Therapeutic Penetrating Keratoplasty in Nonhealing Corneal Ulcer

BACKGROUND Corneal blindness has been a significant visual disability in developing countries like India. Corneal ulcer contributes mainly as the leading cause for monocular blindness. Considering the common condition, the studies and literature have been surprisingly less when it comes to corneal ulcer and their management. But with the advent of therapeutic penetrating keratoplasty (TPK), the scenario and prevalence of corneal blindness can be reduced. Hence this study was done to know the importance of therapeutic penetrating keratoplasty in case of non-healing infective and perforated corneal ulcers. The objectives were to assess the clinical outcome in a non-healing and perforated corneal ulcer, reduction in symptoms and signs of infection, anatomical or structural integrity of the globe and also evaluate the visual outcome following therapeutic penetrating keratoplasty. METHODS Data were obtained from 30 patients operated at our institute for therapeutic penetrating keratoplasty. Patients with less than one year of follow up, paediatric cases, PL negative cases were excluded. The outcome was assessed based on maintenance of structural integrity, reduction in infective load, improvement in visual acuity and graft survival and its correlation with corneal vascularisation, previously failed grafts, donor tissue quality, graft size and type of surgery. RESULTS Structural integrity was maintained in 93.3 % of the cases, reduction of infective load in 90 % of cases and optically clear grafts in 46.7 % of cases and vision was better than 6/60 in 30 % of cases. CONCLUSIONS The study proved that in the case of non-healing and perforated corneal ulcers, therapeutic penetrating keratoplasty had a good prognosis in reducing infective load, maintaining structural integrity without which eye could have been lost. KEYWORDS Therapeutic Penetrating keratoplasty, Perforated corneal ulcer, non-healing corneal ulcer, corneal blindness, TPK

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Pythium keratitis: clinical course of an emerging scourge

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v17i3.753 ◽

2020 ◽

Vol 17 (3) ◽

pp. 318-323

Author(s):

Radhika Natarajan ◽

Ankit Anil Harwani ◽

Ramya Ravindran

Keyword(s):

Polymerase Chain Reaction ◽

Confocal Microscopy ◽

Penetrating Keratoplasty ◽

Clinical Presentation ◽

Corneal Ulcer ◽

Clinical Course ◽

Chain Reaction ◽

Polymerase Chain ◽

Therapeutic Penetrating Keratoplasty

We hereby report two cases of the emerging and devastating Pythium keratitis for their different presentations, prolonged clinical course, and suspicion of recurrence after therapeutic penetrating keratoplasty (TPK). The history, clinical presentation, investigations including smears, cultures, polymerase chain reaction (PCR) and confocal microscopy, the tumultuous course of the infection, and outcome of TPK have been discussed for two cases having this unusual and severe emerging infection. These two cases demonstrate that Pythium keratitis can present as a central reticular or peripheral guttering corneal ulcer with dense infiltration. PCR is a valuable tool for diagnosis. Pythium keratitis has a severe and prolonged clinical course. Response to antibiotics is modest and needs to be closely monitored. It can present with inflammation after TPK that mimics the dreaded recurrence of the infection. Pythium keratitis presents variably and can be suspected from typical clinical and microbiological findings. It needs protracted treatment with close follow-up. Although the infection is known torecur in the therapeutic graft, not all recurrences are what they seem.

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Corneal Phaeohyphomycosis Caused by Bipolaris hawaiiensis

Case Reports in Ophthalmology ◽

10.1159/000447737 ◽

2016 ◽

Vol 7 (2) ◽

pp. 364-371 ◽

Cited By ~ 1

Author(s):

Winai Chaidaroon ◽

Sumet Supalaset ◽

Napaporn Tananuvat ◽

Nongnuch Vanittanakom

Keyword(s):

Fungal Infection ◽

Penetrating Keratoplasty ◽

Corneal Ulcer ◽

Nucleotide Sequence Analysis ◽

Laboratory Findings ◽

History Of ◽

Oral Itraconazole ◽

Eye Examination ◽

Diagnostic Clue ◽

Therapeutic Penetrating Keratoplasty

Purpose: To report a rare case of keratitis infected by Bipolaris hawaiiensis. Methods: A patient who was diagnosed as fungal keratitis caused by B. hawaiiensis was retrospectively reviewed for history, clinical characteristics, risk factors, laboratory findings, treatments, and outcomes. Results: A 63-year-old man with a history of trauma and saw dust in the left eye presented with a corneal ulcer. Eye examination revealed whitish infiltration with a feathery edge and small brownish deposits in the anterior stroma of the left cornea. Numerous septate hyphal fragments were detected in a corneal specimen, and nucleotide sequence analysis identified B. hawaiiensis. Treatment was started with 5% natamycin eyedrops and oral itraconazole. Subsequently, a corneal plaque developed which did not respond to medication and debridement. The patient underwent therapeutic penetrating keratoplasty. Conclusions: B. hawaiiensis is a rare cause of corneal phaeohyphomycosis. A brownish pigmented infiltration is an important diagnostic clue, however microbiologic studies are required to obtain a definite diagnosis. Although antifungal medication and debridement are the mainstay of most corneal fungal infection, therapeutic penetrating keratoplasty can prevent morbidity related to this fungal infection.

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