Infectious crystalline keratopathy: Management of three cases with different risk factors

Abstract

We present the management of three cases of infectious crystalline keratopathy. The first one, in a 46-year-old patient with two previous penetrating keratoplasties; the second one, in a 46-year-old patient with chronic alcoholism and limbal insufficiency; and the third one, in a 70-year-old patient with bullous keratopathy. Other systemic conditions that may mimic infectious crystalline keratopathy, such as multiple myeloma, gout or cystinosis were ruled out on each patient by laboratory testing. The cases were managed with topical or topical and systemic treatment that led to the disappearance of the symptoms. Infectious crystalline keratopathy is a chronic and indolent pathology in which interlamellar bacterial plaques are observed in absence of apparent ocular inflammatory signs. Microorganisms penetrate the cornea through epithelial defects, commonly after a penetrating keratoplasty, although other risk factors may be present.

Cytologic detection of Simonsiella‐like bacteria suggesting oral contamination in cases of canine ulcerative keratitis

“…are most frequently identified in cases of ICK. 20,21 ICK may be a sequelae of local or systemic immunosuppression, [22][23][24] corneal surgery, [24][25][26][27] or chronic keratitis. 26 Two of three cases in our series had previously undergone surgery (phacoemulsification in one case; conjunctival graft surgery in another case).…”

Paraproteinaemic keratopathy simulating a crystalline keratopathy

“…Branching needle-like opacities in the absence of corneal or anterior segment inflammation are considered characteristic of ICK [ 4 , 5 ]. A history of previous epithelial defect, surgical procedures or topical corticosteroids are also important considerations in the diagnosis of ICK.…”

“…Treatment of ICK involves aggressive, prolonged antibiotic therapies, due to the biofilm generated by the microorganism, drugs are usually less efficient. A penetrating keratoplasty may be required in refractory cases (therapeutic keratoplasty) and in cases of scars that affect the visual axis (optical keratoplasty) [ 5 ].…”