scholarly journals Fortified Fluconazole Eyedrops for Treatment of Culvularia Corneal Ulcer

2020 ◽  
Vol 3 (2) ◽  
pp. 58-65
Author(s):  
Muhammad Reza Arlas ◽  
Petty Purwanita
Keyword(s):  
Visual Acuity ◽  
Clinical Manifestations ◽  
The United States ◽  
Fungal Keratitis ◽  
Ergosterol Biosynthesis ◽  
Eye Drops ◽  
Dematiaceous Fungi ◽  
Blurred Vision ◽  
Fungal Cell ◽  
Clinical Series

Abstract Introduction. Fungal keratitis is less common than bacterial keratitis, generally representing less than 5%–10% of corneal infections in reported clinical series in the United States. But in developing countries (Ghana, India, China) it accounts for more than 90% of the cases. Corneal trauma by plant or vegetative material is the leading risk factor for fungal keratitis. One or more topical antifungals are usually administered with systemic support of oral antifungals. The most common classes of antifungal used for medical therapy include the polyenes, azoles, and the echinocandins. Case Illustration. A 47-year-old male presented with a widening white patch on his left eye since 4 days before coming to our hospital. The left eye was injured by wood flakes 3 weeks ago. He felt a sore, red, watery left eye and blurred vision. He washed his eyes with betel leaf water. His left eye visual acuity was 1/60 and not improved with pinhole. There were blepharospasm, ciliary and conjunctival injection. Corneal examination showed a cloudy cornea, a central corneal defect sized 8x6 mm with an irregular margin, 2/3 to stromal depth, infiltrate, satellite lesion, and positive fluorescein staining at the defect margin. KOH examination demonstrated hyphae. The culture test of left corneal discharge identified a fungi species (Curvularia sp). We prescribed fortified fluconazole eye drops in combination with supportive therapy for 2.5 months. This regimen showed a significant increase in visual acuity to 6/30 with pinhole improvement of 6/21 in the left eye. Discussion. Imidazole acts by inhibiting ergosterol biosynthesis of the fungal cell wall, through action on the cytochrome P450-dependent enzyme. This leads to cell membrane destabilization and leakage. Curvularia sp belongs to the family of dematiaceous fungi. Its clinical manifestations include raised lesions and feathery edges; hypopyon rarely occurs, and the prognosis is quite good. Fluconazole (2 mg/ml) is available for injection and is a well-tolerated eye drop. The intravenous injection can be used as a topical treatment and can be given subconjunctivally at the same concentration. Conclusions. Fortified fluconazole eyedrops (2 mg/ml) can become an alternative and additional therapy for deep fungal keratitis, especially for Curvularia sp.

scholarly journals Sweet disaster: use of honey-based eye drops as an alternative treatment for vernal keratoconjunctivitis

2019 ◽  
Vol 1 (2) ◽  
pp. 133-138
Author(s):  
Kenneth Teow Kheng Leong ◽  
Rebecca Jennifer Mary Louis ◽  
Lai Yin Peng ◽  
Rohanah Alias ◽  
Safinaz Mohd Khialdin
Keyword(s):  
Visual Acuity ◽  
Anterior Chamber ◽  
Alternative Treatment ◽  
Marked Improvement ◽  
Traditional Healer ◽  
Fungal Keratitis ◽  
Vernal Keratoconjunctivitis ◽  
Eye Drops ◽  
The Past

A 16-year-old boy with underlying bronchial asthma, vernal keratoconjunctivitis, and bilateral eye steroid-induced glaucoma presented with right eye itchiness, redness, and progressive painful blurring of vision for the past 3 weeks. His mother had been treating him with honey-based eye drops purchased from an unregistered source/traditional healer. On presentation his right visual acuity was counting fingers, the cornea was hazy, and a small central stromal abscess with a large endothelial plaque was seen in the anterior chamber. He was treated for right eye fungal keratitis and subsequently admitted for intensive treatment. He showed marked improvement and was discharged. His final vision on follow-up was 6/15.

scholarly journals FUNGAL KERATITIS WITH CORNEAL ULCER IN FARMER

2020 ◽  
Vol 3 (1) ◽  
pp. 58
Author(s):  
Nugraha Wahyu Cahyana
Keyword(s):  
Visual Acuity ◽  
Corneal Ulcer ◽  
Fungal Keratitis ◽  
Eye Drops ◽  
Slit Lamp ◽  
Good Clinical Response ◽  
Specific Diagnosis ◽  
The World ◽  
Corneal Blindness ◽  
Test Result

Fungal keratitis is an important cause of corneal blindness all over the world, especially in developing countries. Fungal Keratitis can diagnosis by slit-lamp biomicroscopic examination and culture is essential for early specific diagnosis and must be taken into consideration to establish the most effective treatment and avoid severe complications. The study was present a case of Fungal Keratitis in Farmer with a corneal ulcer caused by rice seeds corneal corpus allienum. A corneal ulcer is a complication was caused by ineffective therapy especially Steroid topical that should be avoided. The culture test result was C. Albicans and was treated with natamycin 5% Eye drops. Finally, patients have a good clinical response, however with the sequel of decreased visual acuity.  

scholarly journals Neuroretinitis Syphilis in Human Immunodeficiency Virus-Infected Patient

2019 ◽  
Vol 7 (12) ◽  
pp. 1987-1990
Author(s):  
AA Mas Putrawati Triningrat ◽  
Ni Made Wasiastiti Budi ◽  
IGAM Juliari ◽  
Ni Made Ayu Surasmiati ◽  
IGA Ratna Suryaningrum ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Infected Patient ◽  
Hand Movement ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Penicillin G ◽  
Eye Drops ◽  
Syphilis Infection ◽  
Standard Regimen ◽  
History Of

BACKGROUND: In HIV-infected patient who accompanied by syphilis often difficult to diagnose and difficult to treat. The aim is to diagnostics understanding and to optimise the management and response therapy in patients with neuroretinitis syphilis in HIV-infected patients. CASE PRESENTATION: A 53-years old, bisexual, male patient whose initial presentation was a blurry vision on the left eye. History of a painless genital lesion, HIV infection (+) on ARV therapy. The visual acuity of hand movement (HM), RAPD (+), with vitreous opacities and optic disc swelling. The OCT RNFL showed neural layer thickening in all areas. VEP showed increased P100 latency, normal head and orbital CT scan. High VDRL and TPHA titer. Lumbar puncture examination showed non-reactive VDRL. Treated with topical prednisolone eye drops, oral neurotropic vitamin, and intramuscular injection of Benzathine Penicillin G. Diagnosed with OS neuroretinitis et causa syphilis infection, HIV stage II on HAART. Follow up in 2 months, the visual acuity improved, and serology post-therapy VDRL was decreased. CONCLUSION: High accuracy is needed for screening signs and symptoms in syphilis patients because of the varied clinical manifestations. Ocular syphilis manifestation in HIV has a higher risk for neurologic complications and the risk of failing treatment with the standard regimen.

Recent Status and Advancements in the Development of Antifungal Agents: Highlights on Plant and Marine Based Antifungals

2019 ◽  
Vol 19 (10) ◽  
pp. 812-830 ◽  
Author(s):  
P. Marie Arockianathan ◽  
Monika Mishra ◽  
Rituraj Niranjan
Keyword(s):  
Cell Wall ◽  
Antifungal Agents ◽  
Fungal Diseases ◽  
Fungal Cell Wall ◽  
Fungal Resistance ◽  
Ergosterol Biosynthesis ◽  
Fungal Cell ◽  
Ergosterol Synthesis ◽  
Glucan Synthesis ◽  
Anti Fungal

The developing resistance in fungi has become a key challenge, which is being faced nowadays with the available antifungal agents in the market. Further search for novel compounds from different sources has been explored to meet this problem. The current review describes and highlights recent advancement in the antifungal drug aspects from plant and marine based sources. The current available antifungal agents act on specific targets on the fungal cell wall, like ergosterol synthesis, chitin biosynthesis, sphingolipid synthesis, glucan synthesis etc. We discuss some of the important anti-fungal agents like azole, polyene and allylamine classes that inhibit the ergosterol biosynthesis. Echinocandins inhibit β-1, 3 glucan synthesis in the fungal cell wall. The antifungals poloxins and nikkomycins inhibit fungal cell wall component chitin. Apart from these classes of drugs, several combinatorial therapies have been carried out to treat diseases due to fungal resistance. Recently, many antifungal agents derived from plant and marine sources showed potent activity. The renewed interest in plant and marine derived compounds for the fungal diseases created a new way to treat these resistant strains which are evident from the numerous literature publications in the recent years. Moreover, the compounds derived from both plant and marine sources showed promising results against fungal diseases. Altogether, this review article discusses the current antifungal agents and highlights the plant and marine based compounds as a potential promising antifungal agents.

scholarly journals Upbeat vertical nystagmus after brain stem cavernoma resection: a rare case of nucleus intercalatus/nucleus of roller injury

2020 ◽  
Vol 267 (10) ◽  
pp. 2865-2870
Author(s):  
Torstein R. Meling ◽  
Aria Nouri ◽  
Adrien May ◽  
Nils Guinand ◽  
Maria Isabel Vargas ◽  
...  
Keyword(s):  
Rare Case ◽  
Vascular Malformations ◽  
Clinical Manifestations ◽  
Neurological Injury ◽  
Medial Longitudinal Fasciculus ◽  
Blurred Vision ◽  
Complete Excision ◽  
First Case ◽  
Vertical Nystagmus ◽  
Upbeat Nystagmus

Abstract Introduction CNS cavernomas are a type of raspberry-shaped vascular malformations that are typically asymptomatic, but can result in haemorrhage, neurological injury, and seizures. Here, we present a rare case of a brainstem cavernoma that was surgically resected whereafter an upbeat nystagmus presented postoperatively. Case report A 42-year old man presented with sudden-onset nausea, vomiting, vertigo, blurred vision, marked imbalance and difficulty swallowing. Neurological evaluation showed bilateral ataxia, generalized hyperreflexia with left-sided predominance, predominantly horizontal gaze evoked nystagmus on right and left gaze, slight left labial asymmetry, uvula deviation to the right, and tongue deviation to the left. MRI demonstrated a 13-mm cavernoma with haemorrhage and oedema in the medulla oblongata. Surgery was performed via a minimal-invasive, midline approach. Complete excision was confirmed on postoperative MRI. The patient recovered well and became almost neurologically intact. However, he complained of mainly vertical oscillopsia. The videonystagmography revealed a new-onset spontaneous upbeat nystagmus in all gaze directions, not suppressed by fixation. An injury of the rarely described intercalatus nucleus/nucleus of Roller is thought to be the cause. Conclusion Upbeat nystagmus can be related to several lesions of the brainstem, including the medial longitudinal fasciculus, the pons, and the dorsal medulla. To our knowledge, this is the first case of an iatrogenic lesion of the nucleus intercalatus/nucleus of Roller resulting in an upbeat vertical nystagmus. For neurologists, it is important to be aware of the function of this nucleus for assessment of clinical manifestations due to lesions within this region.

scholarly journals Novel technique of explantation of rigid phakic iris-claw lens and cataract extraction by sutureless manual small-incision surgery

2019 ◽  
Vol 12 (12) ◽  
pp. e233128
Author(s):  
Prateek Agarwal ◽  
Samuel Edward Navon ◽  
Neha Mithal
Keyword(s):  
Visual Acuity ◽  
Cataract Extraction ◽  
Blurred Vision ◽  
Novel Technique ◽  
Small Incision ◽  
Complicated Cataract ◽  
Uncorrected Visual Acuity ◽  
Lens Surgery ◽  
Iris Claw Lens ◽  
Iris Claw

A 38-year-old patient presented to us with complaints of blurred vision and photophobia in the left eye with an uncorrected visual acuity of 20/400, improving to 20/60 with pinhole. The patient underwent phakic iris-claw lens surgery 15 years ago for high myopia. On examination, there was anterior chamber rigid phakic iris-claw lens along with complicated cataract. We planned for sutureless self-sealing 6.5 mm sclerocorneal tunnel for explantation of rigid phakic iris-claw lens along with cataract extraction with irrigating vectis. There was postoperative reduction in astigmatism due to incision planned on steep axis, and visual acuity improved to 20/30 uncorrected. This technique provides significant advantages from the previously described techniques in terms of decreased postop astigmatism, no need for sutures, no issues of chamber instability and iris trauma and without the need for phacoemulsification.

Postherpetic Neuralgia: A Patient’s and a Physician’s Perspective

2016 ◽  
Author(s):  
James H. Diaz
Keyword(s):  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Clinical Manifestations ◽  
The United States ◽  
Evidence Based ◽  
Pain Medicine ◽  
High Prevalence ◽  
Antiviral Medications ◽  
Physician’S Perspective

Herpes zoster can plague anyone who has had varicella or has received the varicella or chickenpox vaccine. The incidence of herpes zoster increases with age and rises exponentially after 60 years of age. Postherpetic neuralgia (PHN) may occur after herpes zoster at any age but typically occurs after 50 years of age, with over 40% of persons over 60 years of age suffering from PHN after a shingles attack. Up to 1 million new cases of herpes zoster and 200,000 new cases of PHN may now be anticipated in the United States every year, with the incidence rate increasing as the population grows and ages with prolonged life expectancies. Although new antiviral medications will improve and shorten the course of herpes zoster, they do not guarantee the prevention of PHN. Given the high prevalence of PHN in an aging population and the availability of primary prevention by vaccination, the objectives of this review are to describe the epidemiology, pathophysiology, and clinical manifestations of zoster and PHN and to recommend a combination of strategies for the clinical management and prevention of PHN. This review contains 6 figures, 4 tables and 13 references Key words: evidence-based pain medicine, herpes zoster, neuropathic pain, postherpetic neuralgia

scholarly journals Choroidal Neovascularization Associated with Punctate Inner Choroidopathy: Combination of Intravitreal Anti-VEGF and Systemic Immunosuppressive Therapy

2015 ◽  
Vol 6 (3) ◽  
pp. 385-389 ◽  
Author(s):  
Bettina Hohberger ◽  
Michael Rudolph ◽  
Antonio Bergua
Keyword(s):  
Visual Acuity ◽  
Choroidal Neovascularization ◽  
Combined Therapy ◽  
Retinal Pigment ◽  
Posterior Pole ◽  
Prednisolone Acetate ◽  
Eye Drops ◽  
Punctate Inner Choroidopathy ◽  
Anti Vegf ◽  
Systemic Medication

Purpose: Choroidal neovascularization (CNV) associated with punctate inner choroidopathy (PIC) is a rare clinical entity, yet still a challenge for medical treatment. A case of a young myopic woman developing CNV secondary to unilateral PIC is presented. Clinical morphology, diagnostic procedure and follow-up are reported. Case Report: A 29-year-old woman presented with multiple yellowish dots at the posterior pole. No other signs of inflammation could be seen. Angiography with fluorescein yielded hyperfluorescent signals in the affected areas with a diffuse leak, and SD-OCT showed a slightly elevated retinal pigment epithelial layer, consistent with the diagnosis of PIC. Additionally a classic CNV was observed. Results: Anti-inflammatory therapy with local prednisolone acetate eye drops in combination with intravitreal injection of anti-vascular endothelial growth factor (VEGF, bevacizumab) yielded an increased best-corrected visual acuity. As CNV reappeared, systemic medication with prednisone and azathioprine in combination with two further intravitreal injections of anti-VEGF stabilized CNV and increased visual acuity again. Conclusion: Combined therapy of immunosuppression with intravitreal anti-VEGF injections can be considered as therapeutic strategy in the management of recurrent CNV associated with PIC.

scholarly journals Amnwiotic Membrane Transplantation as a Treatment for Sterile Infiltration and Corneal Melting after Corneal Crosslinking for Keratoconus

2018 ◽  
Vol 9 (1) ◽  
pp. 185-189 ◽  
Author(s):  
Takanori Sasaki ◽  
Takeshi Ide ◽  
Ikuko Toda ◽  
Naoko Kato
Keyword(s):  
Visual Acuity ◽  
Diclofenac Sodium ◽  
Corneal Stroma ◽  
Amniotic Membrane Transplantation ◽  
Eye Drops ◽  
Epithelial Defect ◽  
Persistent Epithelial Defect ◽  
Corneal Crosslinking ◽  
Corneal Epithelial Defect ◽  
Corneal Melting

We report a case of corneal melting through sterile infiltration presumably due to excessive use of nonsteroidal anti-inflammatory eye drops after corneal crosslinking (CXL). It was treated using steroids combined with amniotic membrane transplantation (AMT). A 33-year-old man with progressing keratoconus underwent left eye CXL. We prescribed betamethasone and levofloxacin eye drops 5 times daily and diclofenac sodium eye drops 3 times daily for 3 days. Three days after CXL, there was a persistent epithelial defect and the left corneal stroma was clouded. His visual acuity remained unchanged. We prescribed betamethasone hourly and 20 mg prednisolone daily. At 1 week after CXL, the corneal epithelial defect and infiltration were unchanged. He had not stopped using diclofenac at the prescribed time. On day 17, we performed AMT and his cornea and visual acuity improved. AMT may be effective against persistent epithelial defects and corneal melting after CXL.

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