Showing papers on "corneal ulcer published in 2023"

Antibiotic Recommendations for Treatment of Canine Stromal Corneal Ulcers

Abstract: Simple Summary Infection of the cornea is among the most frequent causes for the loss of vision in dogs. The purpose of this study was to determine which particular antibiotics can be used immediately at the time of infection to eliminate bacteria from the infected region and prevent the loss of the eye. This study showed that combinations of antibiotics (amikacin and neopolybac or ofloxacin and neopolybac) are potentially the best first choice of treatment to eliminate the majority of commonly isolated bacteria from corneal infections in dogs. Abstract The aim of the study was to identify the aerobic bacterial isolates and determine corresponding antibiotic susceptibility profiles in vitro in canine clinical specimens with stromal corneal ulcers, with the goal of providing recommendations for first-line treatment with antibiotics. A total of 198 canine corneal stromal ulcer samples were studied between 2018 and 2021. A corneal swab was collected and cultured under aerobic conditions. Bacterial organisms were identified at the species level by MALDI-TOF mass spectrometry. Antibiotic susceptibility testing for commonly used topical and systemic antibiotics was performed by disk diffusion. Bacterial growth was obtained from 80% of samples. A variety of bacterial species were identified wherein the most common specimens were represented by Staphylococcus pseudintermedius (22%), Staphylococcus epidermidis (12%), Staphylococcus capitis (11%), and Pseudomonas aeruginosa (10%). Based on the overall antibiotic susceptibility data, neopolybac alone (96%) or a combination of neopolybac with either ofloxacin or amikacin (each 99%) showed the best coverage for commonly isolated bacterial organisms from canine corneal stromal ulcers. Results of this study support the use of the combined antibiotics as the first-line response for the treatment of canine corneal stromal ulcers. A statically significant increase in acquired bacterial resistance was detected during the longitudinal data observation.

Pseudomonas aeruginosa Corneal Ulcer Associated With Artificial Tears Eye Drops.

Abstract: This case report describes vision loss in a 72-year-old woman following use of EzriCare eye drops.

Treatment of corneal ulceration and bullous keratopathy using a nictitating membrane flap in two horses.

Abstract: OBJECTIVE The aim of this study was to describe placement of a nictitating membrane flap as a treatment for corneal ulceration and bullous keratopathy in two horses. ANIMALS STUDIED A 13-year-old American Saddlebred mare presented for severe corneal edema, superficial stromal ulceration, and a central bulla of the left eye. A 4-year-old Trakhener stallion also presented with a large axial bulla of the left eye with concurrent severe corneal edema and a deep stromal ulcer. PROCEDURE A complete ophthalmic examination was performed. Samples were obtained for corneal cytology, and both horses were started on aggressive medical therapy. Both underwent general anesthesia for placement of a nictitating membrane flap and a subpalpebral lavage system (SPLS). RESULTS Corneal cytology for each horse revealed a mixed bacterial population. Moderate Pseudomonas aeruginosa was cultured from the mare, while Aspergillus species and a few Enterococcus gallinarum were cultured from the stallion. The bullae in both horses resolved at 3 and 4 weeks and vision returned in the affected eye 4.5 and 3 months postoperatively at the last follow-up, respectively. CONCLUSION Aggressive medical management with concurrent placement of a nictitating membrane flap is effective to treat bullous keratopathy in two horses. The described treatments could be used to treat horses that develop severe or progressive bullous corneal lesions.

Multidirectional corneoconjunctival transposition in the treatment of large keratomalacia in 7 dogs and 5 cats.

Abstract: OBJECTIVE To describe the use of multidirectional corneoconjunctival transposition (CCT) as a surgical treatment for large keratomalacia. METHOD A prospective study including dogs and cats initially presenting with keratomalacia larger than 6 × 6 mm and affecting more than half of the corneal thickness. Signalment, concurrent eye diseases, ulcer size, bacterial culture and susceptibility testing results, follow-up, and outcome were recorded. The surgery consisted of harvesting of two or three opposite corneoconjunctival grafts, after removal of the malacic tissue using a square-edge keratectomy. The medical treatment consisted of administration of topical and systemic antibiotics, topical atropine, and N-acetylcysteine. Follow-up examinations were performed at D7, D14, D21, and D28, and then at various time points. The corneal clarity score (CCS) was recorded upon completion of the follow-up period. RESULTS Seven dogs and five cats were included. Brachycephalic dogs were overrepresented, with no breed predisposition in cats. Concurrent eye diseases were corneal pigmentation in three dogs, hypopyon in two dogs, nictitating membrane wound in one dog, and corneal perforation in one cat. The size of the keratomalacia ranged from 6 × 6 to 9.5 × 11.5 mm. The short-term complications were suture dehiscence (two of 12) and progression of the keratomalacia (one of 12). The long-term complications were corneal pigmentation (10 of 12), corneal epithelial inclusion cyst (two of 12), and marginal synechiae (one of 12). All animals were sighted at the last follow-up. The median CCS was G3 (range G2-G4). CONCLUSION Multidirectional CCT is an effective surgical treatment for large keratomalacia in dogs and cats.

Intrastromal voriconazole as successful adjunctive approach for recalcitrant deep fungal keratitis

Abstract: Aim: To assess efficacy of intrastromal voriconazole (ISV) in the treatment of fungal keratitis non-responding to conventional antifungals. Methods: Eighteen patients with smear positive fungal keratitis, not responding to conventional topical/ systemic antifungal therapy up to 2 weeks, were included in the study. Afterwards, they were given ISV (50 µg in 0.1 ml) around the ulcer and continued to receive conventional antifungal therapy. Responses to treatment (decrease in size of the ulcer and infiltrates) were recorded daily for 3-days, at 1-week and every 2 weeks for 3-months, or until the ulcer had healed completely. Results: The mean age at presentation was 51 ± 17.83 years. The most common organism isolated was Fusarium (17/ 18), followed by Aspergillus (1/ 18). All the patients were successfully treated in terms of corneal healing, but one case did not improve in vision due to the existence of diabetic macular oedema. 6 patients improved after a single injection, 7 had to receive 2 and 5 improved after 3 injections. The mean number of injections in 17 treated patients was 1.94 ± 0.78. Moreover, the mean resolution time was 18.50 ± 6.25 days. The size of ulcer and height of hypopyon at presentation were noteworthy risk-factors linked to management outcomes. Deeper ulcers required a greater number of injections when compared to superficial ulcers. The mean best-corrected visual acuity improved from 0.94 to 0.25 at 3 months follow-up in all the patients. Conclusion: Intrastromal Voriconazole (50 µg/ 0.1 mL) appears to be an effective adjunct therapy in cases of recalcitrant deep fungal keratitis non-responding to conventional antifungals. Though, some may require repeated injections, timely ISV administration certainly reducing the need for tectonic/ therapeutic keratoplasty. Abbreviations: ISV = Intrastromal Voriconazole, AS-OCT = anterior-segment optical coherence topography, KOH = potassium hydroxide, BCVA = best-corrected visual acuity

Outcome of therapeutic keratoplasty in non-healing corneal ulcer: a retrospective study.

Abstract: Background: In developing nations like India, corneal blindness has been a major cause of visual impairment. Primarily, corneal ulcer is the primary cause of monocular blindness. Considering the prevalence of the condition, there have been surprisingly few studies and publications on corneal ulcers and their management. With the introduction of therapeutic penetrating keratoplasty (TPK), however, the incidence and prevalence of corneal blindness can be diminished. In order to determine the significance of therapeutic penetrating keratoplasty in cases of non-healing infected and perforated corneal ulcers, this study was conducted. Aim: The objectives were to evaluate the clinical outcome of a perforated and non-healing corneal ulcer, the reduction of symptoms and indicators of infection, the anatomical or structural integrity of the globe, and the visual outcome of therapeutic penetrating keratoplasty. Methods: Data were obtained from 74 patients who underwent therapeutic penetrating keratoplasty at our institution. Patients with a follow-up period of less than one-year, paediatric cases, and PL-negative cases were excluded. The outcome was evaluated based on the maintenance of structural integrity, reduction in infectious burden, improvement in visual acuity, and graft survival, as well as its correlation with corneal vascularisation, previously failed grafts, donor tissue quality, graft size, and surgery type. Results: From a total of 74 cases, 47 (63.51%) were male. The majority of the patients were farm labourers. In our study, refractory corneal ulcer treated with Hypopion was the most prevalent indication for TPK. Conclusion: In the case of non-healing and perforated corneal ulcers, the study demonstrated that therapeutic penetrating keratoplasty has a favorable prognosis for reducing the infectious burden and maintaining structural integrity, without which the eye could have been lost.

Investigating and Treating a Corneal Ulcer Due to Extensively Drug-Resistant Pseudomonas aeruginosa

Abstract: Resistant Gram-negative bacteria are a growing concern in the United States, leading to significant morbidity and mortality. We identified a 72-year-old female patient who presented with unilateral vision loss. ABSTRACT Resistant Gram-negative bacteria are a growing concern in the United States, leading to significant morbidity and mortality. We identified a 72-year-old female patient who presented with unilateral vision loss. She was found to have a large corneal ulcer with hypopyon. Culture of corneal scrapings grew extensively drug-resistant Pseudomonas aeruginosa. Treatment involved a combination of systemic and topical antibiotics. Whole genome sequencing revealed the presence of blaVIM-80, blaGES-9, and other resistance determinants. This distinctive organism was linked to an over-the-counter artificial tears product.

Role of topical insulin eye drop and its comparison with pack-cxl in case of non healing corneal ulcer

Abstract: Present study evaluates efcacy of topical insulin eye drops and PACK-CXL in treatment of non-healing corneal ulcer. For this total 20 patients of corneal ulcer were taken and categorise as two groups, Group-1 and Group-2. Patients of Group-1 were treated with topical insulin eye drop, while 2 Group-2 with PACK-CXL. In result, mean area of ulcer before starting treatment in Group-1 was 25.45 ± 16.5 mm and we observed complete corneal reepithelization in all patients, with mean duration of reepithelization seen in 35 days. In group-2 mean area of non-healing ulcer before 2 starting treatment was 20.58±10.63 mm , after PACK-CXL, we observed complete corneal reepithelization in all patients with, mean duration of 25.4 days. Final visual acuity was improved from baseline in both groups. Both topical Insulin eye drop and PACK-CXL can promote and accelerate corneal reepithelization of non-healing corneal ulcers but topical insulin eye drop is cost-effective with no adverse effect

The approach to diagnosis and management of corneal ulcers

Abstract: Corneal ulcers are among the major causes of corneal blindness. The cause of corneal ulceration is a variety of infections. The key to improving clinical and visual results in cases of corneal ulcers is an accurate, speedy diagnosis and rapid treatment. However, there are no established standards or guidelines for treating corneal ulcers. Even seasoned eye care professionals occasionally have trouble predicting how the disease will progress in most patients. This article makes an effort to offer a general overview of the diagnosis process and treatment plan for a corneal ulcer.

Multi-drug resistant Klebsiella-induced corneal ulcer following pterygium surgery: a case report

Abstract: Management of pterygium is dependent on the grading of pterygium and its clinical presentation (inflamed or quiescent), and surgical excision is the final choice of treatment for the pterygium extending beyond the limbus. Infectious keratitis is one of the most commonly reported complications in recent years. To the best of our knowledge, Klebsiella keratitis after pterygium surgery has not been described in the current literature. Here, we report a patient with corneal ulcer formation following pterygium surgical excision.A 62-year-old woman presented with complaints of pain, blurred vision, photophobia and redness in her left eye for a month. She had a history of pterygium surgical excision two months ago. Slit-lamp examination showed conjunctival congestion, a central whitish corneal ulcer with a central epithelial defect, and hypopyon. Corneal scraped sample revealed multidrug resistant (MDR) Klebsiella pneumonia and the strain was found to be sensitive to cefoxitin and ciprofloxacin. Intracameral cefuroxime (1 mg/0.1 mL) injection, fortified cefuroxime ophthalmic suspension (50 mg/mL) and moxifloxacin ophthalmic suspension (0.5%) were successfully administered to control the infection. Since residual central stromal opacification remained persistent, final visual acuity did not improve beyond finger counting at two meters.Klebsiella keratitis is a rare and sight-threatening complication following pterygium excision. This report emphasizes the importance of close follow-up examination following pterygium surgeries.

Safety and efficacy of eye drops from umbilical cord blood platelet lysate to treat resistant corneal ulcer

Abstract: Background: Umbilical cord blood (UCB) is a novel treatment of resistant corneal ulcers owing to the unique anti-inflammatory molecules and growth factors it contains. Platelet lysates are a potential future alternative. The aim of the present study was to assess the role of human UCB platelet lysate in treating resistant corneal ulcers. Methods: This was prospective, non-comparative, interventional case series involving 40 eyes of patients aged 6 – 65 years with persistent corneal ulcers from the Mansoura Ophthalmic Center and Mansoura Research Center for Cord Stem Cells. Patients were classified according to the cause of persistent corneal ulcer into four groups: group I, including 14 eyes with dry eye disease; group II, including six eyes post-keratoplasty; group III, including four eyes with corneal chemical burn; and group IV, including 16 eyes with persistent corneal ulcer from other causes. All participants underwent detailed ophthalmic examinations, and baseline and final best-corrected distance visual acuity (BCDVA) were recorded. Eye drops were prepared from UCB platelet lysate and administered to all patients along with detailed meticulous instructions for the method of use. Clinical progression of wound healing was continuously observed. The treatment response was identified as complete healing, improvement, or treatment failure. Results: BCDVA improved significantly in all studied groups (all P < 0.05). In group I, complete healing, improvement, and treatment failure occurred in 71%, 29%, and 0% of cases. In group II, complete healing, improvement, and treatment failure occurred in 67%, 33%, and 0% of cases. In group III, complete healing, improvement, and treatment failure occurred in 50%, 50%, and 0% of cases. In group IV, complete healing, improvement, and treatment failure occurred in 63%, 12%, and 25% of cases. No adverse events associated with the treatment were observed or subjectively self-reports in the study period. Conclusions: Eye drops from UCB platelet lysate were a novel therapeutic blood component with unique growth factors and anti-inflammatory compounds that could be an effective and safe treatment option in managing persistent corneal ulcers of different causes. A future randomized clinical trial with a large sample size and a longer follow-up is required to confirm these preliminary outcomes.

[A case of bilateral corneal ulcer after left eye cataract extraction surgery].

Abstract: The patient is a 73-year-old female who developed bilateral corneal ulcers one month after cataract surgery in her left eye. The diagnosis is bilateral conjunctival pemphigoid. She underwent a left-eye amniotic membrane transplant and a right-eye lamellar corneal transplant, and was treated with oral immunosuppressants. The patient's condition is stable.

Clinical Observation of Low-Temperature Plasma Ablation Combined with Drug Therapy in the Treatment of Fungal Keratitis

Abstract: To observe the efficacy and prognosis of low-temperature plasma ablation + drug therapy in the treatment of fungal corneal ulcers.The present paper presents a retrospective clinical study with a subject base of 34 eyes. Patients with a fungal corneal ulcer who visited the Affiliated Eye Hospital of Nanchang University between August 2019 and December 2021 were selected as the study participants. They were found to have highly reflective fungal hyphae in the corneal stroma layer via confocal microscope examination, which were revealed to be positive on etiology examination, with the ulcer and infiltration depths ≤1/2 of the corneal thickness. The efficacy and prognosis were observed after treatment with low-temperature plasma ablation + drug therapy.A total of 34 cases (34 eyes) had clinical manifestations of corneal infiltration and corneal ulcer formation, with a corneal lesion diameter of 1.31-8.64 mm (average = 4.79 ± 2.03 mm). The average healing time of corneal ulcers was 6.2 ± 1.7 days. Among a total of 34 cases (34 eyes) in patients with fungal keratitis, the infection was controlled and the ulcers gradually healed after treatment with low-temperature plasma system + drug therapy in a total of 30 cases (30 eyes, 88%). A total of three cases (3 eyes, 9%) exhibited no clear improvement after the treatment, and the patients underwent conjunctival flap covering surgery. One case (one eye, 3%) exhibited no clear improvement after further treatment, with the patient experiencing corneal perforation and ultimately undergoing penetrating keratoplasty.Low-temperature plasma ablation + drug therapy can effectively control the progression of fungal keratitis infection, as well as significantly shorten the ulcer healing time, and is, therefore, an effective method.

Evaluation of Microbiological Culture and Antibiogram of the Patient with Corneal Ulcer due to Exposure Keratitis in the Intensive Care Unit in Sina Farshchian Hospital (2019-2020)

Abstract: Since patients admitted to the intensive care unit have a compromised immune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetracaine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thioglycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42 %) Erythromycin (85%) had the highest resistance against isolated bacteria. The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.

Microbial profile of ulcerative keratitis at tertiary level hospital

Abstract: Background: Keratitis is the term applied for inammations of the cornea. Ulcerative keratitis is a common potentially sight threatening ocular infection that may be caused by bacteria, fungi, viruses or parasites. Corneal ulcer is an ocular emergency that requires prompt management to ensure the best visual outcome for the patient. Otherwise, it can result in scarring and blindness. Aim and objectives: To study Microbial causes and to identify risk factors, and corelation of clinical features of ulcerative keratitis with etiological agents Materials and methods: Total 325 corneal ulcer cases were studied. Corneal scrapings were collected and subjected for examination by Gram's stain, 10% KOH, bacterial and fungal culture. Antibiotic susceptibility of the bacterial pathogens was performed by Kirby Bauer disc diffusion method as per CLSI guidelines with various groups of antibiotics. MIC for vancomycin were determined for study isolates by Epsilometer test. Results: Totally 325 infectious corneal ulcers were studied in detail. Aetiological agents were isolated in 115 (35.38%) cases. Majority of the isolates were fungal agents (44.18%), belonging to the Aspergillus (21.05%), Fusarium (14.47%). Bacterial corneal ulcer was less common (25.49%). The predominant bacterial pathogen isolated was Staphylococcus epidermidis, followed by Pseudomonas aeruginosa. no Acanthamoeba were identied. The sensitivity of potassium hydroxide staining was almost 100% in culture-proven fungal cases. Trauma is the leading cause for the corneal ulcers. Majority of the bacterial isolates were susceptible to amikacin. Conclusion: Ulcerative keratitis being a sight threatening disorder, early suspicion, rational use of laboratory diagnostic procedures, identication of the causative organisms and timely institution of appropriate antimicrobial therapy based on the prevailing sensitivity pattern of the isolates could save the eye from this preventable cause of blindness

Corneal Perforation Repair Using a Novel Lyophilized Amniotic Membrane Graft Technique: Plug and Patch

Abstract: BACKGROUND The use of amniotic membranes for corneal perforations using different surgical techniques has been widely described in the literature. This case report is a novel variation in the technique that can be useful for incorporating in clinical practice when the need arises. CASE REPORT A 36-year-old male patient presented to our clinic with a corneal ulcer in his left eye caused by herpetic keratitis, treated with a topical non-steroidal anti-inflammatory (indomethacin 0.1% solution). Examination revealed a paracentral 2-mm wide corneal perforation on the site of the corneal ulcer. The patient was admitted to the hospital. He was treated with intravenous piperacillin-ofloxacine, and an emergency surgical intervention using a lyophilized amniotic membrane was performed using a "plug and patch" technique. Postoperatively, the patient received 48 h of intravenous antibiotics and was discharged on topical antibiotic/corticosteroid eyedrops along with a 10-day course of oral antibiotics (ofloxacin) and antiviral therapy (valaciclovir). Three months after surgery, the anterior chamber was formed, the corneal defect was closed, and visual acuity improved. One year after initial presentation, anterior segment optical coherence tomography showed a large scarred but healed cornea. CONCLUSIONS We report the successful use of combination of a single round-shaped rolled amniotic membrane with a multilayered amniotic membrane transplantation for the treatment of a 2-mm-wide perforated corneal ulcer. This technique allowed for preservation of the globe integrity without the need for a keratoplasty, stopped further tissue loss, and was associated with a rapid visual recovery.

Lactoferrin Influence on the Course of Suppurative Corneal Ulcer

Abstract: Research justification. Corneal ulcer is a common corneal pathology dangerous because of its complications, which occur in 2.5–37.9 % of cases despite modern treatment. Thus, the development of novel methods improving the results of corneal ulcer treatment is very important.Research objective was to evaluate the efficacy of lactoferrin-based therapy for experimental suppurative corneal ulcer.Material and methods. The study was performed in male chinchilla rabbits. Three intact rabbits (6 eyes) were used as control animals. Staphylococcus suppurative corneal ulcer was modeled in both eyes of 63 experimental animals. These rabbits were randomized into three groups. The first group was administered placebo therapy, the second group received antibacterial therapy, and the third group — instillations of lactoferrin. The area of ulcerative lesion was used as the measure of the therapeutic efficacy of the treatment. Then, a histological study was performed, and microsamples were photographed with LOMO TC-500 digital camera (Russia).Results. Lactoferrin instillations resulted in reliable increase in the number of transfers from infiltration stage to epithelization stage, decrease in the percentage of ulcerations, and in the proportion of critical thinning of the cornea, as well as decrease in the proportion of perforations. However, it was noticed that lactoferrin treatment when continued after the end of epithelization process resulted in excessive formation of opaque scar tissue.Conclusion. Local administration of lactoferrin stimulates the epithelium regeneration and the formation of the connective tissue and thus prevents the development of complications of suppurative corneal ulcer. However, the identified excessive formation of opaque scar tissue in lactoferrin treatment lasting too long has to be taken into consideration when developing the optimal scheme for lactoferrin treatment.

Validation of the C-DU(KE) Calculator as a Predictor of Outcomes in Patients Enrolled in Steroids for Corneal Ulcer and Mycotic Ulcer Treatment Trials

Abstract: The aim of this study was to validate the C-DU(KE) calculator as a predictor of treatment outcomes on a data set derived from patients with culture-positive ulcers.C-DU(KE) criteria were compiled from a data set consisting of 1063 cases of infectious keratitis from the Steroids for Corneal Ulcer Trial (SCUT) and Mycotic Ulcer Treatment Trial (MUTT) studies. These criteria include corticosteroid use after symptoms, visual acuity, ulcer area, fungal etiology, and elapsed time to organism-sensitive therapy. Univariate analysis was performed followed by multivariable logistic regressions on culture-exclusive and culture-inclusive models to assess for associations between the variables and outcome. The predictive probability of treatment failure, defined as the need for surgical intervention, was calculated for each study participant. Discrimination was assessed using the area under the curve for each model.Overall, 17.9% of SCUT/MUTT participants required surgical intervention. Univariate analysis showed that decreased visual acuity, larger ulcer area, and fungal etiology had a significant association with failed medical management. The other 2 criteria did not. In the culture-exclusive model, 2 of 3 criteria, decreased vision [odds ratio (OR) = 3.13, P < 0.001] and increased ulcer area (OR = 1.03, P < 0.001), affected outcomes. In the culture-inclusive model, 3 of 5 criteria, decreased vision (OR = 4.9, P < 0.001), ulcer area (OR = 1.02, P < 0.001), and fungal etiology (OR = 9.8, P < 0.001), affected results. The area under the curves were 0.784 for the culture-exclusive model and 0.846 for the culture-inclusive model which were comparable to the original study.The C-DU(KE) calculator is generalizable to a study population from large international studies primarily taking place in India. These results support its use as a risk stratification tool assisting ophthalmologists in patient management.

Graft Outcome of Corneal Patch for Perforated Corneal Ulcer

Abstract: Background: Corneal patch graft (CPG) is a part of the tectonic penetrating keratoplasty procedure performed on the perforated corneal ulcer. This procedure involves filling affected areas with full or partial-thickness cornea donors. This study aimed to determine the clinical results of corneal patch grafts in perforated corneal ulcers. Methods: A retrospective study assessing clinical results of CPG on the perforated corneal ulcer with iris prolapse. Clinical assessments include graft condition, anterior chamber depth (ACD), and visual acuity after surgery, with a follow-up duration of up to 8 weeks. Results: Twenty-one cases of perforated corneal ulcer with iris prolapse in 15 males (71.4%) and 6 females (28.6%). Locations of ulcer are peripheral and paracentral corneal. Visual acuity showed around light perception (LP) to 0.4. The most common etiology for corneal ulcers was infection (88.9%), followed by non-infection (Mooren’s ulcer) (11.1%). The graft condition after surgery showed promising results in 18 cases (85.7%), infection in 1 case (4.8%), and melting in 2 cases (9.5%). Adequate ACD was obtained in 77.8% of cases. An increase in visual acuity was shown in 44.4% of cases, depending on the location and severity of the ulcer. Conclusion: A corneal patch graft is an appropriate choice in treating perforated corneal ulcers to maintain ocular integrity (tectonic keratoplasty). However, in non-infectious ulcers, this procedure has not shown a good result, which may be related to disease progressivity.

Successful Management of Fungal Keratitis by Alternaria alternata Complicating Mooren’s Ulcer

Abstract: Abstract Mooren’s ulcer is an idiopathic peripheral ulcerative keratitis whose pathogenesis is thought to be due to an autoimmune reaction. The first-line treatment for Mooren’s ulcer is the use of topical steroids, which can be difficult to discontinue. The 76-year-old patient in this case was receiving topical steroids for bilateral Mooren’s ulcer and developed a feathery corneal infiltration and perforation in the left eye. On suspicion of a fungal keratitis complication, we started topical voriconazole treatment and performed lamellar keratoplasty. Topical betamethasone was continued twice a day. The identified causative fungus was Alternaria alternata, which is known to be susceptible to voriconazole. The minimum inhibitory concentration of voriconazole was later proven to be 0.5 μg/mL. After 3 months of treatment, the residual feathery infiltration disappeared and the left vision recovered to 0.7. In this case, topical voriconazole was effective, and the eye was successfully treated with continuing topical steroids. Fungal species identification and antifungal susceptibility test proved helpful for symptom management.

Management of perforated peripheral ulcerative keratitis (PUK-Mooren’s ulcer) with iris prolapse study in two cases

Abstract: Aim: The aim of this study was to describe the management of two cases of perforated peripheral ulcerative keratitis (PUK-Mooren’s ulcer) with iris prolapse by using dried sclero-corneal patch graft and subsequently replacing donor sclero-corneal patch graft. Methods: After sectoral conjunctival resection, ulcer margin excision, and prolapsed iris excision, preserved dried sclero-corneal tissue is fashioned, and patch grafting is done as an emergency. After getting the donor sclerocorneal rim, it was again fashioned (matching the size and removal of Descemet’s membrane) and replaced the dried scleral patch graft followed by a bandage contact lens. Results: Eleven to 16 months after their initial evaluation, these patients still had some useful vision and selfsatisfaction. Conclusion: A dried sclera-corneal patch graft could be a satisfactory option in the temporary management of perforated PUK with iris prolapse until donor tissue is available. This patch graft prevents hypotony, posterior synechiae, and secondary glaucoma.

Management of perforated corneal ulcer with iris prolapse by cyanoacrylate glue: A case report

Abstract: We report a rare case of perforated corneal ulcer due to recurrent viral keratitis with stromal necrosis and iris prolapse. The patient was 75 years old farmer, normotensive, diabetic, and presented with complaints of pain, watering, photophobia, redness and dimness of vision in the left eye. The left eye's visual acuity was perception of light and projection of rays in all four quadrants. Slit lamp examination found swollen eyelids, matted eyelashes, congested conjunctiva, seidel test positive, an inferonasal corneal perforation, shallow anterior chamber, irregular pupil, and prolapse of the iris through the perforated cornea. The patient was diagnosed with a left-sided perforated corneal ulcer (recurrent viral keratitis with stromal necrotizing variety) having iris prolapse. The perforation was sealed by cyanoacrylate glue and a soft bandage contact lens. This improved the patient’s condition. Early medical and surgical interventions thus can save vision as well as the eyeball. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 66-69

Nocardia keratitis presenting as an anterior chamber ball of exudates and its management

Abstract: A man in late 40s presented with corneal ulcer of the right eye of 1 month duration. He had a central corneal epithelial defect measuring 4.6×4.2 mm with an underlying 3.6×3.5 mm anterior to mid stromal patchy infiltrate and 1.4 mm hypopyon. Gram stain of the colonies on chocolate agar showed presence of confluent thin branching, gram-positive beaded filaments, which were positive after 1% acid fast stain. This confirmed our organism to be Nocardia sp. Topical amikacin was started but continued worsening of the infiltrate and presence of a ball of exudates in the anterior chamber, prompted the use of systemic trimethoprim-sulfamethoxazole. There was a dramatic improvement in the signs and symptoms, with complete resolution of infection over a period of 1 month.