Viral Keratitis Research Articles

Analysis of the application effect of continuous care for patients with viral keratitis.

In recent years, the incidence of viral keratitis has been on the rise. This study explored the application effect of continuous care for patients with viral keratitis. A total of 148 patients with viral keratitis admitted to the ophthalmology department of the authors' hospital from January 2019 to December 2020 were selected and divided into the observation group and the control group via the random number table method, with 74 cases in each group. Continuous care was conducted following routine discharge guidance for patients in the observation group, while routine discharge guidance only was provided for the control group. The patients in both groups were continuously observed for one year. The medication compliance, return visit rate, recurrence rate, nursing satisfaction, and quality of life between the two groups were compared and analyzed after one year. The medication compliance was higher in the observation than in the control group and the difference was statistically significant (P< 0.05). The rate of return visits at 1 week, 1 month, 3 months, 6 months, and 1 year in the observation group were higher than those in the control group and the differences were statistically significant (P< 0.05). The difference in the recurrence rate between the two groups at 1 week was not statistically significant (P> 0.05), while the recurrence rate at 1, 3, and 6 months, and 1 year in the observation group were higher than those in the control group, and the difference was statistically significant (P< 0.05). The total score of the quality of life in the observation group was higher than in the control group and the difference was statistically significant (P< 0.05). Continuous care had a good application effect on patients with viral keratitis, which could potentially effectively improve medication compliance and the rate of return visits, reduce recurrence rate, and improve patient satisfaction and their quality of life. Accordingly, the results of this study present high clinical value.

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.

Misdiagnosis and Treatment of Corneal Complications Caused by Suture Exposure After Buried-Suture Double-Eyelid Blepharoplasty

PurposeThe purpose of this study was to summarize the misdiagnosis and treatment of corneal complications associated with suture exposure in cases of buried-suture double-eyelid blepharoplasty.MethodsThis study retrospectively analyzed 14 patients with palpebral conjunctival and corneal complications due to suture exposure after buried-suture double-eyelid blepharoplasty at the First Affiliated Hospital of Harbin Medical University from January 2020 to July 2022. The patients’ clinical symptoms included photophobia, lacrimation, pain, foreign body sensation, swelling of the eyelids, conjunctival hyperemia, secretion, etc. We recorded the patient's sex, age, surgical method, length of exposed suture, suture type, number of double-eyelid surgeries, surgical site, timepoint when eye discomfort occurred, misdiagnosed disease and treatment.ResultsThree patients were misdiagnosed with dry eye, nine patients were misdiagnosed with viral keratitis, and two patients were misdiagnosed with allergic conjunctivitis. All 14 patients had manifestations of photophobia, lacrimation, pain, foreign body sensation and conjunctival hyperemia. Eight patients had manifestations of swelling of the eyelids. Five patients had manifestations of eye secretions. There were 8 patients with corneal epithelial injuries and 6 patients with corneal ulcers. All patients underwent suture removal without further progression. Ten patients were treated with artificial tears, and 4 patients were treated with calf serum deproteinized gel after suture removal.ConclusionIf there is postoperative eye discomfort caused by eyelid and corneal complications in patients after buried-suture double-eyelid blepharoplasty, clinicians should carefully check whether there is suture exposure and determine the cause in a timely manner. Suture removal is the best way to treat this complication.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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.

Clinical Characterization and Outcomes of Culture- and Polymerase Chain Reaction-Negative Cases of Infectious Keratitis.

To examine the clinical presentation, management, and outcomes of culture and polymerase chain reaction (PCR) negative cases of infectious keratitis. In this retrospective case series, we evaluated the laboratory and medical records of culture- and PCR-negative cases (2016-2020) reported to a tertiary care center, which were presumed to be infectious keratitis on the basis of clinical history and presentation. A total of 121 cases with culture-negative keratitis were included in this study. The mean age of the patients was 48.42 ± 1.89 years, and 53.72% were female. At presentation, the presumed etiology was viral in 38.01%, bacterial in 27.27%, fungal in 8.26%, Acanthamoeba in 6.61%, and unlisted in 28.92% of cases. The most common risk factors were a previous history of ocular surface diseases (96.69%) and contact lens use (37.19%). In total, 61.98% of the patients were already on antimicrobial medication at presentation. The initial management was altered in 79 cases (65.29%) during the treatment course. Average presenting and final (post-treatment) visual acuities (VA) were 0.98 ± 0.04 (LogMAR) and 0.42 ± 0.03 (LogMAR), respectively. A significantly higher frequency of patients with a final VA worse than 20/40 (Snellen) had worse VA at initial presentation (p < 0.0001). A history of ocular surface disease, cold sores, and recurrent infection (p < 0.05) were more commonly associated with a presumed diagnosis of viral keratitis. The patients with presumed bacterial etiology were younger and had a history of poor contact lens hygiene (p < 0.05). We observed a distinct difference in clinical features among patients with culture-negative and PCR-negative keratitis managed for presumed viral and bacterial infections. Although there was significant variability in presentation and management duration in this cohort, the visual outcomes were generally favorable.

Atypical viral keratitis in a graft

A 70-year-old male patient, a known case of rheumatoid arthritis, presented with multiple elevated atypical vesicular corneal lesions admixed with an active epithelial defect in the right eye for 2 days. The patient was operated penetrating keratoplasty for mixed keratitis 2 months back. Based on history and clinical findings, a working diagnosis of viral keratitis was made, and the treatment regimen was changed to topical and systemic anti-viral therapy. Subsequently at the end of 2 weeks, the vesicular lesions transformed themselves into umbilicated lesion and healed thereof. Viral keratitis can have a myriad of atypical presentations; therefore, under such circumstances, a strong clinical suspicion with pre-emptive systemic examination will be helpful in achieving optimal outcomes.

Decision-making in Herpes Simplex viral keratitis grafts.

Keratoplasty after healed herpes simplex viral keratitis is a challenge due to problems arising preoperatively, intraoperatively, and postoperatively. In this video, we describe the necessary challenges and the steps, which can be taken to prevent and manage those cases of healed herpes simplex virus (HSV) keratitis that would require a keratoplasty. The video talks about both the typical and atypical features of HSV keratitis, clinical examination, the scenarios which would require a keratoplasty, problems arising intraoperatively and how to manage them, and finally how to approach these high-risk grafts postoperatively. Our video highlights the diagnosis of HSV keratitis, which cases are ready for surgery, and preoperative, intraoperative, and postoperative considerations before corneal transplantation in healed HSV keratitis. Decision-making before corneal transplant in HSV grafts can become more structured if these points are followed. https://youtu.be/xMT7Ki8vuc4.

Rapid detection and diagnosis of herpetic keratitis using quantitative microfluidic polymerase chain reaction system for herpes simplex and varicella-zoster virus DNA: a case series

BackgroundA microfluidic real-time polymerase chain reaction (PCR) system can rapidly detect the viral DNA in specimens. Detection of herpes simplex virus (HSV) and varicella-zoster virus (VZV) DNA in tears is a useful diagnostic tool for herpes simplex virus keratitis (HSK) and herpes zoster ophthalmicus (HZO).MethodsIn total, 20 patients were included in this cross-sectional study. Among them, 8 patients with infectious epithelial HSK and 12 patients with HZO were included in HSK and HZO groups, respectively. In addition, 8 patients with non-herpetic keratitis and 4 healthy individuals without keratitis were included in the control group. Numbers of HSV and VZV DNA copies in tears of all patients and individuals were evaluated using a microfluidic real-time PCR system. Regarding HSV/VZV DNA test, tear specimens were collected by filter paper method using Schirmer’s test paper, and subsequently, DNA was extracted from the filter paper using an automated nucleic acid extractor. Afterward, quantitative PCR was performed using a microfluidic real-time PCR system.ResultsFrom tear collection to real-time PCR result determination, the HSV/VZV DNA test took approximately 40 min. In the HSK group, the sensitivity and specificity of the HSV DNA tests were 100% each. The median value (range) of number of HSV DNA copies for affected eyes was 3.4 × 105 copies/μL (under a lower detection limit of 7.6). In the HZO group, the sensitivity and specificity of the VZV DNA tests were 100% each. The median value (range) of number of VZV DNA copies for affected eyes was 5.3 × 105 copies/μL (under a lower detection limit of 5.6 × 10–2).ConclusionIn conclusion, quantitative PCR for HSV and VZV DNA in tears using a microfluidic real-time PCR system is useful for diagnosing and monitoring HSK and HZO.

Management of perforated corneal ulcer with iris prolapse by cyanoacrylate glue: A case report

We report a rare case of perforated corneal ulcer due to recurrent viral keratitis with stromal necrosis and iris prolapse. The patient was 75 years old farmer, normotensive, diabetic, and presented with complaints of pain, watering, photophobia, redness and dimness of vision in the left eye. The left eye's visual acuity was perception of light and projection of rays in all four quadrants. Slit lamp examination found swollen eyelids, matted eyelashes, congested conjunctiva, seidel test positive, an inferonasal corneal perforation, shallow anterior chamber, irregular pupil, and prolapse of the iris through the perforated cornea. The patient was diagnosed with a left-sided perforated corneal ulcer (recurrent viral keratitis with stromal necrotizing variety) having iris prolapse. The perforation was sealed by cyanoacrylate glue and a soft bandage contact lens. This improved the patient’s condition. Early medical and surgical interventions thus can save vision as well as the eyeball.

Epidemiological profile of microbial keratitis in Alexandria-Egypt a 5 years retrospective study

ObjectiveTo evaluate the epidemiologic profile of microbial keratitis in Alexandria- Egypt, with special emphasis on risk factors, visual outcome and microbiological results.MethodsThis retrospective study reviewed files of patients treated for microbial keratitis during a period of 5 years at Alexandria Ophthalmology Hospital Cornea Clinic, Alexandria- Egypt, between February 2017 and June 2022. The patients were evaluated for the risk factors e.g., trauma, eyelid disorders, co-morbidities, and contact lens use. They were also evaluated for their clinical picture, the identified microorganisms, visual outcomes, and complications. Non-microbial keratitis and incomplete files were excluded from the study.ResultsA total of 284 patients were diagnosed as microbial keratitis in our study. Viral keratitis was the most common cause of microbial keratitis (n = 118 (41.55%)), followed by bacterial keratitis (n = 77 (27.11%)), mixed keratitis (n = 51 (17.96%)), acanthamoeba keratitis (n = 22 (7.75%)) and the least cause was fungal keratitis (n = 16 (5.63%)). Trauma was the most common risk factor for microbial keratitis (29.2%). Fungal keratitis had a statistically significant association with trauma (p < 0.001), while the use of contact lenses had a statistically significant association with Acanthamoeba keratitis (p < 0.001). The percentage of culture-positive results in our study was 76.8%. Gram-positive bacteria were the most frequently isolated bacterial isolate (n = 25 (36.2%)), while filamentous fungi were the most frequently isolated fungi (n = 13(18.8%)). After treatment, there was a significant increase in the mean visual acuity among all groups; it was significantly higher in Acanthamoeba keratitis group with a mean difference of 0.262 ± 0.161 (p = 0.003).ConclusionViral keratitis followed by bacterial keratitis were the most frequent etiologic agents causing microbial keratitis found in our study. Although trauma was the most frequent risk factor for microbial keratitis, contact lens wear was found an important preventable risk factor for microbial keratitis in young patients. Performing culture properly whenever indicated before starting antimicrobial treatment increased the cultures’ positive results.

Intrastromal Injections in the Management of Infectious Keratitis.

Infectious keratitis is a major global cause of vision loss and blindness. Prompt diagnosis and targeted antibiotic treatment are crucial for managing the condition. Topical antimicrobials are the most effective therapy for bacterial keratitis, but they can lead to unsatisfactory results due to ocular perforation, scarring, and melting. Intrastromal injection is a newer technique for delivering antimicrobials directly to the site of infection and has been successful in treating severe, treatment-resistant infectious keratitis, especially when surgery is not recommended. In cases where deep stromal disease is resistant to topical treatment, intrastromal antimicrobial injections may be necessary to achieve higher drug concentration at the infection site. However, the use of intrastromal antibiotics is limited, as topical antibacterial agents have better penetration than antifungal agents. Bacterial and fungal keratitis have been extensively researched for intrastromal medication injections, while there is limited evidence for viral keratitis. This review emphasizes the potential of intrastromal antimicrobial injections as an alternative for managing severe refractory infectious keratitis. The technique offers direct targeting of the infection site and faster resolution in some cases compared to topical therapy. However, further research is needed to determine the safest antimicrobials options, minimal effective doses, and concentrations for various pathogens. Intrastromal injections may serve as a non-surgical treatment option in high-risk cases, with benefits including direct drug delivery and reduced epithelial toxicity. Despite promising findings, more studies are required to confirm the safety and efficacy of this approach.

Evaluating the Diagnostic Potential of Chorismate Mutase Poly-Clonal Peptide Antibody for the Acanthamoeba Keratitis in an Animal Model.

Acanthamoeba spp. is the causative agent of Acanthamoeba keratitis (AK), a vision-threatening parasitic disease whose primary risk factor has been attributed to poor contact lens hygiene. Unfortunately, differential diagnosis of AK is challenging as the clinical manifestations for AK are similar to those of bacterial, fungal, or even viral keratitis. Since delayed AK diagnosis can incur permanent vision impairment, a rapid and sensitive diagnostic method is urgently needed. Here, the diagnostic potential of polyclonal antibodies targeting the chorismate mutase (CM) of Acanthamoeba spp. was evaluated in AK animal models. CM antibody specificity against Acanthamoeba trophozoites and cysts was confirmed by immunocytochemistry after co-culturing Acanthamoeba with Fusarium solani, Pseudomonas aeruginosa, and Staphylococcus aureus, and human corneal epithelial (HCE) cells. Enzyme-linked immunosorbent assay (ELISA) was performed using CM-specific immune sera raised in rabbits, which demonstrated that the antibodies specifically interacted with the Acanthamoeba trophozoites and cysts in a dose-dependent manner. To evaluate the diagnostic potential of the CM antibody, AK animal models were established by incubating contact lenses with an inoculum containing A. castellanii trophozoites and subsequently overlaying these lenses onto the corneas of BALB/c mice for 7 and 21 days. The CM antibody specifically detected Acanthamoeba antigens in the murine lacrimal and eyeball tissue lysates at both time points. Our findings underscore the importance of antibody-based AK diagnosis, which could enable early and differential AK diagnosis in clinical settings.

Automatic Diagnosis of Infectious Keratitis Based on Slit Lamp Images Analysis.

Infectious keratitis (IK) is a common ophthalmic emergency that requires prompt and accurate treatment. This study aimed to propose a deep learning (DL) system based on slit lamp images to automatically screen and diagnose infectious keratitis. This study established a dataset of 2757 slit lamp images from 744 patients, including normal cornea, viral keratitis (VK), fungal keratitis (FK), and bacterial keratitis (BK). Six different DL algorithms were developed and evaluated for the classification of infectious keratitis. Among all the models, the EffecientNetV2-M showed the best classification ability, with an accuracy of 0.735, a recall of 0.680, and a specificity of 0.904, which was also superior to two ophthalmologists. The area under the receiver operating characteristics curve (AUC) of the EffecientNetV2-M was 0.85; correspondingly, 1.00 for normal cornea, 0.87 for VK, 0.87 for FK, and 0.64 for BK. The findings suggested that the proposed DL system could perform well in the classification of normal corneas and different types of infectious keratitis, based on slit lamp images. This study proves the potential of the DL model to help ophthalmologists to identify infectious keratitis and improve the accuracy and efficiency of diagnosis.

Use of corneal cross-linking beyond keratoconus: a systemic literature review.

The success of corneal collagen cross-linking in altering keratoconus' clinical course has driven a search for further uses of this procedure. This literature review aims to analyze the scientific evidence available for the benefit of cross-linking in the management of ophthalmic diseases other than progressive keratoconus or ectasia induced by corneal refractive procedures. A systemic literature review. We reviewed 97 studies. We found that collagen cross-linking can limit the progression of several other corneal ectasias, thus reducing and limiting the need for keratoplasty. Collagen cross-linking also can reduce the refractive power of the cornea and can be considered for a moderate degree of bacterial keratitis or when the organism is unidentified, which is refractive to antibiotics alone. However, the comparative rarity of these procedures has limited the extent of evidence. In fungal, Acanthamoeba, and herpes virus keratitis, the evidence is inconclusive of the safety and efficacy of cross-linking. Current clinical data is limited, and laboratory data has not fully correlated with published clinical data.

Clinical Features of Pediatric Age Herpes Simplex Virus Keratitis.

The objective of this study is to evaluate the clinical features of pediatric herpes simplex virus keratitis, its recurrence rates, and its effects on visual acuity. In this retrospective case series, records of pediatric patients (0-16 years) who presented with herpes simplex virus keratitis between January 2012 and September 2021 were evaluated. Data including age, gender, additional systemic diseases, the number of recurrences, recurrence time, treatment protocol, follow-up period, and presence of amblyopia were reviewed. Twenty-four patients (16 females and 8 males) with a mean age of 6.6 ± 4 (1.1-15) years were included in the study. The mean follow-up time was 21 ± 19.9 (7-94) months. Four patients (16.6%) had bilateral keratitis. Including all 4 patients with bilateral involvement, a total of 10 (41.6%) patients had additional systemic diseases that cause immunodeficiency. After prophylactic antiviral treatment for at least 6 months (except for isolated epithelial keratitis), recurrence was detected in 5 (22.7%) patients, who were all immunodeficient. Among immunodeficient individuals, the recurrence rate was found to be 50%. Keratitis recurrence was significantly associated with immunodeficiency ( P = 0.03). However, type of keratitis ( P = 0.42), gender ( P = 0.47), and bilaterality ( P = 0.54) were not related with recurrence. 66.7% of the patients younger than 10 years developed amblyopia during follow-up. In childhood, the most frequent corneal manifestation of herpes simplex virus is stromal keratitis that mostly progresses with corneal scarring, residual astigmatism, and amblyopia. The recurrence rate increases in the presence of immunosuppression. Close follow-up, rapid diagnosis, and treatment are critical for battling against amblyopia and achieving good visual prognosis.

Antimicrobial resistance in topical treatments for microbial keratitis: protocol for a systematic review and meta-analysis

IntroductionThere is evidence for increased resistance against the antimicrobials used to treat keratitis. This review aims to provide global and regional prevalence estimates of antimicrobial resistance in corneal isolates and...

A study on childhood microbial keratitis in South India.

The aim of this study was to determine the predisposing risk factors, clinical characteristics, microbiological profile, and visual and functional treatment outcome of microbial keratitis including viral keratitis in children. A prospective study was carried out in a tertiary care institute over a period of 18 months on 73 pediatric patients. Data collected was analyzed for demographics of the patient population, causative organisms, and management outcome in terms of visual and functional outcome. Patients in the age group from 1 month to 16 years were included, with a mean age of 10.81 years. Trauma was the commonest risk factor (40.9%), with unidentified foreign body fall being the most common (32.3%). No predisposing factors were identified in 50% of cases. Also, 36.8% of eyes were culture positive, with bacterial isolates in 17.9% and fungus in 82.1%. Moreover, 7.1% eyes were culture positive for Streptococcus pneumoniae and Pseudomonas aeruginosa each. Fusarium species (67.8%) was the commonest fungal pathogen, followed by Aspergillus species (10.7%). Also, 11.8% were clinically diagnosed as viral keratitis. No growth was found in 63.2% of patients. Treatment with broad-spectrum antibiotics/antifungals was administered in all cases. At the final follow-up, 87.8% achieved a best corrected visual acuity (BCVA) of 6/12 or better. Therapeutic penetrating keratoplasty (TPK) was required by 2.6% of eyes. Trauma was the major cause for pediatric keratitis. Majority of the eyes responded well to medical treatment, with only two eyes needing TPK. Early diagnosis and prompt management helped majority of the eyes to achieve a good visual acuity after the resolution of keratitis.

Acute keratoconus: clinical cases

Indrė Rašinskaitė1 , Saulius Galgauskas1,2 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania 2Vilnius University, Faculty of Medicine, Institue of Clinical Medicine, Clinic of Era, Nose, Throat and Eye Diseases, Center of Eye Diseases, Vilnius, Lithuania Abstract Background. Keratoconus is chronic ectatic corneal disease. The progressive thinning of corneal stroma causes corneal cone shape and impaired vision. The etiology of the disease is associated with genetic, environmental factors, allergic and atopic diseases. Keratoconus usually progresses slowly firstly affecting one eye. Acute course of the disease is rare, manifested by acute swelling of the cornea. Clinical case No.1. 21 y.o. man presented at emergency department with decreasing visual acuity of the right eye. Complaints appeared two weeks ago, during that time he used artificial tears. One week after the onset of symptoms, the patient was consulted by an ophthalmologist and diagnosed with acute right eye keratitis. Swelling of the right corneal stroma, descemetitis was observed during admission to the hospital. Topographic revealed greater corneal curvature in the lower right eye. Clinical case No.2. 28 y.o. patient with Down syndrome was consulted due to impaired left eye visual acuity, tearing lasting five days. Ophthalmologist observed corneal edema, viral keratitis was suspected and levofloxacin drops and aciclovir tablets were prescribed. During objective examination, a strong swelling of the left corneal stroma, bulls, rupture of the Descemete’s membrane were observed. Keratoconus was diagnosed by corneal topography. Conclusion. Acute corneal hydrops is a rare complication of keratoconus. The diagnosis of keratoconus is complicated if acute hydrops occurs as the first symptom following eye irritation, pain, photophobia. The main diagnostic method of keratoconus is topography. Keywords: keratoconus, corneal hydrops, ectasia, corneal topography Full article https://doi.org/10.53453/ms.2023.2.6

STUDY OF EPIDEMIOLOGICAL FEATURES, MICROBIOLOGICAL DIAGNOSIS AND TREATMENT OUTCOME OF INFECTIVE KERATITIS

Introduction; Keratitis is an inammations of the cornea and Microbial keratitis is a most common type. Potentially sight threatening ocular infection are known to be the second most signicant cause of monocular blindness rated after cataract in some developing nations in particular. The aetiology of microbial keratitis varies signicantly from country to country. Objective; To determine the epidemiological features, microbiological diagnosis and treatment outcome of infective keratitis. Methods: This hospital based prospective study conducted on 75 patients with clinical diagnosis of corneal ulceration at ophthalmology department, RNT Medical College and Hospital Udaipur, over a period of 18 months. Result: majority of cases were from 41-60age group and most common factor was ocular vegetative trauma. Microorganisms were isolated from 75.86% of the 58 corneas that were cultured. culture proven bacterial keratitis. 58 patients taken for the laboratory investigation by smears and culture. Pure bacterial growth was present in 21(36.2%) pure fungal growth was present in 19 (32.8%) mixed growth was present in 4 (6.9%), 14(24.1% were not showing any culture growth. Out of 75, 19 (25.33%) were viral keratitis

Pattern of Herpes Simplex Virus Keratitis at A Tertiary Eye Care Center in Mid-Western Region of Nepal

Objective: The purpose of the study was to determine the clinical pattern of Herpes Simplex Virus (HSV) Keratitis and to evaluate the precipitating factors and associated visual loss. Materials and Methods: This was a retrospective study of all consecutive patients clinically diagnosed with HSV keratitis in the Cornea department of Rapti eye hospital from January 2022 to December 2022. The major outcome measures studied were demographic characteristics, clinical pattern of HSV keratitis, precipitating factors and visual acuity. Result: A total of 218 cases of HSV keratitis were included in the study. Mean age of patients was 39.23±20.19 years with majority belonging to age group 15-40 years. Stromal keratitis was the most common manifestation (109 cases; 50%) followed by disciform keratitis. Majority of cases had spontaneous onset and others had precipitating factors like minor ocular trauma, steroid and fever. Presenting visual acuity of &lt;3/60 was present in 14.2% of cases. Conclusion: Productive age group are most commonly affected with HSV keratitis with stromal keratitis as the most common presentation. HSV keratitis may lead to significant scarring and severe visual impairment and blindness.