Alternaria keratitis after deep anterior lamellar keratoplasty

Naik, Mekhla; Shahbaaz, Mohd; Sheth, Jay; Sunderamoorthy, S K

doi:10.4103/0974-9233.124121

Cited by 13 publications

(7 citation statements)

References 9 publications

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“…Interface irrigation with antibacterial agents such as vancomycin (5%) has reportedly been effective in clearing DALK-related IIK ( 132 ). Use of antifungal agents such as amphotericin B (0.15–0.5%), voriconazole (1.0–5.0%), and fluconazole (5%) have also been described ( 91 , 133 , 136 , 137 ). Apart from treatment, Wessel et al ( 133 ) have suggested using the irrigation fluid obtained after interface wash for microbiological investigations.…”

Section: Treatmentmentioning

confidence: 99%

“…In cases where the primary procedure was DALK, the interface is more likely to provide a potential space for sequestration of infection resulting in recurrences later ( 147 ). Although clear grafts have been achieved in repeat DALK procedures following IIK post-DALK ( 136 , 148 ), recurrences of infections have been reported with cases then requiring PKP ( 147 , 149 ). Emergency therapeutic PKP may be required in cases with non-responding infiltrates and impending/actual perforations ( 139 , 147 ).…”

Section: Treatmentmentioning

confidence: 99%

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Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes

et al. 2021

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Post-keratoplasty infectious keratitis (PKIK) represents a unique clinical entity that often poses significant diagnostic and therapeutic challenges. It carries a high risk of serious complications such as graft rejection and failure, and less commonly endophthalmitis. Topical corticosteroids are often required to reduce the risk of graft rejection but their use in PKIK may act as a double-edged sword, particularly in fungal infection. The increased uptake in lamellar keratoplasty in the recent years has also led to complications such as graft-host interface infectious keratitis (IIK), which is particularly difficult to manage. The reported incidence of PKIK differs considerably across different countries, with a higher incidence observed in developing countries (9.2–11.9%) than developed countries (0.02–7.9%). Common risk factors for PKIK include the use of topical corticosteroids, suture-related problems, ocular surface diseases and previous corneal infection. PKIK after penetrating keratoplasty or (deep) anterior lamellar keratoplasty is most commonly caused by ocular surface commensals, particularly Gramme-positive bacteria, whereas PKIK after endothelial keratoplasty is usually caused by Candida spp. Empirical broad-spectrum antimicrobial treatment is the mainstay of treatment for both PKIK, though surgical interventions are required in medically refractory cases (during the acute phase) and those affected by visually significant scarring (during the late phase). In this paper, we aim to provide a comprehensive overview on PKIK, encompassing the epidemiology, risk factors, causes, management and outcomes, and to propose a treatment algorithm for systematically managing this challenging condition.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes

et al. 2021

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“…According to the literature, the development of multiple infiltrates located in the donor-recipient interface was the first sign of keratitis, without any signs of inflammation in the anterior chamber. Laboratory investigations, including either corneal scraping or excised cornea culture, were taken to identify the microorganism and yielded Candida spp., [3,7,9,12,14,16,21] Klebsiella pneumonia , [8,17] Alternaria , [10] Mycobacterium chelonae , [11] Aspergillus flavus , [13] Gram-positive Cocci , [15] Actynomices , [18] Lecytophora mutabilis [19] and Herpes simplex virus . [20] Infectious pathogens were identified from cultures of the excised donor buttons in almost all cases and from the culture and smear tests from the material employed to irrigate the graft–host interface in 1 case.…”

Section: Discussionmentioning

confidence: 99%

Multi-drug resistant Enterococcus faecium in late-onset keratitis after deep anterior lamellar keratoplasty

D’Oria¹,

Galeone²,

Pastore³

et al. 2019

Medicine

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Rationale:Interface keratitis after lamellar keratoplasty is one of the causes of graft failure. We report the first case of microbiologically proven Enterococcus faecium infection following deep anterior lamellar keratoplasty (DALK) and review the available literature.Patient concerns:A 37-years-old Caucasian man presented with pain, redness and severe vision loss in his right eye. Five weeks before, he underwent DALK using the FEMTO LDV Z8 in the same eye for the surgical correction of keratoconus.Diagnoses:Upon presentation, slit-lamp biomiscroscopy revealed corneal graft edema with multiple infiltrates located in the graft-host interface.Interventions:Therapeutic penetrating keratoplasty (PKP) was carried out in addition with cultures of the donor lenticule removal. Laboratory results isolated a multi-resistant Enterococcus faecium interface infection. According to the antibiogram, the patient was treated with systemic Tigecycline and Linezolid for 7 days.Outcomes:During the following weeks, clinical features improved over time and no signs of active infection were visible seven months postoperatively.Lessons:Early PKP showed to be a good therapeutic option with great anatomic and functional outcomes.

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“…BCLs provide protection usually provided by the lids; this protection is needed to allow migrating epithelial cells to develop proper adherence to the underlying basement membrane, promoting epithelialization [ 18 ]. However, it has also been reported that the prolonged use of BCLs may be associated with a risk of infectious keratitis [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of bandage contact lens application in corneal epithelialization and pain alleviation following corneal transplantation; prospective, randomized clinical trial

et al. 2016

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BackgroundTo assess the efficacy of bandage contact lens (BCL) application to promote epithelialization and alleviate pain following corneal transplantation.MethodsTwenty-six consecutive patients who underwent corneal transplantation were randomly assigned to undergo BCL application (BCL group, n = 14) or no BCL application (control group, n = 12) at the end of the surgery. Corneal epithelialization was analyzed by photography using fluorescein staining, and ocular pain was measured using a visual analog scale.ResultsThe mean size of the epithelial defect relative to the graft area in the BCL group was 21.80 ± 35.10 % at the end of surgery, 18.20 ± 31.10 % on postoperative day 1, and 5.45 ± 11.10 % on postoperative days 3 to 5. These values in the control group were 9.64 ± 17.60 % at the end of surgery, 11.50 ± 25.70 % on postoperative day 1, and 0.00 ± 0.00 % on postoperative days 3 to 5. There were no significant differences in the speed of epithelialization between the two groups. The mean preoperative pain score in the BCL group was slightly higher than that control (4.27 ± 1.96 vs. 2.41 ± 2.18, respectively; P = 0.039). The scores significantly increased on postoperative day 1 and promptly returned to preoperative levels by day 7 in both groups, and there were no significant differences between the groups.ConclusionsNo significant benefits of BCL application at the time of corneal transplantation were observed in this study. The efficacy and safety of BCLs in eyes with compromised epithelialization require further study.Trial registration numberUMIN 000019091. Date of registration: 2015/09/22

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Alternaria keratitis after deep anterior lamellar keratoplasty

Cited by 13 publications

References 9 publications

Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes

Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes

Multi-drug resistant Enterococcus faecium in late-onset keratitis after deep anterior lamellar keratoplasty

Effectiveness of bandage contact lens application in corneal epithelialization and pain alleviation following corneal transplantation; prospective, randomized clinical trial

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