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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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Late onset of microbial keratitis after laser in situ keratomileusis surgery: case series. J Cataract Refract Surg 2021; 47:1044-1049. [PMID: 34292889 DOI: 10.1097/j.jcrs.0000000000000581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To report predisposing factors, clinical features, microbiology spectrum, antibiotic resistance, antimicrobial therapy, and outcomes of patients with a previous laser in situ keratomileusis (LASIK) surgery and diagnosed with presumed microbial keratitis. SETTING Sydney Eye Hospital, Sydney, New South Wales, Australia. DESIGN Retrospective case review. METHODS Patients were identified from pathology and hospital coding data from 2012 to 2016. Inclusion criteria were all patients with a previous LASIK surgery, a presumed diagnosis of microbial keratitis, and a corneal scrape performed and aged older than 18 years. Demographics, clinical details, and outcomes were collated from the medical records. RESULTS Sixteen patients were included, with median age of 41.5 years (range 22 to 85 years) and 56.2% of women. The median time between LASIK procedure and microbial keratitis presentation was 38.3 months (interquartile range 6.7 to 77.45 months). Cultures were positive for bacteria in 12 (75%) of 16 scrapes. Of the bacterial isolates, 12 (85.7%) were gram-positive and 2 (14.3%) gram-negative. Sensitivity profiles for the isolated bacteria were similar between fortified antibiotics (cefalotin and gentamicin) and commercial products (chloramphenicol and ofloxacin). Complications included the need for tectonic grafts, nonhealing epithelial defects, thinning, and neovascularization. CONCLUSIONS Late onset of keratitis after LASIK can occur with no positive cultures for nontuberculous mycobacteria, no interface involvement, and no other usual features reported in case series of infectious keratitis in LASIK patients. It has a similar clinical course to non-LASIK keratitis, such that the surgery may not have been a risk factor for infection.
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Khurana A, Chanda S, Bhagat P, Aggarwal S, Sharma M, Chauhan L. Clinical characteristics, predisposing factors, and treatment outcome of Curvularia keratitis. Indian J Ophthalmol 2021; 68:2088-2093. [PMID: 32971614 PMCID: PMC7728016 DOI: 10.4103/ijo.ijo_90_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose To report clinical characteristics, predisposing factors, and treatment outcome of Curvularia keratitis. Methods Retrospective chart review of consecutive culture-proven Curvularia keratitis patients who presented to a tertiary eye care center in north India. Patients with mixed infections with Curvularia as one of the pathogens were also included. Standard case report form was developed to capture demographic information, clinical features, etiology, treatment, and outcome. Binary logistic regression was done to ascertain the effect of identified variables on final visual acuity. Results Medical records of 97 patients of Curvularia keratitis were reviewed. Median age of patients was 45.3 years. Seventy-nine (79.4%) patients presented during the months of September to November. History of corneal trauma was present in 69.1%. Trauma from sugarcane leaf was identified in 66.1% of cases with corneal trauma with vegetative matter. Presenting visual acuity was worse than 20/60 in 57.8% of patients. Hypopyon and pigmented plaque-like infiltrate was present in 16.5% and 28.8% of patients, respectively. Mixed infection was reported in 14.4% of cases. Median time of antifungal therapy was 24.5 days. Surgical intervention was required in 18.5% cases. Of all, 11.1% patients achieved final VA of more than 20/200 who were managed surgically as compared to 68 (86%) patients who were managed medically. Younger age, absence of comorbidities, and lesser infiltrate size were found associated with good final visual acuity. Conclusion Working males were most affected by Curvularia keratitis. Corneal trauma with sugarcane leave was the most common predisposing factor in the study area. Most of the cases presented with worse visual acuity but could be managed medically.
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Affiliation(s)
- Ashi Khurana
- Department of Cornea and Refractive Error, C. L. Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Sanjay Chanda
- Department of Cornea and Refractive Error, C. L. Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Preeti Bhagat
- Department of Cornea and Refractive Error, C. L. Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Swati Aggarwal
- Department of Cornea and Refractive Error, C. L. Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Mohit Sharma
- Department of Microbiology, C. L. Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Lokesh Chauhan
- Department of Clinical and Public Health Research, C. L. Gupta Eye Institute, Moradabad, Uttar Pradesh, India
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Liatis T, Theochari F, Kalogianni L, Soubasis N, Oikonomidis IL, Velegraki A, Psalla D, Triantafyllou E, Patsikas M, Polizopoulou Z. Brainstem phaeohyphomycosis due to Curvularia lunata (Cochliobolus lunatus) in a cat. Aust Vet J 2021; 99:273-278. [PMID: 33830496 DOI: 10.1111/avj.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Abstract
A 13-year-old female neutered domestic short-hair cat was presented with chronic progressive vestibular ataxia, lethargy and anorexia. Clinical examination revealed bilateral mucopurulent nasal discharge. Neurological examination revealed obtundation, a right head tilt, ambulatory tetraparesis, generalised vestibular ataxia, decreased postural reactions in all limbs, right Horner's syndrome, spontaneous conjugate jerk rotatory nystagmus and right positional ventral strabismus. Neuroanatomical localisation was observed in the right central vestibular system. Computed tomography revealed a solitary ill-defined contrast-enhancing mass lesion at the level of the right cerebellopontine angle. Cerebrospinal fluid (CSF) analysis revealed mild mononuclear pleocytosis and fungal elements. CSF culture was positive for Curvularia spp. Further tests for underlying diseases were all negative. The cat was treated with antibiotic and antifungal treatment, but it deteriorated rapidly and was euthanased. Necropsy of the brainstem mass lesion revealed pyogranulomatous inflammation. Panfungal polymerase chain reaction (PCR) targeting the internal transcribed spacer (ITS) region and subsequent sequencing identified Curvularia lunata in the formalin fixed brain tissue. This is the first report of brainstem phaeohyphomycosis by Curvularia lunata (Pleosporales) in a cat. In addition, this is the first report among animal and humans where fungal elements of Curvularia lunata were found in the CSF cytology. Opportunistic fungal pathogens should be always considered within the differential diagnoses list in cats with neurological signs and advanced imaging findings compatible with solitary mass lesions in the brain. In feline patients with pyogranulomatous meningoencephalitis and a suspicion of a fungal aetiology, panfungal PCR for the ITS region and sequencing should be performed regardless of the absence of fungal elements in histopathology.
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Affiliation(s)
- T Liatis
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK.,Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 27, Greece
| | - F Theochari
- Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 27, Greece
| | - L Kalogianni
- Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 27, Greece
| | - N Soubasis
- Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 27, Greece
| | - I L Oikonomidis
- Easter Bush Pathology, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, EH25 9RG, UK.,Diagnostic Laboratory, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 27, Greece
| | - A Velegraki
- Mycology Research Laboratory and UOA/HCPF Culture Collection, Microbiology Department, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece.,Mycology Laboratory, Biomedicine S.A., Athens, 115 25, Greece
| | - D Psalla
- Pathology Laboratory, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 27, Greece
| | - E Triantafyllou
- Vet Analyses - Veterinary Diagnostic Lab S.A., Larissa, 412 22, Greece
| | - M Patsikas
- Diagnostic Imaging Laboratory, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 27, Greece
| | - Z Polizopoulou
- Diagnostic Laboratory, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 27, Greece
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Post-keratorefractive Surgery Infections: Management Strategies. CURRENT OPHTHALMOLOGY REPORTS 2015. [DOI: 10.1007/s40135-015-0074-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ide T, Kurosaka D, Senoo T, Kinoshita S, Ohashi Y, Inoue Y, Tsubota K. First multicenter survey on infectious keratitis following excimer laser surgery in Japan. Taiwan J Ophthalmol 2014. [DOI: 10.1016/j.tjo.2014.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Solomon R, Donnenfeld ED, Holland EJ, Yoo SH, Daya S, Güell JL, Mah FS, Scoper SV, Kim T. Microbial keratitis trends following refractive surgery: results of the ASCRS infectious keratitis survey and comparisons with prior ASCRS surveys of infectious keratitis following keratorefractive procedures. J Cataract Refract Surg 2011; 37:1343-50. [PMID: 21700112 DOI: 10.1016/j.jcrs.2011.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/03/2011] [Accepted: 03/15/2011] [Indexed: 10/18/2022]
Abstract
In 2008, the American Society of Cataract and Refractive Surgery (ASCRS) surveyed its 9121 United States and international members to evaluate the changing trends and incidence, culture results, treatment, and visual outcomes of infectious keratitis following keratorefractive procedures worldwide. This paper presents and analyzes the results with comparisons to the data in surveys conducted in 2001 and 2004. Nineteen infections were reported by 14 surgeons who had performed an estimated 20,941 keratorefractive procedures, an incidence of 1 infection in every 1102 procedures. Sixteen cases presented in the first postoperative week, 1 case during the second week, 1 case between the second and fourth weeks, and 1 case at 1 month or later. The 16 cases that presented in the first week were diagnosed at initial presentation. The most common organism cultured was methicillin-resistant Staphylococcus aureus (MRSA). Microbial keratitis following refractive surgery is an increasingly recognized sight-threatening complication.
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Affiliation(s)
- Renée Solomon
- Department of Ophthalmology, NYU Medical Center, New York, New York, USA.
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Alfonso EC, Galor A, Miller D. Fungal Keratitis. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shetty K, Giannini P, Achong R. Chronic craniofacial dematiaceous fungal infection: a case report. SPECIAL CARE IN DENTISTRY 2006; 26:155-8. [PMID: 16927738 DOI: 10.1111/j.1754-4505.2006.tb01717.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Curvularia is a saprobic dematiaceous mold that has been associated with a wide spectrum of human infection. In non-immunosuppressed patients, infections frequently involve the paranasal sinus, skin, and soft tissue, whereas systemic dissemination and endocarditis are extremely rare. The optimal antifungal therapy for Curvularia infection is not known, and responses to treatment with amphotericin B, miconazole, ketoconazole, terbinafine, and itraconazole have been reported. We describe a patient with an invasive dematiaceous fungal sinusitis who was immunocompetent and was infected with Curvularia. The patient was successfully treated with oral itraconazole by otolaryngology and the infectious disease service.
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Affiliation(s)
- Kishore Shetty
- Medically Complex Patient Clinic, Department of Restorative Dentistry, The University of Texas Dental Branch at Houston, USA.
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Patel SR, Hammersmith KM, Rapuano CJ, Cohen EJ. Exophiala dermatitidis keratitis after laser in situ keratomileusis. J Cataract Refract Surg 2006; 32:681-4. [PMID: 16698496 DOI: 10.1016/j.jcrs.2006.01.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Accepted: 08/10/2006] [Indexed: 11/17/2022]
Abstract
A 52-year-old man had laser in situ keratomileusis in March 2002 and 2 weeks later had a corneal infection that was found to be caused by Exophiala dermatitidis. This infection waxed and waned for 9 months despite therapy with natamycin, itraconazole, and fluconazole but eventually responded to topical amphotericin. He recovered good visual acuity in this eye with a rigid gas-permeable lens. This case shows the importance of selecting the appropriate agent in fungal keratitis.
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Affiliation(s)
- Seema R Patel
- Cornea Service, Wills Eye Hospital, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Verma K, Vajpayee RB, Titiyal JS, Sharma N, Nayak N. Post-LASIK Infectious Crystalline Keratopathy Caused by Alternaria. Cornea 2005; 24:1018-20. [PMID: 16227855 DOI: 10.1097/01.ico.0000159735.83295.1c] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a case of infectious crystalline keratopathy (ICK) after laser in situ keratomileusis (LASIK) caused by Alternaria species. METHODS A case report of a 29-year-old woman who presented with clinical features of ICK 3 weeks after LASIK surgery. RESULTS Medical therapy failed to control and resolve the corneal infection. Penetrating keratoplasty was performed, which controlled the infection and aided in visual recovery of 20/30. The culture of the corneal button revealed the presence of Alternaria species fungus. CONCLUSIONS Alternaria species fungus may cause ICK after LASIK.
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Affiliation(s)
- Kamna Verma
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
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Abstract
PURPOSE OF REVIEW Throughout the world, fungal keratitis is a leading cause of ocular morbidity. The purpose of this review is to discuss the recently published literature in relation to the epidemiology, etiology, diagnosis, and therapy of fungal keratitis. RECENT FINDINGS Globally, the incidence of keratomycoses and systemic mycoses is rising. Current therapies are often ineffective. Ongoing research toward rapid diagnosis and specific drug therapy could minimize the morbidity caused by this preventable disease. New antifungal drugs, including voriconazole, have been applied recently for the treatment of keratomycosis. SUMMARY The incidence of fungal keratitis is on the rise in the densely populated continents of Asia and Africa. Filamentous fungi are the most frequently reported pathogens. Polyene antifungal antibiotics, the first-line therapy in fungal keratitis, are not effective in severe keratomycosis. Imidazole derivatives such as voriconazole and echinocandin may be the better choice in the future.
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