1/6. Polymicrobial keratitis after laser in situ keratomileusis.PURPOSE: To report a case of polymicrobial infectious keratitis in one eye of a patient who had undergone bilateral simultaneous laser in situ keratomileusis (LASIK). methods: A 21-year-old healthy female developed infectious keratitis in her right eye after bilateral LASIK surgery. Material obtained from the infective foci was sent for bacterial and fungal cultures and herpes simplex virus antigen detection, and broad spectrum antimicrobial therapy was instituted. RESULTS: staphylococcus epidermidis and fusarium solani were detected on culture and herpes simplex virus antigen was found to be positive. The patient did not respond to medical therapy and subsequently the ulcer perforated. A therapeutic keratoplasty was performed and the final best-corrected visual acuity was 20/40, 1 month after keratoplasty. CONCLUSION: Polymicrobial infectious keratitis, although rare, is a potential sight-threatening complication of LASIK.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/6. Infectious keratitis after laser refractive surgery.PURPOSE: To report two cases of infectious keratitis, one fungal after photorefractive keratectomy (PRK) and the other bacterial after laser in situ keratomileusis (LASIK). DESIGN: Two interventional case reports. PARTICIPANTS: Case 1 is a male who was seen 3 weeks after PRK with a corneal ulceration. Case 2 involves a female who was seen 7 weeks after LASIK with interface granularity. RESULTS: Cultures in case 1 were identified as scopulariopsis species, and despite intensive treatment, a therapeutic penetrating keratoplasty (PK) was eventually performed. Case 2 had cultures identified as mycobacterium chelonae and also ultimately required a therapeutic PK. CONCLUSIONS: Two unusual infectious keratitides are reported after different laser refractive surgery techniques.- - - - - - - - - - ranking = 0.71428571428571keywords = keratitis (Clic here for more details about this article) |
3/6. Six cases of scleritis associated with systemic infection.Isolated scleritis (without keratitis) associated with infections is uncommon, and correct diagnosis and appropriate therapy for it are often delayed. Six patients with infection-associated scleritis were seen at our institution between May 1983 and May 1990 (these patients represented 4.6% of all patients with scleritis [six of 130 patients] in that period). Three of these cases were associated with systemic infections. One was associated with syphilis, one was associated with tuberculosis, and one was associated with toxocariasis. Three cases resulted from local infections. One was associated with infection with proteus mirabilis, one was associated with infection with herpes zoster virus, and one was associated with infection with aspergillus. The aspergillus infection developed after trauma and the P. mirabilis-induced infection developed after strabismus surgical procedures. Four of the six cases were initially misdiagnosed and inappropriately managed. Correct diagnosis was made seven days to four years after onset of symptoms. review of systems, scleral biopsy, culture, and laboratory investigation were used to make the diagnosis. Differential diagnosis of scleritis must include infective agents.- - - - - - - - - - ranking = 0.14285714285714keywords = keratitis (Clic here for more details about this article) |
4/6. Microbial keratitis--the false negative.The investigation of presumed microbial keratitis includes microscopy and culture of corneal specimens obtained by scraping the infiltrated cornea. Routine microscopy fails to identify the infecting organism in about 15% of cases. We discuss the problems presented by 20 such eyes which required further investigation. We present a diagnostic algorithm aimed at reducing the delay in identifying the pathogen and increasing the rate of positive culture. This is important since unusual pathogens may require treatment with drugs other than the 'first line' broad spectrum combination of an aminoglycoside and a cephalosporin. The algorithm allows sequential restaining and reculturing of specimens for more thorough investigation. In addition to the use of special stains and culture conditions, it presents indications for further corneal scrapes and biopsies. Uncontrolled infection resulted in five perforations and penetrating keratoplasty was indicated in 11 cases. The visual outcome for these patients was poor with fewer than 30% achieving 6/12 acuity. The delay in diagnosis increases morbidity and this should be significantly reduced by adopting the algorithm we propose.- - - - - - - - - - ranking = 0.71428571428571keywords = keratitis (Clic here for more details about this article) |
5/6. Infectious keratitis with corneal perforation associated with corneal hydrops and contact lens wear in keratoconus.BACKGROUND: corneal perforation is an uncommon complication associated with keratoconus. The first cases of infectious keratitis and corneal perforation associated with corneal hydrops and contact lens wear are reported in two keratoconus patients. methods: A retrospective chart review and histopathological examination were carried out. RESULTS: Both patients progressed to corneal perforation and emergency penetrating keratoplasty. One patient cultured fusarium and the second patient serratia marcesens. Both patients wore contact lenses against medical advice. CONCLUSIONS: The tear in Descement's membrane, stromal oedema, and epithelial bedewing associated with corneal hydrops results in loss of the epithelial-endothelial barrier of the cornea, creating a conduit for infectious organisms through the cornea. Acute hydrops associated with epithelial keratitis, stromal swelling, and a Descement's membrane tear may be a significant risk factor for infectious keratitis and corneal perforation. contact lenses should not be worn during an active corneal hydrops owing to the increased risk for severe infectious keratitis and corneal perforation.- - - - - - - - - - ranking = 1.1428571428571keywords = keratitis (Clic here for more details about this article) |
6/6. Consultation section. Refractive surgical problem.A 29-year-old Hispanic man who had bilateral radial keratotomy (RK) and astigmatic keratotomy (AK) in his right eye 1 year previously went swimming in a lake. He subsequently developed foreign-body sensation and pain with a gradual decrease in vision over the following 5 weeks, despite treatment with ciprofloxacin hydrochloride (Ciloxan) and diclofenac sodium (Voltaren). The patient sought a second opinion. On examination, best corrected visual acuity was 20/40 in the right eye and 20/20 in the left. Slitlamp examination revealed mild conjunctival and scleral injection and a 3.5 mm diameter stromal infiltrate densest at the edges (Figure 1). The infiltrate involved one RK and one AK incision with gaping of both, approximately 90% depth incisions (Figure 2). The anterior chamber was deep and quiet. Examination was otherwise unremarkable. The cornea was scraped, but the smears were negative. The Ciloxan and Voltaren were stopped, and scopolamine four times a day was started. Cultures for aerobic, anaerobic, fungal, acid-fast bacilli, and acanthamoeba were performed but showed no growth in the following week. Except for vascular ingrowth, there was no change in the appearance of the microbial keratitis during this week. An incisional biopsy and rescraping were performed, but there was again no growth of micro-organisms and no change in the microbial keratitis in the following 4 days. How would you manage this patient at this time?- - - - - - - - - - ranking = 0.28571428571429keywords = keratitis (Clic here for more details about this article) |