Deep Fungal Corneal Abscess

O’Day, Denis M.

doi:10.1001/archopht.1971.01000010416010

Cited by 22 publications

(5 citation statements)

References 6 publications

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“…21 The role of topical corticosteroids in the management of therapeutic PKP performed for fungal keratitis is controversial. 21,22 In our series, both patients with clinical cures after therapeutic PKP (cases 2 and 4) benefited from control of severe postoperative inflammation with topical corticosteroids and maintained clear grafts. One patient (case 3) without a clinical cure after 2 therapeutic PKPs may have experienced enhancement of postoperative fungal proliferation as a result of topical corticosteroid use.…”

Section: Discussionmentioning

confidence: 69%

Trichophyton Fungal Keratitis

Mohammad

AlRajhi²,

Wagoner³

2006

Cornea

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Section: Discussionmentioning

confidence: 69%

Trichophyton Fungal Keratitis

Mohammad

AlRajhi²,

Wagoner³

2006

Cornea

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“…In 1971, the prevailing idea surrounding the local administration of corticosteroids due to enhancing fungal growth was not only relevant to fungal endophthalmitis but also applied to other fungal eye infections, including fungal eye infections of the cornea. O'day et al provided a case of a deep fungal corneal abscess treated with combined corticosteroidantifungal therapy followed by penetrating keratoplasty that successfully resolved the fungal infection while preserving vision [25]. Their use of corticosteroids considered the risk of worsening intrinsic ocular disease.…”

Section: In Vivo Effect Of Corticosteroids On Immune Response Against...mentioning

confidence: 99%

“…Their use of corticosteroids considered the risk of worsening intrinsic ocular disease. However, they decided during their specific case that it could not be made much worse and proceeded despite the possibility of systemic spread, which they deemed improbable in an immune-competent patient [25]. The high doses of corticosteroid they utilized were tolerated, and a good visual result was achieved, leading to this study being cited by future studies as a basis for steroid use in similar fungal eye infections [25].…”

Section: In Vivo Effect Of Corticosteroids On Immune Response Against...mentioning

confidence: 99%

“…However, they decided during their specific case that it could not be made much worse and proceeded despite the possibility of systemic spread, which they deemed improbable in an immune-competent patient [25]. The high doses of corticosteroid they utilized were tolerated, and a good visual result was achieved, leading to this study being cited by future studies as a basis for steroid use in similar fungal eye infections [25]. They also predicted that with the advent of more effective antifungal agents, corticosteroid use would become more prevalent in fungal eye infections and may be used earlier in treatment.…”

Section: In Vivo Effect Of Corticosteroids On Immune Response Against...mentioning

confidence: 99%

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The Role of Adjuvant Systemic and Intravitreal Corticosteroids in Fungal Endophthalmitis Treatment

Azhari,

Tetelbom,

Sallam

2023

JoF

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Endophthalmitis refers to inflammation involving internal ocular structures, including the anterior and posterior eye segments, associated with infectious agents, most commonly bacteria and fungi. This review focuses on endophthalmitis caused by fungi. Medical and surgical management are the two main treatment modalities for fungal endophthalmitis, with medical management utilizing systemic or intravitreal antifungals. The use of systemic or intravitreal corticosteroids as an adjuvant treatment to dampen the severity of inflammation is controversial. Based on the pathobiology of fungal endophthalmitis as well as the mechanism of action of corticosteroids, it was hypothesized that corticosteroids affected the immune response against fungal infection. In vitro studies mostly carried out during the 1980s showed that dexamethasone plays a role in the suppression of phagocytosis of yeasts and demonstrated the facilitation of yeast proliferation by dexamethasone. In vivo studies analysis was compromised entirely of retrospective studies describing steroid use in fungal endophthalmitis, with the outcomes of the patients in these studies varying greatly and often being anecdotally noted, thus difficult to discern any definitive results. Given the limited clinical data and the heterogeneity of the existing studies, additional experimentation human studies with clinical trials or observations over more extended periods analyzing the effect of systemic and intravitreal corticosteroids in fungal endophthalmitis are needed before definitive conclusions can be drawn.

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“…20,21 Few studies have reported on patients intentionally treated with topical corticosteroids after a diagnosis of fungal keratitis, although 1 retrospective study reported use of topical steroids in 16 patients with fungal keratitis, administered a mean of 42 days (range 13-100 days) after administering topical antifungal therapy, and found recurrence in only 1 patient. 22,23 Adjuvant steroid therapy has typically been avoided for fungal keratitis in trials studying the efficacy of antifungal medications or surgical procedures such as crosslinking. 24,25 Some have advocated treating inflammation with topical calcineurin inhibitors such as cyclosporine or tacrolimus instead of steroids, especially given in vitro reports demonstrating that cyclosporine inhibits growth of several species of Fusarium.…”

Section: Fungal Keratitismentioning

confidence: 99%

Steroids in the Management of Infectious Keratitis

Keenan

2023

Cornea

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Purpose: To summarize the evidence base on the use of topical corticosteroids for infectious keratitis. Methods: Narrative review. Results: Infectious keratitis is a painful condition that often results in visually significant corneal stromal scarring, even when antimicrobial therapy is successful. Corticosteroids may reduce inflammation and subsequent scar formation and while relieving the acute ocular pain associated with a corneal ulcer. However, corticosteroids also reduce the host immune response, which could hinder the ability to clear infection. The safety and effectiveness of corticosteroids depends to a large part on the efficacy of the antimicrobials being used to treat the underlying infection. Randomized trials have found that corticosteroids are safe and effective for herpetic keratitis when used with appropriate antiviral therapy, and are safe for bacterial keratitis when used with broad spectrum topical antibiotics. The effectiveness of corticosteroids for bacterial keratitis has not been shown conclusively, although more advanced bacterial corneal ulcers may do better with corticosteroids. No randomized trials have assessed the safety and effectiveness of steroids for fungal or acanthamoeba keratitis. Animal studies suggest corticosteroids may be harmful in fungal keratitis, and observational human studies have found that steroids are harmful for fungal and acanthamoeba keratitis when started prior to anti-amoebics. Conclusions: Topical corticosteroids, when used as an adjunct to antimicrobial therapy, may be beneficial if the antimicrobial being used can effectively clear or suppress the infection, such as in bacterial and herpetic keratitis. Randomized trials would be helpful to further delineate the role of corticosteroids for infectious keratitis.

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Deep Fungal Corneal Abscess

Cited by 22 publications

References 6 publications

Trichophyton Fungal Keratitis

Trichophyton Fungal Keratitis

The Role of Adjuvant Systemic and Intravitreal Corticosteroids in Fungal Endophthalmitis Treatment

Steroids in the Management of Infectious Keratitis

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