A 43-year-old male patient came for routine evaluation. Best-corrected visual acuity was 20/20 in both eyes and intraocular pressure was 13 mm Hg in both eyes. No significant finding was noted in slitlamp biomicroscopy. Fundus examination revealed an optic disc with 0.6 excavation in the right eye and 0.4 in the left eye and subtle superior folds peripapillary in the internal limiting membrane in the right eye (Fig. 1A). In the optical coherence tomography evaluation, we observed abnormal thickening of the retinal nerve fiber layer and also schisis within the inner and outer retina (Fig. 1B-E), confirming the diagnostic of peripapillary retinoschisis (PPRS).In general, PPRS are hardly seen in optic disc color photograph, since patients may present thick normal retinal nerve fiber layer, however in this case, subtle folds in the internal limiting membrane (Fig. 1A) were observed. PRRS can be detected in 6% of patients with diagnosed glaucoma or glaucoma suspects and are related to Muller cell dysfunction. 1,2 It is important to use both glaucoma and retinal optical coherence tomography scan protocols placed on the optic nerve to properly detect and monitor changes in the patterns of the schisis over time.
To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty. Methods: A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded. Results: IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%). Conclusions: The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.