Cases reported "Corneal Ulcer"

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1/5. Infectious keratitis after photorefractive keratectomy in a comanaged setting.

    A 48-year-old man had simultaneous bilateral photorefractive keratectomy (PRK). The surgeon who performed the PRK did not see the patient in follow-up, and there was confusion regarding the comanaging doctor. Therefore, the patient was not examined immediately postoperatively. Several days later, he was hospitalized for an unrelated, painful orthopedic problem and heavily sedated. Seven days after the PRK, an ophthalmologist was consulted for ocular irritation and discharge. Examination showed bilateral, purulent conjunctivitis and severe infectious keratitis in the left eye. The patient was treated with periocular and topical antibiotics. Corneal cultures yielded staphylococcus aureus. The keratitis resolved slowly, leaving the patient with hand motion visual acuity. A corneal transplant and cataract extraction was performed 15 months later, resulting in a best corrected visual acuity of 20/400 because of glaucomatous optic nerve damage. Severe infectious keratitis may occur after PRK. Poor communication between the surgeon, comanaging doctor, and patient may result in treatment delay.
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2/5. serratia marcescens corneal ulcer as a complication of orthokeratology.

    PURPOSE: To report a case of serratia marcescens corneal ulcer as a complication of orthokeratology treatment. methods: Case report. RESULTS: A 9-year-old male who underwent orthokeratology treatment for 6 months suffered from a corneal ulcer. The refractive state of lesion eye was -5.5D/-1.25D x 180 degrees, and visual acuity was hand motion at 30 cm. He wore a retainer lens, rigid gas permeable lens, overnight for 2 months before the corneal ulcer occurred. Ulcer became worse after tobramycin and gentamycin treatment for 2 days. After ciprofloxacin treatment, the ulcer healed and visual acuity recovered to 20/20 with spectacle correction. Cultures of the cornea tissue and contact lens storage solution both grew serratia marcescens, which was sensitive to ciprofloxacin. CONCLUSION: Overnight wearing of a rigid contact lens is a risk factor for a corneal ulcer.
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3/5. Pseudomonas corneal ulcer related to overnight orthokeratology.

    PURPOSE: To report two cases of pseudomonas aeruginosa corneal ulcers as a complication of overnight orthokeratology lens wear. methods: Case report. RESULTS: Two 11-year-old girls with acute central corneal ulcers were referred to our hospital. In both cases, the ulcers were about 2 mm in diameter, located centrally, contained dense cellular infiltration, and discharged purulent material. Intensive topical ceftazidime was applied to treat the ulcers. Cultures of the scraped corneal tissues and the contact lens storage solutions in both cases grew P. aeruginosa, which was sensitive to the antibiotic. The presenting best-corrected visual acuity was hand motion at 20 cm in one patient and 6/20 in the other. Both patients had received several months of overnight orthokeratology treatment with rigid gas permeable contact lenses to correct myopia (-4.25 D and -4.75 D in the two affected eyes). The final best-corrected visual acuity was 6/60 in one patient and 6/7.5 in the other. CONCLUSIONS: Overnight orthokeratology contact lens wear carries a potential risk of corneal ulcer and may cause significant visual impairment in children.
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4/5. Penetrating keratoplasty following scleral patch graft procedure.

    PURPOSE: To present the benefit of preserved sclera for immediately repairing perforated corneal ulcer and report the clinical outcome of patients undergoing penetrating keratoplasty after scleral patch graft. patients AND METHOD: The results of perforated corneal ulcer patients, who underwent penetrating keratoplasty after scleral patch graft between January 1996 and December 2002, were reviewed retrospectively. The causes of the corneal ulcer were also included. RESULTS: Penetrating keratoplasty was performed after scleral patch graft for perforated corneal ulcer on four patients, three males and one female. The culture results from corneal scraping showed fusarium spp in two cases and Streptococus pneumoniae in one. One patient had a presumed bacterial corneal ulcer. The post-penetrating keratoplasty visual acuity ranged from hand motions to 20/40. CONCLUSION: The scleral patch graft procedure for perforated corneal ulcer may benefit in circumstances of unavailable corneal donors. The results of penetrating keratoplasty after scleral patch graft were favorable.
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5/5. trichophyton fungal keratitis.

    OBJECTIVE: To report 5 cases of fungal keratitis caused by trichophyton schoenleinii. methods: case reports. RESULTS: trichophyton schoenleinii is responsible for aggressive fungal keratitis that is associated with keratolysis as a result of collagenase expression by the organism. Clinically, the organism seems to be sensitive to topical natamycin but resistant to topical amphotericin B and miconazole. Two patients achieved clinical cures with medical therapy alone, but with visual outcomes of only 20/125 and hand motions because of corneal scarring. Two patients achieved clinical cures with therapeutic penetrating keratoplasty (PKP), which remained clear and provided final visual outcomes of 20/60 and 20/200. One patient developed fungal scleritis and panophthalmitis despite 2 therapeutic PKPs and required enucleation. CONCLUSION: trichophyton schoenleinii is a rare cause of fungal keratitis that may be associated with progressive keratolysis and perforation, scleral extension, and endophthalmitis. Therapeutic keratoplasty may be successful in achieving cure in medically unresponsive cases.
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