scholarly journals Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011-2020: A 10-Year Study

2021 ◽  
Author(s):  
Darren Shu Jeng Ting ◽  
Mohamed Galal ◽  
Bina Kulkarni ◽  
Mohamed S. Elalfy ◽  
Damian Lake ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Unmet Need ◽  
Visual Outcome ◽  
Fungal Keratitis ◽  
Ocular Infection ◽  
Candida Spp ◽  
Corneal Surgery ◽  
Surgical Interventions ◽  
Poor Visual Outcome ◽  
Culture Positive

Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen’s Medical Centre, Nottingham, and Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. A total of 117 patients (n=117 eyes) with FK were included in this study. The mean age was 59.0±19.6 years (range, 4-92 years) and 51.3% patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with Candida spp. (33, 62.3%), Fusarium spp. (9, 17.0%), and Aspergillus spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9±16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67±1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all p<0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcome, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.

scholarly journals Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study

2021 ◽  
Vol 7 (11) ◽  
pp. 966
Author(s):  
Darren Shu Jeng Ting ◽  
Mohamed Galal ◽  
Bina Kulkarni ◽  
Mohamed S. Elalfy ◽  
Damian Lake ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Unmet Need ◽  
Treatment Strategies ◽  
Healing Time ◽  
Fungal Keratitis ◽  
Ocular Infection ◽  
Candida Spp ◽  
Corneal Surgery ◽  
Surgical Interventions ◽  
Culture Positive

Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen’s Medical Centre, Nottingham, and the Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. We included 117 patients (n = 117 eyes) with FK in this study. The mean age was 59.0 ± 19.6 years (range, 4–92 years) and 51.3% of patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with Candida spp. (33, 62.3%), Fusarium spp. (9, 17.0%), and Aspergillus spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9 ± 16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67 ± 1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3 mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all p < 0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcomes, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.

scholarly journals Clinical analysis of fungal keratitis according to prior topical steroid use: A retrospective study

2019 ◽  
Author(s):  
Chan Ho Cho ◽  
Sang-Bumm Lee
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Ocular Surface ◽  
Clinical Characteristics ◽  
Topical Steroid ◽  
Fungal Keratitis ◽  
Ocular Surface Disease ◽  
Ocular Infection ◽  
Steroid Use

Abstract Background: To compare the clinical characteristics and treatment outcomes of microbiologically-proven fungal keratitis between prior topical steroid users (PS) and no prior topical steroid users (NPS). Methods: Eighty-three cases with microbiologically-proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors and clinical characteristics, microbiological profiles, and treatment outcomes were compared between the PS and NPS groups. The treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated on the bases of the total cohort and analyzed using multivariate logistic regression. Results: A total of 30 cases with PS group and 53 cases with NPS group were included. No significant differences were observed in mean age, sex, occupation, and baseline clinical characteristics between the two groups. Differences were observed between the PS and NPS groups in the cases of previous ocular surface disease (43.3% vs. 22.6%, p=0.048), identified fungal isolates (53.3% vs. 26.4%, p=0.014), and diagnosed by repeat microbiological tests (40.0% vs. 17.0%, p=0.020). Candida was the most common organism in both groups (6 cases, respectively), while the Aspergillus (4 cases) was found only in the PS group (p=0.015). Regarding treatment outcomes, the use of voriconazole (topical 10% vs. 0%, p=0.044; systemic 23.3% vs. 1.9%, p=0.003), surgical intervention (43.3% vs. 20.8%, p=0.029) and treatment failure (46.7% vs. 22.6%, p=0.023) were more common in the PS group than in the NPS group. The risk factors for treatment failure were hypopyon (odds 5.95, p=0.003), prior topical steroid use (odds 3.45, p=0.034), and non-vegetable corneal trauma (odds 4.46, p=0.037). Conclusions: The PS group was more associated with previous ocular surface disease, and no significant differences were observed in the baseline clinical characteristics between the two groups. Diagnosis was more difficult and treatment results were worse in the PS group in this study. Repeat microbiological tests can be helpful in diagnosing fungal infections especially in the prior topical steroid used group. Keywords: Fungal ocular infection, Steroids, Ulcerative keratitis.

scholarly journals Risk Factors, Clinical Outcomes and Prognostic Factors of Bacterial Keratitis: The Nottingham Infectious Keratitis Study

2021 ◽  
Author(s):  
Darren Shu Jeng Ting ◽  
Jessica Cairns ◽  
Bhavesh Gopal ◽  
Charlotte Ho ◽  
Lazar Krstic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Contact Lens ◽  
Visual Outcome ◽  
Bacterial Keratitis ◽  
Contact Lens Wear ◽  
Poor Visual Outcome ◽  
Corrected Distance Visual Acuity ◽  
Culture Positive ◽  
Lens Wear

Background/aim: To examine the risk factors, clinical characteristics, outcomes and prognostic factors of bacterial keratitis (BK) in Nottingham, UK. Methods: This was a retrospective study of patients who presented to the Queens Medical Centre, Nottingham, with suspected BK during 2015-2019. Relevant data, including the demographic factors, risk factors, clinical outcomes, and potential prognostic factors, were analysed. Results: A total of 283 patients (n=283 eyes) were included; mean age was 54.4+/-21.0 years and 50.9% were male. Of 283 cases, 128 (45.2%) cases were culture-positive. Relevant risk factors were identified in 96.5% patients, with ocular surface diseases (47.3%), contact lens wear (35.3%) and systemic immunosuppression (18.4%) being the most common factors. Contact lens wear was most commonly associated with P. aeruginosa whereas Staphylococci spp. were most commonly implicated in non-contact lens-related BK cases (p=0.017). At presentation, culture-positive cases were associated with older age, worse presenting corrected-distance-visual-acuity (CDVA), larger epithelial defect and infiltrate, central location and hypopyon (all p<0.01), when compared to culture-negative cases. Hospitalisation was required in 57.2% patients, with a mean length of stay of 8.0 +/- 8.3 days. Surgical intervention was required in 16.3% patients. Significant complications such as threatened/actual corneal perforation (8.8%), loss of perception of light vision (3.9%), and evisceration/enucleation (1.4%) were noted. Poor visual outcome (final corrected-distance-visual-acuity of <0.6 logMAR) and delayed corneal healing (>30 days from initial presentation) were significantly affected by age >50 years, infiltrate size >3mm, and reduced presenting vision (all p<0.05). Conclusion: BK represents a significant ocular morbidity in the UK. Culture positivity is associated with more severe disease at presentation but has no significant influence on the final outcome. Older age, large infiltrate, and poor presenting vision were predictive of poor visual outcome and delayed corneal healing, highlighting the importance of primary prevention and early intervention for BK.

Early postoperative infection following lamellar keratoplasty: a review

2021 ◽  
pp. bjophthalmol-2020-318305
Author(s):  
Shilpa Das ◽  
Sunita Chaurasia ◽  
Savitri Sharma ◽  
Sujata Das
Keyword(s):  
Visual Outcome ◽  
Drug Susceptibility ◽  
Lamellar Keratoplasty ◽  
Corneal Tissue ◽  
Tissue Storage ◽  
Treatment Protocols ◽  
Surgical Interventions ◽  
Poor Visual Outcome ◽  
Microbiological Testing ◽  
Descemet’S Stripping Endothelial Keratoplasty

With the growing popularity of lamellar keratoplasty for selective replacement of diseased corneal tissue, it is important to understand the risk of developing an infection after the procedure. Although lesser than that postpenetrating keratoplasty, the reports on post lamellar keratoplasty infectious keratitis are not negligible. Trends of acute infections arising within 2 months of surgery are a subject of interest. Most of these infections are reported post Descemet’s stripping endothelial keratoplasty with a preponderance of Candida species. A donor to host transmission of infection is not uncommon. Among the Candida cases, about 80% seem to occur due to a donor to host transmission. Infections presenting as or progressing to endophthalmitis lead to a poor visual outcome. Strict aseptic measures and protocols during corneal tissue harvesting, tissue processing, tissue storage and surgery are essential to prevent occurrence of these infections. After the infection has occurred, determining the aetiology and drug susceptibility through microbiological testing is vital. This helps to guide treatment protocols and hence determines final outcome of these cases. Most cases require some form of surgical management for resolution of infection, most often a graft removal and therapeutic keratoplasty. Secondary surgical interventions are performed to restore graft clarity and achieve a good final visual outcome.

scholarly journals Risk Factors, Clinical Outcomes, and Prognostic Factors of Bacterial Keratitis: The Nottingham Infectious Keratitis Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Darren Shu Jeng Ting ◽  
Jessica Cairns ◽  
Bhavesh P. Gopal ◽  
Charlotte Shan Ho ◽  
Lazar Krstic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Contact Lens ◽  
Visual Outcome ◽  
Contact Lens Wear ◽  
Poor Visual Outcome ◽  
Ocular Surface Diseases ◽  
Corrected Distance Visual Acuity ◽  
Culture Positive ◽  
Lens Wear

Background/Aim: To examine the risk factors, clinical characteristics, outcomes, and prognostic factors of bacterial keratitis (BK) in Nottingham, UK.Methods: This was a retrospective study of patients who presented to the Queen's Medical Centre, Nottingham, with suspected BK during 2015–2019. Relevant data, including the demographic factors, risk factors, clinical outcomes, and potential prognostic factors, were analysed.Results: A total of 283 patients (n = 283 eyes) were included; mean age was 54.4 ± 21.0 years and 50.9% were male. Of 283 cases, 128 (45.2%) cases were culture-positive. Relevant risk factors were identified in 96.5% patients, with ocular surface diseases (47.3%), contact lens wear (35.3%) and systemic immunosuppression (18.4%) being the most common factors. Contact lens wear was most commonly associated with P. aeruginosa whereas Staphylococci spp. were most commonly implicated in non-contact lens-related BK cases (p = 0.017). At presentation, culture-positive cases were associated with older age, worse presenting corrected-distance-visual-acuity (CDVA), use of topical corticosteroids, larger epithelial defect and infiltrate, central location and hypopyon (all p &lt; 0.01), when compared to culture-negative cases. Hospitalisation was required in 57.2% patients, with a mean length of stay of 8.0 ± 8.3 days. Surgical intervention was required in 16.3% patients. Significant complications such as threatened/actual corneal perforation (8.8%), loss of perception of light vision (3.9%), and evisceration/enucleation (1.4%) were noted. Poor visual outcome (final corrected-distance-visual-acuity of &lt;0.6 logMAR) and delayed corneal healing (&gt;30 days from initial presentation) were significantly affected by age &gt;50 years, infiltrate size &gt;3 mm, and reduced presenting vision (all p &lt; 0.05).Conclusion: BK represents a significant ocular morbidity in the UK, with ocular surface diseases, contact lens wear, and systemic immunosuppression being the main risk factors. Older age, large infiltrate, and poor presenting vision were predictive of poor visual outcome and delayed corneal healing, highlighting the importance of prevention and early intervention for BK.

scholarly journals FACTORS RESPONSIBLE FOR POOR VISUAL OUTCOME IN FUNGAL KERATITIS

2015 ◽  
Vol 4 (57) ◽  
pp. 9938-9945
Author(s):  
Pankaj Choudhary ◽  
Sujatha Lakhtakia ◽  
Charudatt Chalisgoankar ◽  
Anamika Dwivedi ◽  
Kanchanbala Rathore
Keyword(s):  
Visual Outcome ◽  
Fungal Keratitis ◽  
Poor Visual Outcome

Dual stain kit for the microscopic gram classification of ocular infection bacteria

1993 ◽  
Vol 51 ◽  
pp. 248-249
Author(s):  
Jacob S. Hanker ◽  
Dale N. Holdren ◽  
Kenneth L. Cohen ◽  
Beverly L. Giammara
Keyword(s):  
Contact Lenses ◽  
Ocular Infection ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Gram Staining ◽  
Ocular Infections ◽  
Different Types ◽  
Culture Positive ◽  
Increased Susceptibility

Keratitis and conjunctivitis (infections of the cornea or conjunctiva) are ocular infections caused by various bacteria, fungi, viruses or parasites; bacteria, however, are usually prominent. Systemic conditions such as alcoholism, diabetes, debilitating disease, AIDS and immunosuppressive therapy can lead to increased susceptibility but trauma and contact lens use are very important factors. Gram-negative bacteria are most frequently cultured in these situations and Pseudomonas aeruginosa is most usually isolated from culture-positive ulcers of patients using contact lenses. Smears for staining can be obtained with a special swab or spatula and Gram staining frequently guides choice of a therapeutic rinse prior to the report of the culture results upon which specific antibiotic therapy is based. In some cases staining of the direct smear may be diagnostic in situations where the culture will not grow. In these cases different types of stains occasionally assist in guiding therapy.

scholarly journals THU0597 CORNEAL MELT - DON’T ALWAYS BLAME RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 540.3-540
Author(s):  
A. Munir ◽  
C. Sheehy
Keyword(s):  
Rheumatoid Arthritis ◽  
Renal Biopsy ◽  
Systemic Vasculitis ◽  
Lower Lobe ◽  
Visual Outcome ◽  
Eye Drops ◽  
Poor Visual Outcome ◽  
Methyl Prednisolone ◽  
History Of ◽  
And Function

Background:Corneal melt is a rare inflammatory disease of the peripheral cornea; it may lead to perforation of the globe and visual failure. Corneal melt can be a manifestation of systemic vasculitis in patients with RA and other conditions, such as cancer. Without early and aggressive treatment it may be associated with a poor visual outcome and a high mortality. It has been reported in patients with stable RA.Objectives:A case report in a patient with long standing but well controlled Rheumatoid Arthritis (RA) and metastatic disease.Methods:A 75 year old male with a background of sero positive Rheumatoid Arthritis for more than 10 years presented to the Eye Casualty with a two week history of a painful left red eye. His other medical history was significant for Stage IIB poorly differentiated cancer of the left lower lobe. Left lower lobectomy with a patch of diaphragm resected. Intratumoural lymphovascular invasion noted. He completed Adjuvant Carboplatin/Vinorelbine chemotherapy September, 2017. He had DVT proximal left leg 22ndof September, 2017. Follow up CT in 2018 demonstrated a right renal upper pole lesion for which he was awaiting biopsy with?metastatic lung disease vs primary renal carcinoma. His RA was well controlled on Methotrexate 10mg weekly. He had been treated by the ophthalmology team for left marginal Keratitis for the prior 2 months with steroid eye drops without significant improvement. On presentation to ED, he described sharp eye pain, waking him from the sleep, associated with watery discharge and photophobia. Examination showed corneal melt in left eye involving 25% of inferior portion of the cornea and spastic entropion with injecting eye lashes. He had no active joints and there were no other signs of vasculitis. CRP was 4.1. He had a negative ANA and ANCA; viral swabs were negative. He was admitted under the medical team. Intravenous Methyl Prednisolone was started. The patient felt better after 5 days of Methyl Prednisolone. Left temporary tarsorrhaphy was done by Ophthalmology. Cyclophosphamide was initiated after discussion with Oncologist pending the result of the renal biopsy. Patient was discharged after 5 days of admission in the hospitalResults:The renal biopsy was positive for metastatic Squamous cell carcinoma of lung. Cyclophosphamide was withdrawn and he was started on Carboplatin/Gemcitabine. The corneal melt improved with complete resolution of his visual symptoms.Conclusion:In this case, although the history of RA was felt by the ophthalmology team to be the most likely association with the corneal melt, we would argue the oncological diagnoses were likely the driving force behind the presentation.References:[1]Sule A, Balakrishnan C, Gaitonde S, Mittal G, Pathan E, Gokhale NS, et al. Rheumatoid corneal melt. Rheumatology (Oxford)2002;41:705–6.[2]S. Yano, K. Kondo, M. Yamaguchi et al., “Distribution and function of EGFR in human tissue and the effect of EGFR tyrosine kinase inhibition,” Anticancer Research, vol. 23, no. 5, pp. 3639–3650, 2003.Disclosure of Interests:None declared

Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

2021 ◽  
pp. 112067212110006
Author(s):  
Xin Liu ◽  
Lufei Wang ◽  
Fengjuan Yang ◽  
Jia’nan Xie ◽  
Jinsong Zhao ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Management ◽  
Pediatric Patients ◽  
Vitreous Hemorrhage ◽  
Visual Outcome ◽  
Poor Visual Outcome ◽  
Early Vitrectomy ◽  
Open Globe ◽  
Time From Injury ◽  
Ocular Sign

Purpose: To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. Methods: Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. Results: Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. Conclusion: Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.

Retinal Arterial Macroaneurysms: Risk Factors of Poor Visual Outcome

2005 ◽  
Vol 219 (6) ◽  
pp. 366-372 ◽  
Author(s):  
Chang-Sue Yang ◽  
Der-Chong Tsai ◽  
Fenq-Lih Lee ◽  
Wen-Ming Hsu
Keyword(s):  
Risk Factors ◽  
Visual Outcome ◽  
Poor Visual Outcome
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