1/181. Streptococcal keratitis after myopic laser in situ keratomileusis.A 24-year-old healthy male underwent uncomplicated laser in situ keratomileusis (LASIK) in left eye. One day after the surgery, he complained of ocular pain and multiple corneal stromal infiltrates had developed in left eye. Immediately, the corneal interface and stromal bed were cleared, and maximal antibiotic treatments with fortified tobramycin (1.2%) and cefazolin (5%) were given topically. The causative organism was identified as 'streptococcus viridans' both on smear and culture. Two days after antibiotic therapy was initiated, the ocular inflammation and corneal infiltrates had regressed and ocular pain was relieved. One month later, the patient's best corrected visual acuity had returned to 20/20 with -0.75 -1.00 x 10 degrees, however minimal stromal scarring still remained. This case demonstrates that microbial keratitis after LASIK, if treated promptly, does not lead to a permanent reduction in visual acuity.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
2/181. Bacterial keratitis following laser in situ keratomileusis for hyperopia.A 42-year-old Bahraini man had uneventful laser in situ keratomileusis for hyperopia (OD: 3.00 0.75 x 155 degrees; OS: 2.00 0.50 x 155 degrees). Three weeks later, he presented with localized keratitis in his right eye, with localized keratitis at the flap margin with stromal edema. Uncorrected visual acuity was 20/80 OD with no improvement with pinhole, and was 20/20 OS. Corneal smear culture showed a positive growth of staphylococcus aureus. The patient was immediately treated with subconjunctival gentamicin and intensive topical ofloxacin 0.3% with systemic cephalosporin. The patient recovered from keratitis within 2 weeks and his uncorrected visual acuity OD improved to 20/20. keratitis following LASIK should be treated promptly so that it does not lead to permanent reduction in visual acuity.- - - - - - - - - - ranking = 1.5keywords = visual (Clic here for more details about this article) |
3/181. Use of a low nutrient culture medium for the identification of bacteria causing severe ocular infection.A low nutrient culture medium was used to identify the pathogens in four cases of persisting ocular infection. Bacto R2A agar was used in addition to conventional liquid- and solid-phase media to culture pathogenic bacteria from one case of recurrent keratitis, one case of suture-related keratitis with endophthalmitis and two eyes (two patients) with post-operative endophthalmitis. In each case, a pathogen was identified solely with R2A agar after culture for 6 days. Species isolated were pseudomonas aeruginosa (one), propionibacterium acnes (two) and staphylococcus aureus (one). Antibiotic therapy was tailored to conform to the sensitivity of the cultured organism in each case. The use of Bacto R2A low nutrient agar should be considered in culture negative eyes not showing clinical improvement, or for chronic cases where bacteria may have become adapted to more stringent ocular environments.- - - - - - - - - - ranking = 0.8309735485772keywords = sensitivity (Clic here for more details about this article) |
4/181. Sterile interface keratitis after laser in situ keratomileusis: three episodes in one patient with concomitant contact dermatitis of the eyelids.PURPOSE: To illustrate a case in which sterile interface keratitis after laser in situ keratomileusis (LASIK) occurred concomitantly with an allergic contact dermatitis of the eyelids. methods: Retrospective case review. RESULTS: Resolution of the interface keratitis and dermatitis occurred following an intense course of topical corticosteroids and brief course of oral corticosteroids. Despite an attempt to eliminate potential causes, the same patient developed interface keratitis in the fellow eye following both the initial LASIK and an enhancement, in which no microkeratome was used. Intense treatment with both topical and oral corticosteroids led to a final uncorrected visual acuity of 20/20 in the right eye and 20/25 2 in the left eye. CONCLUSION: The etiology and mechanism of sterile interface keratitis after LASIK are unknown, but are probably multifactorial. The concomitant contact dermatitis reaction may indicate a common immune mechanism.- - - - - - - - - - ranking = 0.5keywords = visual (Clic here for more details about this article) |
5/181. The spectrum of ocular inflammation caused by euphorbia plant sap.OBJECTIVE: To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from euphorbia species. DESIGN: Clinical case series. SETTING: ophthalmology emergency referrals in the United Kingdom. patients: We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of euphorbia species. INTERVENTIONS: All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. patients were observed until all signs and symptoms had resolved. MAIN OUTCOME MEASURES: Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification. RESULTS: Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs and symptoms had resolved by 1 to 2 weeks. CONCLUSIONS: These cases illustrate the range of severity of euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
6/181. Ring keratitis from topical anaesthetic misuse.BACKGROUND: Topical anaesthetic abuse is now an established differential diagnosis of ring keratitis. Published evidence suggests that this condition often has a poor prognosis, with the eyes sometimes requiring penetrating keratoplasty or the patient becoming blind. METHOD: A case of topical anaesthetic abuse and its subsequent management is presented. Ocular examination including pachymetry and specular microscopy is reported. RESULTS: The cornea made an excellent recovery, allowing a visual acuity of 6/6. Pachymetry showed corneal thickening and specular microscopy demonstrated a decreased cell count in the affected eye. CONCLUSIONS: With prompt recognition and appropriate treatment the prognosis for these cases can be excellent. However, there is evidence to suggest permanent cellular damage to the endothelium.- - - - - - - - - - ranking = 0.5keywords = visual (Clic here for more details about this article) |
7/181. Multiple cranial neuropathy in Cogan's syndrome.A 20 year old woman presented with recurrent alternative keratitis for four months. One month before admission, she developed progressive hearing loss, visual impairment, facial diparesis and bilateral trigeminal neuropathy. Cogan's syndrome was diagnosed. Prompt treatment with corticosteroid resulted in dramatic improvement of the ocular, otological and neurological dysfunctions.- - - - - - - - - - ranking = 0.5keywords = visual (Clic here for more details about this article) |
8/181. Delayed keratitis after laser in situ keratomileusis.We report 2 cases of delayed keratitis that occurred after uneventful laser in situ keratomileusis (LASIK). The first patient presented with a peripheral corneal infiltrate 3 months after a LASIK enhancement procedure. The infiltrate progressed despite treatment with topical combination tobramycin-dexamethasone. The flap was then lifted and the interface was irrigated with fortified antibiotics. The keratitis promptly resolved, and the patient recovered a best corrected visual acuity (BCVA) of 20/20. The second patient presented with decreased vision, inflammation, and a sublamellar infiltrate 1 month after primary LASIK. The flap was promptly lifted and irrigated with antibiotics. Cultures were positive for staphylococcus epidermidis. One week later, the infiltrate had resolved and BCVA had returned to 20/20. Delayed bacterial keratitis has been described as a rare occurrence after incisional refractive surgery. To the best of our knowledge, it has not yet been reported after LASIK. It is important to consider infectious keratitis in the differential diagnosis of a patient who presents with corneal inflammation, even months after having LASIK.- - - - - - - - - - ranking = 0.5keywords = visual (Clic here for more details about this article) |
9/181. Nocardia keratitis after traumatic detachment of a laser in situ keratomileusis flap.PURPOSE: Nocardia are gram-positive bacteria existing ubiquitously in the environment; they can cause keratitis. nocardia asteroides keratitis occurred in the interface between the stromal bed and flap after traumatic detachment of the flap 4 months after an initially uncomplicated laser in situ keratomileusis (LASIK) procedure. methods: nocardia asteroides keratitis was confirmed by culture. Therapy included topical and oral trimethoprim-sulfamethoxazole. RESULTS: Thirteen months after the trauma, the patient's spectacle-corrected visual acuity was 20/20 with a manifest refraction of -2.25 -1.00 x 30 degrees. CONCLUSIONS: The immediate steps of management consisting of surgically lifting the corneal flap, rapid microbial identification, and proper treatment with specific antibiotics resulted in the successful treatment of nocardia asteroides keratitis in a traumatized eye after LASIK.- - - - - - - - - - ranking = 0.5keywords = visual (Clic here for more details about this article) |
10/181. Marginal keratitis: an uncommon form of topical dorzolamide allergy.PURPOSE: To report a case of marginal keratitis resulting from topical dorzolamide hypersensitivity. METHOD: Case report. RESULTS: A 68-year-old woman presented with bilateral marginal keratitis 2 weeks after commencing bilateral topical dorzolamide. One week after discontinuation of topical dorzolamide, the patient was asymptomatic with complete resolution of corneal infiltrates. CONCLUSIONS: Topical dorzolamide may cause a hypersensitivity reaction in the form of marginal keratitis. Discontinuation of the offending medication should result in complete resolution.- - - - - - - - - - ranking = 1.6619470971544keywords = sensitivity (Clic here for more details about this article) |
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