Corneal Intrastromal Gatifloxacin Crystal Deposits After Penetrating Keratoplasty

Awwad, Shady T.; Haddad, Walid; Wang, Ming X.; Parmar, Dipak N.; Conger, Darrel; Cavanagh, Harrison D

doi:10.1097/01.icl.0000133241.56713.2f

Cited by 35 publications

(15 citation statements)

References 31 publications

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“…Fluoroquinolones such as gatifloxacin and ciprofloxacin are not recommended for intrastromal injection as this can result in macroscopic crystalline deposits. 11 In our experience, an intrastromal antibiotic agent was an effective alternative to the excision of infected tissue and tectonic grafting. The deep stromal location of the keratitis made identification of the infective organism difficult.…”

Section: Discussionmentioning

confidence: 96%

Intrastromal injection of antibiotic agent in the management of recalcitrant bacterial keratitis

Liang

Lee

2011

Journal of Cataract and Refractive Surgery

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Intrastromal injection is a novel method of delivering an antibiotic agent directly to the site of keratitis. Although intrastromal antifungal agents have been used to manage refractory fungal keratitis, the experience with intrastromal antibiotic agents for bacterial keratitis is more limited. We report a case of refractory bacterial keratitis treated with an intrastromal antibiotic agent and discuss the potential for the clinical use of this modality.

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Section: Discussionmentioning

confidence: 96%

Intrastromal injection of antibiotic agent in the management of recalcitrant bacterial keratitis

Liang

Lee

2011

Journal of Cataract and Refractive Surgery

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“…[13][14][15][16][17][18] SchlotzerSchrehardt et al 19 reported corneal stromal calcium deposition in all levels of the stroma, secondary to topical dexamethasone phosphate therapy in the context of chronic keratoconjunctivitis in a patient with StevensJohnson syndrome. In the latter study, histopathological analysis of the corneal button evidenced calcium deposits closely associated with intracellular and pericellular accumulations of glycosaminoglycans, suggesting a possible role of dexamethasone phosphate treatment altering the glycosaminoglycan metabolism of stromal keratocytes in the calcification process.…”

Section: Discussionmentioning

confidence: 99%

New insight into non-healing corneal ulcers: iatrogenic crystals

Livingstone

Stefanowicz

Connolly

et al. 2013

Eye

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Aims To characterise and correlate crystalline precipitations implicated in non-healing corneal ulceration in two patients with a previous history of acanthamoeba keratitis. Materials and methods Persistence of acanthamoeba and secondary bacterial infection was excluded with negative corneal scrapes. Confocal microscopy identified crystal-like deposits within the corneal stroma. To investigate possible precipitating combinations, all concurrent treatments at the time of presentation were mixed in wells, with observation of precipitate formation. Precipitates were observed with phasecontrast microscopy, and subsequently characterised via crystallography techniques and electrospray ionisation mass spectrometry. Results Combinations of dexamethasone 0.1% minims and chlorhexidine gluconate 0.2% formed an amorphous material characterised by electrospray ionisation mass spectrometry as an insoluble chlorhexidine salt. Combinations of chloramphenicol drops and timolol 0.5% formed a crystal identified via X-ray crystallography as santite (K(B 5 O 6 (OH) 4 ).(H 2 O) 2 ). This is a borate mineral identified in nature, arising from thermal springs, but never reported in biological tissues. Clinical improvement was observed following the cessation of the implicated precipitating combinations. Conclusion Our observations suggest iatrogenic precipitate formation, with a potential deleterious effect upon healing. The substrates for these precipitates include several frequently prescribed topical ophthalmic treatments. These findings shed new light on the aetiopathogenesis of nonhealing corneal ulceration, and have broad implications on topical prescribing for this challenging condition.

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“…4 In contrast to older fluoroquinolones, there is currently only one report of gatifloxacin crystalline deposition occurring in a deepithelialized corneal graft after penetrating keratoplasty. 5 The authors later reported that the crystalline deposits were improved, but still present in the graft, after 2 years. 6 This case is the first report of gatifloxacin crystalline deposition in the setting of an intact corneal epithelium.…”

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confidence: 97%

Corneal Crystalline Deposits Associated With Topically Applied Gatifloxacin

Elia

Khodadadeh²,

Chow³

2014

Cornea

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Corneal Intrastromal Gatifloxacin Crystal Deposits After Penetrating Keratoplasty

Abstract: Gatifloxacin, a fourth-generation fluoroquinolone, can cause intrastromal macroscopic crystalline deposits through a compromised corneal epithelium, similar to what has been described for ciprofloxacin, a second-generation fluoroquinolone.

Cited by 35 publications

References 31 publications

Intrastromal injection of antibiotic agent in the management of recalcitrant bacterial keratitis

Intrastromal injection of antibiotic agent in the management of recalcitrant bacterial keratitis

New insight into non-healing corneal ulcers: iatrogenic crystals

Corneal Crystalline Deposits Associated With Topically Applied Gatifloxacin

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