An Evaluation of a Simplified Impression Membrane Sampling Method for the Diagnosis of Microbial Keratitis

The purpose of this study was to compare bacterial isolation rate using a corneal impression membrane (CIM) and a sharp instrument for obtaining corneal samples from patients with suspected microbial keratitis (MK). Data was retrospectively collected for all patients that had corneal samples taken for presumed MK between May 2014 and May 2020. Prior to May 2017 samples were collected by scraping the edges of the ulcer with a blade. From May 2017, samples were collected by placing a CIM (Millicell cell culture insert) against the ulcer. All corneal samples were processed using the same conventional diagnostic culture method. A total of 3099 corneal samples were included, of which 1214 (39.2%) were corneal scrapes and 1885 (60.9%) CIMs. Microorganisms were isolated from 235 (19.4%) and 1229 (65.2%) cases using a corneal scrape and CIM, respectively (p < 0.001). Of routinely described pathogenic microorganisms, there were significant increases in the isolations of S. aureus (2.4% to 11.3%) and Serratia (0.5% to 1.7%) using the CIM and no significant changes in the isolations of S. pneumoniae and P. aeruginosa. No significant differences were seen between the isolation rates of fungi or Acanthamoeba species. There was a significant increase in the isolation rates of other Streptococcal species (0.7% to 6.9%) and CNS species, specifically, S. epidermidis (2.1% to 26.2%), S. capitis (0.4% to 2.6%) and S. warneri (0.3% to 1.6%) using the CIM. The simplified CIM sampling method is an effective method for collecting corneal samples from patients with presumed MK in clinical practice.

Unusual finding of two filamentous fungi in a contact lens-related keratitis

This is a rare case report of two filamentous fungi in a patient with contact lens related keratitis. An early corneal scrape may be useful in detecting multiple causative pathogens and aiding management. The main learning point is to consider fungal infections in patients with atypical ulcer appearances, as prompt diagnosis may reduce the morbidity burden.

A case report of pregnant female with right eye acremonium keratitis

Study report a case of a 22-years-old female with history of vegetative trauma in right eye with 7th running months of amenorrhoea (RMOA). She came after 10 days of trauma, with chief complaint of pain, watering and diminution of vision in right eye. Her visual acuity was PLPR4 in affected eye and 6/9 in other. Central corneal ulcer with abscess and hypopyon was noted with inability to see fundal glow. To study response of fungal keratitis to voriconazole and natamycin eye drop. Corneal tissue obtained by a corneal scrape was plated on Sabouraud’s agar, KOH mount, gram and giemsa staining was performed. SDA shows a filamentous colony of fungus is grown upon aerobic incubation at 37◦C for 5-7 days. Patient was treated with combination therapy of voriconazole and natamycin eye drop. Patient responded well to combination therapy of voriconazole and natamycin eye drop. Patient developed corneal healing with little amount of fibrosis. We lost patient on follow up after that. Patient responded well to combination therapy of voriconazole and natamycin eye drop. The most common risk factors for acremonium fungal keratitis is ocular trauma, and acremonium fungal keratitis might be treated better with natamycin and voriconazole than other alternatives. our results are clinically significant and may provide some useful information on the diagnosis and management of acremonium fungal keratitis.