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Abu Dail Y, Daas L, Flockerzi FA, Seitz B. [Bilateral chronic contact lens-associated keratitis]. DIE OPHTHALMOLOGIE 2024; 121:410-414. [PMID: 38315191 DOI: 10.1007/s00347-024-01993-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Y Abu Dail
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - F A Flockerzi
- Institut für Pathologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
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Berger T, Seitz B, Flockerzi F, Daas L. Recurrent Filamentous Fungal Keratitis Caused When the Primarily Selected Graft Diameter was Too Small. Klin Monbl Augenheilkd 2023; 240:1098-1102. [PMID: 35320860 DOI: 10.1055/a-1756-5147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To establish the importance of using a sufficiently large corneal graft in primary penetrating keratoplasty in order to prevent recurrence of fungal keratitis. OBERSERVATIONS A 58-year-old female patient underwent emergency penetrating keratoplasty (diameter 7.0 mm, double running suture) for therapy-resistant fungal keratitis (Fusarium solani) at an external eye clinic. Despite intensive antifungal therapy, new fungal infiltrates appeared in the host cornea after a few days. The patient was referred to our department for further treatment. On first presentation, circular infiltrates were seen around the corneal graft with anterior chamber involvement and therapy-resistant hypopyon. We performed an emergency penetrating repeat keratoplasty (diameter of 13.0 mm, 32 interrupted sutures) combined with anterior chamber lavage and intracameral and intrastromal drug injection. CONCLUSION AND IMPORTANCE Fungal keratitis sometimes has a frustrating clinical course. Therefore, early diagnosis with effective therapy initiation is of the utmost importance. In cases of penetrating keratoplasty, optimal planning and timing (before anterior chamber involvement) should be provided. Sufficient safety distance must be ensured in the choice of graft diameter, fixation with multiple interrupted sutures, and anterior chamber lavage, as well as intracameral and intrastromal drug administration. Incomplete excision carries a risk of recurrence and endophthalmitis in the course. Close postoperative control is necessary to detect early recurrences.
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Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Fidelis Flockerzi
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
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Agarwal S, Pandey S, Srinivasan B, Anand AR, Iyer G. Possible Synergistic Role of Cryo-Alcohol Therapy in Infectious Scleritis-Scope and Rationale for Expanding Indications and Review of the Literature. Cornea 2023; 42:194-203. [PMID: 35249984 DOI: 10.1097/ico.0000000000003007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/10/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to highlight the use of topical ethanol as an adjunct to cryotherapy, termed cryo-alcohol therapy, in the management of fungal/acanthamoeba scleritis along with a review of the literature. METHOD Retrospective interventional case reports of fungal and acanthamoeba scleritis along with a review of the literature. RESULTS The patient with circumferential necrotic fungal scleritis resolved in 6 weeks achieving a best-corrected visual acuity (BCVA) of 20/20, and the patient with acanthamoeba scleritis is awaiting optical keratoplasty after complete resolution in 8 weeks. The literature review from January 1990 to December 2020 revealed BCVA >20/200 in 50% of the eyes with a mean time to resolution being 4.16 ± 2.13 months in fungal scleritis, with 27.02% and 75% of the eyes requiring evisceration in fungal and acanthamoeba scleritis, respectively. CONCLUSIONS Cryotherapy is a useful adjunct in managing refractory infectious scleritis, and its efficacy can be enhanced by combining the use of topical ethanol to aid in faster recovery and reduce visual morbidity.
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Affiliation(s)
- Shweta Agarwal
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India ; and
| | - Sunita Pandey
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India ; and
| | - Bhaskar Srinivasan
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India ; and
| | - Appakkudal R Anand
- L and T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Geetha Iyer
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India ; and
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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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Rabbit Fungal Keratitis Model of Fusarium solani Tested Against Three Commercially Available Antifungal Drugs. Eye Contact Lens 2021; 46:274-280. [PMID: 32134799 PMCID: PMC7447183 DOI: 10.1097/icl.0000000000000689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to develop a reproducible preclinical Fusarium solani keratitis model, which would allow comparative testing of currently available antifungals (NATACYN [Alcon, Fort Worth, TX], voriconazole 1%, and amphotericin B 0.1%) as well as efficacy testing of new antifungals for translation into clinical practice in the future.
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Chen Y, Miao X, Gao M, Song L. Comparison of modified corneal cross-linking with intrastromal voriconazole for the treatment of fungal corneal ulcer. Exp Ther Med 2021; 22:786. [PMID: 34055085 PMCID: PMC8145909 DOI: 10.3892/etm.2021.10218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/01/2021] [Indexed: 01/14/2023] Open
Abstract
The present study aimed to evaluate the efficacy of modified corneal cross-linking (CXL) for the treatment of fungal corneal ulcers compared with that following intrastromal voriconazole injection. In total, 31 patients with fungal corneal ulcers treated at The General Hospital of Northern Theater Command between October 2017 and October 2019 were enrolled. Among them, 10 eyes were treated with ultraviolet A (UV-A)/riboflavin CXL (CXL group), whilst 21 eyes were treated with debridement combined with intrastromal voriconazole (stromal injection group). Preoperative microbiological examination was performed in both groups, and evaluated using Fisher's exact test. Postoperatively, infection control and total efficacy rates, localized lesion, ulcer healing rate 1 week after surgery, visual acuity and complications were evaluated using Fisher's exact test, however visual acuity was analyzed by mixed-model ANOVA. The results showed that the pre-operative species distribution between the CXL and stromal injection groups did not significantly differ. The infection control rate in the CXL group was notably higher compared with that in the stromal injection group (P=0.04). Furthermore, the total efficacy rate in the CXL group was also markedly higher compared with that in the stromal injection group, though no statistically significant differences were observed. Localized lesions were observed in nine eyes (90.0%) in the CXL group and nine eyes (42.9%) in the stromal injection group (P=0.02). However, the rate of ulcer healing at 1 week postoperatively and the logarithm of the minimum angle of resolution (logMAR) of visual acuity were not found to be significantly different between the two groups. In terms of complications, with the exception of one patient in the CXL group exhibiting loss of corneal transparency and one patient in the stromal injection group presenting with partial corneal thinning, no other forms of complications were observed. In conclusion, the present study suggested that CXL could have a beneficial impact for treating fungal corneal ulcers in the aspects of infection control, localized lesions and accelerated epithelialization. In addition, except the loss of corneal transparency, this treatment approach could be applied with reduced risks of adverse events.
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Affiliation(s)
- Yingxin Chen
- Department of Ophthalmology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
| | - Xingya Miao
- Department of Ophthalmology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
| | - Minghong Gao
- Department of Ophthalmology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
| | - Lixin Song
- Department of Dermatology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
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Yang H, Xu X, Ran X, Ran Y. Successful Treatment of Refractory Candidal Granuloma by Itraconazole and Terbinafine in Combination with Hyperthermia and Cryotherapy. Dermatol Ther (Heidelb) 2020; 10:847-853. [PMID: 32405702 PMCID: PMC7367946 DOI: 10.1007/s13555-020-00384-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Indexed: 02/05/2023] Open
Abstract
Candidal granuloma is a rare and refractory disease in clinical practice, usually reported in immunocompromised patients. We report a 57-year-old man who presented with candidal granuloma caused by Candida tropicalis. The diagnosis was confirmed according to histopathology and molecular identification. Prolonged duration of initial antifungal therapy did not obtain satisfactory improvement. Finally, the refractory disease was successfully treated by itraconazole and terbinafine in combination with hyperthermia and cryotherapy. The "blackish-red dot" dermoscopic sign of the verrucous granuloma gradually resolved during the treatment.
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Affiliation(s)
- Heli Yang
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxi Xu
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuping Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China.
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8
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Experimental Models for Fungal Keratitis: An Overview of Principles and Protocols. Cells 2020; 9:cells9071713. [PMID: 32708830 PMCID: PMC7408389 DOI: 10.3390/cells9071713] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/21/2022] Open
Abstract
Fungal keratitis is a potentially blinding infection of the cornea that afflicts diverse patient populations worldwide. The development of better treatment options requires a more thorough understanding of both microbial and host determinants of pathology, and a spectrum of experimental models have been developed toward this end. In vivo (animal) models most accurately capture complex pathological outcomes, but protocols may be challenging to implement and vary widely across research groups. In vitro models allow for the molecular dissection of specific host cell–fungal interactions, but they do so without the appropriate environmental/structural context; ex vivo (corneal explant) models provide the benefits of intact corneal tissue, but they do not provide certain pathological features, such as inflammation. In this review, we endeavor to outline the key features of these experimental models as well as describe key technical variations that could impact study design and outcomes.
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9
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Guo Y, Karimi F, Fu Q, G Qiao G, Zhang H. Reduced administration frequency for the treatment of fungal keratitis: a sustained natamycin release from a micellar solution. Expert Opin Drug Deliv 2020; 17:407-421. [PMID: 32009483 DOI: 10.1080/17425247.2020.1719995] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Natamycin is the only topical ophthalmic antifungal drug approved by the Food and Drug Administration (FDA) of the United States, but has unsatisfactory factors such as high dosing frequency.Methods: We report the synthesis and preparation of self-assembled poly(ethylene glycol)-block-poly(glycidyl methacrylate) (PEG-b-PGMA) micelles. These nanoparticles exhibit sustained delivery of a hydrophobic natamycin by topical administration on eye due to the hydrolysable properties of PGMA segments of micelle. Hydrolysis of glycidyl groups within a physiologically relevant environment provides an additional driving force for drug release by generation of hydrophilic hydroxyl groups to 'push' the encapsulated hydrophobic drug away from the resultant hydrophilic domains and into surrounding environment.Results: In vitro and in vivo results revealed that the self-assembled micelles and the encapsulated natamycin were not cytotoxic and the released drug have strong antifungal ability to Candida albicans. Importantly, sustained natamycin release from micelles leads to the reduced administration frequency of natamycin from 8 times per day to 3 times per day in rabbits suffering from fungal keratitis (FK).Conclusion: This study demonstrates a facile method that can greatly reduce dosing frequency of natamycin administration and thus improve long-term patient compliance.
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Affiliation(s)
- Yiyuan Guo
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Peoples Republic of China.,Department of Chemical Engineering, The University of Melbourne, Melbourne, Australia
| | - Fatemeh Karimi
- Department of Chemical Engineering, The University of Melbourne, Melbourne, Australia.,Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Qiang Fu
- Department of Chemical Engineering, The University of Melbourne, Melbourne, Australia.,The Centre for Technology in Water and Wastewater (CTWW), School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, Australia
| | - Greg G Qiao
- Department of Chemical Engineering, The University of Melbourne, Melbourne, Australia
| | - Hong Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Peoples Republic of China
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10
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Doshi S, Pathengay A, Hegde S, Panchal B. Can cryotherapy be used as an adjunct in select cases of recalcitrant endophthalmitis? - A case report. Indian J Ophthalmol 2019; 67:1894-1896. [PMID: 31638066 PMCID: PMC6836608 DOI: 10.4103/ijo.ijo_259_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report two cases of recalcitrant endophthalmitis, a delayed postoperative fungal endophthalmitis following cataract surgery and an atypical mycobacterial endogenous endophthalmitis associated with infective scleritis. Due to recalcitrant nature of the endophthalmitis, one or more sittings of double freeze and thaw cryotherapy was applied over and adjacent to the infective foci in each case. This cryotherapy was used as an adjunct alongside conventional endophthalmitis management following which resolution of infection was observed in both cases.
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Affiliation(s)
- Shreyansh Doshi
- Vitreoretina and Uveitis Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Avinash Pathengay
- Vitreoretina and Uveitis Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Sharat Hegde
- Vitreoretina and Uveitis Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Bhavik Panchal
- Vitreoretina and Uveitis Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
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Polymicrobial Keratitis With Cryptococcus curvatus, Candida parapsilosis, and Stenotrophomonas maltophilia After Penetrating Keratoplasty: A Rare Case Report With Literature Review. Eye Contact Lens 2019; 45:e5-e10. [DOI: 10.1097/icl.0000000000000517] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Agarwal S, Iyer G, Srinivasan B, Benurwar S, Agarwal M, Narayanan N, Lakshmipathy M, Radhika N, Rajagopal R, Krishnakumar S, K LT. Clinical profile, risk factors and outcome of medical, surgical and adjunct interventions in patients with Pythium insidiosum keratitis. Br J Ophthalmol 2018; 103:296-300. [PMID: 30206158 DOI: 10.1136/bjophthalmol-2017-311804] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 06/05/2018] [Accepted: 08/20/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE To report clinical profile and compare management options for Pythium keratitis. METHOD Retrospective interventional study of 46 patients diagnosed as Pythium keratitis by PCR DNA sequencing from January 2014 to July 2017. Interventions were categorised into medical management (MM) (topical azithromycin and linezolid with oral azithromycin at presentation), surgery (S) (therapeutic penetrating keratoplasty, TPK), surgical adjunct (SA) (cryotherapy±alcohol with TPK) and medical adjunct (MA) (MM after TPK). RESULTS Primary treatment included MM (1 eye), SA (3 eyes) and S (42 eyes). Recurrence occurred in 27/43 eyes (MM+S group). Second surgery (S) was required in 11 eyes (TPK-2), with additional procedures (SA) in 10 eyes and evisceration in five eyes. 8/43 eyes received MA after TPK-1. One eye required TPK-3. Recurrence occured in all eyes that received MA (100%) and in 28 of 54 TPKs (51.8%) (TPK 1+2+3) in 42 eyes. Recurrence was noted in 1/14 (7.1%) that underwent SA. CONCLUSION The currently available and recommended treatment for Pythium keratitis is surgical by means of a TPK and in worse cases evisceration. In our study, MM/MA measures showed no benefit with recurrence or worsening of infection requiring resurgery. Almost 50% of TPKs had a recurrence requiring resurgery. However, adjunctive procedures during TPK appear to have additional benefit with low risk of recurrence and could be included as routine care.
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Affiliation(s)
- Shweta Agarwal
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
| | - Geetha Iyer
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
| | - Bhaskar Srinivasan
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
| | - Saket Benurwar
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
| | - Mamta Agarwal
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
| | - Niveditha Narayanan
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
| | - Meena Lakshmipathy
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
| | - N Radhika
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
| | - Rama Rajagopal
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
| | - S Krishnakumar
- L&T Ophthalmic Pathology Department, Vision Research Foundation, Chennai, Tamil Nadu, India
| | - Lily Therese K
- L&T Microbiology Research Centre, Vision Research Foundation, Chennai, Tamil Nadu, India
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13
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Cold atmospheric pressure plasma jet for the treatment of Aspergillus keratitis. CLINICAL PLASMA MEDICINE 2018. [DOI: 10.1016/j.cpme.2017.12.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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14
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Zawar V, Pawar M, Reddy RR, Chuh A. Liquid nitrogen cryotherapy for chronic recalcitrant interdigital candidiasis of toe spaces-an uncontrolled pilot study. J Am Acad Dermatol 2017; 78:1004-1005. [PMID: 29042226 DOI: 10.1016/j.jaad.2017.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/26/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Vijay Zawar
- MVP's Dr V.P Medical College & Hospital & Research Center, Nashik, India
| | - Manoj Pawar
- MVP's Dr V.P Medical College & Hospital & Research Center, Nashik, India.
| | - R Raghunatha Reddy
- Department of Dermatology, Dr Raghu's Mathapitha Skin Clinic, Bengaluru, India
| | - Antonio Chuh
- JC School of Public Health, The Chinese University of Hong Kong and The Prince of Wales Hospital, Shatin, Hong Kong
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15
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Agarwal S, Iyer G, Srinivasan B, Agarwal M, Panchalam Sampath Kumar S, Therese LK. Clinical profile of pythium keratitis: perioperative measures to reduce risk of recurrence. Br J Ophthalmol 2017; 102:153-157. [PMID: 28903964 DOI: 10.1136/bjophthalmol-2017-310604] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/21/2017] [Accepted: 08/25/2017] [Indexed: 11/03/2022]
Abstract
PURPOSE To report the clinical profile and role of perioperative adjunctive measures to reduce the risk of recurrence in Pythium insidiosum keratitis. METHODS Retrospective analysis of 10 eyes of 10 patients with P. insidiosum keratitis. Diagnosis was confirmed by PCR DNA sequencing. RESULTS 7out of 10 patients were from urban locales, and none had any obvious history of injury with vegetative matter and were being treated for fungal keratitis. 6 eyes presented with central full thickness infiltrates with subepithelial and superficial stromal infiltrates radiating in a reticular pattern. Corneal scraping in all eyes revealed sparsely septate fungal-like filaments on potassium hydroxide/Calcofluor. All eyes underwent the first therapeutic penetrating keratoplasty (TPK) based on worsening or non-responsiveness of clinical features to the antifungal regimen. Recurrence was noted in 7 out of 10 eyes of which 2 eyes underwent evisceration. Of the six eyes that underwent cryotherapy following confirmation of microbiological diagnosis of Pythium (along with primary TPK-1, with re-TPK-5), only one eye had a recurrence and had to be eviscerated. Of the two eyes that did not undergo cryotherapy during re-TPK, following microbiological diagnosis, one eye had a recurrence and had to be eviscerated. In two eyes with adjoining scleritis, the host bed was swabbed using absolute alcohol of which one eye was salvaged. CONCLUSION This series highlights the need to be aware of this entity in the management of refractory fungal keratitis. It also brings to fore the adjunctive measures that could have a beneficial role in the management of pythium keratitis.
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Affiliation(s)
- Shweta Agarwal
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Geetha Iyer
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Bhaskar Srinivasan
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Mamta Agarwal
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Lily K Therese
- L&T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Shah A, Talati M, Mauger T. Medical and surgical management of Pasteurella canis infectious keratitis. IDCases 2017; 9:42-44. [PMID: 28660128 PMCID: PMC5479940 DOI: 10.1016/j.idcr.2017.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 12/11/2022] Open
Abstract
Introduction We describe a case of refractory Pasteurella Canis keratitis that initially failed antimicrobial treatment but was successfully treated with a conjunctival flap followed by a penetrating keratoplasty. Case discussion A 70-year-old male had persistent corneal edema related to previous herpes zoster keratouveitis with visual acuity of 20/400. An endothelial keratoplasty was performed with improvement in vision to 20/25. Several months after this surgery the patient developed a corneal infiltrate and cultures grew Pasturella canis. The infection persisted despite topical treatment with broad spectrum fortified vancomycin, tobramycin and fluoroquinolones. A conjunctival flap combined with corneal cryotherapy was performed to help mitigate symptoms and to allow the ulcer to heal. A penetrating keratoplasty was done several months later. Discussion The patient achieved pain relief immediately after the flap was placed. Medications were tapered off in the following few months after the procedure. A penetrating keratoplasty was performed 4 months later. The patient has remained almost entirely symptom free, and the graft remained clear one year after surgery. Conclusions A keratitis caused by Pasteurella canis that is resistant to medical therapy can be treated successfully with a conjunctival flap and cryotherapy followed by a penetrating keratoplasty.
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Affiliation(s)
- Ankit Shah
- Ohio State University Havener Eye Institute Department of Ophthalmology and Visual Science, USA
| | - Mansi Talati
- Ohio State University Havener Eye Institute Department of Ophthalmology and Visual Science, USA
| | - Thomas Mauger
- Ohio State University Havener Eye Institute Department of Ophthalmology and Visual Science, USA
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Kim HJ, Lim HR, Koh JW. Cryotherapy on Refractory Fungal Corneal Ulcer: A Case Report. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.10.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Ju Kim
- Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea
| | - Hwa Rang Lim
- Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea
| | - Jae Woong Koh
- Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea
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Chen Y, Gao M, Duncan JK, Ran D, Roe DJ, Belin MW, Wang M. Excisional keratectomy combined with focal cryotherapy and amniotic membrane inlay for recalcitrant filamentary fungal keratitis: A retrospective comparative clinical data analysis. Exp Ther Med 2016; 12:3014-3020. [PMID: 27882109 DOI: 10.3892/etm.2016.3699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 07/21/2016] [Indexed: 12/23/2022] Open
Abstract
The aim of the present study was to investigate the efficacy of a novel surgical intervention, excisional keratectomy combined with focal cryotherapy and amniotic membrane inlay (EKCAI), for the treatment of recalcitrant filamentary fungal keratitis. A retrospective analysis was performed of patients who underwent excisional keratectomy combined with conjunctival flap inlay (EKCFI), EKCAI or therapeutic penetrating keratoplasty (TPK) from January 2006 to January 2011. Recalcitrance was determined as being unresponsive to standard medical antifungal therapy for at ≥1 week. Outcome measures among the three intervention modalities were compared. A total of 128 patients had a follow-up of ≥1 year after the primary intervention. The success rates of interventions at 1-year follow-up were 58.33% in the EKCFI group, 88.37% in the EKCAI group and 93.44% in the TPK group (P<0.0002). The preoperative visual acuity of the three groups were similar (P=0.6458), while the postoperative best-corrected visual acuity (BCVA) of patients without recurrence was significantly different among the three groups 3 months after surgery. The best postoperative BCVA was found in the TPK group, while the worst was in the EKCFI group. In conclusion, EKCAI does not require donor cornea, is straightforward surgically, and has a favorable success rate compared with EKCFI.
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Affiliation(s)
- Yingxin Chen
- Department of Ophthalmology, The General Hospital of Shenyang Military Command, Shenyang, Liaoning 110016, P.R. China
| | - Minghong Gao
- Department of Ophthalmology, The General Hospital of Shenyang Military Command, Shenyang, Liaoning 110016, P.R. China
| | - Joshua K Duncan
- Department of Ophthalmology and Visual Science, College of Medicine, The University of Arizona, Tucson, AZ 85711, USA
| | - Di Ran
- Epidemiology and Biostatistics Division, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Denise J Roe
- Epidemiology and Biostatistics Division, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Michael W Belin
- Department of Ophthalmology and Visual Science, College of Medicine, The University of Arizona, Tucson, AZ 85711, USA
| | - Mingwu Wang
- Department of Ophthalmology and Visual Science, College of Medicine, The University of Arizona, Tucson, AZ 85711, USA
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