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Ahmed A, Fard AM, Hsu HY. Post-LASIK Exophiala jeanselmei Keratitis. Eye Contact Lens 2024; 50:416-417. [PMID: 39028227 DOI: 10.1097/icl.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE To describe a patient diagnosed with Exophiala jeanselmei keratitis. METHODS We report a case of a patient who developed infectious keratitis following laser in situ keratomileusis and chronic topical steroid use for approximately six months in both eyes. An atypical infiltrate containing dark pigmentation was noted in the left eye on the initial presentation. During treatment, the infiltrates of the right eye began to exhibit a similar pigmentation. RESULTS Early treatment with topical antifungals was initiated in the left eye and later in the right eye once culture results returned. Both eyes recovered with good vision after approximately one month. CONCLUSIONS Patients treated with postoperative topical corticosteroids should be cautioned of potential adverse effects of chronic use and have close follow-up. If infectious keratitis develops, particularly after two weeks, then atypical organisms, such as fungi, should be considered. In addition, our case highlights the significance of recognizing and associating dark-pigmentation with fungal etiologies.
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Affiliation(s)
- Adil Ahmed
- Doheny Eye Center of UCLA (A.A., H.Y.H.), Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Loma Linda University Medical Center (A.M.F.), Department of Ophthalmology, Loma Linda, CA
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Nakajima I, Fukuda K, Ishida W, Kishimoto T, Kuwana A, Suzuki T, Kaito C, Yamashiro K. Staphylococcus aureus-derived virulent phenol-soluble modulin α triggers alarmin release to drive IL-36-dependent corneal inflammation. Microbes Infect 2024; 26:105237. [PMID: 37805122 DOI: 10.1016/j.micinf.2023.105237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/22/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients with keratitis produces substantial amounts of phenol-soluble modulin α (PSMα). However, the role of PSMα in S. aureus keratitis remains unclear. We observed that PSMα-producing and PSMα-deficient strains could infect the cornea in our experimental mouse keratitis model; however, only the PSMα-producing strain delayed epithelial wound healing and induced stromal inflammation. PSMα induced damage to the epithelium, the release of alarmins IL-1α and IL-36α, and the expression of inflammatory chemokines by resident corneal cells in the mouse corneal organ culture. The IL-36 (but not IL-1) receptor antagonist attenuated mouse keratitis induced by PSMα-containing bacterial culture supernatants, as well as by infection with PSMα-producing S. aureus, suggesting that the corneal inflammations were dependent on IL-36. Recombinant PSMα elicited IL-36-dependent corneal inflammation in mice. Thus, PSMα and the subsequently released IL-36 are critical factors triggering inflammation during S. aureus keratitis.
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Affiliation(s)
- Isana Nakajima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan.
| | - Waka Ishida
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tatsuma Kishimoto
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Aozora Kuwana
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takashi Suzuki
- Department of Ophthalmology, Toho University, Tokyo, Japan
| | - Chikara Kaito
- Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
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Boz AAE, Atum M, Özmen S, Yuvacı İ, Çelik E. Comparison of three different intraocular lens implantation techniques in the absence of capsular support: sutured scleral, haptic flanged intrascleral, and four flanged intrascleral fixations. Int Ophthalmol 2023; 43:5045-5053. [PMID: 37851141 DOI: 10.1007/s10792-023-02907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION After lens extraction, if the capsular bag insufficiency occurs, there are different IOL implantation techniques. IOL implantation in the posterior chamber is safer in eyes with low endothelial cell count, peripheral anterior synechiae, shallow anterior chamber, and glaucoma. Alternative approaches for scleral fixation techniques, both with and without sutures, continue to undergo development. In this study, we aimed to compare the postoperative outcomes of the sutured scleral fixation (SSF), haptic flanged intrascleral fixation (HFISF) and four flanged intrascleral fixation (FFISF) IOL implantation techniques in eyes with the absence of capsular support. MATERIALS AND METHODS A hundred and thirty-seven aphakic eyes with the absence of capsular support were included in the study. The patients were divided into three groups: group 1-SSF, group 2-HFISF (Yamane technique), and group 3-FFISF. Surgical time in minutes, preoperative and postoperative parameters such as best corrected visual acuity (BCVA), corneal astigmatism, lenticular astigmatism, intraocular pressure (IOP), specular microscopy, central macular thickness (CMT) were recorded. Pseudophacodonesis was assessed at 6 months postoperatively using a slit lamp, and early and late complications were recorded. RESULTS Of the 137 eyes, 69 eyes were included in the SSF group, 41 eyes in the HFISF group, and 27 eyes in the FFISF group. No statistically significant differences were observed among the three groups in terms of age, gender, preoperative mean BCVA, corneal astigmatism, IOP, endothelial cell density, and CMT. It was observed that the mean BCVA significantly improved compared to the preoperative visual acuity in all three groups. Postoperative lenticular astigmatism, pseudophacodonesis score, percentage of the endothelial cell loss were found to be higher in FFISF groups. The surgical time was found to be shorter in the HFISF group. IOL decentration was observed in 1.44% of the SSF group and 7.40% of the FFISF group. Cystoid macular edema was observed in 5.79% of the SSF group, 4.87% of the HFISF group, and 7.40% of the FFISF group. Retinal detachment was observed in 1.44% of the SSF group and 7.31% of the HFISF group. CONCLUSIONS The optimal technique for treating aphakia without capsular support remains uncertain. Surgeons are tasked with a complex decision, aiming for both excellent vision and minimal risk. This decision is based on their expertise, the distinctive ocular condition of the patient, and the availability of essential operating room equipment. In this study, the following findings were observed: in the HFISF technique, the average surgical time was found to be shorter, the SSF technique demonstrated greater stability in terms of astigmatism and pseudophacodonesis and the FFISF technique was recognized for its relatively straightforward application method. It is important to note that the three IOL implantation techniques yielded comparable outcomes in terms of postoperative BCVA, as well as early and late complications.
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Affiliation(s)
- Ali Altan Ertan Boz
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey.
| | - Mahmut Atum
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - Sedat Özmen
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - İsa Yuvacı
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - Erkan Çelik
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
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Liu M, Song W, Gao W, Jiang L, Pan H, Luo D, Shi L. Impact of Latent Virus Infection in the Cornea on Corneal Healing after Small Incision Lenticule Extraction. Microorganisms 2023; 11:2441. [PMID: 37894101 PMCID: PMC10609374 DOI: 10.3390/microorganisms11102441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of the present study is to analyze the impact of cornea virus latent infection on corneal healing after small incision lenticule extraction (SMILE) and predict the positive rate of virus latent infection in corneal stroma. A total of 279 patients who underwent SMILE were included in this study. Fluorescence quantitative PCR was used to detect virus infection in the lenticules, which were taken from the corneal stroma during SMILE. Herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) were detected. Postoperative visual acuity, spherical equivalent, intraocular pressure, corneal curvature (Kf and Ks), corneal transparency, and corneal staining were compared between the virus-positive group and the virus-negative group. The number of corneal stromal cells and inflammatory cells, corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), corneal total branch density (CTBD), and corneal nerve fiber width (CNFW) were evaluated using an in vivo confocal microscope. Out of 240 herpes simplex virus (HSV) tested samples, 11 (4.58%) were positive, among which 5 (2.08%) were HSV-1-positive and 6 (2.50%) were HSV-2-positive. None of the 91 CMV- and EBV-tested samples were positive. There was no statistical significance in the postoperative visual acuity, spherical equivalent, intraocular pressure, Kf and Ks, corneal transparency, corneal staining, the number of corneal stromal cells and inflammatory cells, CNFD, CNBD, CNFL, CTBD, and CNFW between the virus-positive and virus-negative groups (p > 0.05). In conclusion, there is a certain proportion of latent HSV infection in the myopia population. Femtosecond lasers are less likely to activate a latent infection of HSV in the cornea. The latent infection of HSV has no significant impact on corneal healing after SMILE.
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Affiliation(s)
- Ming Liu
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
| | - Wenting Song
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Hefei 230001, China; (W.S.); (D.L.)
| | - Wen Gao
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
| | - Lili Jiang
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
| | - Hongbiao Pan
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
| | - Dan Luo
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Hefei 230001, China; (W.S.); (D.L.)
| | - Lei Shi
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
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Liu J, Guo X, Wei Z, Zhang Y, Zhang Z, Xu X, Liang Q. Infectious Keratitis After Keratorefractive Surgery: Update and Review of the Literature. Eye Contact Lens 2023; 49:275-282. [PMID: 37166228 PMCID: PMC10281179 DOI: 10.1097/icl.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To summarize the clinical manifestations, microbiological profile, treatment, and prognosis of corneal infections after different keratorefractive surgery. METHODS To obtain relevant studies, English-language databases, including PubMed, Ovid Embase, Web of Science, and CLNAHL, were searched from January 1979 to March 2022. The fundamentals of the literature, clinical characteristics, pathogens, and treatments were retrieved for each included article. RESULTS Eighty-four studies involving 306 infectious eyes were included in this review. Risk factors of potential infection included a history of blepharitis, contact lens usage, and contaminated surgical instruments. The mean onset time was 22.9±38.7 days (range: 1 day to 3 years). The most common organism isolated from infectious keratitis after keratorefractive surgery were Staphylococcus aureus , followed by Mycobacterium and coagulase-negative Staphylococcus . Most of the infections after refractive procedures were sensitive to medical treatment alone, and the ultimate best-corrected visual acuity after medical treatment was as follows: 20/20 or better in 82 cases (37.0%), 20/40 or better in 170 cases (76.5%), and worse than 20/40 in 52 cases (23.5%). Surgical interventions including flap lift, flap amputation, ring removal, and keratoplasty were performed in 120 eyes (44.5%). CONCLUSIONS Most infections after keratorefractive surgery occur within a week, whereas more than half of the cases after laser-assisted in situ keratomileusis happen after about a month. Gram-positive cocci and mycobacterium are the most common isolates. Infections after LASIK, intracorneal ring (ICR) implantation, and small incision lenticule extraction, which primarily occur between the cornea layers, require irrigation of the tunnels or pocket with antibiotics.
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Affiliation(s)
- Jiamin Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xiaoyan Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Yuheng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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Ung L, Chodosh J. Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis. Ocul Surf 2023; 28:378-400. [PMID: 34461290 PMCID: PMC10721114 DOI: 10.1016/j.jtos.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Ong HS, Sharma N, Phee LM, Mehta JS. Atypical microbial keratitis. Ocul Surf 2023; 28:424-439. [PMID: 34768003 DOI: 10.1016/j.jtos.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/16/2023]
Abstract
Atypical microbial keratitis refers to corneal infections caused by micro-organisms not commonly encountered in clinical practice. Unlike infections caused by common bacteria, cases of atypical microbial keratitis are often associated with worse clinical outcomes and visual prognosis. This is due to the challenges in the identification of causative organisms with standard diagnostic techniques, resulting in delays in the initiation of appropriate therapies. Furthermore, due to the comparatively lower incidence of atypical microbial keratitis, there is limited literature on effective management strategies for some of these difficult to manage corneal infections. This review highlights the current management and available evidence of atypical microbial keratitis, focusing on atypical mycobacteria keratitis, nocardia keratitis, achromobacter keratitis, and pythium keratitis. It will also describe the management of two uncommonly encountered conditions, infectious crystalline keratopathy and post-refractive infectious keratitis. This review can be used as a guide for clinicians managing patients with such challenging corneal infections.
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Affiliation(s)
- Hon Shing Ong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore; Tissue Engineering and Cell Therapy Department, Singapore Eye Research Institute, Singapore; Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore.
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Lynette M Phee
- Department of Pathology, Sengkang General Hospital, SingHealth, Singapore
| | - Jodhbir S Mehta
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore; Tissue Engineering and Cell Therapy Department, Singapore Eye Research Institute, Singapore; Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore; School of Material Science & Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
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Soleimani M, Keykhaei M, Tabatabaei SA, Shahriari M, Farrokhpour H, Ramezani B, Cheraqpour K. Post photorefractive keratectomy (PRK) infectious keratitis; six-year experience of a tertiary eye hospital. Eye (Lond) 2023; 37:631-637. [PMID: 35273348 PMCID: PMC9998852 DOI: 10.1038/s41433-022-02009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES As an essential development in the new century, surface ablation procedures have attracted increasing attention. There exists a concern regarding the risk of infectious keratitis. Hence, we aimed to investigate the rate and predisposing factors of infectious keratitis after photorefractive keratectomy (PRK). SUBJECTS/METHODS This retrospective study was designed in two phases. First, the rate of post-PRK keratitis of Farabi Eye Hospital was investigated. In other words, the targeted population was the patients who developed keratitis after performing procedure at Farabi Eye Hospital. In the second phase, all the patients with the diagnosis of post-PRK keratitis were studied regardless of the centre where surgery was performed. Patients with the diagnosis of infectious keratitis between 2014 and 2020 were enrolled and following information was analyzed: demographics, presentation time after surgery, perioperative medications, culture results, risk factors, medical treatment, complications, and final visual acuity. RESULTS The total number of PRK procedures in our centre was 24,986 (13,253 patients), in which 6 eyes of 5 patients developed keratitis. Beside these 5 patients, 24 referred patients (24 eyes) from the other centres were enrolled. Finally, a total number of 29 patients (30 eyes) were included. Our analysis revealed that manipulation of contact lens, dry eye, and blepharitis were the essential predisposing factors for keratitis development. CONCLUSION The overall post-PRK keratitis occurrence rate of our study was 0.02%. Our observation highlighted the importance of preoperative examination and treatment of the lids and dry eye disease.
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Affiliation(s)
- Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoor Shahriari
- Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Farrokhpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Ramezani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Nie AQ, Chen XM, Li Q. Herpes simplex keratitis following Smart Pulse Technology assisted transepithelial photorefractive keratectomy: a case report. BMC Ophthalmol 2022; 22:442. [DOI: 10.1186/s12886-022-02654-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Herpes simplex keratitis (HSK) is a rare and sight-threatening complication following refractive surgery. SmartSurfACE surgery is the result of combining transepithelial photorefractive keratectomy (trans-PRK) with Smart Pulse Technology (SPT) to diminish surface irregularities of the residual stromal bed after surgery with less pain, faster re-epithelialization, and better postoperative visual acuity. In this article, we report the first case of HSK following SmartSurf ACE without history of herpetic eye disease.
Case presentation
A 21-year-old woman underwent bilateral SmartSurfACE without history of clinical herpetic infection, active eye disease, or systemic disease. Mild superficial punctate keratitis occurred on the tenth postoperative day. The condition was not improved by ophthalmic drugs of anti-inflammation or epithelial healings. Dendritic corneal ulcer appeared within one month, which is the commonly recognized clinical manifestation of herpes simplex keratitis. The patient was managed with topical and systemic antiviral agents. After nine days of antiviral therapy, the lesion healed up, remaining mild stromal scarring in both eyes ultimately.
Conclusion
Herpes simplex keratitis is a rare but sight-threatening complication following refractive surgery. For the ocular irritation symptoms of postoperative patients, we should consider the possibility of HSK and give timely treatment.
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Agarwal S, Khan TA, Vanathi M, Srinivasan B, Iyer G, Tandon R. Update on diagnosis and management of refractory corneal infections. Indian J Ophthalmol 2022; 70:1475-1490. [PMID: 35502013 PMCID: PMC9333031 DOI: 10.4103/ijo.ijo_2273_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/16/2021] [Accepted: 10/26/2021] [Indexed: 11/06/2022] Open
Abstract
Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to the emergence of resistant or refractory microorganisms has further worsened the prognosis. Coexisting ocular surface diseases, delay in diagnosis due to inadequate microbiological sample, a slow-growing/virulent organism, or systemic immunosuppressive state all contribute to the refractory response of the ulcer. With improved understanding of these varied ocular and systemic factors contributing to the refractory nature of the microbes, role of biofilm formation and recent research on improving the bioavailability of drugs along with the development of alternative therapies have helped provide the required multidimensional approach to effectively diagnose and manage cases of refractory corneal ulcers and prevent corneal perforations or further dissemination of disease. In this review, we explore the current literature and future directions of the diagnosis and treatment of refractory keratitis.
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Affiliation(s)
- Shweta Agarwal
- Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface Disorders, C. J. Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Tanveer A Khan
- Cornea, Lens and Refractive Surgery Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi, India
| | - Murugesan Vanathi
- Cornea, Lens and Refractive Surgery Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi, India
| | - Bhaskar Srinivasan
- Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface Disorders, C. J. Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Geetha Iyer
- Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface Disorders, C. J. Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Radhika Tandon
- Cornea, Lens and Refractive Surgery Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi, India
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Susceptibility of Ocular Staphylococcus aureus to Antibiotics and Multipurpose Disinfecting Solutions. Antibiotics (Basel) 2021; 10:antibiotics10101203. [PMID: 34680784 PMCID: PMC8533015 DOI: 10.3390/antibiotics10101203] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 12/18/2022] Open
Abstract
Staphylococcus aureus is a frequent cause of ocular surface infections worldwide. Of these surface infections, those involving the cornea (microbial keratitis) are most sight-threatening. S. aureus can also cause conjunctivitis and contact lens-related non-infectious corneal infiltrative events (niCIE). The aim of this study was to determine the rates of resistance of S. aureus isolates to antibiotics and disinfecting solutions from these different ocular surface conditions. In total, 63 S. aureus strains from the USA and Australia were evaluated; 14 were from niCIE, 26 from conjunctivitis, and 23 from microbial keratitis (MK). The minimum inhibitory (MIC) and minimum bactericidal concentrations (MBC) of all the strains to ciprofloxacin, ceftazidime, oxacillin, gentamicin, vancomycin, chloramphenicol, azithromycin, and polymyxin B were determined. The MIC and MBC of the niCIE strains to contact lens multipurpose disinfectant solutions (MPDSs) was determined. All isolates were susceptible to vancomycin (100%). The susceptibility to other antibiotics decreased in the following order: gentamicin (98%), chloramphenicol (76%), oxacillin (74%), ciprofloxacin (46%), ceftazidime (11%), azithromycin (8%), and polymyxin B (8%). In total, 87% of all the isolates were multidrug resistant and 17% of the isolates from microbial keratitis were extensively drug resistant. The microbial keratitis strains from Australia were usually susceptible to ciprofloxacin (57% vs. 11%; p = 0.04) and oxacillin (93% vs. 11%; p = 0.02) compared to microbial keratitis isolates from the USA. Microbial keratitis isolates from the USA were less susceptible (55%) to chloramphenicol compared to conjunctivitis strains (95%; p = 0.01). Similarly, 75% of conjunctivitis strains from Australia were susceptible to chloramphenicol compared to 14% of microbial keratitis strains (p = 0.04). Most (93%) strains isolated from contact lens wearers were killed in 100% MPDS, except S. aureus 27. OPTI-FREE PureMoist was the most active MPDS against all strains with 35% of strains having an MIC ≤ 11.36%. There was a significant difference in susceptibility between OPTI-FREE PureMoist and Biotrue (p = 0.02). S. aureus non-infectious CIE strains were more susceptible to antibiotics than conjunctivitis strains and conjunctivitis strains were more susceptible than microbial keratitis strains. Microbial keratitis strains from Australia (isolated between 2006 and 2018) were more susceptible to antibiotics in comparison with microbial keratitis strains from the USA (isolated in 2004). Most of the strains were multidrug-resistant. There was variability in the susceptibility of contact lens isolates to MPDSs with one S. aureus strain, S. aureus 27, isolated from niCIE, in Australia in 1997 being highly resistant to all four MPDSs and three different types of antibiotics. Knowledge of the rates of resistance to antibiotics in different conditions and regions could help guide treatment of these diseases.
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Lu M, Parel JM, Miller D. Interactions between staphylococcal enterotoxins A and D and superantigen-like proteins 1 and 5 for predicting methicillin and multidrug resistance profiles among Staphylococcus aureus ocular isolates. PLoS One 2021; 16:e0254519. [PMID: 34320020 PMCID: PMC8318242 DOI: 10.1371/journal.pone.0254519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant (MDR) S. aureus strains are well recognized as posing substantial problems in treating ocular infections. S. aureus has a vast array of virulence factors, including superantigens and enterotoxins. Their interactions and ability to signal antibiotics resistance have not been explored. OBJECTIVES To predict the relationship between superantigens and methicillin and multidrug resistance among S. aureus ocular isolates. METHODS We used a DNA microarray to characterize the enterotoxin and superantigen gene profiles of 98 S. aureus isolates collected from common ocular sources. The outcomes contained phenotypic and genotypic expressions of MRSA. We also included the MDR status as an outcome, categorized as resistance to three or more drugs, including oxacillin, penicillin, erythromycin, clindamycin, moxifloxacin, tetracycline, trimethoprim-sulfamethoxazole and gentamicin. We identified gene profiles that predicted each outcome through a classification analysis utilizing Random Forest machine learning techniques. FINDINGS Our machine learning models predicted the outcomes accurately utilizing 67 enterotoxin and superantigen genes. Strong correlates predicting the genotypic expression of MRSA were enterotoxins A, D, J and R and superantigen-like proteins 1, 3, 7 and 10. Among these virulence factors, enterotoxin D and superantigen-like proteins 1, 5 and 10 were also significantly informative for predicting both MDR and MRSA in terms of phenotypic expression. Strong interactions were identified including enterotoxins A (entA) interacting with superantigen-like protein 1 (set6-var1_11), and enterotoxin D (entD) interacting with superantigen-like protein 5 (ssl05/set3_probe 1): MRSA and MDR S. aureus are associated with the presence of both entA and set6-var1_11, or both entD and ssl05/set3_probe 1, while the absence of these genes in pairs indicates non-multidrug-resistant and methicillin-susceptible S. aureus. CONCLUSIONS MRSA and MDR S. aureus show a different spectrum of ocular pathology than their non-resistant counterparts. When assessing the role of enterotoxins in predicting antibiotics resistance, it is critical to consider both main effects and interactions.
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Affiliation(s)
- Min Lu
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Jean-Marie Parel
- Department of Ophthalmology, Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Darlene Miller
- Department of Ophthalmology, Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
- * E-mail:
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Late onset of microbial keratitis after laser in situ keratomileusis surgery: case series. J Cataract Refract Surg 2021; 47:1044-1049. [PMID: 34292889 DOI: 10.1097/j.jcrs.0000000000000581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To report predisposing factors, clinical features, microbiology spectrum, antibiotic resistance, antimicrobial therapy, and outcomes of patients with a previous laser in situ keratomileusis (LASIK) surgery and diagnosed with presumed microbial keratitis. SETTING Sydney Eye Hospital, Sydney, New South Wales, Australia. DESIGN Retrospective case review. METHODS Patients were identified from pathology and hospital coding data from 2012 to 2016. Inclusion criteria were all patients with a previous LASIK surgery, a presumed diagnosis of microbial keratitis, and a corneal scrape performed and aged older than 18 years. Demographics, clinical details, and outcomes were collated from the medical records. RESULTS Sixteen patients were included, with median age of 41.5 years (range 22 to 85 years) and 56.2% of women. The median time between LASIK procedure and microbial keratitis presentation was 38.3 months (interquartile range 6.7 to 77.45 months). Cultures were positive for bacteria in 12 (75%) of 16 scrapes. Of the bacterial isolates, 12 (85.7%) were gram-positive and 2 (14.3%) gram-negative. Sensitivity profiles for the isolated bacteria were similar between fortified antibiotics (cefalotin and gentamicin) and commercial products (chloramphenicol and ofloxacin). Complications included the need for tectonic grafts, nonhealing epithelial defects, thinning, and neovascularization. CONCLUSIONS Late onset of keratitis after LASIK can occur with no positive cultures for nontuberculous mycobacteria, no interface involvement, and no other usual features reported in case series of infectious keratitis in LASIK patients. It has a similar clinical course to non-LASIK keratitis, such that the surgery may not have been a risk factor for infection.
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Postrefractive infectious keratitis: prevention, diagnosis, management, and prognosis. Curr Opin Ophthalmol 2021; 32:309-314. [PMID: 33973908 DOI: 10.1097/icu.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Improve outcomes from an elective procedure by preventing a rare but sight-threatening complication. RECENT FINDINGS Advancement in anti-infective prophylaxis, and therefore shift in the causative organism permits better diagnostic and empiric management. SUMMARY Infectious keratitis presents in different patterns depending on the refractive procedure. Atypical causative organisms may respond poorly to empiric therapy and impair vision. Therefore, microbial identification is of utmost importance and therapy is adjusted accordingly.
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Das S, Garg P, Mullick R, Annavajjhala S. Keratitis following laser refractive surgery: Clinical spectrum, prevention and management. Indian J Ophthalmol 2021; 68:2813-2818. [PMID: 33229656 PMCID: PMC7856934 DOI: 10.4103/ijo.ijo_2479_20] [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] [Indexed: 11/29/2022] Open
Abstract
Laser refractive surgery (LRS) is one of the most demanding areas of ophthalmic surgery and high level of precision is required to meet outcome expectations of patients. Post-operative recovery is of vital importance. Keratitis occurring after LRS can delay visual recovery. Both surface ablations [Photorefractive keratectomy (PRK)] as well as flap procedures [Laser in-situ keratomileusis (LASIK)/Small incision lenticule extraction] are prone to this complication. Reported incidence of post-LRS infectious keratitis is between 0% and 1.5%. The rate of infections after PRK seems to be higher than that after LASIK. Staphylococci, streptococci, and mycobacteria are the common etiological organisms. About 50–60% of patients present within the first week of surgery. Of the non-infectious keratitis, diffuse lamellar keratitis (DLK) is the most common with reported rates between 0.4% and 4.38%. The incidence of DLK seems to be higher with femtosecond LASIK than with microkeratome LASIK. A lot of stress is laid on prevention of this complication through proper case selection, asepsis, and use of improved protocols. Once keratitis develops, the right approach can help resolve this condition quickly. In cases of suspected microbial keratitis, laboratory identification of the organism is important. Most lesions resolve with medical management alone. Interface irrigation, flap amputation, collagen cross-linking and therapeutic penetrating keratoplasty (TPK) are reserved for severe/non-resolving cases. About 50–75% of all infectious keratitis cases post LRS resolve with a final vision of 20/40 or greater. Improved awareness, early diagnosis, and appropriate intervention can help limit the damage to cornea and preserve vision.
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Affiliation(s)
- Shilpa Das
- Cornea and Refractive Services, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Prashant Garg
- Paul Dubord Chair of Cornea, L.V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ritika Mullick
- Cornea and Refractive Services, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sriram Annavajjhala
- Cornea and Refractive Services, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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Ramirez-Miranda A, Mangwani-Mordani S, Quiroz-Casian N, Oliva-Bienzobas V, Cabral-Macias J, Navas A, Graue-Hernandez EO. Combined Bacterial and Herpes Simplex Virus Keratitis following Small-Incision Lenticule Extraction for the Correction of Myopia. Case Rep Ophthalmol 2021; 12:227-231. [PMID: 33976687 PMCID: PMC8077540 DOI: 10.1159/000511374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022] Open
Abstract
A 28-year-old male presented unilateral visual loss, intense ocular pain, redness and intraocular hypertension in his right eye 2 days after undergoing small-incision lenticule extraction (SMILE) in both eyes. Initial examination of the affected eye revealed the presence of white infiltrates within the corneal interface, as well as a central epithelial defect. The patient was diagnosed with infectious keratitis, posteriorly the eye was irrigated with balanced saline solution and treatment was initiated with hourly moxifloxacin 0.5%. Since this approach failed to resolve symptoms, a sample from the interface was obtained for PCR assay, which revealed the presence of herpes simplex virus DNA, confirming the cause of the infection. The patient was prescribed a regimen of oral acyclovir, topical ganciclovir and prednisolone. Clinical improvement following resolution of the epithelial defect was observed. Although rare, herpetic keratitis following SMILE is best managed via early diagnosis and initiation of appropriate anti-herpetic treatment.
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Affiliation(s)
- Arturo Ramirez-Miranda
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Simran Mangwani-Mordani
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Natalia Quiroz-Casian
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Valeria Oliva-Bienzobas
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Jesus Cabral-Macias
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Alejandro Navas
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Enrique O Graue-Hernandez
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
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Ganesh S, Brar S, Nagesh BN. Management of infectious keratitis following uneventful small-incision lenticule extraction using a multimodal approach - A case report. Indian J Ophthalmol 2020; 68:3064-3066. [PMID: 33229708 PMCID: PMC7856942 DOI: 10.4103/ijo.ijo_2418_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 42-year-old female presented with pain, photophobia, and superficial corneal infiltrates in mid-periphery in the left eye, after 2 days of uneventful bilateral SMILE procedure. Inspite of the medical treatment with fortified antibiotics, the infection spread to the interface, close to visual axis reducing UDVA from 20/16 to 20/80. Immediate surgical intervention in the form of scraping of interface lesions with 26G needle, interface wash with antibiotics and photoactivated chromophore for keratitis (PACK-CXL) was performed. After 24 h of bacterial culture Staphylococcus aureus was yielded. Interface wash and PACK-CXL was repeated after 48 h by which infiltrates reduced and early scarring was observed by 10th post-op day. Subsequent topical steroids helped in limiting scar formation and UDVA improved to 20/30 at the final visit. Combined approach of interface wash with antibiotics and PACK-CXL may be a safe and effective modality in treating early onset infectious keratitis following SMILE surgery.
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Affiliation(s)
- Sri Ganesh
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - B N Nagesh
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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Afsharpaiman S, Zare M, Yasemi M, Jamialahmadi T, Sahebkar A. The Prevalence of Infectious Keratitis after Keratorefractive Surgery: A Systematic Review and Meta-Analysis Study. J Ophthalmol 2020; 2020:6329321. [PMID: 32774907 PMCID: PMC7407012 DOI: 10.1155/2020/6329321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The keratorefractive surgeries (KRS) are one of the most common ocular surgeries. One of the dangerous complications of these surgeries is infectious keratitis (IK), which is the second cause of blindness after cataract surgery. The purpose of this study was to estimate the prevalence of IK after KRS in different parts of the world. METHODS In order to obtain relevant studies, all national and international databases including IranMedex, SID, Magiran, IranDoc, Medlib, ScienceDirect, PubMed, Scopus, Cochrane, Embase, Web of Science, and Google Scholar were searched using standard keywords. RESULTS IK prevalence after KRS was 0.000496% (0.000145% for the left eye and 0.000149% for the right eye). IK prevalence after KRS in the United States, Europe, and Asia was 0.000667%, 0.000473%, and 0.000045%, respectively, in all of which the common microorganisms were Staphylococci. Meta-regression showed no significant association between IK after KRS and either sample size or publication year of the studies. IK prevalence after KRS in the right eye was more than that in the left one. Also, the probability of IK incidence after LASIK surgery was more than PRK and LASEK. In the evaluation of continents, IK after KRS in the United States was more frequent compared with Europe and Asia. CONCLUSIONS This study provided data as to the overall prevalence of IK following KRS and its variations according to the types of eye, surgery, pathogenic microorganism, and geographical location.
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Affiliation(s)
- Shahla Afsharpaiman
- Health Research Center, Life Style Institute, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - Musa Zare
- Department of Ophthalmology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Masoud Yasemi
- Health Research Center, Life Style Institute, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - Tannaz Jamialahmadi
- Department of Food Science and Technology, Quchan Branch, Islamic Azad University, Quchan, Iran
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Halal Research Center of IRI, FDA, Tehran, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Thareja T, Kowalski RP, Jhanji V, Kamyar R, Dhaliwal DK. MRSA Keratitis and Conjunctivitis: What Does It Mean Practically? CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00206-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Very late-onset flap margin corneal ulcer following laser in situ keratomileusis. Int Ophthalmol 2019; 39:2533-2538. [PMID: 30982142 DOI: 10.1007/s10792-019-01100-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To report and characterize cases of very late onset (5 years or more after surgery) flap margin corneal ulcers after laser in situ keratomileusis (LASIK) procedure. METHODS A retrospective case series of consecutive patients who were diagnosed with very late flap margin corneal ulcers following LASIK, between January 2014 and July 2017. All patients were treated with topical antibiotics and were followed up until complete resolution. RESULTS A total of eight patients, with a mean age of 46.5 ± 11 years, (range 31-64 years), were included in this study. All patients underwent uneventful myopic LASIK 13.3 ± 3 (range 10-20) years before presentation. Patients best corrected visual acuity (BCVA) at presentation was 0.20 ± 0.15 logMAR compared to a final BCVA of 0.10 ± 0.10 logMAR (p = 0.28). The ulcer was located in the bottom two clock hours of the flap margin (5-7 o'clock) in six (75%) patients and superior (11 o'clock) in the remaining two patients (p = 0.048). Seven patients (87.5%) suffered from blepharitis, and only one did not. CONCLUSIONS LASIK may be associated with an increased risk of late-onset corneal ulcer occurring years after the procedure. Instability of the flap margin, blepharitis and dry eye are possible causes of epithelial disturbance and may account for this complication.
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Chehaibou I, Sandali O, Ameline B, Bouheraoua N, Borderie V, Laroche L. Bilateral infectious keratitis after small-incision lenticule extraction. J Cataract Refract Surg 2018; 42:626-30. [PMID: 27113888 DOI: 10.1016/j.jcrs.2016.03.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 12/28/2022]
Abstract
UNLABELLED We report the clinical features and management of a patient with severe bilateral infectious keratitis developing after simultaneous bilateral small-incision lenticule extraction. A 39-year-old man was referred to our emergency department 2 days after a small-incision lenticule extraction procedure for moderate myopia. He reported decreased vision, photophobia, and pain bilaterally. Visual acuity was counting fingers in the right eye and hand motion in the left eye. Slitlamp examination showed multiple white corneal infiltrates at the corneal cap-stromal bed interface. The interface was first rinsed with povidone-iodine 10.0% and then with vancomycin (50 mg/mL). Fortified antibiotics eyedrops administration was initiated. Cultures showed Streptococcus pneumonia. Anterior segment spectral-domain optical coherence tomography scans were performed daily. Once the infection was controlled 4 days later, corticosteroids eyedrops were begun. Three months postoperatively, the patient had a corrected distance visual acuity of 20/32 in the right eye and 20/25 in the left eye. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Ismaël Chehaibou
- From Quinze-Vingts National Eye Hospital, UPMC - Sorbonne Universities, Paris, France.
| | - Otman Sandali
- From Quinze-Vingts National Eye Hospital, UPMC - Sorbonne Universities, Paris, France
| | - Barbara Ameline
- From Quinze-Vingts National Eye Hospital, UPMC - Sorbonne Universities, Paris, France
| | - Nacim Bouheraoua
- From Quinze-Vingts National Eye Hospital, UPMC - Sorbonne Universities, Paris, France
| | - Vincent Borderie
- From Quinze-Vingts National Eye Hospital, UPMC - Sorbonne Universities, Paris, France
| | - Laurent Laroche
- From Quinze-Vingts National Eye Hospital, UPMC - Sorbonne Universities, Paris, France
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Bacterial Keratitis in Toronto: A 16-Year Review of the Microorganisms Isolated and the Resistance Patterns Observed. Cornea 2018; 36:1528-1534. [PMID: 28938380 DOI: 10.1097/ico.0000000000001390] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the incidence, distribution, current trends, and resistance patterns of bacterial keratitis isolates in Toronto over the past 16 years. METHODS Microbiology records of suspected bacterial keratitis that underwent a diagnostic corneal scraping and cultures from January 1, 2000, through December 31, 2015, were retrospectively reviewed. The distribution of the main isolated pathogens and in vitro laboratory minimum inhibitory concentration testing results were used to identify resistance patterns. RESULTS A total of 2330 corneal scrapings were taken over 16 years. A pathogen was recovered in 1335 samples (57.3%), with bacterial keratitis accounting for 1189 of the positive cultures (86.0% of all isolates). The total number of gram-positive and gram-negative isolates was 963 and 324, respectively. Coagulase-negative Staphylococcus and Pseudomonas aeruginosa were the most common gram-positive and gram-negative bacteria isolates, respectively. A decreasing trend in the number of isolates in gram-positive bacteria (P = 0.01), specifically among Staphylococcus aureus (P < 0.0001) and Streptococcus species (P = 0.005), was identified. When analyzing the susceptibilities of gram-positive and gram-negative isolates, an increasing trend in antibiotic resistance was observed in erythromycin (P = 0.018), ceftazidime (P = 0.046), and piperacillin/tazobactam (P = 0.005). The susceptibility of tested gram-positive microorganisms to vancomycin was 99.6%. CONCLUSIONS There has been a decreasing trend in the number of isolates in gram-positive microorganisms over the past 16 years. An increasing trend in resistance for various antibiotics against gram-negative and gram-positive isolates was identified. High susceptibility to vancomycin reinforced the empirical use of fortified tobramycin and vancomycin in the initial management of severe bacterial keratitis.
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Identification of the Infection Source of an Outbreak of Mycobacterium Chelonae Keratitis After Laser in Situ Keratomileusis. Cornea 2018; 37:116-122. [PMID: 29111994 DOI: 10.1097/ico.0000000000001423] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Nontuberculous mycobacteria keratitis is a rare but challenging complication of laser in situ keratomileusis (LASIK). This study was conducted to determine the source(s) of infection in a cluster of cases of keratitis after LASIK and to describe this outbreak and patients' outcomes. METHODS In this retrospective, case series, single-center study, 86 patients were included who underwent LASIK or photorefractive keratectomy between December 2011 and February 2012. Corneal scrapes from the affected eyes, samples of tap and distilled water, water from the reservoir of the distilling equipment, steamer, and autoclave cassette; antiseptic and anesthetic solutions and surgical instrument imprints were cultivated in liquid and on solid media. Gram-negative bacteria and yeasts were identified using automated systems and mycobacteria by polymerase chain reaction-restriction enzyme analysis of the hsp65 gene (PRA-hsp65) and DNA sequencing. Mycobacterial isolates were typed by pulsed-field gel electrophoresis. The cases and outcomes are described. The main outcome measure was identification of the source(s) of the mycobacterial infections. RESULTS Eight (15 eyes) of 86 patients (172 eyes) who underwent LASIK developed infections postoperatively; no patients who underwent photorefractive keratectomy developed infections. Mycobacterium chelonae was isolated from 4 eyes. The distilled water collected in the surgical facility contained the same M. chelonae strain isolated from the patients' eyes. Different gram-negative bacteria and yeasts were isolated from samples collected at the clinic but not from the patients' eyes. CONCLUSIONS Tap water distilled locally in surgical facilities may be a source of infection after ocular surgery and its use should be avoided.
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Suzuki T, Yamamoto T, Kaito C, Miyamoto H, Ohashi Y. Impact ofpsm-mecin Methicillin-ResistantStaphylococcus aureus(ST764) Strains Isolated from Keratitis Patients. Microb Drug Resist 2016; 22:589-597. [DOI: 10.1089/mdr.2015.0315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takashi Suzuki
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Toshihiro Yamamoto
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Chikara Kaito
- Laboratory of Microbiology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Hitoshi Miyamoto
- Department of Clinical Laboratory, Ehime University Hospital, Toon, Japan
| | - Yuichi Ohashi
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Japan
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Kitazawa K, Sotozono C, Sakamoto M, Sasaki M, Hieda O, Yamasaki T, Kinoshita S. Nasal and conjunctival screening prior to refractive surgery: an observational and cross-sectional study. BMJ Open 2016; 6:e010733. [PMID: 27160843 PMCID: PMC4874159 DOI: 10.1136/bmjopen-2015-010733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To investigate bacterial flora of clinically healthy conjunctiva and nasal cavity among patients prior to refractive surgery, as well as the characteristics of patients with methicillin-resistant Staphylococcus aureus (MRSA) colonisation. DESIGN Observational and cross-sectional study. SETTING A single-centre study in Japan. PARTICIPANTS 120 consecutive patients pre-refractive surgery. PRIMARY AND SECONDARY OUTCOME MEASURES METHODS Samples were obtained from the right conjunctival sac and the nasal cavity of 120 consecutive patients prior to refractive surgery and were then measured for the levels of the minimum inhibitory concentration (MIC) of antibiotics. Patients were interviewed regarding their occupation, family living situation and any personal history of atopic dermatitis, asthma, smoking or contact lens wear. RESULTS Propionibacterium acnes (P. acnes) (32.5%) and Staphylococcus epidermidis (4.2%) were detected from the conjunctival sac. S. epidermidis was the most commonly isolated (68.3%) in the nasal cavity. Of the 30 patients (25.0%) with colonisation by S. aureus, 2 patients, both of whom were healthcare workers with atopic dermatitis, were found to be positive for MRSA in the nasal cavity. A history of contact lens wear, asthma or smoking, as well as patient gender and age, was not associated with MRSA colonisation. CONCLUSIONS There were only 2 patients who were colonised with MRSA, both of whom were healthcare workers with atopic dermatitis. P. acnes was predominantly found in the conjunctival sac. Further study is needed to investigate the involvement between nasal and conjunctival flora, and risk factors for infectious complications.
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Affiliation(s)
- Koji Kitazawa
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Baptist Eye Clinic, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masako Sakamoto
- Research Foundation for Microbial Diseases of Osaka University, Suita, Japan
| | - Miho Sasaki
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Hieda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Romanowski EG, Kowalski TA, O'Connor KE, Yates KA, Mah FS, Shanks RMQ, Kowalski RP. The In Vitro Evaluation of Tigecycline and the In Vivo Evaluation of RPX-978 (0.5% Tigecycline) as an Ocular Antibiotic. J Ocul Pharmacol Ther 2015; 32:119-26. [PMID: 26545167 DOI: 10.1089/jop.2015.0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The goals of the current study were to determine the in vitro antibacterial activity of tigecycline against multiple clinically relevant ocular pathogens and to evaluate the in vivo ocular tolerability and efficacy of 0.5% tigecycline in a methicillin-resistant Staphylococcus aureus (MRSA) keratitis model. METHODS In vitro: Minimum inhibitory concentrations (MICs) were determined for 110 clinical conjunctivitis isolates, 26 keratitis isolates of Pseudomonas aeruginosa, and 10 endophthalmitis isolates each of MRSA, methicillin-susceptible S. aureus (MSSA), MR, and MS coagulase-negative Staphylococcus. TOLERABILITY Six uninfected rabbits were topically treated in both eyes with 0.5% tigecycline, vehicle, or saline every 15 min for 3 h. EFFICACY Thirty-two rabbits were intrastromally injected with 700 Colony Forming Units (CFU) of MRSA in both eyes and were separated into 4 groups (n = 8): tigecycline 0.5%; vancomycin 5%; saline; and no treatment (euthanized before treatment for baseline CFU). Four hours after MRSA challenge, topical treatment of 1 drop every 15 min for 5 h was initiated. One hour after treatment, the corneas were harvested for CFU. The data were analyzed nonparametrically. RESULTS In vitro: Tigecycline demonstrated lower MICs than the other tested antibiotics against gram-positive organisms, especially MRSA, while MICs against gram-negative pathogens, including fluoroquinolone-resistant P. aeruginosa, appeared to be in the treatable range with aggressive topical therapy. TOLERABILITY 0.5% tigecycline was graded as minimally irritating. EFFICACY 0.5% tigecycline and vancomycin produced similar reductions in CFU and were less than saline (P < 0.05). Tigecycline and vancomycin demonstrated 99.9% reductions compared with baseline CFU. CONCLUSIONS Tigecycline is a potential candidate for a topical ocular antibiotic.
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Affiliation(s)
- Eric G Romanowski
- Department of Ophthalmology, The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center and the UPMC Eye Center, Ophthalmology and Visual Science Research Center, Eye and Ear Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Tyler A Kowalski
- Department of Ophthalmology, The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center and the UPMC Eye Center, Ophthalmology and Visual Science Research Center, Eye and Ear Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Katherine E O'Connor
- Department of Ophthalmology, The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center and the UPMC Eye Center, Ophthalmology and Visual Science Research Center, Eye and Ear Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Kathleen A Yates
- Department of Ophthalmology, The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center and the UPMC Eye Center, Ophthalmology and Visual Science Research Center, Eye and Ear Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Francis S Mah
- Department of Ophthalmology, The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center and the UPMC Eye Center, Ophthalmology and Visual Science Research Center, Eye and Ear Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Robert M Q Shanks
- Department of Ophthalmology, The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center and the UPMC Eye Center, Ophthalmology and Visual Science Research Center, Eye and Ear Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Regis P Kowalski
- Department of Ophthalmology, The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center and the UPMC Eye Center, Ophthalmology and Visual Science Research Center, Eye and Ear Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
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Abstract
PURPOSE We compared the resistance patterns of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) keratitis isolates with the common topically applied ophthalmic antimicrobials. METHODS We reviewed the antibiotic susceptibility results of 122 MRSA and 276 MSSA keratitis isolates from January 1993 to November 2012. In vitro susceptibility testing of each Staphylococcus aureus (SA) isolate was performed using Kirby-Bauer disk diffusion based on modified serum interpretations for cefoxitin, bacitracin, cefazolin, ciprofloxacin, gatifloxacin, gentamicin, moxifloxacin, ofloxacin, polymyxin B, sulfamethoxazole, tobramycin, and trimethoprim. RESULTS MRSA represented 30.7% (122 of 398) of the total SA isolates. All the SA isolates were susceptible to vancomycin, whereas they were less susceptible to the fluoroquinolones than to the non-fluoroquinolones. In comparison with MSSA, MRSA was significantly more resistant to all the antibiotics tested other than polymyxin B (both equally resistant) and vancomycin (both equally susceptible) (P < 0.001). Besides vancomycin, MRSA demonstrated the best susceptibilities to sulfamethoxazole (94.3%), bacitracin (89.3%), trimethoprim (88.5%), and gentamicin (86.1%). Additionally, MRSA was found to be significantly more resistant to the second-generation fluoroquinolones (ciprofloxacin and ofloxacin) than to the fourth-generation fluoroquinolones (moxifloxacin and gatifloxacin). An increase in resistance to the fourth-generation fluoroquinolones was detected for both MRSA and MSSA over the study period. CONCLUSIONS The in vitro susceptibilities of commonly used topical antibiotics differ for MRSA and MSSA isolates; thus, successful treatment of bacterial keratitis should be supported with laboratory studies. Vancomycin remains the treatment of choice for MRSA keratitis. The empiric use of second-generation fluoroquinolones seems to be contraindicated in the treatment of MRSA keratitis.
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Post-keratorefractive Surgery Infections: Management Strategies. CURRENT OPHTHALMOLOGY REPORTS 2015. [DOI: 10.1007/s40135-015-0074-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Methicillin-Resistant Staphylococcus aureus Ocular Infection after Corneal Cross-Linking for Keratoconus: Potential Association with Atopic Dermatitis. Case Rep Ophthalmol Med 2015; 2015:613273. [PMID: 25866692 PMCID: PMC4381680 DOI: 10.1155/2015/613273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To report the risk of methicillin-resistant Staphylococcus aureus (MRSA) ocular infection after UVA-riboflavin corneal collagen cross-linking in a patient with atopic dermatitis. Methods. A 22-year-old man, with bilateral evolutive keratoconus and atopic dermatitis, underwent UVA-riboflavin corneal cross-linking and presented with rapidly progressive corneal abscesses and cyclitis in the treated eye five days after surgery. The patient was admitted to the hospital and treated with broad-spectrum antimicrobic therapy. Results. The patient had positive cultures for MRSA, exhibiting a strong resistance to antibiotics. Antibiotic therapy was modified and targeted accordingly. The intravitreal reaction is extinguished, but severe damage of ocular structures was unavoidable. Conclusion. Riboflavin/UVA corneal cross-linking is considered a safe procedure and is extremely effective in halting keratoconus' progression. However, this procedure is not devoid of infectious complications, due to known risk factors and/or poor patients' hygiene compliance in the postoperative period. Atopic dermatitis is a common disease among patients with keratoconus and Staphylococcus aureus colonization is commonly found in patients with atopic dermatitis. Therefore, comorbidity with atopic dermatitis should be thoroughly assessed through clinical history before surgery. A clinical evaluation within three days after surgery and the imposition of strict personal hygiene rules are strongly recommended.
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Schechter BA, Parekh JG, Trattler W. Besifloxacin ophthalmic suspension 0.6% in the treatment of bacterial keratitis: a retrospective safety surveillance study. J Ocul Pharmacol Ther 2014; 31:114-21. [PMID: 25409447 DOI: 10.1089/jop.2014.0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The objective of this study was to collect and evaluate retrospective safety information about the use of besifloxacin ophthalmic suspension 0.6% for the treatment of bacterial keratitis. METHODS This was a retrospective, postmarketing surveillance study conducted at 10 clinical centers in the United States. The study population included 142 patients treated with besifloxacin ophthalmic suspension 0.6% for bacterial keratitis in one or both eyes. For perspective, data on 85 patients treated at these centers with moxifloxacin ophthalmic solution 0.5% for bacterial keratitis were also included. The analysis was designed to measure the types and rates of adverse events (AEs) reported during the treatment of bacterial keratitis with besifloxacin ophthalmic suspension 0.6%. Other treatment outcomes of interest included the development of corneal scarring and corneal neovascularization, measured or presumed bacterial eradication, ending visual acuity, and duration of pain before and after treatment. RESULTS There was one reported AE of mild superficial punctate keratitis in a patient using besifloxacin ophthalmic suspension 0.6%. The difference in AE frequencies between groups was not significant (P>0.999). Additional treatment outcomes were similar for both groups. Limitations of this report include the retrospective nature of the study. CONCLUSIONS These retrospective data suggest that besifloxacin ophthalmic suspension 0.6% was well tolerated when included in the treatment of bacterial keratitis; no serious AEs were reported. A prospective clinical trial is needed to better isolate the contribution of besifloxacin to the therapeutic outcome and to confirm these observations.
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Goktas S, Kurtoglu MG, Sakarya Y, Ugurluoglu C, Ozcimen M, Sakarya R, Alpfidan I, Ivacık IS, Erdogan E, Bukus A. New therapy option for treatment of methicillin-resistant Staphylococcus aureus keratitis: tigecycline. J Ocul Pharmacol Ther 2014; 31:122-7. [PMID: 25330310 DOI: 10.1089/jop.2014.0052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of the present study was to evaluate the effectiveness of topically applied tigecycline for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) in a rabbit model. METHODS Experimental bacterial keratitis was induced in rabbits by a corneal intrastromal injection of 100 colony-forming units (CFUs) of MRSA bacteria. Sixteen hours after the injection, 28 rabbits were randomly divided into 4 treatment groups of 7 rabbits each. In each group, the rabbits' eyes were treated topically with 19 doses of topical tigecycline (10 or 50 mg/mL), vancomycin (50 mg/mL), or isotonic saline. Slit lamp examinations were performed before and after the inoculation by two observers masked to the study for the determination of clinical severity. Corneas were harvested for bacterial quantitation and histopathologic examination. RESULTS No significant differences were observed in the clinical scores between pretreatment and posttreatment in the 4 groups (P>0.05). The mean difference between the pretreatment and posttreatment clinical scores from the 4 treatment groups was also not significant (P>0.05). All treatment groups had significantly lower CFUs compared with the control group. There were no significant differences in the bacterial load among the treatment groups. The minimum inhibitory concentration (MIC) for tigecycline was 0.12 μg/mL, whereas the MIC for vancomycin was 2.2 μg/mL. The tigecycline 10 mg/mL group had the lowest mean epithelial erosion values among the treatment groups. CONCLUSIONS Topical tigecycline significantly reduced the bacterial load in infected rabbit corneas and may be as effective as vancomycin for the topical treatment of MRSA keratitis.
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Affiliation(s)
- Sertan Goktas
- 1 Department of Ophthalmology, Konya Training and Research Hospital , Konya, Turkey
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Genotypic characterization of Staphylococcus aureus isolates from cases of keratitis and healthy conjunctival sacs. Cornea 2014; 33:72-6. [PMID: 24145629 DOI: 10.1097/ico.0b013e3182a4810f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Staphylococcus aureus is the predominant pathogen that causes keratitis, and the rate of occurrence of drug-resistant S. aureus is increasing. However, little is known about its clinical epidemiology in Japan. This study was designed to characterize the genotypes of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) isolates from keratitis and healthy conjunctival sacs. METHODS Thirty keratitis isolates (19 MSSA and 11 MRSA) and 18 healthy conjunctival sac isolates (16 MSSA and 2 MRSA) obtained before cataract surgery were used. They were characterized by multilocus sequence typing. The prevalence of Panton-Valentine leukocidin was determined. RESULTS In multilocus sequence typing analysis, ST5 and ST764 (ST5 variant) were the most frequently identified sequence types in MRSA strains from both keratitis and healthy conjunctival sacs. ST188 was the most frequently identified sequence type in the 19 MSSA isolates from keratitis (4 isolates, 21.1%), but was only identified in 1 of the 16 commensal MSSA strains. ST8 was found to be predominant among the 16 commensal MSSA strains (5 isolates, 31.3%). None of the isolates had Panton-Valentine leukocidin genes. CONCLUSIONS MRSA isolates from keratitis and healthy conjunctival sacs may have similar genotypic characteristics, but certain clones occur more often among MSSA isolates from keratitis than among commensal MSSA strains. These results suggest that specific MSSA lineages that possess genotypic characteristics can more effectively cause keratitis.
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Abstract
INTRODUCTION Cornea ulceration and infectious keratitis are leading causes of corneal morbidity and blindness. Infectious causes are among the most frequent and most severe. Management strategies for bacterial corneal ulcers have changed significantly over the last decades, however with a more limited progress in the treatment and management of nonbacterial, infectious ulcers. AREAS COVERED This paper provides an overview of the current principles, strategies and treatment choices for infectious corneal ulcers in adults. EXPERT OPINION Topical application with a broad-spectrum antimicrobial remains the preferred method for the pharmacological management of infectious corneal ulcers. Increasing reports of clinical failures and in vitro resistance to antibiotics to treat the most common infectious (bacterial) corneal ulcers are increasing concerns. New approaches for improvement in the pharmacological management of corneal ulcers should focus on strategies for a more rational and evidence-based use of current antimicrobials and development of products to modulate the host immune response and to neutralize microbial toxins and other immune modulators.
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Affiliation(s)
- Darlene Miller
- University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Anne Bates Leach Eye Hospital, Miami, Florida 33136, USA.
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Gadaria-Rathod N, Fernandez KB, Kheirkhah A, Asbell PA. New insights into infectious keratitis. Int Ophthalmol Clin 2013; 53:163-172. [PMID: 23221892 DOI: 10.1097/iio.0b013e3182713413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Lichtinger A, Yeung SN, Kim P, Amiran MD, Iovieno A, Elbaz U, Ku JY, Wolff R, Rootman DS, Slomovic AR. Shifting Trends in Bacterial Keratitis in Toronto. Ophthalmology 2012; 119:1785-90. [DOI: 10.1016/j.ophtha.2012.03.031] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/15/2012] [Accepted: 03/16/2012] [Indexed: 11/25/2022] Open
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Tang A, Balzli CL, Caballero AR, McCormick CC, Taylor SD, O'Callaghan RJ. Staphylococcus aureus infection of the rabbit cornea following topical administration. Curr Eye Res 2012; 37:1075-83. [PMID: 22916736 DOI: 10.3109/02713683.2012.716485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the ability of diverse S. aureus strains to infect the rabbit cornea following topical inoculation, with special emphasis on a strain of unusual virulence. MATERIALS AND METHODS S. aureus strains (5 × 10(5) colony forming units; CFU) were topically applied onto scarified rabbit corneas or 100 CFU were intrastromally injected into rabbit corneas. Eyes were scored by slit lamp examination (SLE) and corneas were cultured to determine the log CFU. Polymorphonuclear leukocytes (PMN) were quantified by myeloperoxidase assays and corneas underwent histopathological analysis. Hemolysin titers of S. aureus strains were determined and S. aureus interactions with rabbit tears or human corneal epithelial cells were investigated. RESULTS All strains injected into the cornea produced high SLE scores and multi-log increases in CFU. Following topical inoculation, four strains produced low SLE scores with no bacterial replication. One strain (UMCR1) topically infected the cornea, causing high SLE scores, extensive PMN infiltration, and multi-log increases in CFU. Histopathologic analysis demonstrated a PMN influx into the UMCR1-infected cornea, destruction of the corneal epithelium, and severe edema. Strain UMCR1 did not demonstrate a high hemolysin titer or resistance to the bactericidal activity of rabbit tears, but did invade human corneal epithelial cells with relatively high efficiency. CONCLUSIONS One S. aureus strain demonstrated the ability to topically infect the rabbit cornea. This strain was previously found to be unique in its ability to infect the anterior chamber and conjunctiva, suggesting that a key mechanism may be employed to overcome the host defenses of these three ocular sites.
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Affiliation(s)
- Aihua Tang
- Department of Microbiology, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Chuang CC, Hsiao CH, Tan HY, Ma DHK, Lin KK, Chang CJ, Huang YC. Staphylococcus aureus ocular infection: methicillin-resistance, clinical features, and antibiotic susceptibilities. PLoS One 2012; 8:e42437. [PMID: 22880135 PMCID: PMC3413655 DOI: 10.1371/journal.pone.0042437] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 07/09/2012] [Indexed: 11/19/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) infection is an important public health issue. The study aimed to determine the prevalence of ocular infections caused by MRSA and to identify the clinical characteristics and antibiotic susceptibility of ocular MRSA infections by comparing those of ocular methicillin-sensitive S. aureus (MSSA) infections. Methodology/Principal Findings The medical records of the patients (n = 519) with culture-proven S. aureus ocular infections seen between January 1, 1999 and December 31, 2008 in Chang Gung Memorial Hospital were retrospectively reviewed. Two hundred and seventy-four patients with MRSA and 245 with MSSA ocular infections were identified. The average rate of MRSA in S. aureus infections was 52.8% and the trend was stable over the ten years (P value for trend = 0.228). MRSA ocular infections were significantly more common among the patients with healthcare exposure (P = 0.024), but 66.1% (181/274) patients with MRSA ocular infections had no healthcare exposure. The most common clinical presentation for both MRSA and MSSA ocular infections was keratitis; MRSA and MSSA caused a similar disease spectrum except for lid infections. MRSA was significantly more resistant than MSSA to clindamycin, erythromycin and sulfamethoxazole/trimethoprim (all P<0.001). Conclusions/significance We demonstrated a paralleled trend of ocular MRSA infection in a highly prevalent MRSA country by hospital-based survey. Except for lid disorder, MRSA shared similar spectrum of ocular pathology with MSSA. Since S. aureus is a common ocular pathogen, our results raise clinician’s attention to the existence of highly prevalent MRSA.
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Affiliation(s)
- Chih-Chun Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Ophthalmology, Yuan-Sheng Hospital, Changhua, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ken-Kuo Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- * E-mail:
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Wu X, Jiang H, Xu Y, Yue W, Yang L, Song Z, Chen H, Liu T. Efficacy of Gemifloxacin for the Treatment of Experimental Staphylococcus aureus Keratitis. J Ocul Pharmacol Ther 2012; 28:420-7. [DOI: 10.1089/jop.2011.0229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xianggen Wu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, P.R. China
| | - Haoran Jiang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, P.R. China
| | - Yuanyuan Xu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, P.R. China
| | - Wenjie Yue
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, P.R. China
| | - Lingling Yang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, P.R. China
| | - Zicheng Song
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, P.R. China
| | - Hao Chen
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, P.R. China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, P.R. China
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Current world literature. Curr Opin Ophthalmol 2012; 23:330-5. [PMID: 22673820 DOI: 10.1097/icu.0b013e32835584e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lyall DA, Srinivasan S, Roberts F. A case of interface keratitis following anterior lamellar keratoplasty. Surv Ophthalmol 2012; 57:551-7. [PMID: 22542911 DOI: 10.1016/j.survophthal.2012.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 01/26/2012] [Accepted: 01/31/2012] [Indexed: 11/29/2022]
Abstract
Anterior lamellar keratoplasty (ALK) is indicated in patients with anterior corneal opacities. Benefits over penetrating keratoplasty include quicker visual rehabilitation, less postoperative astigmatism, and preservation of the host endothelium, thus minimizing the chances of graft rejection. A rare complication of lamellar corneal surgery is infectious interface keratitis between the donor and host tissue. We report a case of infectious interface keratitis following automated ALK successfully treated medically and by removal of the ALK disk, eventually having a deep anterior lamellar keratoplasty with good visual recovery.
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Affiliation(s)
- Douglas A Lyall
- Department of Ophthalmology, Ayr University Hospital, Ayr, Scotland, UK
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