Purulent Corneal Ulcers Research Articles

The study of ability to integrate with the recipient cornea of xenomaterial “Corneoplast” for keratoplasty in the animal experiment

Currently, there is a significant shortage of donor materials for replacing corneal tissue that is why it is relevant to create xenomaterials, which are able to replace a donor cornea with various types of keratoplasty. “Corneoplast” is a new medical device, which is a devitalized, fixed by the method of double crosslinking (dehydrothermic + UV), pork cornea.Purpose: to assess the biocompatibility and ability to integrate with the recipient cornea of implants based on the xenomaterial “Corneoplast”.Materials and methods. The experiment was based on biomicroscopy examination, high-resolution optical coherence tomography and histological examination of the experimental rabbits’ corneas (group I–IV: total of 8 eyes were examined), where keratoplasty was performed with the “Corneoplast” material.Results. High biocompatibility and ability to integrate with the recipient’s cornea were observed in all types of keratoplasty: penetrating, superficial lamellar and intralamellar keratoplasty. On the next day, the implant was transparent with slight swelling of the recipient’s corneal stroma. A week later, the slight swelling of implant was recorded without cornea edema. Its transparency decreased. The recipient’s cornea was reactive. A month later, the moderate neovascularization was noted towards the sutures. After 6 months, the recipient’s cornea was clear, transparent. The implant was translucent and neovascularization was absent. The entire surface of cornea and implant was epithelialized. On the series of optical coherent tomograms, a normal thickness of the epithelium continuous layer was determined in 6 months after the surgery. The complete integration of material with the recipient’s cornea was noted. The layered structure characteristic of corneal tissue was preserved. The cornea retained a layered structure and the endothelium was preserved. On histological examination, there were no differences in the intact cornea and implanted material.Conclusion. The “Corneoplast” material is sufficiently biocompatible and capable of integration with the recipient’s cornea in an animal experiment. This allows, at a certain stage of preclinical trials completion, to use it for replacing corneal tissue in penetrating keratoplasty, intralamellar and superficial anterior layer-by-layer implantations and to cover purulent corneal ulcers of various depths.

Результаты хирургического лечения гнойной язвы роговицы у пациентов с ВИЧ-инфекцией

Purulent corneal ulcers – severe inflammatory disease, often with unfavourable outcome. Therapeutic keratoplasty of this disease is the main treatment way. The total number of HIV cases in Russia and throughout the world is permanently increasing. 75 % of HIV-infected have ophthalmology manifestations, among all of them only 5 % is infection corneal lesions. The information about patients initial immune status could contribute to the successful surgical results. Results of surgical treatment of corneal ulcer in HIV-patients was analysed. Period of operations was from 2018 to 2022 years and the clinical base was Kemerovo Regional Clinical Ophthalmological Hospital. Among patients were 2 females and 4 males, the age was from 36 to 72 years old. Penetrating keratoplasty for emergency reasons with tectonic or organ preservation aims was made for all of them. Retrospective analysis showed that transparent engraftment of the transplant was better after the only operation. The secondary keratoplasty was needed in 50 % cases. Corneal leucoma after the keratoplasty and the previous infection was in patients with 10 years HIV-infection in the anamnesis regardless of the number of keratoplasty and young ages of patients. Transparent condition of transplant was for the period from 4 months to 2 years and there were only uveitis after keratoplasty, there were not any cases of endophthalmitis. Keywords: purulent corneal ulcer; HIV-infection; keratoplasty

Реабилитация пациента с субтотальным расплавлением роговицы, ассоциированным с ношением контактных линз, на основе сквозной кератопластики с использованием криоконсервированного трансплантата и последующей пересадкой жизнеспособного эндотелия: 3 года наблюдения

Purpose. To evaluate the clinical and functional results of transplantation of viable endothelium after penetrating keratoplasty with cryopreserved cornea subjected to the cross-linking procedure for the treatment of a patient with subtotal corneal melting associated with contact lenses. Material and methods. The patient B., 33 years old. Diagnosis at admission: OS – purulent corneal ulcer with perforation. From the anamnesis: she used soft contact lenses that were not daily replaced, for a month she underwent treatment in one of the Moscow clinics for keratitis, where she underwent epikeratoplasty. Treatment was performed without positive effect. Upon admission to the Fyodorov Institution, an emergency penetrating keratoplasty with a cryopreserved cornea and subsequent conservative treatment was performed. One year after penetrating keratoplasty, the phacoemulsification with intraocular lens implantation + DSAEK was performed, followed by conservative treatment. Results. Transparent engraftment was observed, no corneal edema was identified. best spectacle-corrected visual acuity was 0,4. Endothelial cell density – 1047 cells/mm2. Astigmatism was 4,25 D. Conclusion. Cryopreserved cornea subjected to the cross-linking procedure allows to preserve the structural properties of its stroma. Subsequent transplantation of viable endothelium by DSAEK allows to restore the optical properties of the cornea and to achieve visual rehabilitation of the patient. Key words: penetrating keratoplasty, cryopreserved cornea, posterior keratoplasty, DSAEK

EXPERIENCE IN THE TREATMENT OF PURULENT CORNEAL ULCERS WHILE WEARING SOFT CONTACT LENSES

Purulent corneal ulcer – a serious eye disease, which is the outcome of gross corneal scarring with persistent depression of vision and, in extreme cases, loss of an eye as an organ. It proceeds most aggressively against the background of wearing soft contact lenses.

Clinical results of modified crosslinking in the treatment of purulent keratitis and corneal ulcers

To evaluate the efficiency of modified crosslinking (M-CXL) in the treatment of purulent keratitis (PK) and corneal ulcers, including ulcers of mixed etiology. M-CXL method involves simultaneous performance of CXL and frequent instillations of anti-infective agents (one drop every 5 minutes for 1 hour). The study included 39 patients (41 eyes) with purulent corneal ulcers (PCU) of various origin. The main group consisted of 26 patients (27 eyes) who were treated with M-CXL in combination with active conservative therapy. In the control group (13 patients, 14 eyes) only active conservative management was used. Complete suppression of the purulent process in the main group was achieved in 21 (77.8%) eyes after 32.6±10.66 days, in the control group - in 9 (64.3%) eyes in 52.4±16.6 days. Complete suppression of purulent keratitis was achieved in 100% of cases with bacterial keratitis, 83% of cases with fungal keratitis and 70.5% of cases with mixed keratitis. When purulent infiltration occupied the entire depth of the stroma but was limited in area (less than 6 mm), the efficiency of M-CXL decreased to 66.6%. The clinical effect of M-CXL was absent or insufficient when PK extended to the Descemet's membrane with an area of more than 7 mm. In 77.8% of cases, modified crosslinking has showed pronounced therapeutic effect - complete arrest of purulent corneal infiltration. Recovery time in the main group was 1.6 times shorter than in the control group (p<0.05). Resorption of the purulent infiltration occupying all layers of the stroma up to the Descemet's membrane with extensive areas was not achieved, however the corneal melting and keratitis progression were stopped, which allowed planned therapeutic penetrating keratoplasty with a graft of smaller diameter to be performed.

Modified crosslinking in the treatment of purulent keratitis and corneal ulcers

To evaluate the efficacy of modified crosslinking (M-CXL) in the treatment of purulent corneal ulcers, including those of mixed etiology. The M-CXL method consists of simultaneous cross-linking and frequent instillations (FI) of anti-infective solutions. We observed 36 patients (37 eyes) with purulent corneal ulcers (PCU) of various etiologies. The test group included 24 patients (24 eyes) who received 1–2 sessions of M-CXL with active conservative therapy. In the control group (12 patients, 13 eyes), only active conservative therapy was performed. Complete reduction of the purulent process was achieved in 18 (75%) eyes in 29.6 ± 9.38 days in the test group; and in 8 eyes (61.5%) in 50.4 ± 15.9 days in the control group. The efficiency of M-CXL ranged from 100% to 66.6% depending on depth and width (square area) of the infiltration in question. In cases where infiltration affected the entire stromal thickness, the M-CXL efficacy sharply decreased to 66.6%, even with its small (<6 mm) area. In cases where infiltrations extended to the Descemet’s membrane with an overall area >7 mm, the clinical effect of M-CXL was absent or insufficient. In 75% cases, M-CXL showed complete reduction of PCU. Comparing with control groups, the duration of treatment in the test group decreased 42% (P less than 0.05). In infiltrations over a wide area affecting all the layers up to the Descemet’s membrane, resorbtion of the purulent focus was not achieved. However, it’s spread and purulent fusion were sufficiently suspended, thereby allowing therapeutic penetrating keratoplasty to be performed with a smaller graft diameter.

A method of treating purulent corneal ulcer in the eyes with neuroparalytical keratitis and lagophthalmos

To develop a method for treatment of advanced purulent corneal ulcers in eyes with neurotrophic keratitis that developed as a complication of intracranial pathological processes or brain surgeries. The study involved 13 patients (14 eyes) that underwent combined surgery - keratoplasty, autoconjunctival flap covering, partial tarsorrhaphy performed simultaneously. Before and after the surgery, patients received frequent instillations of antimicrobial agents and autologous serum. The organ of vision was preserved in all patients, visual function - in 50% of cases, it improved in 35.7% of cases from 0.07±0.05 to 0.26±0.11. Lagophthalmos has decreased from 6.11±0.99 to 2.78±0.62 mm. Patients with intracranial lesions and complicated by neurotrophic keratitis and lagophthalmos often develop advanced severe and progressive corneal purulent ulcers, which seldom respond to the most active conservative therapy. Simultaneous surgery that includes keratoplasty, auto conjunctival flap covering and partial superficial tarsorrhaphy is an effective treatment option that helps preserve visual function in such eyes.

Influence of frequent instillations of anti-infective solutions on eye tissues (an experimental study)

To investigate the toxic effects of frequent instillations of anti-infective solutions (antibiotic eye drops - 0.3 and 1.4% tobramycin, 0.5% levofloxacin and 0.5% moxifloxacin; antiseptic eye drops - 0.05% pyloxidine and 0.025% chlorhexidine; antifungal drug - 2 mg/ml fluconazole solution) on ocular tissues. The study was conducted on 21 Wistar rats (42 eyes) using method of semi-fine sections. The majority of antibiotics and antifungal agents do not cause toxic reactions in rats` eyes when instilled with frequent regimen with the exception of 'fortified' 1.4% tobramycin and pyloxidine solutions, which caused a decrease in corneal endothelial cells density and formation of fibrovascular tissue in the anterior chamber. Frequent instillations of antimicrobial drug solutions is a safe method for the treatment of purulent corneal ulcers and purulent keratitis. The exceptions were solutions of 'fortified' 1.4% tobramycin and piloxidine (vitabact).

Palliative surgery for refractory purulent corneal ulcer

Palliative surgery for refractory purulent corneal ulcer

Лечение гнойных язв роговицы методом модифицированного кросслинкинга

Лечение гнойных язв роговицы методом модифицированного кросслинкинга

Experimental purulent corneal ulcer in rabbits as a model to study ocular dosage forms

Aim. The aim of this work was to develop experimental model of purulent corneal ulcer in rabbits for its application in the studies of ocular dosage forms.&#x0D; Methods. Rabbits body temperature was measured in three groups: (1) without corneal injury; (2) with the injury and formation of purulent ulcer, but without any therapy; (3) with the injury and formation of purulent ulcer, treated with ciprofloxacin. In parallel, swabs containing purulent discharge were taken for microbiological analysis. In the end of 10-days experiment rabbits (groups 2 and 3) were sacrificed; their corneas were extracted and analysed.&#x0D; Results. One day following the injury all rabbits had a purulent discharge, moderate eyelids edema and conjunctival hyperemia. Rabbits in groups 2 and 3 had a purulent corneal ulcer developed. The mean body temperature in group 1 was 38.6±0.1 °С; in group 2 it was 40.0±0.3 °С, in group 3 it was 39.1±0.3 °С. The levels of infection in group 2 in the beginning and on 10-th day of experiments were 1.0×107 colony forming units (CFU) and 4.3×106 CFU, respectively (not significant, p &gt;0.1). In group 3 these levels were 1.0×107 CFU and 4.6×103 CFU, respectively (significant, p &lt;0.0001). The histological investigation of enucleated eyes with corneal ulcers revealed the presence of edema, stratification, deep epithelial defects, endothelium desquamation, and corneal infiltration by neutrophils.&#x0D; Conclusion. Formation of a corneal ulcer leads to an increase in animal body temperature, which depends on timely therapy. Rectal temperature measurements in rabbits could serve as an easy parameter to follow the development of inflammation.

Contact lens-related keratitis and purulent corneal ulcers

To analyze cases of severe infectious keratitis and corneal ulcers associated with contact lenses (CL), to develop the optimum treatment strategy for these patients, and to identify areas for improvement in prevention, diagnosis and treatment methods. The study included 97 patients (103 eyes) with infectious keratitis and corneal ulcers associated with usage of contact lenses (CL) who were followed up from 2009 to 2016. Medical history of the patients was thoroughly analyzed. Scraping was taken from the cornea and conjunctiva of 61 patients for seeding. A three-step treatment strategy using 2-4 types of antimicrobial agents was developed. In 77 cases (79.3%) the occurrence of infection was associated with violation of the recommended rules of CL wearing and maintenance. Extended-wear CL had higher complication rate (62 patients) compared with daily-wear CL (17 patients) and orthokeratology (8 patients). Rigid CL was used in 1 case. In 9 patients CL type was unknown. Visual acuity upon admission varied from 1.0 to irregular perception of light projections; in 71 cases visual acuity was 0.3 or lower. According to microbiological examination, growth of microflora was observed in 20 cases (informational content 32.8%): Pseudomonas aeruginosa (9 eyes); Staphylococcus epidermidis, Acinetobacter species and mold fungi (3 eyes); Cryptococcus laurentii, Serratia marcescens, Burkholderia cepacia, Staphylococcus hominis, Candida (1 eye). In 10% of patients, non-bacterial infections (fungi and Acanthamoeba) were found. The average hospital stay duration was 15.2±8.9 days. Surgical treatment was required in 15 patients (15.5%) including 5 cases of penetrating keratoplasty. Visual acuity outcome was 0.3-1.0 in 67 cases; 3 patients had light perception with correct projection, and 2 - light perception with irregular projection. An effective treatment strategy for patients with CL-related keratitis and purulent corneal ulcers was developed. It is necessary to improve microbiological research methods. Creating a unified national database of such CL-related complications is advisable.

Surgery treatment of purulent corneal ulcers associated with neuroparalytic keratitis

The study objective was to develop a method for surgical treatment of advanced purulent corneal ulcer in the setting of neuroparalytic keratitis developed after acoustic neuroma removal and strokes. The study included 12 patients (13 eyes). All patients underwent single-step keratoplasty, conjunctival autografting, and partial permanent tarsorrhaphy. The eye as an organ was spared in 100% of cases; vision was spared in 50% of cases and improved, from 0.09±0.05 to 0.21±0.13, in 29% of cases. Lagophthalmos was reduced from 5.86±1.35 to 3.01±0.75 mm. Patients with intracranial lesions complicated by neuroparalytic keratitis often develop progressive purulent corneal ulcers. The simultaneous use of surgery, including keratoplasty, conjunctival autografting, and partial (external) tarsorrhaphy, is an effective treatment that can preserve the visual function of these eyes.

ДВУХСТОРОННИЙ ГНОЙНЫЙ КЕРАТОСКЛЕРИТ, ВЫЗВАННЫЙ СИНЕГНОЙНОЙ ПАЛОЧКОЙ, У ПАЦИЕНТКИ В КОМЕ

The article describes a clinical case of bilateral keratoscleritis caused by Ps. aeroginosa in a female patient suffering from occlusive hydrocephaly and intracranial hypertension with duration of coma and artificial pulmonary ventilation (APV) for 20 days. Materials and methods. At the moment of examination (in 7 days after purulent keratoscleritis started and rapidly progressed) the patient had lagophthalmos, purulent corneal ulcer, purulent xerotic sclera of OU, keratorrhexis of OS. On the same day directly in the intensive care unit, emergency penetrating sclerokeratoplasty was performed on OU in order to save eyes as organs. Forced instillations of antibiotics and antiseptics were used in the post-operative period. In 2 years 2 penetrating keratoplasties were performed in OD for optic purposes. Results. Emergency theurapetical penetrating sclerokeratoplasty with instillation of anterior segment and intraocular administration of a high dilution antibiotic were the only chance to save vision in OD. OS, where keratorrhexis developed due to advanced purulent sclerokeratitis and purulent iridocyclitis was lost despite all the efforts. After three surgeries (sclerokeratoplasty and 2 keratoplasties) vision acuity in the only right eye makes 0.1, which can be regarded as a satisfactory outcome. Conclusions. A malicious course of the disease, peracute progress and extremely severe consequences are typical of the advanced corneal ulcer caused by Ps. aeroginosa. Special attention is to be paid to the eyes of patients being in an intensive care unit in a coma and having continuous artificial pulmonary ventilation due to the high risk of developing purulent corneal ulcer and eye loss.

МODIFIED CROSS-LINKING IN THE TRЕATMENT OF ADVANCED PURULENT CORNEAL ULCER. СLINICAL CASE

Purpose: To describe the clinical case of advanced purulent corneal ulcer successfully treated with modified cross-linking (M-CXL). Key points: A developed purulent corneal ulcer augmenting from the center to the limb with stromal lysis in the zone of keratotomy incisions gradually progressed despite active conservative treatment during 1 month. After 2 sessions of modified PACK-CXL performed with simultaneous frequent instillations of preservant-free moxifloxacin eye drops, the purulent process and corneal lysis was successfully stopped. It allowed to perform optical penetrating keratoplasty in the non-inflamed eye and use smaller graft diameter. Conclusion: M-CRL demonstrated an excellent therapeutic effect — rapid resorption of active purulent infiltration and suppression of purulent corneal melting. This allowed to avoid emergency keratoplasty and to conduct it as a planned operation. M-CXL can become a promising method of treating purulent corneal ulcers in the absence of the effect of drug therapy, and also be used as a preparation for keratoplasty surgery to reduce the severity of inflammation and the risk of infection recurrence in the postoperative period.

Surgical treatment of purulent corneal ulcers in eyes with neurotrophic keratitis and paralytic lagophthalmos

to develop a surgical approach to the treatment of purulent corneal ulcer in eyes with neurotrophic keratitis with lagophthalmos after auditory neuroma removal or stroke. A total of 12 patients (13 eyes) have been managed. All received combined surgery that included simultaneous keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy. Ocular integrity was preserved in all cases, and also vision - in half of them. In 29% of cases, visual acuity increased from 0.09±0.05 up tо 0.21±0.13. Lagophthalmos decreased from 5.86±1.35 mm down to 3.01±0.75 mm. Patients with intracranial lesions complicated by neurotrophic keratitis and lagophthalmos often develop progressive purulent ulcers of the cornea. One-step keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy is an effective treatment that can help preserve visual function in such eyes.

ДИРОФИЛЯРИОЗ ПРИДАТОЧНОГО АППАРАТА ГЛАЗА И ОРБИТЫ

Background: Floppy eyelid syndrome is a rare disorder characterized by tarsal atonia, common spontaneous eversion of the upper eyelids in conjunction with chronic papillary conjunctivitis. Floppy eyelid syndrome is a frequent cause of recurrent keratitis of different severity up to corneal ulceration. Aim: To assess tear production, tear film and status of cornea in patients with floppy eyelid syndrome. Materials and methods: We examined 8 women aged 47–81 years (median 59 years) with clinical signs of floppy eyelid syndrome. For functional assessment, Schirmer and Norn tests were used. Results: All patients had dry eye syndrome due to increased evaporation and fluid loss from the ocular surface in combination with meibomian gland dysfunction. In all cases, keratitis of varied severity was diagnosed: pitted corneal erosions in 7 patients, severe keratitis on 1 patient. In this patient, untimely diagnosis of floppy eyelid syndrome and inadequate treatment resulted in the development of purulent corneal ulcer, endophthalmitis and subsequent eye enucleation. In all patients, medical treatment involved artificial tear, night gauze bandage and therapeutic eye gels. Conclusion: In patients with floppy eye syndrome, early diagnosis and timely treatment may prevent the development of corneal ulcer.

MICRO DIATHERMOCOAGULATION IN THE TREATMENT OF INFECTIOUS CORNEAL ULCERS

Aim. To improve the treatment of early infectious corneal ulcers by combining microdiathermocoagulation (MDC), external autocytokinotherapy, and antiviral and/or antibacterial therapy. patients and methods. The study enrolled 2 groups of outpatients (a total of 112 patients, 112 eyes) who either showed no improvement or deteriorated under 7-day to 1.5-month therapeutic treatment. Group I included 70 patients (70 eyes) with superficial corneal ulcers due to herpes virus infection under antiviral therapy (instillations and periocular injections of Poludan (PolyA:PoliU) as well as Zovirax 3% ophthalmic ointment), group II — 42 patients (42 eyes) with early-stage purulent corneal ulcers under instillations of modern antibiotics (current-generation fluoroquinolones). results and discussion. The combination of MDC and external autocytokinotherapy is the most effective treatment for torpid herpetic ulcerative keratitis that allows a reliable reduction in the recovery period: from 24.1±2.2 days (therapeutic treatment only) down to 9.2±1.3 days (both methods plus antiviral therapy). Moreover, MDC is the treatment of choice in outpatients with purulent corneal ulcer in its early stage. The healing period in this case can be also reliably reduced (р&lt;0.05) from 18.6±1.9 days (MDC plus antibacterial therapy). Hence, MDC is a highly effective urgent method of treatment available to ambulatory care patients with herpetic keratitis and early-stage purulent corneal ulcers. External autocytokinotherapy shows a pronounced anti-inflammatory and regenerative effect. When applied together, MDC and external autocytokinotherapy act synergistically and provide twice as short treatment periods. MDC as well as its combination with external autocytokinotherapy, if started early, allow to avoid keratoplasty in most patients with herpetic keratitis and early-stage purulent corneal ulcers.

Modern treatments for purulent corneal ulcers

This review covers the most widely used modern treatment methods, minimally invasive and surgical, for therapy-resistant purulent corneal ulcers.

Novel approach to treatment of lagophthalmos-associated neuroparalytic keratitis

Aim - to develop effective treatment approaches to lagophthalmos-associated neuroparalytic keratitis. A total of 34 patients (36 eyes) with neuroparalytic keratitis were enrolled. Group 1 consisted of 20 patients (21 eyes), in whom autoconjunctivoplasty was performed in combination with eyelid surgery. Group 2 consisted of 12 lagophthalmic patients (13 eyes) with purulent corneal ulcers, who additionally underwent corneal transplantation. Group 3 included 2 patients (2 eyes) with central corneal ulcer in the only seeing eye, who received, besides other things, upper sector iridectomy intended to serve as a pupil (RU 2299048 with priority date of 15.07.2005). In group 1, corneal re-epithelization and complete recovery was achieved in all patients within 3.00±0.69 weeks. Visual acuity (VA) has generally increased over the first year after treatment from 0.14±0.06 to 0.25±0.13 in group 1 and from 0.09±0.05 to 0.21±0.13 in group 2. In group 3, sector iridectomies also yielded an increase in VA - from 0.01 to 0.02 in one case and from 0.2 to 0.6 in the other. Autoconjunctivoplasty enabled rapid and stable re-epithelization of corneal defects in all cases. One-stage corneal and eyelid surgery has been shown to be more effective in treating lagophthalmos-associated neuroparalytic keratitis than previous methods. The novel approach ensures acute symptoms of keratitis resolve and the eye is saved, moreover, it allows to maintain visual acuity and prevent recurrences in 64% and 65% of patients, respectively.