Clinical Outcomes and Prognostic Factors Associated With Acanthamoeba Keratitis

Chew, Hall F.; Yıldız, Elvin; Hammersmith, K.M.; Eagle, Ralph C.; Rapuano, Christopher J.; Laibson, Peter R.; Ayres, Brandon D.; Jin, Ya-Ping; Cohen, Elisabeth J.

doi:10.1097/ico.0b013e3181ec905f

Cited by 57 publications

(52 citation statements)

References 26 publications

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“…It is a leading cause of monocular blindness in developing countries (1)(2)(3)(4) . Most cases are bacterial, but the condition can also be caused by fungi, protozoa, and viruses (5)(6)(7)(8)(9) . The current standard therapy for bacterial and fungal keratitis is based on antibiotics and antifungals (10,11) .…”

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confidence: 99%

“…Although this is effective in most cases, some classes of microorganisms have been shown to be resistant to available antimicrobial agents (12,13) . Thus, even with timely treatment, the inflammatory process may progress with worsening ulceration, corneal melting, and ocular perforation (4,8) . When medical treatment fails, surgical procedures such as a conjunctival flap or corneal transplantation can be used (14)(15)(16) .…”

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confidence: 99%

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Efeito terapêutico do crosslinking corneal na ceratite infecciosa

Escarião¹,

Ribeiro²,

Jorge³

et al. 2013

Rev. bras.oftalmol.

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Purpose:To evaluate the effect of corneal crosslinking (CXL) RESUMOObjetivo: Avaliar o efeito do crosslinking (CXL) no tratamento de ceratite infecciosa, resistente ao tratamento clínico, e investigar a relação com o agente etiológico. Métodos: Foram incluídos 11 pacientes com diagnóstico de ceratite infecciosa de etiologia bacteriana (sete olhos) e fúngica (quatro olhos) na Fundação Altino Ventura (FAV) no período de outubro de 2011 a maio de 2012. Os pacientes incluídos estavam em uso de colírios há pelo menos sete dias e não apresentavam melhora da infecção. Estes foram avaliados antes da realização do CXL e no período pós-operatório até cicatrização da úlcera. Para realização do CXL foram instiladas gotas de riboflavina a 0,1% e dextrano a 20%, a cada cinco minutos em um período de 30 minutos antes do procedimento, e durante a aplicação da luz ultravioleta A (UVA). A córnea foi exposta à UVA com comprimento de onda de 370ηm ± 5ηm e uma irradiância de 3mW/cm². Resultados: Os pacientes com infecção bacteriana obtiveram cura do processo infeccioso após o CXL e nenhum paciente com ceratite fúngica apresentou cicatrização. Observou-se associação significante (p = 0,003) entre o agente etiológico e a cicatrização. Conclusão: O CXL mostrou-se eficaz no tratamento da ceratite bacteriana resistente ao tratamento clínico, evitando a realização de transplante tectônico. Em relação à ceratite fúngica, este procedimento não influenciou na melhora do processo infeccioso.Descritores: Córnea; Reagentes para ligações cruzadas/uso terapêutico; Ceratite infecciosa/quimioterapia; Ceratite bacteriana/ quimioterapia; Ceratite fúngica/quimioterapia

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confidence: 99%

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confidence: 99%

Efeito terapêutico do crosslinking corneal na ceratite infecciosa

Escarião¹,

Ribeiro²,

Jorge³

et al. 2013

Rev. bras.oftalmol.

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“…Die topische Vor-oder Anbehandlung einer Keratitis mit Steroiden oder Steroid-Antibiotika Kombinationen stellt in dieser Studie einen Risikofaktor für die Entwicklung einer mikrobiellen Keratitis dar, wie bereits in mehreren Studien gezeigt werden konnte [4,8,9] Die Definition der schweren mikrobiellen Keratitis ergab sich durch die Entscheidung zur stationären Therapie einer Keratitis. Abgesehen vom tatsächlichen Schweregrad einer Keratitis spielen jedoch auch andere Faktoren wie Alter, Allgemeinzustand, Versorgungs-und Pflegesituation von Patienten und nicht zuletzt die interindividuell unterschiedliche Einschätzung durch den aufnehmenden Arzt eine Rolle in dieser Entscheidung, weshalb es hier zu einer Selektions-Bias kommen könnte.…”

Section: Diskussionunclassified

Keimspektrum und Risikofaktoren der schweren mikrobiellen Keratitis

Steger

Speicher

Bechrakis

et al. 2012

Spektrum Augenheilkd.

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Background: Microbial keratitis is a potentially sight-threatening ophthalmologic emergency. A significantly increased incidence has been observed over the course of the past two decades, most likely due to facilitated commercial access to contact lenses. The aim of this study was to describe microbial characteristics, outcome, risk factors, and factors associated with adverse outcome in patients admitted to our hospital for treatment of severe microbial keratitis. Material and Methods: All cases admitted to were retrospectively analyzed, 43 cases were included into this study. Inclusion criteria were a symptom duration of less than four weeks at the time of admittance, diagnosis of microbial keratitis by culture or clinical improvement under antimicrobial therapy, and index cases. Negative outcome was defined as necessity of penetrating keratoplasty or enucleation and any final best-corrected visual acuity of ≤ 0.05 three months after admittance. Results: 79.1 % of all cases were of bacterial origin, 11.6 % caused by fungi, 9.3 % by acanthamoeba. Risk factors included contact lens wear in 55.8 %, chronic ocular surface disease in 27.9 % %, pretreatment with steroids in 16.3 %. Contact lens associated bacterial keratitis was caused by Pseudomonas aeruginosa in 66.7 %, Staphylococcus spp. was the predominant causative agent in cases without this risk factor (72.7 %). Pseudomonas keratitis was characterized by significantly shorter symptom duration before admittance. Adverse outcome was recorded in 32.6 % of all cases. Pretreatment with steroids and symptom duration before admittance of more than 3 days were associated with adverse outcome. Conclusions: Contact lens wear ist the most important risk factor for severe microbial keratitis. Pseudomonas aeruginosa is associated with contact lens related microbial keratitis and a fulminant clinical course. Topical pretreatment of microbial keratitis with steroids is associated with adverse outcome and protracted clinical course. Zusammenfassung: Hintergrund: Die mikrobiell bedingte Keratitis ist ein potentiell visusbedrohender Notfall, dessen Inzidenz in den vergangenen zwei Jahrzehnten durch die zunehmend verbreitete Anwendung von Kontaktlinsen sowie deren unbehinderte kommerzielle Verfügbarkeit zugenommen hat. Das Ziel dieser Studie war es, mikrobielle Charakteristika, Outcome, Risikofaktoren und negative prognostische Parameter der schweren und stationär behandlungsbedürftigen mikrobiellen Keratitiden zu identifizieren. Material und Methode: Nach retrospektiver Analyse aller an der Augenklinik Innsbruck stationär behandelten Fälle mikrobieller Keratitis von Jänner 2007 bis Juni 2010 wurden 43 Fälle inkludiert. Eingeschlossen wurden nur Indexfälle mit einer Symptomdauer vor Aufnahme von unter 4 Wochen und die Diagnose einer mikrobieller Keratitis aus einem positiven Keimnachweis und / oder klinischem Ansprechen auf entsprechende antimikrobielle Therapie. Als negatives Outcome wurden die Notwendigkeit einer perforierenden Keratoplastik, eine Enukleation und ein bestkorr...

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“…A case series in acanthamoeba keratitis suggested that women may have a worse prognoses but did not reach statistical significance 3. Women may have reduced ocular surface healing because of the way androgens mediate the lacrimal and meibomian glands 4.…”

Section: Commentmentioning

confidence: 99%