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Liu J, Guo X, Wei Z, Zhang Y, Zhang Z, Xu X, Liang Q. Infectious Keratitis After Keratorefractive Surgery: Update and Review of the Literature. Eye Contact Lens 2023; 49:275-282. [PMID: 37166228 PMCID: PMC10281179 DOI: 10.1097/icl.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To summarize the clinical manifestations, microbiological profile, treatment, and prognosis of corneal infections after different keratorefractive surgery. METHODS To obtain relevant studies, English-language databases, including PubMed, Ovid Embase, Web of Science, and CLNAHL, were searched from January 1979 to March 2022. The fundamentals of the literature, clinical characteristics, pathogens, and treatments were retrieved for each included article. RESULTS Eighty-four studies involving 306 infectious eyes were included in this review. Risk factors of potential infection included a history of blepharitis, contact lens usage, and contaminated surgical instruments. The mean onset time was 22.9±38.7 days (range: 1 day to 3 years). The most common organism isolated from infectious keratitis after keratorefractive surgery were Staphylococcus aureus , followed by Mycobacterium and coagulase-negative Staphylococcus . Most of the infections after refractive procedures were sensitive to medical treatment alone, and the ultimate best-corrected visual acuity after medical treatment was as follows: 20/20 or better in 82 cases (37.0%), 20/40 or better in 170 cases (76.5%), and worse than 20/40 in 52 cases (23.5%). Surgical interventions including flap lift, flap amputation, ring removal, and keratoplasty were performed in 120 eyes (44.5%). CONCLUSIONS Most infections after keratorefractive surgery occur within a week, whereas more than half of the cases after laser-assisted in situ keratomileusis happen after about a month. Gram-positive cocci and mycobacterium are the most common isolates. Infections after LASIK, intracorneal ring (ICR) implantation, and small incision lenticule extraction, which primarily occur between the cornea layers, require irrigation of the tunnels or pocket with antibiotics.
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Affiliation(s)
- Jiamin Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xiaoyan Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Yuheng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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Said DG, Rallis KI, Al-Aqaba MA, Ting DSJ, Dua HS. Surgical management of infectious keratitis. Ocul Surf 2023; 28:401-412. [PMID: 34592475 DOI: 10.1016/j.jtos.2021.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/18/2021] [Indexed: 12/27/2022]
Abstract
The successful management of infectious keratitis is usually achieved with a combination of tools for accurate diagnosis and targeted timely antimicrobial therapy. An armamentarium of surgical interventions is available in the acute stage which can be resorted to in a step wise manner or in combination guided by the response to treatment. Simple surgical modalities can facilitate accurate diagnosis e.g. corneal biopsy and alcohol delamination. Surgery to promote epithelial healing can vary from tarsorrhaphy, amniotic membrane transplantation or conjunctival flaps depending on the extent of infection, visual prognosis, availability of tissue and surgeon's experience. Collagen crosslinking has been increasingly utilized with successful results to strengthen the cornea and reduce the infective load consequently the need for further elaborate surgical interventions. It has shown encouraging results specially in superficial bacterial and fungal keratitis but for deeper infections, viral and acanthamoeba keratitis, its use remains questionable. When globe integrity is compromised, corneal gluing is the most commonly used procedure to seal small perforations. In larger perforations/fulminant infections a tectonic/therapeutic graft is advisable. Partial thickness grafts are increasingly popular to treat superficial infection or internally tamponade perforations. Peripheral therapeutic grafts face challenges with potential requirement for a manually fashioned graft, and increased risk of rejection due to proximity to the limbal vessels. Late stage visual rehabilitation is likely to require further surgical interventions after complete resolution of infection and inflammation. A preliminary assessment of corneal sensation and integrity of the ocular surface are key for any successful surgical intervention to restore vision.
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Affiliation(s)
- Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK; Research Institute of Ophthalmology, Cairo, Egypt.
| | | | | | - Darren S J Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
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Dallal MMS, Nikkhahi F, Imeni SM, Molaei S, Hosseini SK, Kalafi Z, Yazdi SS, Mirzaei HMA. Amniotic Membrane Transplantation for Persistent Epithelial Defects and Ulceration due to Pseudomonas Keratitis in a Rabbit Model. J Ophthalmic Vis Res 2021; 16:552-557. [PMID: 34840677 PMCID: PMC8593546 DOI: 10.18502/jovr.v16i4.9744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/21/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose The use of amniotic membrane has been suggested in the treatment of infectious keratitis for its intrinsic anti-infective properties probably mediated by its anti-inflammatory effects. The aim of this study was to investigate the effect of amniotic membrane transplantation (AMT) along with ciprofloxacin to cure the primary stages of Pseudomonas keratitis. Methods In total, 28 rabbits were selected and divided in four groups as follows: group 1 as control, group 2 with amniotic membrane, group 3 with ciprofloxacin, and group 4 with amniotic membrane combined with ciprofloxacin. About 0.05 cc suspension of Pseudomonasaeruginosa, 27853 ATCC was injected into corneal stroma. Results The results showed groups of AMT, AMT + ciprofloxacin, and ciprofloxacin had 0% perforation while the control group had 85.6%. Average infiltration of 5.5 mm was observed in ciprofloxacin group, 5 mm in AMT + ciprofloxacin group, 24 mm in AMT group, and finally 23.75 mm for control. Amniotic membrane showed to be effective in prevention of cornea perforation as well as remission of Pseudomonas keratitis. There was no significant difference between ciprofloxacin groups in comparison with ciprofloxacin + AMT group. However, regarding the anti-inflammatory effect, the process of improvement of inflammation in ciprofloxacin + AMT group was faster. Conclusion Transplantation of amniotic membrane in the primary stages of Pseudomonas keratitis treatment remarkably prevents the disease and it can be used to control its process.
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Affiliation(s)
- Mohammad Mehdi Soltan Dallal
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Nikkhahi
- Medical Microbiology Research Center, Qazvin University of Medical Science, Qazvin, Iran
| | - Seyed Mostafa Imeni
- Biodiversitat, Ecología, Technologia Ambiental i Alimentaria )BETA Tech Center(, (TECNIO Network), U Science Tech, University of Vic-Central University of Catalonia, Carrer de la Laura 13, 08500 Vic, Spain
| | - Saber Molaei
- AJA University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Hosseini
- Quality Control Manager of Iranian Tissue Bank Research & Preparation Center, Director of Stem Cells Preparation Unit, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Kalafi
- Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Sharifi Yazdi
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Case Series of Perforated Keratomycosis after Laser-Assisted In Situ Keratomileusis. Case Rep Ophthalmol Med 2020; 2020:7237903. [PMID: 33014490 PMCID: PMC7512097 DOI: 10.1155/2020/7237903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 01/18/2023] Open
Abstract
Background Fungal keratitis is an extremely rare complication of laser vision correction resulting in poor visual outcomes. Amniotic membrane transplantation should be kept in mind in eyes with corneal perforation prior to penetrating keratoplasty. Aim To assess the outcomes of multilayered fresh amniotic membrane transplantation (MLF-AMT) in patients with severe keratomycosis after laser-assisted in situ keratomileusis (LASIK). Study design. Hospital-based prospective interventional case series. Methods Five eyes of 5 patients were included in the study. All cases underwent microbiological scrapings from residual bed and intrastromal injections of amphotericin (50 mcg/mL), with flap amputation if needed, followed by topical 5% natamycin and 0.15% amphotericin. MLF-AMT was performed after corneal perforation. Later, penetrating keratoplasty (PK) was performed when corneal opacity compromised visual acuity. The outcome measures were complete resolution of infection, corneal graft survival, and best-corrected visual acuity (BCVA). Results The mean age of patients was 22 ± 1.2 years with 4/5 (80%) were females. The mean interval between LASIK and symptom onset was 8.8 ± 1 day, and the mean interval between symptom onset and referral was 14 ± 1.4 days. Potassium hydroxide (KOH) smears showed filamentous fungi, and Sabouraud's medium grew Aspergillus in all cases. Melted flaps were amputated in 4 (80%) cases. MLF-AMT was performed in all cases due to corneal perforation after a mean time of 12.4 ± 1.2 days of antifungals. In all cases, complete resolution of infection was seen 26 ± 1.8 days after MLF-AMT, and optical PK was done at a mean of 2.4 months later. No postoperative complications after MLF-AMT or PK were observed, with a 0% incidence of corneal graft rejection, and a final BCVA ranged from 20/20 to 20/80 after a mean follow-up of 14 ± 1.1 months. Conclusion MLF-AMT is a safe and valid option to manage corneal perforation during keratmycosis treatment to avoid emergency therapeutic keratoplasty.
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Siu GDJY, Kam KW, Young AL. Amniotic Membrane Transplant for Bullous Keratopathy: Confocal Microscopy & Anterior Segment Optical Coherence Tomography. Semin Ophthalmol 2019; 34:163-167. [PMID: 31132290 DOI: 10.1080/08820538.2019.1620790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess amniotic membrane retention after amniotic membrane transplant in bullous keratopathy patients and whether there were any corneal structural changes that may hinder further penetrating keratoplasty Methods: A retrospective study including 22 patients who have undergone amniotic membrane transplant from 1 Jan 1998 till 30 Jun 2016. Confocal microscopy and anterior segment optical coherence tomography (ASOCT) were performed to assess the retention of amniotic membrane and to detect any corneal structural changes. The comparison was made with 5 controls who had bullous keratopathy awaiting endothelial keratoplasty. RESULTS Patients had a mean follow-up of 61 ± 33.7 months. Pain reduction was significant (p < .001) although it did not significantly correlate with the regularity of the superficial, intermediate or basal epithelial layers, nor with the retention of the amniotic membrane. No long-term structural changes that may hinder future penetrating keratoplasty were detected. CONCLUSION This procedure is a safe and effective long-term treatment for symptomatic bullous keratopathy patients.
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Affiliation(s)
- Gillian Denise Ji-Yee Siu
- a Department of Ophthalmology & Visual Sciences , The Chinese University of Hong Kong , Hong Kong.,b Department of Ophthalmology , Prince of Wales Hospital , Shatin , Hong Kong.,c Department of Ophthalmology , Alice Ho Miu Ling Hospital , Tai Po , Hong Kong SAR
| | - Ka Wai Kam
- a Department of Ophthalmology & Visual Sciences , The Chinese University of Hong Kong , Hong Kong.,b Department of Ophthalmology , Prince of Wales Hospital , Shatin , Hong Kong.,c Department of Ophthalmology , Alice Ho Miu Ling Hospital , Tai Po , Hong Kong SAR
| | - Alvin Lerrmann Young
- a Department of Ophthalmology & Visual Sciences , The Chinese University of Hong Kong , Hong Kong.,b Department of Ophthalmology , Prince of Wales Hospital , Shatin , Hong Kong.,c Department of Ophthalmology , Alice Ho Miu Ling Hospital , Tai Po , Hong Kong SAR
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Mohammadpour M, Sabet FA. Long-term Outcomes of Amniotic Membrane Transplantation in Contact Lens-Induced Pseudomonas Keratitis with Impending Corneal Perforation. J Ophthalmic Vis Res 2016; 11:37-41. [PMID: 27195083 PMCID: PMC4860985 DOI: 10.4103/2008-322x.180712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: To report the anatomical and visual outcomes of double layered amniotic membrane transplantation (AMT) in eyes with advanced Pseudomonas keratitis leading to Descemetocele formation. Methods: This prospective interventional case series included 6 eyes of 6 female patients with pseudomonas keratitis caused by contact lens-induced infection who underwent double layered AMT. Surgery was performed after the ulcers were found to be poorly responsive to antibiotics, and severe thinning or Descemetocele had developed. All patients underwent a complete examination pre- and postoperatively, as well as anterior segment optical coherence tomography (OCT) and pachymetry or Orbscan after the procedure. Results: Mean follow-up period was 24 months. There was neither frank corneal perforation nor a need for emergent corneal transplantation in any of the eyes. All patients had visual acuity of hand motions before the procedure which improved to 20/50 to 20/30 three months after surgery. No surgical or postoperative complication occurred in this series. Conclusion: Double layered AMT may result in acceptable anatomical outcomes in patients with advanced Pseudomonas keratitis with Descemetocele formation and can eliminate the need for emergent corneal transplantation.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Alsadat Sabet
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Proteomics in the Study of Bacterial Keratitis. Proteomes 2015; 3:496-511. [PMID: 28248282 PMCID: PMC5217394 DOI: 10.3390/proteomes3040496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/13/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022] Open
Abstract
Bacterial keratitis is a serious ocular infection that can cause severe visual loss if treatment is not initiated at an early stage. It is most commonly caused by Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, or Serratia species. Depending on the invading organism, bacterial keratitis can progress rapidly, leading to corneal destruction and potential blindness. Common risk factors for bacterial keratitis include contact lens wear, ocular trauma, ocular surface disease, ocular surgery, lid deformity, chronic use of topical steroids, contaminated ocular medications or solutions, and systemic immunosuppression. The pathogenesis of bacterial keratitis, which depends on the bacterium-host interaction and the virulence of the invading bacterium, is complicated and not completely understood. This review highlights some of the proteomic technologies that have been used to identify virulence factors and the host response to infections of bacterial keratitis in order to understand the disease process and develop improved methods of diagnosis and treatment. Although work in this field is not abundant, proteomic technologies have provided valuable information toward our current knowledge of bacterial keratitis. More studies using global proteomic approaches are warranted because it is an important tool to identify novel targets for intervention and prevention of corneal damage caused by these virulent microorganisms.
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Chen SC, Telinius N, Lin HT, Huang MC, Lin CC, Chou CH, Hjortdal J. Use of Fish Scale-Derived BioCornea to Seal Full-Thickness Corneal Perforations in Pig Models. PLoS One 2015; 10:e0143511. [PMID: 26599018 PMCID: PMC4657996 DOI: 10.1371/journal.pone.0143511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/05/2015] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to test the use of BioCornea, a fish scale-derived collagen matrix for sealing full-thickness corneal perforations in mini-pigs. Two series of experiments were carried out in 8 Lan-Yu and 3 Göttingen mini-pigs, respectively. A 2mm central full thickness corneal perforation was made with surgical scissors and 2mm trephines. The perforations were sealed immediately by suturing BioCornea to the wounded cornea. The conditions of each patched cornea were followed-up daily for 3 or 4 days. Status of operated eyes was assessed with slit lamp examination or optical coherence tomography (OCT). Animals were sacrificed after the study period and the corneas operated were fixated for histological examination. Both OCT imaging and handheld slit lamp observations indicated that a stable ocular integrity of the perforated corneas was maintained, showing no leakage of aqueous humor, normal depth of anterior chamber and only mild swelling of the wounded cornea. Hematoxylin and eosin staining of the patched cornea showed no epithelial ingrowths to the perforated wounds and no severe leucocyte infiltration of the stroma. The fish scale-derived BioCornea is capable to seal full-thickness corneal perforation and stabilize the integrity of ocular anterior chamber in pre-clinic mini-pig models. BioCornea seems to be a safe and effective alternative for emergency treatment of corneal perforations.
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Affiliation(s)
| | - Niklas Telinius
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
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Infectious keratitis: secreted bacterial proteins that mediate corneal damage. J Ophthalmol 2013; 2013:369094. [PMID: 23365719 PMCID: PMC3556867 DOI: 10.1155/2013/369094] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 12/12/2012] [Indexed: 12/17/2022] Open
Abstract
Ocular bacterial infections are universally treated with antibiotics, which can eliminate the organism but cannot reverse the damage caused by bacterial products already present. The three very common causes of bacterial keratitis—Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pneumoniae—all produce proteins that directly or indirectly cause damage to the cornea that can result in reduced vision despite antibiotic treatment. Most, but not all, of these proteins are secreted toxins and enzymes that mediate host cell death, degradation of stromal collagen, cleavage of host cell surface molecules, or induction of a damaging inflammatory response. Studies of these bacterial pathogens have determined the proteins of interest that could be targets for future therapeutic options for decreasing corneal damage.
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Grey F, Carley F, Biswas S, Tromans C. Scleral contact lens management of bilateral exposure and neurotrophic keratopathy. Cont Lens Anterior Eye 2012; 35:288-91. [DOI: 10.1016/j.clae.2012.07.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 11/17/2022]
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A controlled study of amniotic membrane transplantation for acute Pseudomonas keratitis. Can J Ophthalmol 2012; 47:305-11. [PMID: 22687313 DOI: 10.1016/j.jcjo.2012.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 11/29/2011] [Accepted: 12/16/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the efficacy of amniotic membrane transplantation (AMT) to improve the outcomes of acute Pseudomonas keratitis as compared with a control group. DESIGN Prospective interventional case series with retrospective controls. PARTICIPANTS We studied 14 eyes with Pseudomonas keratitis as the AMT group and 11 eyes with Pseudomonas keratitis as the control group. METHODS Eyes in the AMT group were treated with antibiotic therapy followed by single-layer AMT at 2 to 3 days. Eyes in the control group received only antibiotic therapy. Patients were followed for 11.1 ± 2.4 months. RESULTS In the AMT group, pain significantly decreased from a mean score of 2.4 ± 0.5 preoperatively to 1.1 ± 0.9 at day 2 postoperatively (p < 0.001). Corneal epithelial defects healed completely within 13.2 ± 2.6 days in the AMT group compared with 15.5 ± 3.4 days in the control group (p = 0.07). At final follow-up visits, the sizes of corneal opacity and deep neovascularization were not different between the 2 groups. However, the mean score for density of the corneal opacity was significantly less in the AMT group compared with the control group (2.1 ± 0.4 vs 2.5 ± 0.7, respectively, p = 0.04). Although the best corrected visual acuity using hard contact lenses was not different between the 2 groups, uncorrected visual acuity was better in the AMT group (0.45 ± 0.22 logMAR) than in the control group (0.71 ± 0.32 logMAR, p = 0.03). No patient in either group developed significant corneal thinning or perforation. CONCLUSIONS AMT in acute Pseudomonas keratitis was associated with immediate pain relief, less density of the final corneal opacity, and better uncorrected visual acuity at the final follow-up visit.
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Abstract
BACKGROUND Ocular surface disorders (OSD) are challenging to treat. They can introduce serious morbidity and might even lead to visual loss. In such situations, keratoplasty remains the last option. Amniotic membrane transplantation (AMT) has been shown to be effective in the management of ocular surface pathologies. The aim of the study was to assess the efficacy of AMT for various indications of OSD. MATERIALS AND METHODS Experience of AMT in 65 patients with different OSD was evaluated. The aim of AMT was to achieve symptomatic relief, reduced inflammation, recurrence, and corneal haze; improve epithelization, stromal healing and visual acuity; and delay keratoplasty. Fresh amniotic membrane was used in all cases by a single surgeon. Follow-up and observations were done to evaluate success of achieving the goal. RESULTS Indications for AMT included primary and recurrent pterygium, various types of corneal ulcers (non-healing ulcer, descemetocele, corneal thinning and perforation), spheroidal degenerations, chemical burn and bullous keratopathy. The aim of AMT was different in different etiological indications. Postoperative follow-up was between 6 and 18 months. Success and complication rate were observed. Symptomatic relief (reduced pain and redness) was seen in patients with various corneal ulcers, chemical burn and bullous keratopathy. Improved epithelialization and stromal healing was noted in corneal ulcer cases. In spheroidal degenerations, keratectomy with AMT improved vision. Recurrence of pterygium was low (4.61%); graft failure in the form of graft rejection was seen in only 3.07% cases of acute keratitis. Corneal vascularization (4.61%) was present but not severe enough to hamper vision. Success in gaining intended effect was the most significant result with AMT. CONCLUSION AMT in various ocular surface pathologies shows success in achieving the goal of symptomatic relief, improved epithelialization, stromal healing and vision. Reduction in inflammation, corneal haze and recurrence of original disease is achieved with minimum complications.
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Affiliation(s)
- Shreya Thatte
- Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences, Indore, India
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Sedghipour MR, Sorkhabi R, Shenasi A, Dehghan H. Outcome of penetrating keratoplasty in corneal ulcer: a single-center experience. Clin Ophthalmol 2011; 5:1265-8. [PMID: 21966198 PMCID: PMC3180495 DOI: 10.2147/opth.s22959] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Corneal ulcers often lead to scarring and astigmatism, and significant loss of vision is a common consequence. Objective To determine the rate of graft rejection, one of the most serious concerns with this procedure, and to evaluate the recovery of visual function in those patients for whom the operation was successful. Methods We describe a retrospective study of 33 corneal ulcer patients undergoing penetrating keratoplasty (PK) at the Tabriz Nikookari Eye Hospital. Results Mean age of the patients was 44 ± 14 years. Most common risk factors for active keratitis were trauma, dry eye, and malnutrition. Culture-positive results included bacterial keratitis (n = 15) and fungal keratitis (n = 5). Perforation was a significant risk factor for therapeutic failure (P < 0.05). Age or gender had no statistically significant effects on the PK outcome (P > 0.05). Postoperative visual acuity had a significant association with preoperative visual acuity (P < 0.01). Graft rejection rate (27.2%) was similar to that reported in the literature. Conclusion Although lamellar keratoplasty has recently been established, there are practical reasons for continuing the use of PK in centers such as ours, with due attention to the requirement for topical immunosuppression to diminish the rate of graft rejection and antimicrobial treatment to prevent postoperative infection.
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Anand A, Sheha H, Teng CC, Liebmann JM, Ritch R, Tello C. Use of amniotic membrane graft in glaucoma shunt surgery. Ophthalmic Surg Lasers Imaging Retina 2011; 42:184-9. [PMID: 21563743 DOI: 10.3928/15428877-20110426-01] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 03/08/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine the safety and efficacy of amniotic membrane graft in glaucoma drainage device surgery. PATIENTS AND METHODS Institutional retrospective case series of 44 patients undergoing glaucoma drainage device implantation with use of 300-μm thick amniotic membrane as a patch graft. Endpoints assessed were tube exposure, graft thinning, graft clarity, graft-related infection, and inflammation. RESULTS A total of 41 (93%) eyes had an uneventful course over a mean follow-up of 22 ± 3 months (range: 17 to 28 months). Tube exposure and hypotony each occurred in one eye and were successfully treated with a tube revision using double pericardial and amniotic membrane patch graft. The translucency of amniotic membrane graft enabled good visualization of the occluding suture when performing laser suture lysis in 16 eyes. Sequential anterior segment optical coherence tomography showed stable amniotic membrane graft thickness with a change from low to moderate reflectivity in the subconjunctival-graft bilayer. CONCLUSION Amniotic membrane graft offers good tectonic support and allows direct visualization of the underlying tube.
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Affiliation(s)
- Aashish Anand
- Einhorn Clinical Research Center, The New York Eye and Ear Infirmary, New York, New York, USA
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Management of Corneal Perforations. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Li W, Che WJ, Zhang MC. Study of self-made freeze-dried bilayered fibrin-binding amniotic membrane in ocular trabeculectomy in rabbits. Int J Ophthalmol 2011; 4:582-9. [PMID: 22553725 DOI: 10.3980/j.issn.2222-3959.2011.06.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 11/18/2011] [Indexed: 01/23/2023] Open
Abstract
AIM To investigate the antifibrotic effect of freeze-dried bilayered fibrin-binding amniotic membrane on trabeculectomy in a rabbit model. METHODS Twenty-four Japanese white rabbits were randomized into three groups: the experimental group (ocular trabeculectomy in combination with freeze-dried bilayered fibrin-binding amniotic membrane transplantation), the control group (ocular trabeculectomy in combination with natural bilayered fibrin-binding amniotic membrane) and the blank group (single trabeculectomy). Clinical observation, hematoxylin-eosin staining, Massion staining, real-time PCR and immunohistochemistry for α-SMA were performed on days 7, 14, 21 and 30 following surgery. RESULTS Statistical differences were noted in survival analysis and intraocular pressure (IOP) among groups on days 7, 14, 21 and 30 following surgery. Histology, immunohistochemistry and real-time PCR further demonstrated that trabeculectomy in combination with freeze-dried bilayered fibrin-binding amniotic membrane resulted in good wound healing and no scar formation. CONCLUSION Self-made freeze-dried bilayered fibrin-binding amniotic membrane may inhibit the formation of scarring in glaucoma after trabeculectomy.
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Affiliation(s)
- Wan Li
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Lee SY, Heo JW, Wee WR, Lee JH, Kim MK. A Case of Endophthalmitis With Necrotizing Scleritis Treated With Vitrectomy and Permanent Amniotic Membrane Transplantation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.1.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Yoon Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Jang Won Heo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Jin Hak Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Taban M, Lowder CY, Ventura AACM, Sharma S, Nutter B, Hayden BC, Dupps WJ, Kaiser PK. Scleral thickness following fluocinolone acetonide implant (Retisert). Ocul Immunol Inflamm 2010; 18:305-13. [PMID: 20482407 DOI: 10.3109/09273941003658292] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate whether intravitreal fluocinolone acetonide (FA) implantation (Retisert) leads to scleral thinning. METHODS Scleral thickness was measured at the pars plana region (4 quadrants) with anterior segment OCT (Visante) in FA implanted eyes (18) with noninfectious posterior uveitis in comparison to eyes with prior vitrectomy (8), and normal eyes without prior surgery (30). RESULTS Mean scleral thickness in normal (nonsurgical) eyes was 0.99/0.93/0.88/0.86, and 0.92 mm in the inferonasal/inferotemporal/superotemporal/superonasal quadrants, and overall, respectively. Sclera was thinner in each quadrant of the FA implanted eyes compared to the fellow or nonsurgical eyes, although none reached statistical significance, as the differences were small. However, a few FA implanted eyes demonstrated more dramatic scleral thinning than others. CONCLUSIONS FA implant appears to lead to statistically nonsignificant scleral thinning overall with few exceptions. Clinicians should be aware of potential scleral thinning in select cases, important for reimplantation and long-term follow-up.
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Affiliation(s)
- Mehran Taban
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Nubile M, Carpineto P, Liberali T, Barile P, Lanzini M, Mastropasqua L. Amniotic membrane transplantation in a perforated corneal graft: clinical and histopathological findings. Acta Ophthalmol 2010; 88:e13-4. [PMID: 19416120 DOI: 10.1111/j.1755-3768.2008.01377.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Hori Y, Inoue R, Ikuno Y, Inoue T, Maeda N, Tano Y. Severe methicillin-resistant Staphylococcus aureus infection after multilayer amniotic membrane transplantation. Jpn J Ophthalmol 2009; 53:61-62. [PMID: 19184313 DOI: 10.1007/s10384-008-0616-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 09/17/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Yuichi Hori
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan. .,Department of Ophthalmology, Osaka University Medical School, 2-2 Yamadaoka, Room E7, Suita, Osaka, 565-0871, Japan.
| | - Ryo Inoue
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
| | - Yasushi Ikuno
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
| | - Tomoyuki Inoue
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
| | - Naoyuki Maeda
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
| | - Yasuo Tano
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
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