Treatment of Pseudomonas Keratitis by Continuous Infusion of Topical Antibiotics With the Morgan Lens

Wang, Mingwu; Smith, Wally; Duncan, Joshua K.; Miller, Joseph M.

doi:10.1097/ico.0000000000001128

Cited by 13 publications

(9 citation statements)

References 9 publications

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“…In 2006, by implanting infusion tube into the superior conjunctival fornix of patients, Meallet 11 reported for the first time of using continuous antibiotic irrigation on the ocular surface to treat persistent infectious keratoscleritis, which effectively eradicated recalcitrant corneal and scleral infections. In 2017, Wang, et al 7 reported two cases of severe Pseudomonas keratitis cured by continuous administration of antibiotics through an irrigator. Zhao, et al 8 demonstrated in a rabbit experiment that through continuous administration of antibiotics, a higher drug concentration was rapidly reached in the anterior segment tissues.…”

Section: Discussionmentioning

confidence: 99%

Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis

Liang¹,

Liu²,

Zhang³

et al. 2021

European Journal of Ophthalmology

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Purpose To evaluate the therapeutic effect of incorporating continuous administration of voriconazole in the treatment of recalcitrant fungal keratitis. Methods In this prospective case study, 5 consecutive patients (5 eyes) with fungal keratitis were treated with a standard protocol after the failing maximal conventional medical treatment. The protocol involved continuous lavage of the ulcer with 1% voriconazole through an irrigator for 2 h, twice a day, combined with local and systemic antifungals. Visual acuity, slit lamp findings of the ulcer, and fungal hyphae density by confocal microscope were documented, respectively. Results In 4 patients, the clinical symptoms and slit lamp examination were significantly improved after only 3 days of treatment. The hyphae were shown to decrease in number and morphologically fragmented in corneal stroma by confocal microscopy. After the infection was controlled, 2 cases required further keratoplasty. In one case, the treatment was deemed ineffective and a conjunctival flap had to be created to help control the infection. In all 5 patients, the best spectacle-corrected visual acuity had improved after treatment. With more than 3 months of follow-up, no recurrence of infection was seen in any cases. Conclusion Our treatment protocol demonstrated improvement in the treatment of clinically resistant fungal keratitis. Continuous lavage of voriconazole is easy to be implemented and well-tolerated by patients. Modification of the current protocol should be further explored to optimize the therapeutic effectiveness in future.

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Section: Discussionmentioning

confidence: 99%

Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis

Liang¹,

Liu²,

Zhang³

et al. 2021

European Journal of Ophthalmology

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“…In advanced keratitis, continues infusion of topical antibiotics (ceftazidime 50 mg/ ml) with the Morgan lens was effective when applied for one week followed by conventional topical antibiotics [44]. The early use of 19% topical colistin was found to be effective in the treatment of multi drug resistant Pseudomonas with few side effects [42].…”

Section: Management Of P Aeruginosa Keratitismentioning

confidence: 99%

Management of Psuedomonas Keratitis: a review article

Alsaad¹

2017

int. arab. j antimicrob. agents

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Bacterial keratitis can lead to severe vision loss and corneal scarring, and possibly perforation. Early and appropriate management is a key factor in decreasing and preventing complication.Pubmed and Medline were searched for articles related to Pseudomonas keratitis between year 2000 and 2017 to get current guidelines about the management of Pseudomonas keratitis. These articles are reviewed in this article and information related to management is summarized.The most used agents to treat Pseudomonas are either aminoglycosides (usually gentamicin) fortified with a cephalosporin or mono therapy with a fluoroquinolones usually ciprofloxacin. In most areas, most strains of Pseudomonas were susceptible to ciprofloxacin. The role of topical steroids is discussed, as well as, available options for treatment of multidrug resistant Pseudomonas species.

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“…Bacterial keratitis is a sight-threatening infection that is commonly associated with contact lens wear [1] and can lead to corneal perforation in 24–48 h [2]. Pseudomonas aeruginosa , a Gram-negative rod that is often found in water and soil, is a frequent cause of contact lens-related infective keratitis [3, 4]. Up to 30% of contact lens wearers have Gram-negative bacteria growth with 19% being culture positive for Pseudomonas, which is linked with severe anterior chamber reaction and larger infiltrates [5].…”

Section: Introductionmentioning

confidence: 99%

Recalcitrant Pseudomonas Aeruginosa Keratitis with Hyphaema

Chan

Stanley

et al. 2021

Case Rep Ophthalmol

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Purpose: To report a case of recalcitrant pseudomonas keratitis with a rare presentation of hyphaema. Observation: A 45-year-old female was noted to have contact lens-related pseudomonas keratitis with hyphaema. The organism was refractory to multiple antibiotics and only responded to Tazocin eye drops. Conclusion and Importance: Hyphaema is a rare presentation in bacterial keratitis and could represent infection with an especially virulent organism. Use of Aspirin could precipitate hyphaema in infective keratitis. Alternative antibiotic choices such as Tazocin, colistin, meropenem, and imipenem can be considered when standard therapy is ineffective for multidrug-resistant Pseudomonas keratitis.

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Treatment of Pseudomonas Keratitis by Continuous Infusion of Topical Antibiotics With the Morgan Lens

Cited by 13 publications

References 9 publications

Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis

Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis

Management of Psuedomonas Keratitis: a review article

Recalcitrant <b><i>Pseudomonas Aeruginosa</i></b> Keratitis with Hyphaema

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