1/10. Late traumatic intraocular lens extrusion after penetrating keratoplasty.BACKGROUND: Penetrating keratoplasty places a patient at risk for wound rupture from blunt trauma because the graft-host interface remains weakened for years after the surgery. Violent environments, contact sports, and strenuous activity put patients with compromised corneal structural integrity at high risk of traumatic injury. CASE REPORT: This case report presents a 42-year-old penetrating keratoplasty patient with a history of homelessness, polysubstance abuse, and domestic violence. This patient experienced a ruptured globe at the graft-host junction secondary to a direct blow by a fist, which extruded the intraocular lens from the eye. After emergency wound closure, the graft continued to degrade until bullous keratopathy developed. With little visual recovery potential for this graft, a Gunderson conjunctival flap procedure was implemented to decrease chronic ocular pain. CONCLUSIONS: After penetrating keratoplasty, patients should be periodically reminded of the susceptibility of the graft wound to injury from high-risk activity and violence. Constant use of protective eyewear should be recommended to corneal transplant recipients.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/10. propionibacterium acnes as a cause of visually significant corneal ulcers.PURPOSE: To report propionibacterium acnes as a cause of vision-threatening infectious keratitis and to discuss culture isolation and antibiotic treatment. methods: Retrospective case series presentation collected from three academic medical centers. RESULTS: Six cases of P. acnes infectious keratitis are presented, all of which were associated with a compromised corneal barrier or environment. All cases were culture-positive on thioglycolate broth; none became positive before 7 days of growth. No other organisms were isolated from any culture, and the growth of P. acnes occurred in some cases despite negative gram stains. CONCLUSION: P. acnes can produce vision-debilitating keratitis when the cornea is compromised. growth in culture should be monitored for at least 10 days to ensure isolation of this fastidious organism. P. acnes may respond to several different antibiotics that have gram-positive coverage, but it should be treated with vancomycin to enhance clearance of the organism.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/10. Corneal ulcers in patients with Apert syndrome.morbidity from corneal ulcers is often severe in patients with Apert syndrome. These patients are at an increased risk of developing corneal ulcers because of the compromised corneal environment secondary to exophthalmos. During the past 6 years, three of five patients treated for Apert syndrome at our hospital have developed corneal ulcers. We present a case series discussing each patient, reasons for the development of ulceration, treatment, and outcomes. Morbidities in our group of patients included decreased visual acuity, opacified corneas, amblyopia, and blindness. Treatment is often difficult and complex. Therefore, an ophthalmologist should be an active team member in treating Apert patients.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/10. Infectious keratitis after photorefractive keratectomy.PURPOSE: To elucidate risk factors, microbial culture results, and visual outcomes for infectious keratitis after photorefractive keratectomy (PRK). DESIGN: Multicenter, retrospective chart review, case report, and literature review. methods: The records of 12 patients with infectious keratitis after PRK were reviewed. MAIN OUTCOME MEASURES: Causative organism, response to medical treatment, and visual outcome. RESULTS: Infectious keratitis developed in 13 eyes of 12 patients after PRK. Organisms cultured were Staphylococcus aureus (n = 5), including a bilateral case of methicillin-resistant staphylococcus aureus; staphylococcus epidermidis (n = 4); streptococcus pneumoniae (n = 3); and Streptococcus viridans (n = 1). Four patients manipulated their contact lenses, and 2 patients were exposed to nosocomial organisms while working in a hospital environment. Prophylactic antibiotics used were tobramycin (nine cases), polymyxin b-trimethoprim (three cases), and ciprofloxacin (one case). Final best spectacle-corrected visual acuity ranged from 20/20 to 20/100. CONCLUSIONS: Infectious corneal ulceration is a serious potential complication of PRK. Gram-positive organisms are the most common pathogens. antibiotic prophylaxis should be broad spectrum and should include gram-positive coverage.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/10. Bilateral methicillin-resistant staphylococcus aureus keratitis in a medical resident following an uneventful bilateral photorefractive keratectomy.PURPOSE: To present a case of bilateral methicillin-resistant staphylococcus aureus (MRSA) keratitis after photorefractive keratectomy (PRK). methods: Retrospective chart review.RESULTS A 26-year-old female internal medicine resident underwent an uneventful bilateral PRK. After the procedure, the patient was fit with a bandage contact lens and was prescribed tobramycin 0.3%, fluorometholone 0.1%, and diclofenac sodium 0.1% four times per day. Postoperatively, corneal ulcers were noted in each eye, and the patient was referred for a consultation. Gram stain showed gram-positive cocci. The patient immediately started using vancomycin, 35 mg/mL every half hour, and ofloxacin 0.3% every hour around the clock. Forty-eight hours later, corneal and lid cultures were positive for MRSA. Three months after the infection, there was approximately 40% corneal thinning in the right eye and 10% thinning in the area of the corneal ulceration of the left eye. The patient is awaiting corneal transplantation of the right eye. CONCLUSIONS: To our knowledge, this represents the first reported case of bilateral MRSA keratitis after PRK. Methicillin-resistant S. aureus is a potentially serious infectious agent after PRK and may be associated with exposure to a hospital setting. For patients who have had extensive exposure to a hospital environment and are undergoing ocular surgery, we recommend prophylaxis against MRSA. To treat a possible MRSA keratitis, we suggest starting a fourth-generation topical fluoroquinolone every 30 minutes, alternating it with vancomycin 50 mg/mL every 30 minutes, and discontinuing steroid use. A high degree of suspicion coupled with rapid and appropriate treatment may result in improved visual recovery.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/10. Intrahyphal hyphae in corneal tissue from a case of keratitis due to Lasiodiplodia theobromae.Lasiodiplodia theobromae, a recognized plant pathogen, was isolated in culture from a case of human mycotic keratitis. Chemotherapy with a variety of azoles was unsuccessful and the lesion was removed surgically. Electron microscopy of thin sections of the excised corneal tissue revealed several examples of intrahyphal hyphae, a unique process described previously in in vitro cultures of various zoopathogenic fungi. We believe this to be the first report of the presence of intrahyphal hyphae in parasitized animal or human tissue. The demonstration of this process in vivo is thought to be consistent with the hypothesis that intrahyphal hyphae might represent an attempt by the invading fungus to survive in an otherwise unfavourable environment.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/10. Microbial factors in contact lens fitting.As contact lens practitioners, optometrists work in a nonsterile environment and on a nonsterile part of the human body. Our report describes 10 cases of eye infection related to contact lens wear. Practitioners need to be aware of the problems which can occur when a thoroughly sterilized contact lens is placed on an unsterile and biologically complex eye. We recommend taking swabs of the conjuctiva in all eyes where ocular inflammation is present. In those areas in which the professions of optometry and medicine meet, cooperation should exist. Improving our knowledge and skills in microbiology helps to facilitate such cooperation. Our experience has been most rewarding and interaction in this field with medical practitioners has been positive. The use of a high quality slitlamp is essential.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/10. Bilateral serratia marcescens keratitis after simultaneous bilateral radial keratotomy.PURPOSE/methods: After bilateral simultaneous radial keratotomy, serratia marcescens keratitis, which involved multiple incisions of both eyes, developed in a 46-year-old physician. The keratitis was treated with repeated wound debridement, fortified topical antibiotics, and topical povidone-iodine. RESULTS/CONCLUSIONS: Six months after radial keratotomy, uncorrected visual acuity was R.E.: 20/25 and L.E.: 20/60, both eyes correctable to 20/20. health-care workers who undergo refractive surgery may be at increased risk of acquired postoperative infections because of their work environment. Although the occurrence of simultaneous bilateral ulcerative keratitis after simultaneous bilateral radial keratotomy is rare, it is nonetheless a real possibility, making it prudent to perform radial keratotomy on one eye at a time.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/10. Atypical ocular atopy.BACKGROUND: Atopic keratoconjunctivitis (AKC) is defined as a chronic keratoconjunctivitis associated with atopic dermatitis, but severe progressive keratoconjunctivitis as a sole manifestation of atopy also may occur. The authors report three patients with a longstanding history of chronic conjunctivitis with bilateral pannus formation. These patients denied any history of major atopy at the time of presentation. methods: All patients were evaluated for collagen vascular disease and for evidence of atopy. Conjunctival biopsy was obtained in each case and was analyzed by light microscopy and by immunohistochemical techniques. RESULTS: Systemic evaluation for collagen vascular disease was negative. serum IgE levels were elevated in one patient. Conjunctival biopsy suggested atopy in all patients with characteristic histopathologic findings. Referral to an allergist showed wheal and flare reactions to multiple ubiquitous environmental allergens. Two patients then disclosed a history of atopic dermatitis and another confessed a history of asthma. Each patient responded well to environmental control of allergens, topical cromolyn sodium 4%, and systemic antihistamine therapy with subsequent resolution of the chronic conjunctivitis. The corneal complications were managed with pannus resection and postoperative mitomycin C drops in two patients. CONCLUSION: These patients suffered from the progressive blinding consequences of a chronic keratoconjunctivitis, which we believe is an atypical form of AKC. In this report, it is suggested that atopy should be considered in some cases of external ocular inflammation, even in the absence of the characteristic findings of systemic atopy. Conjunctival biopsy is a valuable diagnostic tool in such cases.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
10/10. flavobacterium indologenes keratitis.flavobacterium indologenes has recently been implicated in nosocomial or opportunistic infection. It has been isolated from lids, conjunctiva, and lacrimal system, and is resistant to most antibiotics. No previous cases of F. indologenes corneal ulcer have been reported in the literature. The natural habitat of Flavobacteria is soil, water, plants, and foodstuffs. In the hospital environment, these bacteria exist in water systems and on wet surfaces. They are not part of the normal ocular flora.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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