infections recoded of those who are putting cosmetic lens

Successful restoration of corneal surface integrity with a tissue-engineered allogeneic implant in severe keratitis patients

ObjectivesCorneal diseases are among the main causes of blindness, with approximately 4.6 and 23 million patients worldwide suffering from bilateral and unilateral corneal blindness, respectively. The standard treatment for severe corneal diseases is corneal transplantation. However, relevant disadvantages, particularly in high-risk conditions, have focused the attention on the search for alternatives. MethodsWe report interim findings of a phase I-II clinical study evaluating the safety and preliminary efficacy of a tissue-engineered corneal substitute composed of a nanostructured fibrin-agarose biocompatible scaffold combined with allogeneic corneal epithelial and stromal cells (NANOULCOR). 5 subjects (5 eyes) suffering from trophic corneal ulcers refractory to conventional treatments, who combined stromal degradation or fibrosis and limbal stem cell deficiency, were included and treated with this allogeneic anterior corneal substitute. ResultsThe implant completely covered the corneal surface, and ocular surface inflammation decreased following surgery. Only four adverse reactions were registered, and none of them were severe. No detachment, ulcer relapse nor surgical re-interventions were registered after 2 years of follow-up. No signs of graft rejection, local infection or corneal neovascularization were observed either. Efficacy was measured as a significant postoperative improvement in terms of the eye complication grading scales. Anterior segment optical coherence tomography images revealed a more homogeneous and stable ocular surface, with complete scaffold degradation occurring within 3–12 weeks after surgery. ConclusionsOur findings suggest that the surgical application of this allogeneic anterior human corneal substitute is feasible and safe, showing partial efficacy in the restoration of the corneal surface.

Differentiating methicillin resistant and susceptible Staphylococcus aureus from ocular infections using photoacoustic labeling.

Antibiotic resistance in bacterial species constitutes a growing problem in the clinical management of infections. Not only does it limit therapeutic options, but application of ineffective antibiotics allows resistant species to progress prior to prescribing more effective treatment to patients. Methicillin resistance in Staphylococcus aureus is a major problem in clinical infections as it is the most common hospital acquired infection. We developed a photoacoustic flow cytometer using engineered bacteriophage as probes for rapid determination of methicillin resistance in Staphylococcus aureus with thirteen clinical samples obtained from keratitis patients. This method irradiates cells under flow with 532 nm laser light and selectively generates acoustic waves in labeled bacterial cells, thus enabling detection and enumeration of them. Staphylococcus aureus isolates were classified from culture isolation as either methicillin resistant or susceptible using cefoxitin disk diffusion testing. The photoacoustic method enumerates bacterial cells before and after treatment with antibiotics. Decreasing counts of bacteria after treatment indicate susceptible strains. We quantified the bacterial cells in the treated and untreated samples. Using k-means clustering on the data, we achieved 100% concordance with the classification of Staphylococcus aureus resistance using culture. Photoacoustics can be used to differentiate methicillin resistant and susceptible strains of bacteria from ocular infections. This method may be generalized to other bacterial species using appropriate bacteriophages and testing for resistance using other antibiotics.

Sub-Genotyping of Acanthamoeba T4 Complex: Experience from North India

The Acanthamoeba genus comprises the free-living amoebae that are ubiquitously present as opportunistic pathogens. They cause serious human diseases—for instance, Acanthamoeba keratitis (AK), granulomatous amoebic encephalitis (GAE), cutaneous acanthamoebiasis and disseminated infections. The traditional method for classifying Acanthamoeba was based on the morphological examination of cysts. However, this method was less consistent as the morphology of cysts changes with the culture conditions. After the advent of molecular techniques, genotyping is considered an essential tool in accurately identifying Acanthamoeba at the species level and is further helpful in classification up to the sub-genotype level. The most recommended and currently used methods for Acanthamoeba genotyping are 18S and 16S rDNA gene sequencing. Based on these two genes, Acanthamoeba is classified into 23 genotypes. Out of these, it is the T4 genotype that is most commonly associated with clinical disease and isolation from environmental samples. The T4 genotype contains more than ten species within it. Differences in geographical distribution, virulence, pathogenesis and drug susceptibility profile have been observed among different genotypes. However, whether such differences exist within sub-genotypes/species under T4 is yet unknown. In the present study, 11 Acanthamoeba isolates, which were already characterized as the T4 genotype by the hypervariable region of diagnostic fragment 3 (DF3) of the 18S rDNA, were sub-genotyped using the 16S rDNA mitochondrial sequence. Nine of these were isolated from patients with AK and two from water samples. Phylogenetic analysis of these isolates attributed them to four sub-genotypes (T4a (n = 6), T4b (n = 1), T4Neff (n = 2) and T4d (n = 2)). The study highlights the potential use of 16S in the sub-genotyping of Acanthamoeba T4. The 16S rDNA sequences of two isolates, one from an Acanthamoebic keratitis (AK) patient and one environmental, were found to group with A. mauritaniensis (T4d). This group was believed to be a non-pathogenic environmental Acanthamoeba and the identification of the AK isolate may be confirmed by whole-genome sequencing.

Should ocular Demodex be checked and treated in refractory keratitis patients without blepharitis?

To evaluate the correlation between Demodex infestation and keratitis, and to assess demodicosis using a simple approach. A modified slit lamp illumination (at 40× magnification) was used to observe Demodex tails in 40 patients with refractory keratitis and 80 healthy controls. Bacterial smear and culture of the conjunctival sac and corneal lesion were performed to identify the pathogen. Tea tree oil ointment (TTOO) was added as a Demodex killing agent for lid scrubs to the treatment when Demodex infestation was confirmed. Demodex tails were found in all patients compared to 42/80 of the controls (P<0.01). Seventeen patients presented blepharitis, while 23 were free of scales and inflammation at the lid margin. The demodicosis was mild, moderate, and severe in 8, 19, and 13 patients, respectively, compared to mild in 42 controls (P<0.01). The keratitis was mild, moderate, and severe in 13, 19, and 8 patients, respectively. The severity of Demodex infestation was not correlated to the severity of keratitis (P=0.126). The growth of Staphylococcus was revealed in nine patients who did not react to antibiotic eye drops prior to the TTOO treatment. Patients' signs and symptoms got resolved after the lid scrub with TTOO. Ocular Demodex needs to be checked and treated in refractory keratitis patients with or without blepharitis. A slit-lamp illumination under high magnification favors the judgment of the severity of Demodex infestation.

A CLINICAL STUDY ON KERATOMYCOSIS IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL

AIM : To study etiology , epidemiological factors leading to keratomycosis in various subgroups of population like different age and sex groups. To determine spectrum of ocular manifestations in patients with keratomycosis. METHODS : This is a prospective study done in 100 patients of fungal keratitis over a period of 1 year with proper recordings of snellens visual acuity chart, slit lamp biomicroscopy, direct and indirect ophthalmoscopy, conrmed by culture, histology and confocal microscopy, PCR, in patients attending tertiary care hospital , kakinada. This study was conducted in 100 pati RESULTS : ents , of most common age group was 31-40 years i.e, which most exposed to trauma to cornea with vegetative matter, immunocompromised people, over usage of steroids and antibiotics and many factors. Males are more affected and among agricultural workers with mostly unilateral in presentation. Majority presented with pain, redness , foreign body sensations, defective vision. Ulcer is dirty looking, feathery margins with wessely ring and satellite lesions. CONCLUSION: Fungal infections of cornea continue to be an important cause of ocular morbidity, particularly in the communities of agriculture of developing countries. A proper understanding of agent and host factors involved in these infections will improve the outcome of this condition.

A CLINICAL STUDY OF BACTERIAL KERATITIS IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL

Aim: To study about the etiological and epidemiological factors,and also the spectrum of ocular manifestations in patients with viral keratitis. It is a prospective study done over a period of 3 Methods: months from June to August 2022.A group of 100 patients of bacterial keratitis from East Godavari district attending Ophthalmology OPD, Government General Hospital, Kakinada , with complaints of visual disturbances in all age groups .All of these patients underwent thorough anterior and posterior segment examination and all other necessary investigations like gram and giemsa staining,AFB staining and bacterial culture. O Results: ut of 100 patients studied,staphylococcus is the most common causative organism of bacterial keratitis.It is usually unilateral,with more incidence in males and in elderly age group.Contact lens wear is the main predisposing factor as per the study.Most of the patients presents with pain and redness and in case of severe bacterial keratitis,if untreated or in case of treatment failure ,it can end up in complications like corneal scarring ,recurrence,toxic iridocyclitis and eventually in phthisis bulbi and even endophthalmitis. Bacteria Conclusion: l keratitis is a potentially sight threatening corneal infection in human eyes.It can proceed very rapidly with complete corneal destruction in few days.Early diagnosis and prompt treatment will help us to minimise the damage and ocular morbidity and thus helps in providing a better visual outcome.

Clinical and microbiologial profile of bacterial and fungal keratitis: A comparison of patients with and without diabetes mellitus

Aims: The aim of the study was to evaluate the predisposing factors, clinical features, causative microorganism, and response to treatment, among persons of infective keratitis, with and without diabetes mellitus and to determine differences between the two groups. Subjects and Methods: This prospective study enrolled 26 patients of infective keratitis who had diabetes mellitus and 52 patients without diabetes mellitus, by consecutive sampling who attended the ophthalmology department at a tertiary care institute. Detailed clinical evaluation and microbiological evaluation were done. Treatment was initiated according to clinical diagnosis. The patients were followed up at 2 weeks, 1 month, and 3 months. Statistical Analysis Used: Statistical testing was done using Chi-square test and Fisher’s exact test for qualitative variables. Quantitative variables were expressed as means and standard deviations. The variables between the two groups were compared using Student’s t-test and Wilcoxon test, where appropriate. Shapiro–Wilk test was used to test normality of data. Analysis was done using the SPSS software. Results: Urban population, monsoon season, and outdoor work were associated more commonly with microbial keratitis. Ocular trauma (69.2%) was the most common risk factor. A greater proportion of patients with diabetes (46.2%) did not have a history of ocular injury compared to those without (23.8%). Poor glycemic control increased severity of keratitis (P = 0.023). Redness and pain were the most common symptoms in both groups. Corneal sensations were significantly reduced in patients with diabetes mellitus. Diabetes mellitus was significantly associated with central ulcers (46.2%), hypopyon (50%) in anterior chamber, and fungal keratitis (35%). Hypopyon and depth of ulcer were significant predictors (P = 0.018 and 0.006) of the time taken for the infective keratitis to heal. Pseudomonas aeruginosa (19.2%) was the most common bacteria isolated in diabetic patients and Methicillin-sensitive Staphylococus aureus (10.3%) among nondiabetic patients. Fusarium was the most common fungus isolated among both groups. Ulcers healing with leukomatous opacities were higher, and the frequency of perforated corneal ulcers was also higher among diabetic patients (P = 0.026). Posttreatment visual acuity showed a statistically significant improvement only in patients without diabetes mellitus. Conclusions: Significant differences existed between the two groups regarding clinical and microbiologial profile. Aggressive treatment, strict glycemic control, and high index of suspicion for fungal keratitis are important in managing microbial keratitis patients with diabetes mellitus.

Clinicomicrobiological profile of mycotic keratitis patients presenting at a tertiary care hospital of rural North India

Clinicomicrobiological profile of mycotic keratitis patients presenting at a tertiary care hospital of rural North India

Effectiveness of Voriconazole in Treating Fungal Keratitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

&#x0D; &#x0D; &#x0D; &#x0D; Antifungal intervention fails in approximately half of fungal keratitis patients, demonstrating its limitations. Voriconazole use for fungal keratitis has raised new interest because of its broad spectrum and good ocular penetration. However, its effectiveness has not been systematically evaluated. Here we try to clarify the benefits of voriconazole in fungal keratitis cases. Randomized controlled trials (RCTs) comparing vorico­nazole to placebo or other antifungal medications for fungal keratitis were searched in several databases, in­cluding PubMed, Scopus, Cochrane Library, ClinicalTrials, and WHO-ICTRP. The primary outcome that analyzed was best spectacle-corrected vision acuity (BSCVA). The secondary outcomes were treatment success, corneal perforation or need for therapeutic penetrating keratoplasty (TPK). From 621 records, nine studies were se­lected for analysis. The results were as follows: As an initial therapy, topical natamycin outperformed vori­conazole in BSCVA (mean difference = 0.14; 95% CI 0.02 to 0.26; P =.03). Voriconazole also has a greater risk of corneal perforation or TPK than natamycin (RR=1.69; 95% CI 1.11 to 2.58; P=.02). As an adjuvant, there is no significant difference found in BSCVA, treatment success, event of corneal perforation, or need for TPK between voriconazole and the other antifungal agents (itraconazole, ketoconazole, amphotericin B, natamy­cin, and placebo). This study shows that voriconazole is less superior than natamycin in treating early infec­tions of fungal keratitis. More RCTs with larger samples are needed to evaluate voriconazole's adjuvant efficacy.&#x0D; &#x0D; &#x0D; &#x0D;