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Abu Dail Y, Daas L, Flockerzi FA, Seitz B. [Bilateral chronic contact lens-associated keratitis]. DIE OPHTHALMOLOGIE 2024; 121:410-414. [PMID: 38315191 DOI: 10.1007/s00347-024-01993-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Y Abu Dail
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - F A Flockerzi
- Institut für Pathologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
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Berger T, Flockerzi E, Daas L, Hamon L, Khattabi Z, Berger M, Seitz B. [Modern corneal diagnostics as the key for the correct classification of the disease and optimal treatment decisions]. DIE OPHTHALMOLOGIE 2023; 120:1238-1250. [PMID: 37707672 DOI: 10.1007/s00347-023-01919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
Corneal diseases include a wide spectrum of different manifestations (inflammatory/noninflammatory) that need to be accurately classified for precise diagnosis and targeted treatment. In addition to the anamnesis and slit lamp biomicroscopy, further device-based examinations can be performed to narrow down the diagnosis. Nowadays, modern corneal imaging provides a variety of technologies, such as topography, tomography, in vivo confocal microscopy and analysis of biomechanics, which are able to reliably classify different pathologies. Knowledge of the available examination modalities helps to guide differential diagnostic considerations, facilitating the indication for stage-appropriate microsurgical intervention.
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Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland.
| | - Elias Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Loïc Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Zaynab Khattabi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Maximilian Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
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Berger T, Seitz B, Flockerzi F, Daas L. Recurrent Filamentous Fungal Keratitis Caused When the Primarily Selected Graft Diameter was Too Small. Klin Monbl Augenheilkd 2023; 240:1098-1102. [PMID: 35320860 DOI: 10.1055/a-1756-5147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To establish the importance of using a sufficiently large corneal graft in primary penetrating keratoplasty in order to prevent recurrence of fungal keratitis. OBERSERVATIONS A 58-year-old female patient underwent emergency penetrating keratoplasty (diameter 7.0 mm, double running suture) for therapy-resistant fungal keratitis (Fusarium solani) at an external eye clinic. Despite intensive antifungal therapy, new fungal infiltrates appeared in the host cornea after a few days. The patient was referred to our department for further treatment. On first presentation, circular infiltrates were seen around the corneal graft with anterior chamber involvement and therapy-resistant hypopyon. We performed an emergency penetrating repeat keratoplasty (diameter of 13.0 mm, 32 interrupted sutures) combined with anterior chamber lavage and intracameral and intrastromal drug injection. CONCLUSION AND IMPORTANCE Fungal keratitis sometimes has a frustrating clinical course. Therefore, early diagnosis with effective therapy initiation is of the utmost importance. In cases of penetrating keratoplasty, optimal planning and timing (before anterior chamber involvement) should be provided. Sufficient safety distance must be ensured in the choice of graft diameter, fixation with multiple interrupted sutures, and anterior chamber lavage, as well as intracameral and intrastromal drug administration. Incomplete excision carries a risk of recurrence and endophthalmitis in the course. Close postoperative control is necessary to detect early recurrences.
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Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Fidelis Flockerzi
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
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Berger T, Seitz B, Bofferding M, Flockerzi F, Schlötzer-Schrehardt U, Daas L. Infectious Crystalline Keratopathy after Penetrating Keratoplasty with Light and Electron Microscopic Examination. Klin Monbl Augenheilkd 2022; 239:1478-1482. [PMID: 36493767 DOI: 10.1055/a-1961-7081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To highlight the typical histological and ultrastructural features of severe infectious crystalline keratopathy (ICK) in a corneal graft, which required excimer laser-assisted repeat penetrating keratoplasty (PKP) and to present the challenging treatment conditions associated with ICK. METHODS An 85-year-old female patient underwent PKP for secondary graft failure after Descemet membrane endothelial keratoplasty (DMEK) for Fuchs' endothelial corneal dystrophy in the left eye. One year later, white branched opacities were observed in the superficial corneal stroma of the graft without surrounding inflammation in the left eye. The patient underwent excimer laser-assisted repeat PKP (8.0/8.1 mm) in the left eye after prolonged refractory topical anti-infectious treatment for 1 month. The corneal explant was further examined by light and transmission electron microscopy (TEM). RESULTS The light microscopic examination of the corneal explant demonstrated aggregates of coccoid bacteria in the superficial and mid-stromal region that were positive for periodic acid-Schiff (PAS) and Gram stain. The bacterial aggregates extended into the interlamellar spaces, showed a spindle-shaped appearance, and were not surrounded by an inflammatory cellular reaction. TEM demonstrated lamellae separation within the anterior corneal stroma with spindle-shaped aggregates of bacteria, which were embedded in an extracellular amorphous matrix with incipient calcification, being consistent with a biofilm. No inflammatory cellular reaction was evident by TEM. At discharge from hospital, the corrected visual acuity was 20/80 in the left eye. CONCLUSION ICK is often challenging due to the difficult diagnosis and treatment conditions. The refractory courses are mainly attributed to a biofilm formation, which inhibits effective topical anti-infectious treatment. In such cases, (repeat) PKP may be necessary to completely remove the pathology, prevent recurrences, and improve vision.
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Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Max Bofferding
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Fidelis Flockerzi
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
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Hamon L, El Halabi M, Flockerzi FA, Seitz B, Daas L. [Purpureocillium lilacinum : Atypical pathogen of mycotic keratitis in an immunocompetent patient]. Ophthalmologe 2022; 119:300-303. [PMID: 33580805 PMCID: PMC8904374 DOI: 10.1007/s00347-021-01325-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Loïc Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - Mohammed El Halabi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - Fidelis A Flockerzi
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
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Schrecker J, Seitz B, Berger T, Daas L, Behrens-Baumann W, Auw-Hädrich C, Schütt S, Kerl S, Rentner-Andres S, Hof H. Malignant Keratitis Caused by a Highly-Resistant Strain of Fusarium Tonkinense from the Fusarium Solani Complex. J Fungi (Basel) 2021; 7:jof7121093. [PMID: 34947075 PMCID: PMC8707679 DOI: 10.3390/jof7121093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/30/2021] [Accepted: 12/11/2021] [Indexed: 12/28/2022] Open
Abstract
Fusarium spp. are moulds ubiquitously distributed in nature and only occasionally pathogenic for humans. Species of the Fusarium solani complex are the predominant keratitis-inducing pathogens, because they are endowed with proper virulence factors. These fungi can adhere to the cornea creating a biofilm and, with the help of enzymes and cytotoxins, penetrate the cornea. Whereas an intact cornea is hardly able to be invaded by Fusarium spp. in spite of appropriate virulence factors, these opportunistic fungi may profit from predisposing conditions, for example mechanical injuries. This can lead to a progressive course of corneal infection and may finally affect the whole eye up to the need for enucleation. Here, we present and discuss the clinical, microbiological and histopathological aspects of a particular case due to Fusarium tonkinense of the Fusarium solani complex with severe consequences in a patient without any obvious predisposing factors. A broad portfolio of antifungal agents was applied, both topically and systemically as well as two penetrating keratoplasties were performed. The exact determination of the etiologic agent of the fungal infection proved likewise to be very challenging.
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Affiliation(s)
- Jens Schrecker
- Department of Ophthalmology, Rudolf Virchow Klinikum Glauchau, Virchowstraße 18, D-08371 Glauchau, Germany;
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Kirrbergstr. 100, D-66424 Homburg, Germany; (B.S.); (T.B.); (L.D.)
| | - Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Kirrbergstr. 100, D-66424 Homburg, Germany; (B.S.); (T.B.); (L.D.)
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Kirrbergstr. 100, D-66424 Homburg, Germany; (B.S.); (T.B.); (L.D.)
| | - Wolfgang Behrens-Baumann
- Emeritus, Department of Ophthalmology, Otto-von-Guericke-University Magdeburg, Eckenbornweg 5j, D-37075 Göttingen, Germany;
| | - Claudia Auw-Hädrich
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Kilianstr. 5, D-79106 Freiburg im Breisgau, Germany;
| | - Sabine Schütt
- MVZ Labor Limbach and Colleagues, Im Breitspiel 16, D-69126 Heidelberg, Germany; (S.S.); (S.K.)
| | - Sabine Kerl
- MVZ Labor Limbach and Colleagues, Im Breitspiel 16, D-69126 Heidelberg, Germany; (S.S.); (S.K.)
| | - Sascha Rentner-Andres
- Limbach Analytics GmbH, Arotop Laboratories, Dekan-Laiststr. 9, D-55129 Mainz, Germany;
| | - Herbert Hof
- MVZ Labor Limbach and Colleagues, Im Breitspiel 16, D-69126 Heidelberg, Germany; (S.S.); (S.K.)
- Correspondence: ; Tel.: +49-6221-34-32-342
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Farah CJ, Seitz B, Hamon L, Sourlis C, Daas L. [Coinfections in contact lens-associated mycotic keratitis with Pseudomonas or Acanthamoeba]. Ophthalmologe 2021; 118:940-943. [PMID: 32821967 PMCID: PMC8413168 DOI: 10.1007/s00347-020-01207-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Kontaktlinsenassoziierte Keratitiden werden immer häufiger. Die mykotische Keratitis ist ein relativ seltenes, aber sehr ernst zu nehmendes Krankheitsbild. Meist wird im Frühstadium eine falsche Diagnose gestellt und dadurch die adäquate Therapie verzögert. Bei der therapierefraktären kontaktlinsenassoziierten mykotischen Keratitis können nicht selten auch Koinfektionen oder Superinfektionen bestehen. Wir stellen 2 Patienten mit initial unklarer Keratitis vor, bei denen eine Mischinfektion der mykotischen Keratitis mit Pseudomonas aeruginosa bzw. Akanthamöben nachgewiesen werden konnte. In beiden Fällen war die zeitnahe perforierende Excimerlaser-Keratoplastik mit Einzelknüpfnähten und adäquater Lokaltherapie über 8 Wochen therapeutisch erfolgreich.
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Affiliation(s)
- C J Farah
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - L Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - C Sourlis
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
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Serfözö A, Suffo S, Viestenz A, Seitz B, Daas L. [Central Sclerocorneoplasty à Chaud in Bacterial Superinfected Mycotic Keratitis Confirmed by Confocal Microscopy at the Base of Recurrent Herpetic Keratitis]. Klin Monbl Augenheilkd 2021; 239:1245-1247. [PMID: 34000745 DOI: 10.1055/a-1386-5229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alexandra Serfözö
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg (Saar), Deutschland
| | - Shady Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg (Saar), Deutschland
| | - Arne Viestenz
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg (Saar), Deutschland
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg (Saar), Deutschland
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Daas L, Viestenz A, Schnabel PA, Fries FN, Hager T, SzentmÁry N, Seitz B. Confocal microscopy as an early relapse marker for acanthamoeba
keratitis. Clin Anat 2017; 31:60-63. [DOI: 10.1002/ca.22925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/22/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Loay Daas
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
| | - Arne Viestenz
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
- Department of Ophthalmology; UKH, Martin- Luther-University Halle-Wittenberg; Halle Germany
| | | | - Fabian N. Fries
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
| | - Tobias Hager
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
| | - Nora SzentmÁry
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
| | - Berthold Seitz
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
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Daas L, Bischoff-Jung M, Viestenz A, Seitz B, Viestenz A. [Confocal microscopy as an early relapse marker after keratoplasty due to Fusarium solani keratitis]. Ophthalmologe 2016; 114:66-69. [PMID: 27260622 DOI: 10.1007/s00347-016-0270-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 11/30/2022]
Abstract
In the case of therapy-resistant keratitis an infection with Fusarium solani should be taken into consideration as a rare but very severe eye disease. In the majority of cases Fusarium solani keratitis will result in a protracted clinical course despite aggressive medicinal and surgical interventions. We describe the case of a referred patient after intensive topical, intracameral and systemic antibacterial and antimycotic therapy as well as surgical treatment with emergency keratoplasty à chaud because of Fusarium solani keratitis. The patient presented to our department with persistent discomfort for further therapeutic interventions. Using confocal microscopy we were able to demonstrate the presence of fungal hyphae in the host cornea and the graft, which was important for making further surgical decisions. Furthermore, this emphasizes the role of confocal microscopy as an early relapse marker during the clinical monitoring.
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Affiliation(s)
- L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66424, Homburg/Saar, Deutschland.
| | - M Bischoff-Jung
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66424, Homburg/Saar, Deutschland
| | - A Viestenz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66424, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66424, Homburg/Saar, Deutschland
| | - A Viestenz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66424, Homburg/Saar, Deutschland
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