[Clinical and diagnostic developments in corneal herpes]

Clinical diagnosis and treatment of rare painless keratitis caused by three pathogens: clinical practice and experiential discussion

There have been numerous reports regarding the occurrence of keratitis in patients with soft contact lenses, but few reports in patients with rigid gas permeable contact lenses. To the best of our knowledge, the occurrence of infection associated with three species of pathogens has never been reported. Here, we describe a patient who exhibited refractory painless keratitis caused by three pathogens (Staphylococcus epidermidis, Acanthamoeba, and herpes simplex virus) and summarize similar reports published at multiple centers worldwide, with the aim of providing guidance for clinicians who might encounter mixed-type corneal infections. We describe the results of many ophthalmologic and laboratory investigations, which guided our treatment selection. We achieved good treatment efficacy, such that the patient exhibited a corrected visual acuity of 20/20 in the affected eye after a series of treatments, including curettage of ulcer lesions. Corneal infections caused by multiple pathogens are challenging in clinical practice. This summary of our experience in patient diagnosis and treatment can help clinicians to achieve a favorable prognosis in treatment of future patients.

Kératoplastie transfixante à chaud dans les ulcères cornéens infectieux perforés

PURPOSE

To evaluate anatomical and functional prognosis of urgent penetrating keratoplasty in perforated infectious corneal ulcers.

METHODS

Seven eyes of seven patients had an urgent penetrating keratoplasty for perforated infectious corneal ulcers. Anatomical success was defined by eradication of infection and preservation of eye from enucleation and phthisis bulbi. Corneal graft survival was defined by the presence of a clear graft.

RESULTS

The patients'mean age was 40.5 years. Four eyes had bacterial corneal ulcer and three eyes had herpetic corneal ulcer. Anatomical success was obtained in six eyes. The graft remained clear in two eyes. Graft rejection was noted in four eyes after a mean period of 4.5 months. Postoperative complications were ocular inflammation (one eye), ocular hypertension (three eyes), cataract (one eye), peripheral anterior synechiae (one1 eye), graft ectasia (one eye), bacterial infection (one eye) and recurrent herpetic keratitis (one eye). The mean follow-up period was 22 months, ranging from 9 to 32 months.

CONCLUSION

Urgent penetrating keratoplasty can preserve eye integrity and eradication of the infectious process in a large part of perforated bacterial and herpetic corneal ulcers. Visual rehabilitation is often a secondary objective. Adapted antimicrobial treatment reduces graft reinfection and steroid treatment reduces the frequency of some complications, especially graft rejection.