scholarly journals Comparative Clinical Analysis of Polymicrobial and Monomicrobial Bacterial Keratitis

2021 ◽  
Vol 62 (11) ◽  
pp. 1465-1477
Author(s):  
Seung Chul Baek ◽  
Chan-Ho Cho ◽  
Sang-Bumm Lee
Keyword(s):  
Clinical Outcome ◽  
Treatment Outcomes ◽  
Contact Lens ◽  
Ocular Surface ◽  
Defect Size ◽  
Ocular Surface Disease ◽  
Symptom Duration ◽  
Bacterial Keratitis ◽  
Epithelial Defect ◽  
Poor Clinical Outcome

Purpose: We comparatively analyzed the microbiological profiles, predisposing factors, clinical aspects, and treatment outcomes of patients with polymicrobial and monomicrobial bacterial keratitis.Methods: A total of 194 cases of culture-proven bacterial keratitis treated between January 2007 and December 2016 were reviewed. Microbiological profiles, the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between the polymicrobial group (polymicrobial bacterial keratitis [PBK]; 29 eyes, 62 isolates) and monomicrobial (monomicrobial bacterial keratitis [MBK]; 165 eyes, 165 isolates) group.Results: The most common isolates were Enterobacter (24%) in the PBK group and Staphylococcus (22%) in the MBK group. There were no significant differences between the two groups in previous ocular surface disease, previous ocular surgery, prior topical steroid use, epithelial defect size, and hypopyon. Age ≥60 years (PBK vs. MBK, 31% vs. 51%, p = 0.048), symptom duration (4.7 days vs. 8.0 days, p = 0.009), and contact lens use (34% vs. 18%, p = 0.036) were significantly different between the two groups. Regarding treatment outcomes, epithelial healing time ≥10 days, the final best-corrected visual acuity (BCVA), a need for surgical intervention, and the rate of poor clinical outcome were not significantly different between the two groups. Significant risk factors for a poor clinical outcome in all patients were an initial BCVA <0.1 (Z = 6.33, two-proportion Z-test), an epithelial defect size ≥5 mm2 (Z = 4.56), and previous ocular surface disease (Z = 4.36).Conclusions: Polymicrobial bacterial keratitis, compared to monomicrobial bacterial keratitis, was more significantly associated with younger age, contact lens use, and shorter symptom duration.

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 Management of Post-LASiK Keratoectasia with a Piggyback Contact Lens System

2015 ◽  
Vol 77 (1) ◽  
pp. 7
Author(s):  
Lacey Haines ◽  
Luigina Sorbara
Keyword(s):  
Contact Lens ◽  
Ocular Surface ◽  
Contact Lenses ◽  
Single Case ◽  
Treatment Options ◽  
Ocular Surface Disease ◽  
Screening Methods ◽  
Lens System ◽  
Intrastromal Corneal Ring ◽  
Current Screening

This case report highlights the clinical challenges involved in managing a patient with post-LASiK keratoectasia. A single case is presented with a focus on contact lens fitting and concurrent ocular surface disease. A review of the literature indicates that current screening methods prior to refractive surgery have made improvements for detecting patients at higher risk of serious complications. Possible treatment options for iatrogenic keratoconus include contact lenses, intrastromal corneal ring segments, corneal cross linking, and keratoplasty. This report demonstrates that post-LASiK keratoectasia with concurrent ocular surface disease can be successfully managed with a piggyback contact lens system.

Gas-permeable scleral contact lens therapy in ocular surface disease

2000 ◽  
Vol 130 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Tatiana Romero-Rangel ◽  
Panagiota Stavrou ◽  
Janis Cotter ◽  
Perry Rosenthal ◽  
Stefanos Baltatzis ◽  
...  
Keyword(s):  
Contact Lens ◽  
Ocular Surface ◽  
Ocular Surface Disease

scholarly journals Clinical analysis of microbiologically proven fungal keratitis according to prior topical steroid use: A retrospective study in South Korea

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 ◽  
Steroid Use ◽  
Deep Infiltration

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, clinical characteristics, microbiological profiles, and treatment outcomes were evaluated and 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. In those, sixteen fungal isolates were identified in the PS group and 14 isolates in the NPS group. 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=0.103). No significant differences were observed in mean age, sex, occupational distribution, epithelial defect size, hypopyon, and presenting BCVA 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) and deep infiltration (53.3% vs. 32.1%, p=0.057). Regarding treatment outcomes, final BCVA <0.1 (60% vs. 44.2%, p=0.133), 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 6.01, p=0.005), deep infiltration (odds 4.38, p=0.013), prior topical steroid use (odds 2.79, p=0.091), and previous ocular surface disease (odds 2.82, p=0.093). Conclusions: The PS group was more associated with previous ocular surface disease and deep infiltration when compared with the NPS group. Treatment progresses and treatment results were worse in the PS group. Careful attention should be paid to the use of steroids in clinical practice.

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