Corneal Ulcer Management Research Papers (original) (raw)

The matrix metalloproteinases (MMPs) have been implicated in a number of diseases involving inflammation or cellular invasion.' GM 6001 is an inhibitor of most of these enzymes with Ki's in the low nanomolar range. Though potent in vitro,... more

The matrix metalloproteinases (MMPs) have been implicated in a number of diseases involving inflammation or cellular invasion.' GM 6001 is an inhibitor of most of these enzymes with Ki's in the low nanomolar range. Though potent in vitro, this molecule is short-lived in circulation with a half-life of a few minutes.

A 45-year-old woman developed a corneal infiltrate 14 months after laser in situ keratomileusis (LASIK) enhancement in the left eye. The LASIK flap was lifted, scraped, and irrigated with fortified vancomycin and ceftazidime. Scraped... more

A 45-year-old woman developed a corneal infiltrate 14 months after laser in situ keratomileusis (LASIK) enhancement in the left eye. The LASIK flap was lifted, scraped, and irrigated with fortified vancomycin and ceftazidime. Scraped samples were cultured and grew Brevundimonas vesicularis. The patient remained on topical ceftazidime until improvement was noted and was then switched to topical levofloxacin. The keratitis resolved on antibiotic agents with strong gram-negative coverage and a steroid. To our knowledge, this is the first report of a B vesicularis ocular infection.

Bacterial resistance is critical for the selection of antibiotics in the treatment of infections, so it is vital to know its current status in our geographical area. To determine in vitro antibiotic susceptibility of bacterial isolates... more

Bacterial resistance is critical for the selection of antibiotics in the treatment of infections, so it is vital to know its current status in our geographical area. To determine in vitro antibiotic susceptibility of bacterial isolates obtained from keratitis and intraocular infections. A retrospective study of microbiological tests in Fundación Oftalmológica de Santander (FOSCAL) was carried out between June, 2011, and January, 2012. A total of 92 samples were examined and 110 bacteria, 27 fungi and 12 free-living amoebae were identified. Polymicrobial infections constituted 50% of the total; 1.1%, 0%, 1.1%, 16.9%, 29.3% and 85% of Gram-positive bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively, while 0%, 8.3%, 0%, 0%, 18.2% and 27.3% of Gram-negative bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively. For methicillin-resistant coagulase-pos...

Purpose Platelet-rich plasma (PRP) harbors high concentrations of growth factors related to the promotion of wound healing. We evaluated the efficacy of PRP eyedrops in the treatment of persistent epithelial defects (PEDs). Methods... more

Purpose Platelet-rich plasma (PRP) harbors high concentrations of growth factors related to the promotion of wound healing. We evaluated the efficacy of PRP eyedrops in the treatment of persistent epithelial defects (PEDs). Methods Autologous PRP and autologous serum (AS) were prepared from whole blood. The concentrations of transforming growth factor (TGF)-b1, TGF-b2, epidermal growth factor (EGF), vitamin A and fibronectin in the PRP and AS were analyzed and compared. The corneal epithelial healing efficacy of PRP was compared with that of AS in patients with PED induced by post-infectious inflammation.

To determine the clinical efficacy and safety of moxifloxacin (1.0%) in patients with bacterial keratitis compared with patients treated with ofloxacin (0.3%) or fortified tobramycin (1.33%)/cephazolin (5%). Prospective randomized trial.... more

To determine the clinical efficacy and safety of moxifloxacin (1.0%) in patients with bacterial keratitis compared with patients treated with ofloxacin (0.3%) or fortified tobramycin (1.33%)/cephazolin (5%). Prospective randomized trial. A total of 229 patients diagnosed with bacterial keratitis were enrolled in the study; 78 patients were randomized to the fortified tobramycin/cephazolin group, 77 patients to the moxifloxacin group, and 74 patients to the ofloxacin group. A total of 225 patients were evaluable for safety and 198 patients were included in the efficacy analysis. After corneal specimens were obtained, the assigned study medication was instilled every hour, day and night, for 48 hours and on the third day, every hour by day and every 2 hours at night. For days 4 and 5, 1 drop every 2 hours by day and every 4 hours at night, and for days 6 and 7, 1 drop every 4 hours. After day 7, the antibiotic was tapered to every 6 hours and stopped when appropriate. Resolution of keratitis and healing of ulcer, time to cure, mean time to discharge, clinical sign score, adverse reactions to study medication, and treatment failures. Of the 186 nonexiting patients, resolution of the keratitis and healing of the ulcer occurred in 175 (94%) nonexiting patients. In the 175 patients in whom the corneal ulcer was cured, there were no statistically significant differences between the treatment groups for the mean time to cure (P = 0.25). There were no statistically significant differences between the 3 treatment groups in the various sign parameters including the sign score. A positive bacterial corneal culture was obtained in 190 (83%) of the 229 enrolled patients. The distribution of the species of bacterial organisms was similar in each treatment group and no significant difference in the percentage of isolates between the groups was observed. Twelve (5.2%) of the treated patients had serious complications (perforation or enucleation). No serious events attributable to therapy occurred during the study and all treatments were safe and well tolerated. No difference in healing rate, cure rate, or complications between fortified cephazolin and tobramycin, ofloxacin, or moxifloxacin was seen in this study.

Congenital upper eyelid entropion is a rare condition that does not spontaneously improve. 1 In congenital entropion, the tarsal plate loses its upright position and becomes inverted partially or entirely along the length of the lid. This... more

Congenital upper eyelid entropion is a rare condition that does not spontaneously improve. 1 In congenital entropion, the tarsal plate loses its upright position and becomes inverted partially or entirely along the length of the lid. This condition may result in keratitis, corneal abrasion, or even ulceration and opacification. Corneal trauma makes this condition an important potential cause of corneal ulceration in infants. 2 Since delayed recognition and treatment may result in permanent visual impairment, early diagnosis and surgical intervention are imperative.

The cornea and precorneal tear film combine to function as a strong refractive lens. To produce such an optically powerful structure, the corneal microanatomy consists of an epithelium and thin epithelial basement membrane, a thick... more

The cornea and precorneal tear film combine to function as a strong refractive lens. To produce such an optically powerful structure, the corneal microanatomy consists of an epithelium and thin epithelial basement membrane, a thick relatively acellular stroma, Descemet's membrane, and a monolayered endothelium.

A 40-day-old male child was admitted with complaints of not opening eyes from 2–3 days after birth. A diagnosis of X3-B keratomalacia was made. The treatment was done with vitamin-A to which the patient had responded. The mother of the... more

A 40-day-old male child was admitted with complaints of not opening eyes from 2–3 days after birth. A diagnosis of X3-B keratomalacia was made. The treatment was done with vitamin-A to which the patient had responded. The mother of the baby had a history of night blindness throughout the pregnancy for which she was also treated. Keratomalacia secondary to vitamin-A deficiency is rare in neontes, although in children it is reported form developing countries.

Lactobacillus acidophilus LF221 produced bacteriocin-like activity against dierent bacteria including some pathogenic and food-spoilage species. Besides some lactic acid bacteria, the following species were inhibited: Bacillus cereus,... more

Lactobacillus acidophilus LF221 produced bacteriocin-like activity against dierent bacteria including some pathogenic and food-spoilage species. Besides some lactic acid bacteria, the following species were inhibited: Bacillus cereus, Clostridium sp., Listeria innocua, Staphylococcus aureus, Streptococcus D. L. acidophilus LF221 produced at least two bacteriocins, acidocin LF221 A and acidocin LF221 B, which were puri®ed by ammonium sulphate precipitation, ion-exchange chromatography, hydrophobic interaction and reverse-phase FPLC. The antibacterial substances were heat-stable, sensitive to proteolytic enzymes (trypsin, pepsin, pronase, proteinase K) and migrated as 3500-to 5000-Da proteins on sodium dodecyl sulphate/polyacrylamide gel electrophoresis. The sequences of 46 amino-terminal amino acid residues of peptide A and 35 of peptide B were determined. Among the residues identi®ed, no modi®ed amino acids were found. No signi®cant homology was found between the amino acid sequences of acidocin LF221 A and other bacteriocins of lactic acid bacteria and 26% homology was found between acidocin LF221 B and brevicin 27. L. acidophilus LF221 may be of interest as a probiotic strain because of its human origin and inhibition of pathogenic bacteria, especially Clostridium dicile.

Methods: In this interventional case series, the medical records of 6 patients with Mooren's ulcer who had cataract surgery were retrospectively reviewed. Five patients had uneventful extracapsular cataract extraction with intraocular... more

Methods: In this interventional case series, the medical records of 6 patients with Mooren's ulcer who had cataract surgery were retrospectively reviewed. Five patients had uneventful extracapsular cataract extraction with intraocular lens (IOL) implantation, and 1 patient had phacoemulsification with IOL implantation. The visual acuity and postoperative course of the patients were reviewed. The patients were followed to detect, and if present treat, a recurrence of Mooren's ulcer.

PURPOSE. This study determined which microbiologic, clinical, demographic, and behavioral factors are associated with corneal infiltrative events (CIEs) during continuous wear of silicone hydrogel (SH) contact lenses.

The ocular penetration and pharmacokinetics of moxifloxacin in comparison to other fluoroquinolones (ofloxacin, ciprofloxacin, gatifloxacin, norfloxacin, levofloxacin, and lomefloxacin) have been determined by in vitro and ex vivo... more

The ocular penetration and pharmacokinetics of moxifloxacin in comparison to other fluoroquinolones (ofloxacin, ciprofloxacin, gatifloxacin, norfloxacin, levofloxacin, and lomefloxacin) have been determined by in vitro and ex vivo techniques, as well as in animal and human studies. This article reviews the original pharmacokinetics work performed by Alcon and other studies reported in the ocular fluoroquinolone literature. The results consistently demonstrate higher maximum concentrations for moxifloxacin relative to the other fluoroquinolones in ocular tissues with levels well above its minimum inhibitory concentrations for relevant ocular pathogens. This superior performance is due to the unique structure of moxifloxacin that combines high lipophilicity for enhanced corneal penetration with high aqueous solubility at physiological pH. The latter property creates a high concentration gradient at the tear film/corneal epithelial interface providing a driving force for better ocular penetration for moxifloxacin. In addition, the higher concentration of moxifloxacin in VIGAMOXă (i.e., 0.5% vs. 0.3%) allows more antibiotic to be available to ocular tissues. It is clear from the array of studies summarized in this report that moxifloxacin penetrates ocular tissues better (two-to three-fold) than gatifloxacin, ciprofloxacin, ofloxacin, or levofloxacin. This consistent, enhanced penetration of topical moxifloxacin offers powerful advantages for ophthalmic therapy. (Surv Ophthalmol 50:S32-S45, 2005. Ć 2005 Elsevier Inc. All rights reserved.)

Objetivo: Averiguar la fracción de pacientes intervenidos de un neurinoma del acústico que recuperan la función normal del nervio facial tras una parálisis facial completa postoperatoria, atendiendo a las complicaciones oftalmológicas... more

Objetivo: Averiguar la fracción de pacientes intervenidos de un neurinoma del acústico que recuperan la función normal del nervio facial tras una parálisis facial completa postoperatoria, atendiendo a las complicaciones oftalmológicas asociadas a la falta de recuperación y sus opciones terapéuticas. Material y método: Se realiza un estudio retrospectivo de 30 pacientes intervenidos de neurinomas del acústico en nuestro servicio que, con preservación anatómica del nervio facial, presentaron una parálisis facial completa (grado VI de House-Brackmann [HB]) postoperatoria. Se analiza la evolución de la parálisis en función del tamaño tumoral, la edad del paciente, el abordaje quirúrgico y la localización del neurinoma. También se estudian las complicaciones oftalmológicas surgidas y su tratamiento. Resultados: De los 30 pacientes estudiados, sólo 5 (16,6 %) recuperaron la función normal facial (grado I de HB). Se observó una tendencia a una peor recuperación en los casos con tamaño tumoral mayor de 2 cm, de sexo masculino, edad mayor de 65 años y abordados por vía translaberíntica. Sólo un paciente presentó complicaciones oftalmológicas graves. Conclusiones: Nuestro análisis revela que un escaso porcentaje de pacientes recupera de forma completa su función facial, y que es necesario estar alerta ante posibles complicaciones oculares en este espectro de pacientes.

Purpose To identify the associated factors and study the clinical and microbiological characteristics of corneal ulcers resulting in evisceration and enucleation in elderly patients in a tertiary care hospital. Methods A review of all... more

Purpose To identify the associated factors and study the clinical and microbiological characteristics of corneal ulcers resulting in evisceration and enucleation in elderly patients in a tertiary care hospital. Methods A review of all patients who required evisceration or enucleation due to microbial keratitis at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia between July 1998 and November 2007 was performed. Of these, patients more than 60 years of age were included in the study for analysis. Results Forty-seven patients with microbial keratitis were included in the study. The mean age of patients was 81± 9.39 years. Major ocular factors associated were glaucoma (49%), persistent corneal epithelial defect (38%) and use of corticosteroid eye drops (23%). Most common associated systemic factor was rheumatoid arthritis (36%). The indications for evisceration or enucleation were extensive non-healing microbial keratitis (22/47) and corneal perforation secondary to microbial keratitis (17/47). Pseudomonas aeruginosa was the most common pathogen, present in 15 patients, and more than 45% of the strains tested were resistant to chloramphenicol. Conclusions Corneal ulcers that result in the loss of eye in elderly population are frequently associated with glaucoma and persistent epithelial defects. The majority of these cases have non-healing microbial keratitis caused by Pseudomonas aeruginosa.

PURPOSE: To evaluate the role of intrastromal injection of voriconazole in the management of deep recalcitrant fungal keratitis. • DESIGN: Interventional case series. • METHODS: SETTING: Cornea services at a tertiary care teaching... more

PURPOSE: To evaluate the role of intrastromal injection of voriconazole in the management of deep recalcitrant fungal keratitis. • DESIGN: Interventional case series. • METHODS: SETTING: Cornea services at a tertiary care teaching hospital. PATIENTS: Three eyes of three patients with deep stromal recalcitrant fungal keratitis not responding to topical antifungal medications. INTERVEN-TION PROCEDURE: Voriconazole 50 micrograms/0.1 ml was injected circumferentially around the fungal abscess in the corneal stroma as an adjunctive to the topical antifungal therapy. MAIN OUTCOME MEASURE: Main outcome measure was a reduction in size of the abscess and resolution of the infection. • RESULTS: Before the intracorneal injection, all three eyes had gradually worsening lesions on topical medications. After the intervention, a faster reduction in the size of corneal infiltration was documented and a complete resolution of the ulcers was seen within three weeks in all cases. • CONCLUSION: Targeted delivery of voriconazole by intracorneal injection may be a safe and effective way to treat cases of deep-seated recalcitrant fungal keratitis responding poorly to conventional treatment modalities. (Am J Ophthalmol 2008;xx:xxx.

Purpose: To report the use of autologous serum eyedrops (ASE) for resolution of a corneal ulcer secondary to bullous keratopathy. Methods: Case report. Results: A 66-year old patient presented with an infected ulcer and hypopyon while... more

Purpose: To report the use of autologous serum eyedrops (ASE) for resolution of a corneal ulcer secondary to bullous keratopathy. Methods: Case report. Results: A 66-year old patient presented with an infected ulcer and hypopyon while using a bandage contact lens for bullous keratopathy. Staphylococcus warneri infection was treated with systemic and topical antibiotics, and ASE were subsequently administered to enhance re-epithelialisation and to avoid the need for a bandage contact lens. ASE treatment lead to closure of the epithelium layer within three weeks and it was subsequently tapered over the next three months. The clinical picture remained stable subjectively and objectively during the seven months of follow-up. Discussion: To the best of our knowledge this is the first report of successful use of autologous serum eyedrops in treating and preventing recurrence of ulcers in the context of bullous keratopathy.

Introduction: Infectious keratitis following penetrating keratoplasty is a common postoperative complication. Intensive topical and systemic treatments do not always prevent the risk of graft failure. In this report we demonstrate the... more

Introduction: Infectious keratitis following penetrating keratoplasty is a common postoperative complication. Intensive topical and systemic treatments do not always prevent the risk of graft failure. In this report we demonstrate the beneficial anti-microbial effect of corneal collagen cross-linking in a late-onset, sight-threatening, corneal graft ulcer.

The ocular penetration and pharmacokinetics of moxifloxacin in comparison to other fluoroquinolones (ofloxacin, ciprofloxacin, gatifloxacin, norfloxacin, levofloxacin, and lomefloxacin) have been determined by in vitro and ex vivo... more

The ocular penetration and pharmacokinetics of moxifloxacin in comparison to other fluoroquinolones (ofloxacin, ciprofloxacin, gatifloxacin, norfloxacin, levofloxacin, and lomefloxacin) have been determined by in vitro and ex vivo techniques, as well as in animal and human studies. This article reviews the original pharmacokinetics work performed by Alcon and other studies reported in the ocular fluoroquinolone literature. The results consistently demonstrate higher maximum concentrations for moxifloxacin relative to the other fluoroquinolones in ocular tissues with levels well above its minimum inhibitory concentrations for relevant ocular pathogens. This superior performance is due to the unique structure of moxifloxacin that combines high lipophilicity for enhanced corneal penetration with high aqueous solubility at physiological pH. The latter property creates a high concentration gradient at the tear film/corneal epithelial interface providing a driving force for better ocular penetration for moxifloxacin. In addition, the higher concentration of moxifloxacin in VIGAMOX (i.e., 0.5% vs. 0.3%) allows more antibiotic to be available to ocular tissues. It is clear from the array of studies summarized in this report that moxifloxacin penetrates ocular tissues better (two- to three-fold) than gatifloxacin, ciprofloxacin, ofloxacin, or levofloxacin. This consistent, enhanced penetration of topical moxifloxacin offers powerful advantages for ophthalmic therapy.

The infection frequency associated to bacterial conjunctivitis, corneal ulcers (CU), and endophthalmitis was studied along a five years period. The isolation and identification of microorganisms were performed by culture-based methods and... more

The infection frequency associated to bacterial conjunctivitis, corneal ulcers (CU), and endophthalmitis was studied along a five years period. The isolation and identification of microorganisms were performed by culture-based methods and biochemical test respectively. Also, a nested PCR to detect gram-negative and gram-positive bacteria in the clinical samples was assayed. Nested PCR was a more efficient method than culture to detect bacteria in the samples. The most frequently isolated species was Staphylococcus epidermidis, a bacterium commonly considered as a human saprophyte. The S. epidermidis strains from conjunctivitis, CU, and endophthalmitis exhibited 46, 33.9, and 34.1% of oxacilin-resistance respectively. A total of 28% of intermediate-vancomycin resistance (MIC = 8-16 µg/ml) was observed among S. epidermidis strain collection. The UPGMA cluster analysis of the multiresistance profile data of intermediate vancomycin-resistant S. epidermidis strains showed a high phenotypic diversity and no relationship between each group and their clinical origin. The biofilm formation capacity was broadly distributed (66%), particularly among intermediate-vancomycin strains (> 75%). In brief, S. epidermidis displayed a high diversity of antibiotic resistance profiles and biofilm formation capacity. These phenotypic traits could explain the high isolation frequency of S. epidermidis from ocular infections and oblige to review the saprophytic status of these bacteria.

To report a case of rapidly progressive infectious keratitis after INTACS implantation for keratoconus. A 32-year-old man presented with pain and decreased vision in the right eye of 2 days' duration. Right eye visual acuity was... more

To report a case of rapidly progressive infectious keratitis after INTACS implantation for keratoconus. A 32-year-old man presented with pain and decreased vision in the right eye of 2 days' duration. Right eye visual acuity was 20/800. He had undergone bilateral INTACS implantation 40 days prior for treatment of keratoconus. Slit-lamp examination revealed corneal ulceration and loose suture. The corneal ulcer progressed despite aggressive therapy, and the patient underwent penetrating keratoplasty 48 hours after admission. The culture from corneal scraping and corneal button was positive for Staphylococcus aureus. Infectious keratitis is a rare but devastating complication of INTACS implantation for treatment of keratoconus. Meticulous wound closure is necessary to reduce the risk of infection, especially in eyes with irregular corneal contour and variable corneal thickness.

Ains/Background-This study was initiated to investigate risk factors for and outcome of Acanthamoeba keratitis. Methods-Results of treatment were studied in 22 patients (23 eyes) presenting to Bristol Eye Hospital between 1985 and... more

Ains/Background-This study was initiated to investigate risk factors for and outcome of Acanthamoeba keratitis. Methods-Results of treatment were studied in 22 patients (23 eyes) presenting to Bristol Eye Hospital between 1985 and February 1995. Details related to the use and disinfection of contact lenses were also obtained. An additional two patients who were seen at Bristol but mainly treated elsewhere were surveyed for contact lens related information only. Results-The incidence ofAcanthamoeba keratitis rose substantially in the 1990s: three patients presented before 1990, while the remaining 21 presented between January 1990 and February 1995. Eleven patients have presented since January 1994. All of the patients in this series were contact lens wearers, 16 (67%) using daily wear disposable contact lenses. Contact lens disinfection data were available in 22 patients of whom 11 (50%) were using chlorine disinfectant. Other types of disinfection were much less common. Four patients (18%) had not used any disinfectant. During the course of the series the average diagnostic delay has fallen markedly, although in 77% of patients a diagnosis of a viral keratitis, most commonly herpes simplex, was made on first presentation. All but three of the series were treated with a combination of polyhexamethylene biguanide and propamidine isethionate. Penetrating keratoplasty was performed in 9/23 eyes (390/); in all of these eyes diagnosis was delayed for at least 6 weeks. All but one ofthe eyes in the series achieved a visual acuity of 6/9 or better after treatment, and 18 eyes (78%) saw 6/6 or better. Conclusions-Most patients with Acanthamoeba keratitis can now expect a good visual result and cure by medical therapy alone is favoured by early diagnosis.

Background: Corneal ulcers are one of the most common eye problems in the horse and can cause varying degrees of visual impairment. Secondary infection and protease activity causing melting of the corneal stroma are always concerns in... more

Background: Corneal ulcers are one of the most common eye problems in the horse and can cause varying degrees of visual impairment. Secondary infection and protease activity causing melting of the corneal stroma are always concerns in patients with corneal ulcers. Corneal collagen cross-linking (CXL), induced by illumination of the corneal stroma with ultraviolet light (UVA) after instillation of riboflavin (vitamin B2) eye drops, introduces crosslinks which stabilize melting corneas, and has been used to successfully treat infectious ulcerative keratitis in human patients. Therefore we decided to study if CXL can be performed in sedated, standing horses with ulcerative keratitis with or without stromal melting. Results: Nine horses, aged 1 month to 16 years (median 5 years) were treated with a combination of CXL and medical therapy. Two horses were diagnosed with mycotic, 5 with bacterial and 2 with aseptic ulcerative keratitis. A modified Dresden-protocol for CXL could readily be performed in all 9 horses after sedation. Stromal melting, diagnosed in 4 horses, stopped within 24 h. Eight of nine eyes became fluorescein negative in 13.5 days (median time; range 4-26 days) days after CXL. One horse developed a bacterial conjunctivitis the day after CXL, which was successfully treated with topical antibiotics. One horse with fungal ulcerative keratitis and severe uveitis was enucleated 4 days after treatment due to panophthalmitis.

Fluoroquinolones are a class of synthetic antibacterial agents that were approved for ocular therapy in 1991 and have become popular therapy for the treatment and prevention of various ocular infections. These agents are synthetic,... more

Fluoroquinolones are a class of synthetic antibacterial agents that were approved for ocular therapy in 1991 and have become popular therapy for the treatment and prevention of various ocular infections. These agents are synthetic, broad-spectrum, rapidly bactericidal, and have good penetration into ocular tissues. Their main mechanism of action is the inhibition of bacterial enzymes needed for bacterial DNA synthesis. However, antibiotic resistance occurred swiftly to the earlier fluoroquinolones and better fluoroquinolones were needed. The fourth-generation fluoroquinolones, such as moxifloxacin and gatifloxacin, have enhanced activity against gram-positive bacteria while retaining potent activity against most gram-negative bacteria. These fourth-generation fluoroquinolones have improved penetration into the anterior chamber and have also demonstrated increased in vivo efficacy in several animal models of ocular infections. In addition, topical ophthalmic antibiotic products can deliver antibiotic concentrations directly to the eye that are thousands of times higher than their MICs. This article reviews published data describing the in vitro potency of moxifloxacin and its in vivo activity for treating and preventing experimental ocular infections. (Surv Ophthalmol 50:S16-S31, 2005. Ć 2005 Elsevier Inc. All rights reserved.) Key words. antibiotic activity • antibiotic potency • antibiotic resistance • in vitro • in vivo • MICs • moxifloxacin • VIGAMOXă

We report the successful management of a rare case of bilateral post-laser in situ keratomileusis (LASIK) Fusarium oxysporum keratitis and propose a therapeutic strategy. A 19-year-old white man with no systemic diseases was referred to... more

We report the successful management of a rare case of bilateral post-laser in situ keratomileusis (LASIK) Fusarium oxysporum keratitis and propose a therapeutic strategy. A 19-year-old white man with no systemic diseases was referred to our emergency service 3 days after microkeratome-assisted myopic bilateral LASIK correction. He complained of blurred-vision, photophobia, and ocular pain. Clinical findings (satellite lesions, hypopyon) suggested fungal keratitis. Flaps were immediately lifted and rinsed with povidone-iodine 10%, and intensive topical and systemic and combined antifungal and antibacterial treatment was introduced. Topical cortisone drops were administered after 3 days. Despite initial deterioration of the clinical picture, all symptoms resolved quickly. Polymerase chain reaction indicated F oxysporum. Relapse occurred in the left eye, which was successfully managed. The final uncorrected distance visual acuity was 20/20 in both eyes. Fusarium oxysporum post-LASIK keratitis may occur in the early phase. Prompt diagnosis, interface irrigation with povidone-iodine solution, and intensive long-term treatment contribute to a favorable outcome.

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... more

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.

The cornea is a major protective shield of the interior of the eye and represents two thirds of its refractive power. It is made up of three tissue layers that have different developmental origins: the outer, epithelial layer develops... more

The cornea is a major protective shield of the interior of the eye and represents two thirds of its refractive power. It is made up of three tissue layers that have different developmental origins: the outer, epithelial layer develops from the ectoderm overlying the lens vesicle, whereas the stroma and the endothelium have mesenchymal origin. In the adult organism, the outermost corneal epithelium is the most exposed to environmental damage, and its constant renewal is assured by the epithelial stem cells that reside in the limbus, the circular border of the cornea. Cell turnover in the stromal layer is very slow and the endothelial cells probably do not reproduce in the adult organism. However, recent experimental evidence indicates that stem cells may be found in these layers. Damage to any of the corneal layers leads to loss of transparency and low vision. Corneal limbal stem cell deficiency results in severe ocular surface disease and its treatment by transplantating ex vivo expanded limbal epithelial cells is becoming widely accepted today. Stromal and endothelial stem cells are potential tools of tissue engineering and regenerative therapies of corneal ulcers and endothelial cell loss. In the past few years, intensive research has focused on corneal stem cells aiming to improve the outcomes of the current corneal stem cell transplantation techniques. This review summarizes the current state of knowledge on corneal epithelial, stromal and endothelial stem cells. Special emphasis is placed on the molecular markers that may help to identify these cells, and the recently revealed mechanisms that could maintain their ''stemness'' or drive their differentiation. The techniques for isolating and culturing/ expanding these cells are also described. '

Purpose-To assess the association between minimum inhibitory concentration (MIC) and clinical outcomes in a fungal keratitis clinical trial. Design-Experimental study using data from a randomized comparative trial. Participants-Of the 323... more

Purpose-To assess the association between minimum inhibitory concentration (MIC) and clinical outcomes in a fungal keratitis clinical trial. Design-Experimental study using data from a randomized comparative trial. Participants-Of the 323 patients enrolled in the trial, we were able to obtain MIC values from 221 patients with monocular fungal keratitis. Methods-The Mycotic Ulcer Treatment Trial I (MUTT I) was a randomized, double-masked clinical trial comparing clinical outcomes of monotherapy with topical natamycin versus voriconazole for the treatment of fungal keratitis. Speciation and determination of MIC to natamycin and voriconazole were performed according to Clinical and Laboratory Standards Institute guidelines. The relationship between MIC and clinical outcome was assessed. Main Outcome Measures-The primary outcome was 3-month best spectacle-corrected visual acuity. Secondary outcomes included 3-month infiltrate/scar size, corneal perforation and/or therapeutic penetrating keratoplasty (TPK), and time to re-epithelialization.

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... more

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.

Infections occurring after laser in situ keratomileusis (LASIK) surgery are uncommon, but the number of reports have steadily increased in recent years. This systematic, comprehensive review and analysis of the published literature has... more

Infections occurring after laser in situ keratomileusis (LASIK) surgery are uncommon, but the number of reports have steadily increased in recent years. This systematic, comprehensive review and analysis of the published literature has been performed in order to develop an integrative perspective on these infections. We have stratified the data by potential associations, microbiology, treatment, and the degree of visual loss, using Fisher's exact tests and Student's t-tests for analysis. In this review, we found that Gram-positive bacteria and mycobacterium were the most common causative organisms. Type of postoperative antibiotic and steroid use was not associated with particular infecting organisms or severity of visual loss. Gram-positive infections were more likely to present less than 7 days after LASIK, and they were associated with pain, discharge, epithelial defects, and anterior chamber reactions. Fungal infections were associated with redness and tearing on presentation. Mycobacterial infections were more likely to present 10 or more days after LASIK surgery. Moderate or severe visual reductions in visual acuity occurred in 49.4% of eyes. Severe reductions in visual acuity were significantly more associated with fungal infections. Flap lift and repositioning peformed within 3 days of symptom onset may be associated with better visual outcome. (Surv Ophthalmol 49:269-280, 2004. Ć 2004 Elsevier Inc. All rights reserved.)

Purpose Amniotic membrane has antifibrotic, anti-angiogenic and antiprotease properties. This retrospective study was designed to investigate the use of equine amniotic membrane transplants (AMT) at preserving vision, maintaining the... more

Purpose Amniotic membrane has antifibrotic, anti-angiogenic and antiprotease properties. This retrospective study was designed to investigate the use of equine amniotic membrane transplants (AMT) at preserving vision, maintaining the structural integrity of the globe and maximizing cosmesis in equine eyes with corneal ulceration and severe keratomalacia. Methods Equine amnion had previously been aseptically harvested from a 12-year-old Thoroughbred mare during an elective Cesarean section. Sections of amnion were stored at − 80 ° C and thawed as needed. Records of equine cases at the University of Florida with keratomalacia that received an AMT without adjunctive conjunctival grafting were examined. Clinical description, details of medical and surgical treatment, globe survival and visual outcome were documented. Etiologies were determined by cytology, culture or histology. Results Three horses with corneal ulceration and severe keratomalacia received an AMT without conjunctival graft between December 2002 and April 2003. Pseudomonas spp. were cultured from all three eyes, with evidence of a concurrent fungal infection in two eyes. The three ulcers were 50, 72, and 76% of corneal diameter, and each one worsened in the face of aggressive medical therapy. In all three cases, the AMT sloughed over a 4 to 6-week period. At last follow-up, all three eyes receiving AMT were comfortable and receiving no medication, with light perception and an inconsistent location-dependent menace response. All three horses returned to their prior work. Conclusions Results of a small number of equine AMT suggest that amnion can be used successfully to preserve both globe structure and limited vision, as well as optimize cosmesis, in horse eyes with corneal ulceration and severe keratomalacia.

Purpose: To evaluate the clinical and epidemiological aspects of contact lensrelated infectious corneal ulcers requiring hospitalization. Methods: A retrospective analysis was performed on the files of patients hospitalized for contact... more

Purpose: To evaluate the clinical and epidemiological aspects of contact lensrelated infectious corneal ulcers requiring hospitalization. Methods: A retrospective analysis was performed on the files of patients hospitalized for contact lens-induced corneal ulcer in the eight Belgian university hospitals over a 7-year period (January 1997 to December 2003. Diagnoses for all hospitalized patients are obligatorily registered using the ICD-9 code. Results: A total of 107 patients with contact lens-related corneal ulcers were documented: the number increased from five in 1997 to 22 in 2003. A total of 99 subjects used soft contact lenses, of whom nine used disposables, 73 planned replacement and 17 conventional lenses. Only six patients used extended wear lenses. Three patients used daily disposable lenses. The most frequently cultured organisms were Pseudomonas and other Gram-negative germs (70%) and Acanthamoeba (16%). The majority (77%) of the corneal ulcerations were centrally located and resulted in an average visual loss of four lines. Conclusion: During the study period, the number of patients hospitalized rose, which is only partially explained by the increasing prevalence of lens wearers: 3.5% and 6.5% of the Belgian population used lenses in 1995 and 2003, respectively. These factual data highlight the need for improvements in patient education.

Rabbits received nonpenetrating central corneal knife wounds. Immediately after wounding, a single 2.5 or 5.0 fxg dose of mesodermal growth factor (MGF) was applied topically to the wound. Controls were treated with saline. Electron... more

Rabbits received nonpenetrating central corneal knife wounds. Immediately after wounding, a single 2.5 or 5.0 fxg dose of mesodermal growth factor (MGF) was applied topically to the wound. Controls were treated with saline. Electron microscopic studies compared, the healing responses of the control and treated animals over a 7-day period. MGF toas a potent mitogen for keratocytes in rabbit corneas. The single dose enhanced fibroblast proliferation and metabolic activity. Control wounds were not healed after 7 days, whereas those of treated, animals showed complete healing.

Purpose: To assess adverse effects of contact lens-induced hypoxia on the rabbit cornea in vivo and determine the relation between binding of Pseudomonas aeruginosa and oxygen transmissibility for rigid and hydrogel lenses.

To identify the most common isolates from the corneal ulcers with antimicrobial pattern of bacterial isolates. All patients with suspected corneal ulceration presenting to BP Koirala Institute of Health Sciences from Jan 2004 - Dec 2008... more

To identify the most common isolates from the corneal ulcers with antimicrobial pattern of bacterial isolates. All patients with suspected corneal ulceration presenting to BP Koirala Institute of Health Sciences from Jan 2004 - Dec 2008 were evaluated. Corneal scraping was performed and processed for direct microscopy, bacteriological and fungal culture. Bacterial isolates were subjected to antimicrobial susceptibility testing. Of 351 specimens examined, growth of etiological agents were obtained in 278 (79.20%). Of these, 113 (40.65%) had pure fungal growth, 108 (38.85%) had pure bacterial growth and 57 (20.50%) had mixed fungal and bacterial infection. The commonest fungal pathogen was Aspergillus spp 50 (33.33%) followed by Fusarium spp 19 (12.66%). Staphylococcal aureus 57 (44.53%) was isolated as commonest bacterial agent. Coagulase Negative Staphylococci 20 (15.6%) was second in the list. Pseudomonas spp 12 (9.40%) was the most common gram negative bacilli isolated. Most of th...

This study evaluated the epidemiology of Pseudomonas aeruginosa keratitis in contact lens (CL) wearers; the relationships between CL storage case contamination and CL hygiene practice and between CL hygiene and the development of... more

This study evaluated the epidemiology of Pseudomonas aeruginosa keratitis in contact lens (CL) wearers; the relationships between CL storage case contamination and CL hygiene practice and between CL hygiene and the development of keratitis. Sixteen CL wearers with keratitis were compared with 44 asymptomatic controls. Lens hygiene practice was assessed and CL care materials, domestic water sites and endogenous sites were evaluated microbiologically. Poor CL hygiene was not associated with Ps. aeruginosa keratitis. There was an association between keratitis and bacterial contamination of the CL and storage case (P < 00005). Lens and storage case contamination were not significantly associated with poor hygiene. No domestic or endogenous source for Ps. aeruginosa was found. Causative organisms may be derived from other sources, but CLs and CL storage cases provide a favourable environment for Ps. aeruginosa colonization. Changing the CL care environment to one less favourable for Ps. aeruginosa may help to eliminate this problem.

Purpose: To examine predisposing factors, treatment costs, and visual outcome of microbial keratitis in an ophthalmic casualty and inpatient population. Design: Retrospective medical records review. Participants: Fifteen-to 64-year-olds... more

Purpose: To examine predisposing factors, treatment costs, and visual outcome of microbial keratitis in an ophthalmic casualty and inpatient population. Design: Retrospective medical records review. Participants: Fifteen-to 64-year-olds with microbial keratitis treated at the Royal Victorian Eye and Ear Hospital between May 2001 and April 2003 (n ϭ 291). Methods: Risk factors were identified from patient files. Demographic, clinical, and microbiological data; severity; outpatient visits; hospital bed days; and vision loss were examined. Main Outcome Measures: Cost to treat (Australian dollars), vision loss, and factors influencing these outcomes. Results: Ocular trauma (106/291 [36.4%]) and contact lens (CL) wear (98/291 [33.7%])