Intrastromal injection of azithromycin and amikacin for recalcitrant non-tuberculous mycobacterial keratitis

We report the self-limited nature of corneal opacification after accidental injection of Healon5 into the corneal stroma. A 52-year-old male with a new diagnosis of severe stage, primary open-angle glaucoma underwent successful trabeculectomy OS, which was complicated by ocular hypotony and shallow anterior chamber (AC) on postoperative day 1. Healon5, a hyaluronic acid-containing viscoelastic device, was accidentally introduced into the corneal stroma during attempted injection into the AC. The cornea hydrodissected and opacified, leading to precipitous loss of best-corrected visual acuity (BCVA). The corneal opacification spontaneously resolved over a 7-month period without specific intervention. During this period, the patient also underwent cataract extraction with posterior chamber intraocular lens placement and YAG capsulotomy, after which his BCVA returned to approximately baseline. Though intrastromal injection of sodium hyaluronate-containing material has been reported elsewhere, this complication with Healon5 use specifically has yet to be described in the literature and may occur in any procedure involving Healon5 in the AC. This case report is important, since the precipitous loss of BCVA can be alarming to the ophthalmologist and the patient. The affected patient may be counseled that the opacification should improve with time.

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Combined intrastromal injection of ganciclovir and depot betamethasone for the management of nummular keratitis: Case series

Archivos de la Sociedad Española de Oftalmología (English Edition) ◽

10.1016/j.oftale.2019.01.007 ◽

2019 ◽

Vol 94 (7) ◽

pp. 347-351

Author(s):

E. Arenas ◽

A. Mieth ◽

D. Muñoz

Keyword(s):

Case Series ◽

Intrastromal Injection

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ATF4 Involvement in TLR4 and LOX-1-Induced Host Inflammatory Response to Aspergillus fumigatus Keratitis

Journal of Ophthalmology ◽

10.1155/2018/5830202 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Shuchao Zhang ◽

Pingping Meng ◽

Guibo Liu ◽

Kuixiang Liu ◽

Chengye Che

Keyword(s):

Inflammatory Response ◽

Aspergillus Fumigatus ◽

Mouse Models ◽

Oxidized Ldl ◽

Ldl Receptor ◽

Activating Transcription Factor 4 ◽

Activating Transcription Factor ◽

Intrastromal Injection ◽

Host Inflammatory Response

Purpose. Activating transcription factor 4 (ATF4) is induced by various stressors. Here, we investigated the expression of ATF4 in the host inflammatory response to Aspergillus fumigatus (A. fumigatus) keratitis. Methods. A. fumigatus keratitis mouse models developed by intrastromal injection as well as corneal epithelium scratching were examined daily with a slit lamp microscope for corneal opacification and ulceration. Subsequent in vitro experimentation was carried out in human corneal epithelial cells (HCECs) as well as THP-1 macrophages infected with A. fumigatus. Inhibitors, including CLI-095, Poly (I), SCH772984, and SP600125, were used to assess the role of proteins like toll-like receptor 4 (TLR4), lectin-type oxidized LDL receptor 1 (LOX-1), extracellular signal-regulated kinases (ERK1/2), and c-Jun N-terminal kinase (JNK) in ATF4 expression as a response to A. fumigatus infection. This assessment was made in both mouse models and HCECs using western blot. Results. Compared to the controls, ATF4 was increased in corneas from two kinds of A. fumigatus keratitis models at 3 days after infection. ATF4 expression was upregulated with A. fumigatus conidia both in HCECs and THP-1 macrophages 16 hours after stimulation. Furthermore, ATF4 expression in response to A. fumigatus infection was shown to be dependent on TLR4 and LOX-1 expression, and ERK1/2 and JNK contributed to the expression of ATF4 in response to A. fumigatus. Conclusion. Our results clearly indicate that ATF4 was involved in the host antifungal immune response to A. fumigatus keratitis; expression was found to be dependent on TLR4, LOX-1 expression, and MAPKs pathway.

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Pseudomonas aeruginosa LasA Protease in Treatment of Experimental Staphylococcal Keratitis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.48.5.1681-1687.2004 ◽

2004 ◽

Vol 48 (5) ◽

pp. 1681-1687 ◽

Cited By ~ 27

Author(s):

Irina S. Barequet ◽

Guy J. Ben Simon ◽

Mary Safrin ◽

Dennis E. Ohman ◽

Efrat Kessler

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Rabbit Model ◽

Treatment Protocols ◽

Methicillin Resistant ◽

Clinical Scores ◽

Lasa Protease ◽

Late Treatment ◽

Intrastromal Injection ◽

Staphylococcus Simulans

ABSTRACT LasA protease is a staphylolytic endopeptidase secreted by Pseudomonas aeruginosa. We have examined the effectiveness of LasA protease in the treatment of staphylococcal keratitis caused by methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) isolates in a rabbit model. Keratitis was induced by intrastromal injection of the bacteria. The eyes were treated topically, and the efficacy of LasA protease was compared to those of lysostaphin (a staphylolytic protease secreted by Staphylococcus simulans) and vancomycin. When treatment was initiated early (4 h) after infection, practically all of the MSSA- and MRSA-infected corneas were sterilized by LasA protease, and its efficacy in eradicating the bacteria was comparable to those of lysostaphin and vancomycin. By contrast, most of the control corneas were heavily infected, with median values of 4.5 × 106 (MSSA) and 5 × 105 (MRSA) CFU/cornea (P < 0.001). When treatment was initiated late (10 h) after infection, LasA protease reduced the numbers of CFU in both MSSA- and MRSA-infected corneas by 3 to 4 orders of magnitude compared to the numbers of CFU for the controls (median values, 1,380 and 30 CFU/cornea, respectively, for the treated animals compared to 1.2 × 106 and 5 × 105 CFU/cornea for the respective controls [P = 0.001]), and it was more effective than vancomycin in eradicating MRSA cells (P = 0.02). In both the early- and the late-treatment protocols, the clinical scores for eyes treated with LasA protease were significantly lower than those for the eyes of the corresponding controls and comparable to those for the lysostaphin- and vancomycin-treated eyes. We conclude that LasA protease is effective in the treatment of experimental S. aureus keratitis in rabbits and may have potential for the treatment of disease in humans.

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Recalcitrant Paecilomyces keratitis

BMJ Case Reports ◽

10.1136/bcr-2019-229226 ◽

2019 ◽

Vol 12 (4) ◽

pp. e229226

Author(s):

Seetha Lakshmi ◽

Cristina Vanessa Garcia

Keyword(s):

Antifungal Agents ◽

Corneal Ulcer ◽

Surgical Intervention ◽

Caucasian Woman ◽

Artificial Eye ◽

Finger Counting ◽

Intrastromal Injection ◽

The Right ◽

Continue Therapy

A 54-year-old Caucasian woman presented with corneal ulcer of the right eye of 4 weeks duration after scratching her cornea while removing her contact lens and artificial eye lashes. Her visual acuity was 20/32 (left eye) and finger counting (right eye). She had a 3x3 mm epithelial defect with underlying corneal oedema and hypopyon. Right eye cultures grew Paecilomyces species. Topical and systemic antifungal agents were initiated. Due to the sight-threatening disease, the patient underwent surgical intervention with intrastromal injection of amphotericin B and a large conjunctival flap covering 75% of the right eye corneal ulcer. After 3 months of therapy, she had near-complete resolution of the corneal ulcer. Unfortunately, recurrence of the corneal ulcer occurred within 3 weeks of cessation of therapy, prompting reinitiation of ophthalmic and systemic antifungal agents. The patient was advised to continue therapy for 6 months with regular follow-up.

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