Recent trends: Medical management of infectious keratitis

Solanki, Sneha; Rathi, Manisha; Khanduja, Sumeet; Dhull, CS; Sachdeva, Sumit; Phogat, Jitender

doi:10.4103/0974-620x.159104

Cited by 23 publications

(14 citation statements)

References 21 publications

(22 reference statements)

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“…Monotherapy with fourth generation fluoroquinolones (moxifloxacin or gatifloxacin are the current, most commonly used antibiotic therapy [62]. However, P. aeruginosa has high ability to trigger antibiotic resistance mechanisms making them difficult to eradicate even using current treatments [63].…”

Section: Antibioticsmentioning

confidence: 99%

Challenges of corneal infections

Hazlett

Suvas

McClellan

et al. 2016

Expert Review of Ophthalmology

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Introduction Ocular infections remain an important cause of blindness worldwide and represent a challenging public health concern. In this regard, microbial keratitis due to fungal, bacterial, or viral infection can result in significant vision loss secondary to corneal scarring or surface irregularity. Left untreated corneal perforation and endophthalmitis can result, leading to loss of the eye. Rigorously studied animal models of disease pathogenesis have provided novel information that suggests new modes of treatment that may be efficacious clinically and emerging clinical data is supportive of some of these discoveries. Areas covered This review focuses on advances in our understanding of disease pathogenesis in animal models and clinical studies and how these relate to improved clinical treatment. We also discuss a novel approach to treatment of microbial keratitis due to infection with these bacterial pathogens using PACK-CXL and recommend increased basic and clinical studies to address and refine the efficacy of this procedure. Expert commentary Because resistance to antibiotics has developed over time to these bacterial pathogens, caution must be exercised in treatment. Attractive novel modes of treatment that hold new promise for further investigation include lipid based therapy, as well as use of small molecules that bind deleterious specific host responsive molecules and use of microRNA based therapies.

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Section: Antibioticsmentioning

confidence: 99%

Challenges of corneal infections

Hazlett

Suvas

McClellan

et al. 2016

Expert Review of Ophthalmology

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“…Also voriconazole was considered one of the best antifungal agents proved by Guber et al [17] and Solanki et al [4] and also the present study revealed that this drug was highly efficient against Fusarium species. It was considered the most potent antifungal agent against both yeasts and filamentous fungi by either in vitro or in vivo susceptibility; also it was the less toxic drug for the corneal tissues.…”

Section: Discussionmentioning

confidence: 91%

“…Still voriconazole from the azole group and natamycine from the polyne group play the most important role in the treatment of fungal keratitis by routes of administration either topical, intracameral or intrastromal injection [4][5][6][7][8]. One study by FlorCruz and Evans [9] reported 12 trial of medical treatment of keratomycosis in countries, they stated variation in the results between antifungal agent such as natamycine, amphotricin B, voriconazole, and itraconazole.…”

Section: Introductionmentioning

confidence: 99%

Different Modalities of Antifungal Agents in the Treatment of Fungal Keratitis: A Retrospective Study

Nada¹,

Bor’i²,

Alsawad³

2017

J Clin Exp Ophthalmol

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Purpose: To evaluate the efficacy of different modalities of antifungal agents in the treatment, clinical features and therapeutic outcome of fungal keratitis Design: Retrospective observational case series. Methods:The study reviewed 251 eyes of 246 patients treated for moderate and severe fungal keratitis in the period from 2010 to 2015. The diagnosis of fungal keratitis based on the clinical characteristics features of fungal keratitis beside laboratory diagnosis. The antifungal drugs were determined according to the commercial availability at the time depending on the clinical features, also to some extent to the laboratory diagnosis. Ten different modalities of antifungal agents beside antibacterial agents and cycloplegic drugs were used.Results: Among the total treated 251 eyes, 194 eyes (77.29%) showed complete healed ulcers. But 121 eyes were treated by five groups of combined therapy of antifungal agents achieving healed ulcer in 97 eyes (80.16%). The study reported 10 groups of different modalities of antifungal agents. The highest curative rate was 88.46% in cases treated by combined therapy of corneal intrastromal injection of amphotericin B beside topical fluconazole with mean duration of healing (25.43 ± 4.09 days). The second rate was 84% in a combination of topical natamycine and subconjunctival injection of amphotericin B with mean duration of healing 27.95 ± 3.46 days. The shortest duration of healing was 24.83 ± 4.39 days in cases treated by a combination therapy of corneal intrastromal injection of voriconazole beside topical natamycine with curative rate 82.14%. Conclusions:The use of a combined therapy of antifungal agents achieved the best treatment modality in cases of fungal keratitis especially the combination of intrastromal injection of antifungal agents with topical one according to curative rate and duration of healed ulcers in cases of moderate and severe fungal keratitis.

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“…V težkih primerih ima CXL skupaj s četrto generacijo fluorokinolonov in novejših azolov obetavno vlogo pri zdravljenju infekcijskega keratitisa. 39 Tudi Xu v svojem preglednem članku opisuje poročila o CXL pri infekcijskem keratitisu, ki so ustvarila dodatno zanimanje za ta način zdravljenja. 40 Keratitis s pseudomonasom z rože-ničnim ulkusom so eksperimentalno inducirali na 56 roženicah 28 kuncev.…”

Section: In Okužbe Roženiceunclassified

Zdravljenje Okužb Roženice S Prečnim Povezovanjem Kolagenih Vlaken

Silih

2016

SlovMedJour

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Zdravljenje okužb roženice s prečnim povezovanjem kolagenih vlakencorneal collagen cross-linking for infectious keratitis mirna Štabuc Šilih IzvlečekPrečno povezovanje kolagenih vlaken roženice z ultravijolično svetlobo poveča stabilnost roženice z uporabo fotosenzitivne snovi -riboflavina (vitamina B2) in ultravijoličnih žarkov A. Osnovna indikacija je napredujoči keratokonus, poseg pa se v svetu vse pogosteje uporablja. Ker gre pri tem postopku za fiziološke spremembe vsega vezivnega tkiva, so bile predlagane še dodatne indikacije. Te so ektazija po operaciji, bulozna keratopatija in predvsem, najbolj zanimiva, infekcijski keratitis.Okužbe roženice lahko brez ustreznega zdravljenja povzročijo slepoto. Vendar je tudi takojšnje in ustrezno antimikrobno zdravljenje odvisno od senzitivnosti in rezistence mikroorganizmov.Prispevek opisuje sedanje možnosti zdravljenja okužb roženice s prečnim povezovanjem kolagenih vlaken.Ta način zdravljenja bo morda postal pomemben, vendar pa ostajajo odprta še mnoga neodgovorjena vprašanja. Odgovore nanje naj bi dali rezultati večjih, prospektivnih primerjalnih raziskav. AbstractCorneal collagen cross-linking increases the stability of the cornea through the use of the photosensitive material-riboflavin (vitamin B2) and ultraviolet A radiation. Progressive keratoconus is the most common indication and the frequency of these procedures is increasing worldwide. As cross-links in the cornea are a physiological principle of all connective tissues, additional indications were proposed. These include post-refractive surgery ectasia, bullous keratopathy, and, infectious keratitis.Without proper antimicrobial therapy, infectious keratitis can lead to blindness. But even prompt initial management with appropriate antimicrobial treatment depends on microorganism sensitivity and resistance. This article presents current data regarding the use of corneal collagen cross-linking in the treatment of corneal infections. This treatment modality may become important, but unanswered questions remain. Larger, prospective comparative studies should provide the answers. UvodVnetni keratitis lahko brez ustreznega antimikrobnega zdravljenja privede do slepote. Tudi če ga odkrijemo v začetni fazi in pravilno zdravimo, lahko napreduje in privede do mehčanja roženice. Zaradi agresivne narave roženičnih patogenov in nevarnosti odpornosti na antibiotike je potrebno razviti nove načine obvladovanja tega hitro napredujočega stanja.1 O prečnem povezovanju kolagenih vlaken roženice z ultravijolično svetlo-

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Recent trends: Medical management of infectious keratitis

Cited by 23 publications

References 21 publications

Challenges of corneal infections

Challenges of corneal infections

Different Modalities of Antifungal Agents in the Treatment of Fungal Keratitis: A Retrospective Study

Zdravljenje Okužb Roženice S Prečnim Povezovanjem Kolagenih Vlaken

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