Background The aims of this study were to identify the organisms responsible for microbial keratitis, as identified by corneal scrape using brain-heart infusion broth, trends over time and antimicrobial sensitivities, over an 11-year period at two eye units in the South West of England; Bristol Eye Hospital and Royal United Hospital, Bath. Methods All corneal scrapes performed and sent for microbiological analysis between 4th April 2006 and 31st October 2017 at the two eye units were retrospectively reviewed. First-line treatment was monotherapy with levofloxacin 0.5% and second-line treatment was a combination of cefuroxime 5% and gentamicin 1.5%. Both direct and enrichment cultures were used. Results In total, 2614 corneal scrapes from 2116 patients (1082 female, mean age 47.7 ± 21.2 years) were identified. 38.1% (n = 996) were culture positive and 1195 organisms were cultured. In all, 91.6% were bacteria (69.4% were gram-positive, 30.6% gram-negative). Coagulase-negative Staphylococci (CoNS) were the most commonly cultured organism (n = 430). Pseudomonas aeruginosa was the most commonly identified gram-negative organism (n = 189). In total, 6.9% (n = 83) of organisms cultured were fungi. In all, 1.4% (n = 17) were acanthamoeba. There was no statistically significant trend in the organisms observed over the study period. Sensitivity testing confirmed reasonable sensitivity to the empiric antibiotics used in clinical practice. Conclusions This is the first report on microbial keratitis trends in the South West of England. Virulent organisms were likely to be detected on direct culture, whereas low virulent organisms such as CoNS were more likely to be detected on enrichment alone. Antibiotic sensitivity testing confirmed fluoroquinolone monotherapy as appropriate first-line treatment.
Ocular rosacea is a chronic inflammatory condition that can occur in the absence of cutaneous features. The most common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring and, rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. It can also be associated with systemic disorders such as cardiovascular disease. Management ranges from local therapy to systemic treatment, depending on the severity of the disease. In this review, we describe the epidemiology, pathophysiology, clinical features and treatment of rosacea and ocular rosacea.
Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It is thought to be the result of immune complex deposition at the limbus, resulting in corneal inflammation and stromal melt. We present a case of a 43-year-old female patient of African origin, presenting with PUK and associated corneal perforation as the primary presentation of HIV infection. An urgent tectonic deep anterior lamellar keratoplasty was performed under general anaesthesia with excellent outcome. The patient was referred to the sexual health clinic and anti-retroviral treatment was initiated. This case is to the best of our knowledge the first report from the UK of PUK with corneal perforation as the primary presentation of HIV infection. As highlighted in this report, infection with HIV may initially be silent; therefore, it is vital to consider HIV infection when dealing with PUK of unknown aetiology.
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