1/57. Cyanoacrylate tissue adhesive augmented tenoplasty: a new surgical procedure for bilateral severe chemical eye burns.PURPOSE: To report on cyanoacrylate tissue adhesive augmented tenoplasty, a new surgical procedure for bilateral severe chemical eye injuries. methods: A 26-year-old man presented with bilateral severe (grade IV) chemical burns involving the eye, periorbital tissues, face, and neck. Despite adequate medical therapy, corneal, limbal, and scleral ulceration progressed in both eyes. Secondary Pseudomonas keratitis necessitated therapeutic penetrating keratoplasty in the right eye. Tenoplasty and glued-on rigid gas permeable contact lens were unsuccessful to arrest progression of corneolimboscleral ulceration in the left eye. We applied n-butyl cyanoacrylate tissue adhesive directly on the ulcerating corneal, limbal, and scleral surface to augment tenoplasty. RESULTS: The left ocular surface healed with resultant massive fibrous tissue proliferation and symblepharon on the nasal side. Ocular surface rehabilitation resulted in a vascularized leukomatous corneal opacity with upper temporal clear cornea. The patient achieved visual acuity of 6/36 in the left eye. CONCLUSION: We suggest that cyanoacrylate tissue adhesive-augmented tenoplasty can be undertaken to preserve ocular integrity and retain visual potential in a severe chemical eye injury.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/57. Bilateral Pseudomonas corneal ulcer in a disposable contact lens wearer.PURPOSE: To describe a case of bilateral corneal ulcers caused by Pseudomonas in a disposable soft contact lens wearer. This case study discusses the role of patient examination, contact lens care instruction, and adequate patient supervision in reducing the risk of serious potential complications. methods AND RESULTS: A 17 year old student who had been using disposable soft contact lenses on an extended wear basis for 6 months presented complaining of pain in the left eye. When he was examined, a corneal ulcer with surrounding infiltrate was observed in the superior middle periphery of the left eye. Samples were collected for culture, and treatment with fortified cefalotin and gentamicin was started. After 8 hours the patient returned, now complaining of pain in the right eye. Examination of the right eye revealed a diffused keratitis with a mucopurulent discharge. A culture was taken, and the same treatment was instituted. The laboratory tests revealed Pseudomonas in both eyes. The bilateral corneal ulcers responded to therapy after 1 week of treatment. CONCLUSIONS: We discuss the factors involved in the occurrence of infectious keratitis in contact lens wearers, and stress that even disposable contact lens wear can be associated with serious complications. This case also highlights extended wear as one of the main risk factors for complications in disposable soft contact lens wear.- - - - - - - - - - ranking = 2keywords = keratitis (Clic here for more details about this article) |
3/57. Unusual case of acanthamoeba polyphaga and pseudomonas aeruginosa keratitis in a contact lens wearer from Gauteng, south africa.acanthamoeba species can cause a chronic, progressive ulcerative keratitis of the eye which is not responsive to the usual antimicrobial therapy and is frequently mistaken for stromal herpes keratitis. An unusual case of coinfection with acanthamoeba polyphaga and pseudomonas aeruginosa as causes of corneal keratitis in a contact lens wearer from Gauteng, south africa, is reported. These two pathogens have previously been assumed to be selectively exclusive. cysts of the isolated acanthameba tolerated an incubation temperature of 40 degrees C, indicating a pathogenic species. This case highlights the importance of culture methods in the diagnosis of corneal infection and the choice of treatment regimen. The patient's history of careless contact lens-disinfecting habits emphasizes the need to adhere strictly to recommended methods of contact lens care.- - - - - - - - - - ranking = 7keywords = keratitis (Clic here for more details about this article) |
4/57. Severe sclerokeratitis due to pseudomonas aeruginosa in noncontact-lens wearers.PURPOSE: To review the clinical presentation, treatment and outcome in four cases of severe anterior segment infection by pseudomonas aeruginosa unrelated to contact lens wear. methods: Four cases presenting over an 18 month period were reviewed. RESULTS: The cases had variable presenting features and outcomes. Complications such as persistent infection, corneal thinning and phthisis bulbi were noted. Possible factors influencing adherence and tissue disruption are discussed. CONCLUSIONS: Suspicion of infection by P. aeruginosa and prompt isolation of the organism is needed early in the course of disease. Intensive and prolonged treatment with parenteral and topical antibiotics combined with judicious use of topical steroid gives the best chance of a favourable outcome.- - - - - - - - - - ranking = 4keywords = keratitis (Clic here for more details about this article) |
5/57. Spontaneous corneal perforation and endophthalmitis in pseudomonas aeruginosa infection in a ventilated patient: a case report.We report a case of Pseudomonas keratitis and endophthalmitis after inoculation from the respiratory tract in a mechanically ventilated patient. In these (semi)comatose and more vulnerable patients, colonisation of the upper respiratory tract by Pseudomonas occurs frequently, and this can lead to inoculation of the eyes. Emphasis lies on careful prevention of ocular inoculation and aggressive therapy as soon as keratitis is noticed.- - - - - - - - - - ranking = 2keywords = keratitis (Clic here for more details about this article) |
6/57. An unusual case of corneal perforation secondary to Pseudomonas keratitis complicating a patient's surgical/trauma intensive care unit stay.We report a case of corneal perforation secondary to bacterial keratitis caused by pseudomonas aeruginosa in a trauma patient in our intensive care unit. A 43-year-old man was involved in a motorcycle crash and suffered multiple injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently P. aeruginosa was cultured from his sputum, blood, and open abdomen. He developed a bacterial keratitis in his right eye, which also grew P. aeruginosa. This infection rapidly progressed to corneal perforation requiring a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to aggressive antibiotic treatment. At the time of discharge from the hospital the patient had the return of vision to light only in his right eye. corneal perforation is an unusual event in the ICU. Prevention or early detection of bacterial keratitis with aggressive antibiotic treatment is needed to prevent such complications. Pseudomonas is one of the more virulent organisms that can infect the cornea and early identification is paramount for a good outcome. Management of this complicated case is discussed and the limited amount of literature on nosocomial bacterial keratitis in the ICU is reviewed.- - - - - - - - - - ranking = 8keywords = keratitis (Clic here for more details about this article) |
7/57. pseudomonas aeruginosa keratitis treated with ticarcillin and tobramycin.A corneal ulcer, infected with pseudomonas aeruginosa and complicated by conjunctivitis and endophthalmitis, was treated successfully with systemic administration of ticarcillin and topical application of tobramycin. It is unlikely that carbenicillin, to which the organism was much less sensitive, would have attained sufficient tissue levels to control the infection.- - - - - - - - - - ranking = 4keywords = keratitis (Clic here for more details about this article) |
8/57. Infectious keratitis in orthokeratology.Orthokeratology is a method of changing refraction in myopic patients by using rigid contact lenses to reduce the curvature of the cornea. This treatment was in use in the two cases of corneal ulcer described in this paper and appears to have contributed to the development of their disease. As with extended wear contact lenses, patients undergoing orthokeratology treatment are frequently advised to wear the orthokeratology lenses overnight increasing the risk of corneal ulceration and infection. patients should be adequately warned of the associated risks and advised that any envisaged benefits of the procedure are temporary.- - - - - - - - - - ranking = 4keywords = keratitis (Clic here for more details about this article) |
9/57. Clinical presentation of microbial keratitis with daily wear frequent-replacement hydrogel lenses: a case series.Microbial keratitis (MK) is a serious complication associated with contact lens wear. In this case series we report three clinical presentations of MK associated with daily-wear monthly-replacement soft contact lenses. All of these patients were using vifilcon A (55% water content, ionic, U.S. food and Drug Administration [FDA] group IV) monthly-replacement soft contact lenses. A gram-stained smear of the corneal scrapings of two patients showed numerous gram-negative cocci bacilli, and tissue cultures showed significant growth of pseudomonas aeruginosa. In the third patient, the corneal scrapings showed numerous gram-negative bacilli, along with gram-positive cocci, and tissue culture showed significant growth of aeromonas species and alpha-hemolytic streptococci. All these cases were resolved by medical therapy. This case series highlights the importance of patient symptoms, clinical features, and microbiologic work-up in making a differentiation between MK and sterile contact lens-induced peripheral ulcer (CLPU). A high index of suspicion and close follow-up care will avoid misdiagnosis and reduce complications.- - - - - - - - - - ranking = 5keywords = keratitis (Clic here for more details about this article) |
10/57. Orthokeratology lens-related pseudomonas aeruginosa infectious keratitis.PURPOSE: To report a case of orthokeratology lens-related Pseudomonas corneal ulcer in an adult. methods: Case report. RESULTS: A 37-year-old man presented with a 1-day history of painful red eye. He was a soft contact lens wearer before he started on nocturnal orthokeratology lens wear of 8 to 10 hours per night 9 months ago. Corneal scraping sent for culture revealed a heavy growth of pseudomonas aeruginosa. The patient was treated with intensive topical fortified tobramycin and ceftazidime drops. The ulcer healed with a residual paraxial corneal scar. Although his best-corrected visual acuity (BCVA) recovered from finger counting (8/200) at presentation to 20/30, he suffered visual loss from a premorbid BSCVA of 20/15. His contrast sensitivity (Vector Vision CSV 1000 test) performance was also worse than his fellow eye. CONCLUSION: Nocturnal orthokeratology lens wear may be associated with an increased risk of infection.- - - - - - - - - - ranking = 4keywords = keratitis (Clic here for more details about this article) |
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