Risk factors in microbial keratitis leading to penetrating keratoplasty

Miedziak, Anita I.; Miller, Mark R.; Rapuano, Christopher J.; Laibson, Peter R.; Cohen, Elisabeth J.

doi:10.1016/s0161-6420(99)90250-6

Cited by 129 publications

(98 citation statements)

References 15 publications

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“…According to the literature, older age, past ocular surgery, severe keratitis, and poor visual acuity at presentation account for the poor prognosis of keratitis. 28,29 In our study, 57.1% of patients (Patients 1, 2, 5, 6, 10, 11, and 13) had a chronic debilitating medical condition (such as stroke) that precluded the early intervention of keratitis, medication compliance or regular follow-up care. All patients in this study had previous ocular surgery that left the eyes pseudophakic or aphakic, thus facilitating the progression of infection to the posterior segments.…”

Section: Resultsmentioning

confidence: 71%

Eye preservation tectonic graft using glycerol-preserved donor cornea

Hc¹,

Sj²,

Chao³

2012

Eye

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Aims To report the surgical outcome of tectonic graft using glycerol-preserved donor corneas to treat perforated keratitis. Methods The medical records were reviewed of all patients treated for perforated keratitis using glycerol-preserved corneas at a single institution between 1 July 2004 and 31 June 2010. The clinical features, precipitating factors, adjuvant therapies, and therapeutic outcomes were analyzed. Success was defined as re-epithelialization of the ocular surface without evisceration. Results Fourteen eyes from 14 patients (6 male and 8 female) were included. Age ranged from 58 to 84 years (average, 70.71±8.52 years) and the follow-up time ranged from 7 to 56 months (mean, 25.35 ± 16.84 months). The culture results showed five bacterial infections, five cases of fungal keratitis, and one mixed infection; the culture results were negative for three patients. Satisfactory anatomical integrity was obtained in eight grafts (57.14%) that healed with neovascularization. Six grafts (48.85%) showed delayed re-epithelialization and were repaired with conjunctival flaps to maintain ocular surface integrity. Three patients developed secondary glaucoma and received trans-scleral cyclophotocoagulation. Thirteen patients had satisfactory anatomical integrity without evisceration or exenteration, while one patient received evisceration at 39-month follow-up because of intractable glaucoma. Conclusions Glycerol-preserved donor corneas combined with anterior vitrectomy with or without conjunctival flaps may be effective substitutes for evisceration surgery in patients with perforated keratitis.

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Section: Resultsmentioning

confidence: 71%

Eye preservation tectonic graft using glycerol-preserved donor cornea

Hc¹,

Sj²,

Chao³

2012

Eye

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“…This is not surprising as ocular surface disease is a significant risk factor for microbial keratitis. 9 In our study, the spectrum of antibiotic sensitivity broadly fell into two groups: that seen in young and old patients. The strains affecting older patients were resistant to ofloxacin unlike two out of the three younger patients (patient nos.…”

Section: Discussionmentioning

confidence: 73%

External ocular infections due to methicillin-resistant Staphylococcus aureus (MRSA)

Shanmuganathan

Armstrong

Buller

et al. 2004

Eye

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Purpose To determine the prevalence and clinical characteristics of external ocular infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in an ophthalmic hospital in the UK. Methods A retrospective analysis of the case notes of patients who had culture proven external ocular Staphylococcal infections during a 44-month period was undertaken. Results There were a total of 548 external eye infections caused by Staphylococcus aureus. Of these, 17 (3%) were MRSA positive. The most common presentation was conjunctivitis seen in six patients. All MRSA isolates were sensitive to chloramphenicol. Ofloxacin resistance was observed in all isolates from patients over the age of 50 years. All patients had an underlying history of either an ocular surface disease, malignancy, or a debilitating medical illness. Conclusions MRSA is as yet an infrequent cause of external ocular infections. Patients typically have underlying ocular risk factors and/or are medically debilitated. Different strains infect young and old age groups with characteristic antimicrobial sensitivity. This study highlights the need for more work to establish the role of MRSA commensals and ocular infections.

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“…Size of the ulcer has been shown to be an important predictor of primary treatment failure for fungal keratitis in previous studies. 5,22 Our analyses show that the size of the ulcer also predicts treatment course, including adverse effects such as perforation, and visual outcomes. Data for this study were collected as part of a randomized controlled trial, comparing outcomes in patients randomized to receive either topical voriconazole or topical natamycin, and to receive either corneal re-scraping or no re-scraping (in a two by two factorial design).…”

Section: Macroscopic Pigmentation Is Typically Characteristicmentioning

confidence: 77%

“…[1][2][3][4] Fungal corneal ulcers tend to have worse outcomes than bacterial ulcers; fungal ulcers tend to be more likely to perforate and to require penetrating keratoplasty. 5,6 Fungal infections of the cornea are difficult to treat, and available treatment options are limited. 7 Commonly recognized risk factors for fungal keratitis include ocular trauma, contact lens use, topical steroid use, ocular surface disease, and history of prior corneal surgery.…”

Section: Introductionmentioning

confidence: 99%

Predictors of outcome in fungal keratitis

Prajna

Krishnan

Mascarenhas

et al. 2012

Eye

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Purpose To analyse predictors of clinical outcome in fungal keratitis. Methods Data was collected during a prospective, randomized, controlled, doublemasked clinical trial of treatment for fungal keratitis. Clinical features at presentation and demographics were collected at the enrolment visit for all patients. Pre-specified clinical outcomes included 3-month visual acuity and infiltrate/scar size, time to re-epithelialization, and corneal perforation. A separate multivariable model with each outcome as the dependent variable included all predictor variables.

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Risk factors in microbial keratitis leading to penetrating keratoplasty

Cited by 129 publications

References 15 publications

Eye preservation tectonic graft using glycerol-preserved donor cornea

Eye preservation tectonic graft using glycerol-preserved donor cornea

External ocular infections due to methicillin-resistant Staphylococcus aureus (MRSA)

Predictors of outcome in fungal keratitis

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