Showing papers on "corneal ulcer published in 2015"

Bioengineered Corneas Grafted as Alternatives to Human Donor Corneas in Three High‐Risk Patients

Abstract: Corneas with severe pathologies have a high risk of rejection when conventionally grafted with human donor tissues. In this early observational study, we grafted bioengineered corneal implants made from recombinant human collagen and synthetic phosphorylcholine polymer into three patients for whom donor cornea transplantation carried a high risk of transplant failure. These patients suffered from corneal ulcers and recurrent erosions preoperatively. The implants provided relief from pain and discomfort, restored corneal integrity by promoting endogenous regeneration of corneal tissues, and improved vision in two of three patients. Such implants could in the future be alternatives to donor corneas for high-risk patients, and therefore, merits further testing in a clinical trial.

Impact of Facial Conformation on Canine Health: Corneal Ulceration

Abstract: Concern has arisen in recent years that selection for extreme facial morphology in the domestic dog may be leading to an increased frequency of eye disorders. Corneal ulcers are a common and painful eye problem in domestic dogs that can lead to scarring and/or perforation of the cornea, potentially causing blindness. Exaggerated juvenile-like craniofacial conformations and wide eyes have been suspected as risk factors for corneal ulceration. This study aimed to quantify the relationship between corneal ulceration risk and conformational factors including relative eyelid aperture width, brachycephalic (short-muzzled) skull shape, the presence of a nasal fold (wrinkle), and exposed eye-white. A 14 month cross-sectional study of dogs entering a large UK based small animal referral hospital for both corneal ulcers and unrelated disorders was carried out. Dogs were classed as affected if they were diagnosed with a corneal ulcer using fluorescein dye while at the hospital (whether referred for this disorder or not), or if a previous diagnosis of corneal ulcer(s) was documented in the dogs’ histories. Of 700 dogs recruited, measured and clinically examined, 31 were affected by corneal ulcers. Most cases were male (71%), small breed dogs (mean± SE weight: 11.4±1.1 kg), with the most commonly diagnosed breed being the Pug. Dogs with nasal folds were nearly five times more likely to be affected by corneal ulcers than those without, and brachycephalic dogs (craniofacial ratio <0.5) were twenty times more likely to be affected than non-brachycephalic dogs. A 10% increase in relative eyelid aperture width more than tripled the ulcer risk. Exposed eye-white was associated with a nearly three times increased risk. The results demonstrate that artificially selecting for these facial characteristics greatly heightens the risk of corneal ulcers, and such selection should thus be discouraged to improve canine welfare.

Corneal Abrasions and Corneal Foreign Bodies

Abstract: Corneal abrasions and corneal foreign bodies are frequently encountered ophthalmological injuries that are commonly diagnosed and managed by primary care physicians. The clinical course of a corneal epithelial defect can range from a relatively benign self-healing abrasion to a potentially sight-threatening complication such as a corneal ulcer, recurrent erosion, or traumatic iritis. A detailed clinical history regarding risk factors and exposure, along with a thorough slit lamp examination with fluorescein dye are essential for proper diagnosis and treatment, as well as to rule out penetrating globe injuries. Referral to an ophthalmologist is recommended in difficult cases or if other injuries are suspected.

Trends in bacterial and fungal keratitis in South India, 2002–2012

Abstract: Objective To assess the trends in microbiological organisms identified from corneal scrapings from patients with infectious keratitis at a tertiary care medical centre in South India. Methods We reviewed the records of the microbiology laboratory at Aravind Eye Hospital in Madurai, India, from 2002 until 2012. We identified the microbiological causes of all corneal ulcers from the culture and smear results, and assessed for trends in bacterial and fungal keratitis over time. Results Of 23 897 corneal patients with ulcer with a corneal smear from 2002 to 2012 a fungal organism was identified in 34.3%, a bacterial organism in 24.7% and no organism in 38.3%. During this period, the annual number of keratitis cases due to bacteria decreased from 677 to 412, and the annual number due to fungus increased from 609 to 863. In analyses accounting for the total number of outpatients seen each year, the decline in number of smears positive for bacteria was statistically significant (p Conclusions At a tertiary eye care centre in South India, there has been a reduction in the numbers of smear-positive bacterial keratitis over the past 11 years. This decline likely reflects economic development in India and increased access to antibiotics.

Acanthamoeba Keratitis: Clinical Characteristics and Management

Abstract: Purpose To review characteristics of clinical features in 260 eyes with Acanthamoeba keratitis (AK) from 1991 to 2013. Methods We retrospectively analyzed 260 eyes from 259 patients diagnosed with Acanthamoeba keratitis (AK) by smear and/or culture and/or laser confocal microscopy between 1991 and 2013 at Beijing Tongren Eye Center. Patient data included age, gender, profession, predisposing risk factors, clinical presentation, treatment, therapy effect, and course of disease. Results The most common risk factor in this study was ocular trauma (53.1%), followed by contact lens wear (29.8%). Most of the AK patients were farmers (50.8%), and students (23.8%) formed the second largest group of AK patients. Most cases (77.8%) were classified as advanced stage AK at initial presentation; only a few patients (5.6%) were diagnosed with early stage disease. Of 90 cases, 77 (85.6%) had salt-like dense infiltrate dots on the corneal ulcer, 54 cases (61.1%) had groove-shaped corneal melting around the corneal ulcer, and 37 cases(41.1%) had classic ring infiltrate. Nine cases experienced improved conditions at the beginning of treatment, which subsequently worsened, and then improved gradually. Treatments were administered according to the disease stage. After topical anti-amoeba drug therapy, 48 of 90 cases (53.3%) were cured with corneal scarring remaining; mean duration of treatment was 5 months. Conclusion Salt-like dense infiltrate dots and groove-shaped corneal melting may serve as useful clues in the diagnosis of AK, in addition to radial neuritis and ring infiltration. Some patients with AK may experience a worsened condition after early improvement with anti-amoeba drug therapy, and then improve gradually.

PACK-CXL: Corneal Cross-linking for Treatment of Infectious Keratitis.

Abstract: This article discusses corneal cross-linking (CXL) and how it transitioned from a modality for treating corneal ectatic disorders to an inventive means of treating infectious keratitis. Initially, CXL was successfully developed to halt the progression of ectatic diseases such as keratoconus, using the standard Dresden protocol. Later, indications were extended to treat iatrogenic ectasia developing after laser-assisted in situ keratomileusis (LASIK) and photo-refractive keratectomy (PRK). At the time, it had been postulated that the combination of ultraviolet light with riboflavin could not only biomechanically strengthen the cornea but also was capable of destroying living cells and organisms including keratocytes and pathogens. Thus a new and innovative concept of treatment for infectious keratitis emerged through the use of CXL technology. Initially only advanced infectious melting ulcers resisting standard microbicidal therapy were treated with CXL in addition to standard therapy. In subsequent studies CXL was also used to treat bacterial keratitis as first line therapy without the use of concomitant antibiotic therapy. With the increasing interest in CXL technology to treat infectious keratitis and to clearly separate its use from the treatment of ectatic disorders, a new term was adopted at the 9(th) CXL congress in Dublin for this specific indication: PACK-CXL (photoactivated chromophore for infectious keratitis). PACK-CXL has the potential to eventually become an interesting alternative to standard antibiotic therapy in treating infectious corneal disorders, and may help reduce the global burden of microbial resistance to antibiotics and other therapeutic agents.

Corneal complications of vernal keratoconjunctivitis.

Abstract: Purpose of reviewVernal keratoconjunctivitis (VKC) is a severe bilateral chronic allergic inflammatory disease of the ocular surface. In most of the cases, the disease is limited to the tarsal conjunctiva and to the limbus. However, in the more severe cases, the cornea may be involved, leading to po

Outcome of therapeutic penetrating keratoplasty in a tertiary eye care center in Nepal.

Abstract: Background Corneal ulcer is an important cause of blindness in developing countries. Therapeutic keratoplasty for infective keratitis is a frequently performed surgery in these countries. Objective To find out the outcome of therapeutic keratoplasty for infective keratitis. Methods Records of 5 years were reviewed of patients who underwent therapeutic keratoplasty from 2006 to 2010. Data collected included demographic parameters, indications for surgery, microbiology of the ulcers, type of surgery performed, and donor tissue details. In the follow-up period, ocular status was evaluated in terms of eradication of disease, anatomic success, graft clarity, visual acuity, and development of glaucoma and cataract. Results In all, 180 eyes of 180 patients were enrolled in the study; 59.4% of the patients were male. Average age was 44.4±16.7 years. Overall, 71% of infective keratitis was perforated. A total of 101 (56%) eyes were positive for organisms of which 49 showed pure fungus and 49 showed pure bacteria. The commonest fungus and bacteria isolated were Aspergillus and Streptococcus, respectively. Average follow-up period was 29±23 months. Overall cure rate of infection was 88.8%, anatomical success rate was 89.5%, and graft clarity was 37.2%. Overall, 43.4% had secondary glaucoma. In the postoperative course, 65.8% of phakic eyes had developed cataract. In all, 38.6% of graft had endothelial failure and 24% of the graft failed due to late infective keratitis. Overall functional success with a visual acuity above 6/60 was 25.4%. Bacterial keratitis had a significantly higher cure rate, anatomical success, and graft clarity compared to fungal keratitis. Conclusion Therapeutic keratoplasty is an important procedure to save the eye and preserve vision in severe infective keratitis. There is a high incidence of postoperative glaucoma, cataract, and graft failure in such a surgery. Bacterial keratitis has a better outcome than fungal keratitis.

Imported Pythium insidiosum Keratitis After a Swim in Thailand by a Contact Lens-Wearing Traveler

Abstract: A 30-year-old woman with a history of contact lens wear and exposure to swimming pool water in Thailand presented with a non-responsive, progressive corneal ulcer of the right eye. Confocal microscopy evidenced septate linear branching structures, raising suspicion of fungal keratitis. She was promptly treated with topical antibiotics and both topical and intravenous caspofungin plus voriconazole. Worsening of the clinical picture after 1 month of intensive medical therapy led to a large therapeutic penetrating keratoplasty being performed. Corneal cultures grew a mold-like organism, which was identified by sequencing as Pythium insidiosum, an aquatic oomycete. After 4 years of follow-up, the graft exhibits no infection relapse, but graft transparency has been lost after two rejection episodes. Keratoplasty combined with antifungal treatment may offer a cure to P. insidiosum keratitis, although long-term preservation of corneal transparency is difficult to obtain.

Cladosporium keratitis – a case report and literature review

Abstract: Background: Fungal keratitis is one of the major causes of infectious keratitis in tropical countries. Symptoms of fungal keratitis consist of blurred vision, redness, tearing, photophobia, pain and foreign body sensation. If not treated effectively, it could lead to blindness. Common causes include Candida spp., Fusarium spp. and Aspergillus spp.. With the limited choices of topical antifungal agents, we were faced with Cladosporium keratitis, a rare cause of fungal keratitis. Case presentation: A 62-year-old Asian male construction worker came to us with intense ocular pain, injection of the conjunctiva, blurred vision, and foreign body sensation in his left eye. His visual acuity was 20/40 OD and 20/400 OS. Slit-lamp exam revealed a corneal ulcer with feathery margin and Descemet’s membrane folding. The culture yielded Cladosporium species. .T he patient did not show improvements after applying topical natamycin (5 %), topical amphotericin B (1mg/ml), topical fluconazole (2mg/ml) and oral ketoconazole (200mg). After shifting the medical regimen to voriconazole via topical and systemic routes (1mg/ml and 200mg respectively), the keratitis was controlled. Conclusions: Fungal keratitis remains a challenge for ophthalmologists as there is no evidence suggesting any particular drug or combination of drugs is more effective than another. A review of common topical antifungal agents was done. Voriconazole could be a good choice for treating corneal infection by Cladosporium species.

Community practice patterns for bacterial corneal ulcer evaluation and treatment.

Abstract: OBJECTIVE To examine current practice patterns in the management of bacterial keratitis among U.S. ophthalmologists and differences in the management and opinions between cornea specialists and non-cornea specialists. METHODS A questionnaire was distributed to randomly selected ophthalmologists in July 2011 using an online survey system. It inquired about the number of patients with corneal ulcers seen monthly, frequency of Gram staining and culturing corneal ulcers, maintenance of diagnostic supplies, opinions on when culturing is necessary for corneal ulcers, treatment preferences for different severities of bacterial corneal ulcers, and opinions regarding relative efficacy of fourth-generation fluoroquinolones and fortified broad-spectrum antibiotics. RESULTS One thousand seven hundred one surveys were distributed, and 486 (28.6%) surveys were returned. A minority of corneal ulcers was Gram stained (23.7%±34.1%, mean±SD) or cultured (35.1%±38.0%), but cornea specialists were more likely to perform both. The most popular antibiotic for the treatment of less severe ulcers was moxifloxacin (55.4%), and the most popular treatment of more severe ulcers was fortified broad-spectrum antibiotics (62.7%). Cornea specialists were significantly more likely than non-cornea specialists to prescribe fortified antibiotics for more severe corneal ulcers (78.1% vs. 53.7%, P<0.0001). A greater number of cornea specialists stated that fourth-generation fluoroquinolones were less effective than fortified antibiotics for the treatment of more severe corneal ulcers (79.6% of cornea specialists vs. 60.9% of non-cornea specialists, P<0.001). CONCLUSIONS Cornea specialists and non-cornea specialists manage bacterial keratitis differently, with cornea specialists more likely to perform diagnostic testing and prescribe fortified broad-spectrum antibiotics for severe bacterial keratitis. Additional prospective studies demonstrating visual outcomes after differential treatment of bacterial keratitis are needed.

Aloe vera gel facilitates re-epithelialization of corneal alkali burn in normal and diabetic rats.

Abstract: Purpose To investigate the efficacy of topical applied aloe vera (AV) and to facilitate the repair of the standardized alkaline corneal ulcer in normal and diabetic rats.

Trastuzumab-induced corneal ulceration: successful no-drug treatment of a "blind" side effect in a case report.

Abstract: We report the first successful treatment of limbal lesions and corneal erosion experienced by a breast cancer patient undergoing trastuzumab treatment. A 49-year-old Caucasian woman with early stage breast cancer was treated with adjuvant trastuzumab and subsequently showed persistent bilateral corneal marginal infiltrates resistant to topical steroid and antibiotic treatment. Autologous serum was applied in the conjunctival sac as an experimental treatment to antagonize the inhibitory effect of the HER2 receptor antibody on the corneal epithelial cells. Topical application of autologous serum led to rapid improvement of the ulcerative keratitis, with complete healing of the corneal defect after 7 days. Continued administration of the serum allowed the resumption of trastuzumab therapy without any further side effects. Persistent bilateral corneal marginal infiltrates may occasionally arise as a side effect of trastuzumab treatment. Topical medication with autologous serum may be an effective therapeutic option for the ocular side effects of trastuzumab therapy.

Experimental study on cryotherapy for fungal corneal ulcer

Abstract: Fungal corneal ulcer is one of the major causes of visual impairment worldwide Treatment of fungal corneal ulcer mainly depends on anti-fungal agents In the current study, we developed an integrated combination therapy of cryotherapy and anti-fungal agents to facilitate effective treatment of fungal corneal ulcer

Microbial Keratitis at an Urban Public Hospital: A 10-Year Update

Abstract: Purpose: To review the epidemiology, risk factors, microbiologic spectrum, and treatment of microbial keratitis during a five-year period at an urban public hospital with comparison to similar findings a decade earlier at the same hospital. Methods: Retrospective chart review in the 5-year interval 2009 through 2014 compared to previously reported cases 2000 through 2004 [Eye & Contact Lens 33(1): 45-49, 2007]. Comparative primary outcome measures included best-corrected visual acuity (BCVA), risk factors, culture and sensitivities, treatment, and complication rates. Results: 318 eyes with microbial keratitis were identified. Contact lens wear, ocular trauma, and ocular surface diseases were the most common risk factors. The culture and recovery rates were 73% and 66% respectively. Gram-positive organisms represented 46%, gram-negative organisms 39%, fungal organisms 15%, and Acanthamoeba <1% of corneal isolates. No common corneal pathogens were resistant to aminoglycosides or vancomycin. 48% of cases were initially treated with fortified antibiotics, 43% with fluoroquinolone monotherapy, and 6% with antifungals. 40% of cases received inpatient treatment. At resolution, average BCVA was 20/82 [logMAR 0.61] with 8% of cases resulting in light perception or worse vision. The perforation rate was 8%. 6% of cases underwent urgent penetrating keratoplasty and 4% of cases underwent urgent enucleation or evisceration. Compared to the prior study, significant differences were: (1) lower culture but higher recovery rates, (2) lower admission rate, (3) more contact lens-related cases of Pseudomonas ulcers, (4) lower resistance of coagulasenegative Staphylococcus to aminoglycoside antibiotics, (5) improved BCVA at resolution, and (6) lower associated complication rates. Conclusion: Microbial keratitis remains a clinical challenge in the urban public hospital setting. In the past ten years, epidemiology has shifted towards greater contact lens wear with more Pseudomonal infections. Visual outcomes have not worsened despite a shift away from routine culture and inpatient care to fluoroquinolone monotherapy and outpatient management.

Matrix Metalloproteinase-13 as a Target for Suppressing Corneal Ulceration Caused by Pseudomonas aeruginosa Infection

Abstract: Bacterial keratitis is a sight-threatening disease that is most commonly associated with extended contact lens wear [1]. Pseudomonas aeruginosa is the common causative agent of keratitis [2]. To cause keratitis, microbes must traverse the epithelial layer and cross the basement membrane to reach the stroma [3, 4]. Pseudomonas aeruginosa keratitis usually presents as a rapidly progressing condition, with distinct inflammatory epithelial edema and stromal ulceration, that can lead to significant stromal tissue destruction and loss of vision [5]. These consequences are largely caused by the host's inflammatory responses, although bacterial toxins and exoproducts may contribute to P. aeruginosa keratitis [5]. Hence, it is of importance to identify pathogenic factors and to delineate their mechanisms of action, which may lead to the development of new therapeutic strategies for treating bacterial keratitis. Innate immunity is the first line of defense against a wide range of pathogens at mucosal surfaces. Studies from our laboratory demonstrated that the activation of Toll-like receptor 5 (TLR5) with flagellin prior to pathogen inoculation significantly improves the clinical outcomes of microbial keratitis in C57BL/6 mouse corneas [6, 7]. This protection is related to its ability to enhance innate responses, as manifested by dampened proinflammatory cytokine expression and augmented antimicrobial peptide production in response to infection, particularly in corneal epithelial cells [7–9]. To comprehensively identify genes altered by flagellin pretreatments, we recently performed a whole genome complementary DNA microarray and found that matrix metalloproteinase-13 (MMP13) is one of the most profoundly affected genes at 6 hours after infection, and flagellin-pretreatment significantly dampens infection-induced MMP13 expression. Hence, a decrease in MMP13 activity might contribute to flagellin-induced protection against P. aeruginosa keratitis [10, 11]. MMP13 belongs to a large family of zinc-dependent neutral endopeptidases that are collectively capable of degrading extracellular matrix. MMP13 is one of the collagenases that degrade native collagen fibrils in vivo and is thought to execute the rate-limiting function in extracellular matrix reorganization, which is essential for morphogenesis and tissue remodeling [12] and corneal wound healing [13]. While all collagenases cleave type I, II, and III collagens, MMP13 (collagenase-3) cleaves collagen type IV, X, and XIV, as well [12, 14, 15]. Because of its exceptionally wide substrate specificity, MMP13 expression is limited to physiological situations in which rapid and effective remodeling of collagenous extracellular matrix is required [16, 17]. In the cornea, MMP13 has been shown to be expressed only at the basal layer of healing corneal epithelium [13, 18], suggesting its potential involvement in remodeling the underlying basement membrane. Moreover, overexpression and/or activation of MMP13 has been linked to the excessive degradation of extracellular matrix in osteoarthritic cartilage, rheumatoid synovium, chronic cutaneous ulcers, intestinal ulcerations, and chronic periodontitis [19–23]. As such, there are many MMP13-specific inhibitors designed to treat osteoarthritis and rheumatoid arthritis without the side effects often associated with many nonselective MMP inhibitors [24, 25]. These inhibitors may also have the potential to be used for ameliorating infection-induced tissue damage and ulceration. In this study, we investigated MMP13 expression in C57BL/6 mouse corneas in response to P. aeruginosa infection and demonstrated that its inhibition decreased the severity of keratitis and significantly reduced the bacterial burden. We also used an MMP13 inhibitor (MMP13i) as an adjunctive therapy to antibiotics used to treat P. aeruginosa keratitis. Our data suggest that increased MMP13 activity contributes to basement membrane breaching and P. aeruginosa stromal invasion and that MMP13i might be used as an adjuvant therapy to reduce basement membrane damage and the stromal destruction associated with microbial keratitis.

Bacterial keratitis in a tertiary eye centre in Iran: A retrospective study

Abstract: Purpose: To report the characteristics and laboratory findings of 182 patients with bacterial keratitis diagnosed at Farabi Eye Hospital in Tehran, Iran. Materials and Methods: In this retrospective study, data were collected on demographics, risk factors, location, size and depth of the ulcer, height of the hypopyon, uncorrected visual acuity, results of smear and culture tests, and antibiotic sensitivity of cultured bacteria. Results: There were 110 (60.4%) males and 72 (39.6%) females with an average age of 56.0 ± 2.3 years. Ocular trauma (17.6%) and positive history of corneal surgery (14.3%) were major risk factors. The mean age of contact lens users was 22.5 ± 7.7 years. Sixty patients (33%) used topical antibiotics, 21 (11.5%) patients utilized topical steroid, and 26 (14.3%) cases used both topical antibiotic and steroid at presentation. Culture results were, 81 (44.5%) cases were Gram-positive, 63 (34.6%) were Gram-negative, 10 (5.5%) were mixed bacteria and in 28 (15.4%) cases had detected growth. The isolated bacterial species from the corneal ulcers were less resistant to ceftazidime (6%) and amikacin (6%). The majority of patients were treated with medical therapy; however, 81 cases (44.5%) received at least one surgical procedure. Conclusion: Among the patients with bacterial corneal ulcers, trauma was the most common risk factor. Over-the-counter antibiotic and steroid were commonly used in the majority of patients. The most common bacteria isolated were Gram-positives, and they were less resistant to ceftazidime and amikacin. Penetrating keratoplasty was the most common surgical procedure in patient who required surgery.

Long-term efficacy of glycerine-processed amniotic membrane transplantation in patients with corneal ulcer.

Abstract: Purpose The aim of this study was to determine the long-term treatment efficacy of glycerine-preserved human amniotic membrane transplantation in patients suffering from corneal ulcers. Methods This was a retrospective, non-controlled, monocentric analysis. Included were patients with corneal ulcers that were non-responsive to ointment or contact lenses and had been treated by amniotic membrane transplantation with either the overlay or sandwich procedure. Analysis parameters were visual acuity before and following treatment, recurrence rate and subjective comfort at the last follow-up. Results Of the 371 amniotic membrane transplantations that were conducted, 135 surgical treatments in 108 patients (51.9% male, 48.1% female; mean age 63.7 years) met the inclusion criteria. In total, 99 overlay and 36 multilayer amniotic membrane transplantations were performed. The follow-up period was 47.5 ± 66.7 weeks (mean ± SD). The recurrence rate at the last follow-up was 47.8% with overlay membranes and 51.8% with the sandwich technique. There was no significant change in best-corrected visual acuity following treatment with overlays (p = 0.219) or sandwich procedure (p = 0.703). At the last follow-up, 72.1% (overlay) and 78.3% (sandwich) of the patients reported either no pain or increased comfort. Conclusion The recurrence rates and changes in visual acuity following overlay or sandwich amniotic membrane transplantation in patients suffering from corneal ulcer were lower than reported elsewhere in the literature. More than half of the patients profited from each of the amniotic membrane transplantation techniques with respect to recurrence and postoperative comfort.

Do Unilateral Herpetic Stromal Keratitis and Neurotrophic Ulcers Cause Bilateral Dry Eye

Abstract: PURPOSE To evaluate and compare the ocular surface condition in herpetic interstitial stromal keratitis and neurotrophic ulcer groups and their normal fellow eyes. METHODS In this observational, cross-sectional case-control study, 85 consecutive patients were included, including 56 cases of treated herpetic interstitial keratitis and 29 patients with neurotrophic ulcers. Fifty-six age- and sex-matched participants were also recruited from a normal population as the control group. We evaluated and scored the subjective and objective measures of dry eye for both eyes of all patients. Then, we compared the score of the groups with one another and also with the control group. The main outcome measures were the discomfort level, visual symptoms of dry eye, conjunctival injection, conjunctival staining, corneal staining, corneal tear signs of dry eye, meibomian gland dysfunction, tear break-up time, Schirmer test score with anesthesia, and tear osmolarity. RESULTS The normal fellow eye of the herpetic keratitis group had significantly higher discomfort levels (1.4 ± 0.9 vs. 1.3 ± 0.5, P = 0.003), visual symptoms (1.7 ± 0.8 vs. 1.3 ± 0.7, P = 0.002), tear break-up time (8.3 ± 3.2 vs. 12.1 ± 3.3 seconds, P = 0.003), Schirmer test scores (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.04), and tear osmolarity (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.003) in comparison with normal controls. The normal fellow eyes of the neurotrophic ulcer group had significantly worse values for discomfort level (1.9 ± 0.9 vs. 1.3 ± 0.5, P < 0.001), tear break-up time (7.9 ± 4 vs. 12.1 ± 3.3, P = 0.004), Schirmer test score (8.1 ± 3.9 vs. 12.9 ± 3, P = 0.005), and tear osmolarity (295 ± 9.2 vs. 292.7 ± 5.9, P = 0.02) compared with normal controls. CONCLUSIONS Both eyes of patients with neurotrophic ulcer and interstitial herpetic keratitis have a significantly poorer ocular surface condition compared with that of normal controls.

Corneal Collagen Cross-linking for Treatment of Non-healing Corneal Ulcers.

Abstract: Purpose: To evaluate the efficacy of corneal collagen cross-linking (CXL) for treatment of corneal ulcers not responding to antimicrobial therapy. Methods: Eight patients with corneal ulcers associated with corneal melting, not responding to conventional antibiotic therapy, were treated with CXL. The procedure was performed according to the standardized protocol for keratoconus. Preoperative medications were continued after CXL in all cases. Microbiological exams revealed Pseudomonas aeruginosa in 3 cases. Follow up continued from 1 to 10 months. Results: In 6 of 8 eyes, progression of corneal melting was halted and complete epithelialization occurred. In one eye emergency keratoplasty was needed due to corneal perforation. A conjunctival flap was performed to treat severe localized corneal thinning in one of the patients a few days after CXL. Significant clinical improvement occurred in all cases of Pseudomonas aeruginosa keratitis. Conclusion: CXL can be considered as a promising new treatment in the management of refractory non-healing corneal ulcers, including Pseudomonas aeruginosa keratitis.

Treatment of Acanthamoeba neurotrophic corneal ulcer with topical matrix therapy

Abstract: This study was done to evaluate the visual and anatomical outcomes of topical regenerating agents as a novel therapy for neutrophic corneal ulcer (NCU) secondary to acanthamoeba infection. A 20-year-old woman with a history of contact lens wear was referred to our hospital for keratitis after responding poorly to conventional treatment. In vivo confocal microscopy images suggested acanthamoeba keratitis with double-walled cysts in the anterior corneal stroma. Acanthamoeba infection was confirmed by laboratory findings. She was started on 0.1 % propamidine and 0.02 % chlorhexidine drops every hour. The antibiotic and antifungal drops were stopped when bacterial and fungal cultures proved negative. A central neurotrophic corneal ulcers (NCU) appeared, and despite treatment with artificial tears, bandage contact lens, and autologous serum, the ulcer worsened and she was treated with topical CACICOL20 (1 drop every 2 days) for 8 weeks. The corneal defect was completely repaired in 3 weeks. The treatment was well tolerated, and no local or systemic side effects were noted. Visual acuity remained 20/400. Two months later, the defect was still closed and the patient continued with 0.1 % propamidine and 0.02 % chlorhexidine drops, bandage contact lens, artificial tears, and autologous serum. Topical regenerating agents interact with components of the extracellular matrix, binding matrix proteins and protecting them from proteolysis, restoring the matrix environment, and improving tissue healing. In this case, CALCICOL20 was effective for vision stabilization, wound healing, and was well tolerated for NCU secondary to acanthamoeba infection.

Easy-to-prepare autologous platelet-rich plasma in the treatment of refractory corneal ulcers.

Abstract: As platelets are rich in growth factors for tissue regeneration, autologous platelet-rich plasma (PRP) has been used to treat some refractory corneal defects. Although PRP is effective, the cost of its preparation is very high. This article presents three cases of refractory corneal ulcer under the prescription of autologous PRP. The autologous PRP used in these cases was easily prepared in the blood bank laboratory. In this paper, we collected three patients with refractory corneal ulcer who were unresponsive to conventional treatment. The patients presented with neurotrophic ulcer, exposure corneal ulcer, and limbal deciency with corneal ulcer after hepatitic keratitis. Although we easily prepared autologous PRP eye drops using simple laboratory centrifugation, this preparation still had a clinical effect on corneal defect. The mean intervention time was 24 ± 6.9 days. The case with exposure corneal ulcer had significant wound healing and the other two cases felt subjective symptom relief. There were some clinical improvements of refractory corneal ulcers in our three cases. We present the clinical results of three cases and report an easy procedure for the preparation of autologous PRP. Autologous PRP prepared simply in the laboratory, it may be an alternative option for treating refractory corneal ulcer.

Bilateral Orbital IgG4-Related Disease with Systemic and Corneal Involvement Showing an Excellent Response to Steroid and Rituximab Therapy: Report of a Case with 11 Years Follow-Up

Abstract: IgG4-related disease is a newly recognized fibro-inflammatory condition. The purpose of this report is to present a patient with 11 years of follow-up, who revealed characteristic features of IgG4-related disease with systemic, orbital and corneal involvement and showed a favorable response to steroids and rituximab treatment.

Effectiveness of the Lower Eyelid Suspension Using Fascia Lata Graft for the Treatment of Lagophthalmos due to Facial Paralysis

Abstract: Purpose. To evaluate of functional and cosmetic effectiveness of lower eyelid sling technique with fascia lata graft in patients with lagophthalmos due to facial paralysis. Material and Method. Ten patients with a mean age of 55.1 ± 19.77 years who underwent lower eyelid sling surgery with a fascia lata graft between September 2011 and January 2014 were included in this prospective study. Preoperatively and postoperatively patients were evaluated in terms of corneal epithelial defects, Schirmer's test, and tear break-up time (TBUT). Cosmetically, vertical eyelid aperture, margin reflex distances 1 and 2 (MRD1 and MRD2) and scleral show were evaluated preoperatively and postoperatively. Results. One patient had facial paralysis on the right side whereas the other 9 patients had facial paralysis on the left side. Preoperatively, 3 patients were detected with corneal ulcer, whereas 7 patients were detected with persistent corneal epithelial defects localized in the lower half of the cornea. In the 3 patients with preoperative corneal ulcer, the ulcer recovered with corneal opacity, whereas in the 7 patients with punctate epitheliopathy, postoperative corneal transparency was obtained. Discussion. Lower eyelid sling technique with fascia lata graft is an effective technique for the repositioning of the lower eyelid and preventing the corneal complications.

Corneal Collagen Cross-linking: A Review of Clinical Applications.

Abstract: Corneal collagen cross-linking (CXL) has been shown to slow down or stop the progression of keratoconus. In addition, CXL has been applied in cases of corneal ectasia. Recent reports of the use of CXL in cases of infectious keratitis have generated further interest in this treatment modality. This review discusses the principle, clinical uses, and complications associated with CXL.

Epidemiology and etiological diagnosis of infective keratitis in eastern region of Nepal.

Abstract: Objective : This study aimed to determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in patients presenting to Biratnagar Eye Hospital (Nepal). Methods : All patients presenting to Biratnagar Eye Hospital between January 1 and December 31, 2011 with corneal ulceration were retrospectively reviewed. Sociodemographic data and information pertaining to risk factors were recorded, all patients were examined and corneal scrapping and cultures were carried out. Results : Over one year period 1644 patients with corneal ulcer were evaluated, out of which 76.6% of patients were in the age range of 30 to 69 years and 65% of patients had presenting visual acuity < 3/60. Ocular trauma was the most common cause of keratitis accounting for 60.3% of corneal ulcer and majority of the patients (40%) presented after 2 weeks of symptoms. Among corneal scraping positive cases 1150 (70%) showed fungus, 73 (4.4%) showed bacteria and 20 (1.2%) showed both bacterial and fungus. Conclusion: Corneal ulcer continues to be one of the leading causes of preventable blindness in this region. Lack of awareness about gravity of this disease, financial constraints and geographic barriers remain the major reasons for delay in seeking proper medical help.