A practical approach to interpretation of corneal specimens

Infectious crystalline keratopathy

Infectious crystalline keratopathy was first reported by Gorovoy and colleagues in 1983 when they identified bacteria colonizing a cornea after a penetrating keratoplasty. Subsequent cases have elaborated on the organisms responsible and the management outcomes. Patients present with a white or gray branching opacity originating from an epithelial defect, commonly after a penetrating keratoplasty. Local immunosuppression contributes to the quiescent nature and the limited inflammatory response associated with infectious crystalline keratopathy. Diagnosis of the infective pathogens may be difficult, with a corneal scraping often being too superficial to obtain an adequate specimen. A biofilm is present that advantages microorganism survival, reduces antibiotic bioavailability, and inhibits diagnostic microbial detection. Treatment begins with topical antimicrobials, initially broad spectrum and then targeted to microorganism sensitivity. Adjunctive therapies to enhance the efficacy of treatment include disruption of the microorganism biofilm by laser, intrastromal antibiotics, and keratectomy. In recalcitrant cases, or where corneal scarring ensues, corneal transplantation is required.

Linear Corneal Epithelial Keratitis with a Horseshoe Pattern

PURPOSE

To report the treatment and follow-up of a linear epithelial keratitis with a horseshoe pattern.

METHODS

A 21-year-old Turkish soldier, who presented with epithelial keratitis with a horseshoe pattern that did not respond to immunosuppressive and multiple anti-microbial treatment, was studied clinically.

RESULTS

No microorganism was identified with different stains, cultures, and herpes simplex virus-polymerase chain reaction. The impression cytology revealed prominent polymorphonuclear leukocyte infiltration at the keratitis line. The keratitis did not respond to different antimicrobial treatment or local and systemic corticosteroids. After a fourth scraping was perfomed deeply with a disc-knife, the lesion healed and did not recur in six months.

CONCLUSION

Linear epitheliitis of cornea with a horseshoe pattern was not found to be associated with any microorganism or systemic disease.