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1.
Indian J Ophthalmol. 2020 Jan;68(1):47. doi: 10.4103/ijo.IJO_2180_19.

Commentary: Analysis of differentially expressed genes in bacterial and fungal keratitis.

Author information

1
Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
PMID:
31856464
DOI:
10.4103/ijo.IJO_2180_19
[Indexed for MEDLINE]
Free full text
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2.
Klin Monbl Augenheilkd. 2019 Dec;236(12):1457-1460. doi: 10.1055/a-0983-1752. Epub 2019 Oct 31.

[Inverted In Vitro Confocal Microscopy in Mycotic Keratitis with Corneal Endothelial Epithelial Decompensation].

[Article in German; Abstract available in German from the publisher]

Author information

1
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar.
2
Institut für Pathologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar.
3
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Martin-Luther Universität Halle-Wittenberg.

Abstract

The sensitivity of confocal microscopy ranges between 80 and 90% and thus lies above the sensitivity of pathogen identification by microbiological culture. Typically, in vivo confocal microscopy enables us to diagnose mycotic keratitis non-invasively and atraumatically on the day of admission. Herein we present a patient with an ulcer on a corneal graft, pronounced corneal endothelial epithelial decompensation and a retrocorneal fungal adhesion after repeat-keratoplasty 5 years ago - due to chronic graft rejection after keratoplasty for Fuchs endothelial corneal dystrophy. Clinically there was a suspicion of fungal keratitis. Conventional en face confocal microscopy, however, did not detect hyphae. Due to the pronounced corneal endothelial epithelial decompensation, we were able to detect the fungal hyphae only after repeat penetrating keratoplasty by means of inverted in vitro confocal microscopy on the day of surgery. Histology confirmed the diagnosis of keratomycosis.

PMID:
31671460
DOI:
10.1055/a-0983-1752
[Indexed for MEDLINE]
Icon for Georg Thieme Verlag Stuttgart, New York
3.
Turk J Ophthalmol. 2019 Oct 24;49(5):294-296. doi: 10.4274/tjo.galenos.2019.02328.

Endogenous Candida Endophthalmitis as a Rare Complication of Trans-Urethral Lithotripsy in a Healthy Woman: A Case Report

Author information

1
Shiraz University of Medical Sciences, Department of Ophthalmology, Shiraz, Iran

Abstract

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.

KEYWORDS:

Endogenous endophthalmitis; Candida endophthalmitis; lithotripsy; ureteral stone

PMID:
31650813
PMCID:
PMC6823585
DOI:
10.4274/tjo.galenos.2019.02328
[Indexed for MEDLINE]
Free PMC Article
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4.
Vestn Oftalmol. 2019;135(4):98-102. doi: 10.17116/oftalma201913504198.

[Fungal keratitis after penetrating keratoplasty].

[Article in Russian; Abstract available in Russian from the publisher]

Author information

1
Volga District Medical Centre, Federal Medical and Biological Agency, 2 Nizhnevolzhskaya embankment, Nizhny Novgorod, Russian Federation, 603001.

Abstract

The article presents a case of fungal keratitis after penetrating keratoplasty (PKP). A 35-years old patient had previously undergone surgical removal of an intraocular foreign body and developed chronic keratouveitis and epithelial-endothelial corneal dystrophy. PKP and early postoperative period were uneventful. The patient was frequently monitored with anterior segment photos. Two weeks later, fungal keratitis occurred on the edge of the donor flap. Direct microscopic evaluation revealed fungus spores and filaments, but growth of fungi in culture was negative. Instillation of steroids and antibiotics was discontinued, specific therapy included fluconazole and amphotericin B. Despite the ongoing treatment, keratitis has repeatedly recurred, and infiltrates were scraped. Topical and systemic voriconazole was administered instead of fluconazole in combination with regular scarification. After 3 weeks of treatment with voriconazole, stable corneal epithelialization was achieved and the cornea has restored its transparency. During 1.5 years of the follow-up, keratitis did not reccur; sutures were removed, corrected visual acuity increased to 1.0. Patients who had undergone PKP are at risk of developing fungal keratitis. Frequent monitoring of such patients contributes to early diagnosis of infectious complications. In the absence of officinal antifungal eye drops, specialist has to supply the patient with ex tempore antimycotic agents and change the treatment according to its effectiveness in each specific case.

KEYWORDS:

corneal transplantation; fungal infection; infectious complications; infectious keratitis

PMID:
31573563
DOI:
10.17116/oftalma201913504198
[Indexed for MEDLINE]
5.
Indian J Ophthalmol. 2019 Oct;67(10):1777-1778. doi: 10.4103/ijo.IJO_1268_19.

Commentary: Dengue hemorrhagic fever: Panophthalmitis or sterile sclerocorneal melt?

Author information

1
Department of Ophthalmology, Sir Ganga Ram Hospital and Vision Eye Centres, New Delhi, India.
2
Senior Consultant, Sir Ganga Ram Hospital, New Delhi, India.
3
Sehgal Neo Hospital, Meera Bagh, Paschim Vihar, New Delhi, India.
PMID:
31546564
PMCID:
PMC6786154
DOI:
10.4103/ijo.IJO_1268_19
[Indexed for MEDLINE]
Free PMC Article
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6.
Indian J Ophthalmol. 2019 Oct;67(10):1701-1702. doi: 10.4103/ijo.IJO_993_19.

Commentary: PACK-CXL in fungal keratitis.

Author information

1
Division of Ophthalmology and Visual Sciences, Queens Medical Centre, University of Nottingham, Nottingham, UK.
PMID:
31546518
PMCID:
PMC6786226
DOI:
10.4103/ijo.IJO_993_19
[Indexed for MEDLINE]
Free PMC Article
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7.
Indian J Ophthalmol. 2019 Oct;67(10):1606. doi: 10.4103/ijo.IJO_793_19.

Commentary: Timing of therapeutic keratoplasty.

Author information

1
Cornea and Refractive Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
PMID:
31546489
PMCID:
PMC6786232
DOI:
10.4103/ijo.IJO_793_19
[Indexed for MEDLINE]
Free PMC Article
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8.
Middle East Afr J Ophthalmol. 2019 Aug 26;26(2):110-113. doi: 10.4103/meajo.MEAJO_284_18. eCollection 2019 Apr-Jun.

Postpartum Endogenous Candida Endophthalmitis.

Author information

1
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Abstract

Postpartum endogenous fungal endophthalmitis in otherwise healthy females is extremely rare disease. We report a case of a 25-year-old female patient referred with a history of decreased vision in her right eye 1 month after uncomplicated vaginal delivery. She presented with multifocal chorioretinal infiltrates. The patient showed persistent inflammation in her right eye then after. Systemic workup was unremarkable apart from a history of vaginal discharge during peripartum period. Vaginal swap confirmed the presence of Candida albicans. Culture of the vitreous sample confirmed the growth of C. albicans. The patient was managed with intravitreal amphotericin B in addition to systemic antifungal treatment followed by pars plana vitrectomy. The patient achieved 20/40 vision with quiet eye after 6 months of follow-up.

KEYWORDS:

Candida albicans; endogenous endophthalmitis; postpartum

PMID:
31543670
PMCID:
PMC6737792
DOI:
10.4103/meajo.MEAJO_284_18
[Indexed for MEDLINE]
Free PMC Article
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9.
Zhonghua Yan Ke Za Zhi. 2019 Aug 11;55(8):601-608. doi: 10.3760/cma.j.issn.0412-4081.2019.08.010.

[Diagnostic value of fungal fluorescence staining on corneal scrapings for fungal keratitis].

[Article in Chinese; Abstract available in Chinese from the publisher]

Author information

1
Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab., Beijing 100730, China.

Abstract

Objective: To analyze the sensitivity and specificity of fungal fluorescent staining in the diagnosis of fungal keratitis, and to compare it with conventional fungal culture, in vivo confocal microscopy (IVCM) and Giemsa staining. To explore its value of clinical application. Methods: Prospective case-control study. A total of 105 consecutive patients (105 eyes) diagnosed with infectious keratitis at Beijing Tongren Hospital from August 2017 to April 2018 were included. Patients with infectious keratitis were divided into fungal keratitis (FK) group and non-fungal keratitis (NFK) group by slit lamp microscopy, corneal in vivo confocal microscopy (IVCM) examination, and the results of Giemsa staining, fluorescent staining and pathogenic culture of corneal scraping from ulcer. The sensitivity and specificity of the above-mentioned examination methods for the diagnosis of fungal keratitis were analyzed. The receiver operating characteristic curve (ROC curve) and Area Under Curve (AUC) values were calculated to determine the diagnostic value of fungal fluorescent staining for fungal keratitis. Results: Among the 105 patients with infectious keratitis, 66 were fungal keratitis, 39 were non-fungal keratitis (29 cases of bacterial keratitis and 10 cases of acanthamoeba keratitis). Isolation from fungal keratitis were mainly Fusarium spp. (43.5%), followed by Alternaria spp. (21.7%) and Aspergillus spp. (19.6%). After fluorescent staining of the ulcer smear, the background of tissue demonstrated homogeneous black or weak blue fluorescence. The cell wall of fungi showed bright blue-violet to blue fluorescence, and the morphology, structure and hyphal density were easily recognized. The sensitivity of different methods for the diagnosis of corneal fungal infection were smear fluorescence staining (97.0%), IVCM (87.9%) , Giemsa staining (86.7%), and fungal culture (69.7%); the specificity of fungal culture was the highest (100%), followed by IVCM and Giemsa staining (94.9%), and fluorescent staining (87.2%). The ascending order of AUC values was: fungal culture (0.848) <Giemsa staining (0.906) <IVCM (0.914) <fluorescence staining (0.921). Conclusion: Fungal fluorescent staining is a rapid and sensitive screening method under microscope with high sensitivity and specificity for the diagnosis of fungal keratitis. It is especially suitable for the diagnosis of patients with low load of hypha or after antifungal therapy. (Chin J Ophthalmol, 2019, 55:601-608).

KEYWORDS:

Eye infections, fungal; Keratitis; Microscopy, fluorescence; Staining and labeling

[Indexed for MEDLINE]
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10.
Int J Mol Sci. 2019 Jul 25;20(15). pii: E3631. doi: 10.3390/ijms20153631.

An Omics Approach to Diagnosing or Investigating Fungal Keratitis.

Author information

1
Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan. mingtse@cgmh.org.tw.
2
Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
3
Department of Ophthalmology, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan.
4
Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
5
Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan. youhling@cgmh.org.tw.

Abstract

Fungal keratitis (FK) is one of the most severe corneal infectious diseases. FK often leads to poor visual prognosis and thus requires accurate diagnosis. Conventional approaches, including clinical diagnoses, smears, and cultures, often fail to provide reliable diagnostic value. Omics approaches, such as those using genomic, metagenomic, and tear proteomic data sources, provide promising features for improving the diagnosis and monitoring the progression of FK. Genomic approaches are based mainly on detecting amplicons of ribosomal RNA genes, and internal transcribed spacers are gradually gaining popularity in clinical practices. A metagenomic approach based on 16S rRNA genes may help monitor the dynamic change of conjunctival microbiota associated with an FK event, whereas that based on shot-gun and 18S rRNA target enrichment sequencing could have the potential to diagnose FK using clinical samples. A tear proteomic approach may provide comprehensive information about ocular surface defense and injury during FK. Representative up- and down-regulated proteins during FK could also be used as biomarkers to determine the clinical course and develop a treatment strategy in different stages of FK. Consequently, a personalized tear proteomic approach will soon play a key role in FK management.

KEYWORDS:

fungal keratitis; genomics; metagenomics; molecular diagnosis; proteomics

PMID:
31349542
PMCID:
PMC6695605
DOI:
10.3390/ijms20153631
[Indexed for MEDLINE]
Free PMC Article
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11.
Cornea. 2019 Oct;38(10):1314-1321. doi: 10.1097/ICO.0000000000002068.

Antimycotic Efficacy and Safety of a New Cold Corneal Storage Medium by Time-Kill and Toxicity Studies.

Author information

1
Alchilife S.r.l., Ponte San Nicolò, Italy.
2
Ophthalmic Biophysics Center Bascom Palmer Eye Institute (BPEI), University of Miami Miller School of Medicine, Miami, FL.
3
Ocular Microbiology Laboratory, Bascom Palmer Eye Institute (BPEI), University of Miami Miller School of Medicine, Miami, FL.

Abstract

PURPOSE:

To evaluate a new corneal cold storage medium including an antimycotic tablet (Kerasave, AL.CHI.MI.A. S.r.l.).

METHODS:

Kerasave and tryptone soy broth (control) were inoculated with 10 and 10 colony-forming units (CFU)/mL of 6 Candida isolates (Candida albicans [n = 4], Candida tropicalis [n = 1], and Candida glabrata [n = 1]). Minimum inhibitory concentrations (MICs) were determined using amphotericin B Etest strips. Sterile porcine corneas contaminated with 10 CFU/mL of each isolate were incubated in Kerasave and control at 4°C. Growth rate and Log10 reduction at 4°C at different time intervals were determined for liquid samples and tissue homogenates. Kerasave biocompatibility was assessed according to ISO 10993-5 and ISO 10993-10.

RESULTS:

No C. albicans or C. tropicalis colonies were recovered from Kerasave inoculated with 10 CFU/mL after incubation for 3 days at 4°C. C. glabrata was inhibited but not killed after 3 days at 4°C. Four of the 6 strains contaminated with 10 CFU/mL demonstrated a significant ≥ 3 Log10 reduction in media and tissue homogenates within 5 days as compared to controls (p < 0.01). Amphotericin B MICs ranged from 0.19 to 0.38 μg/mL for C. albicans (n = 3) and C. tropicalis (n = 1). C. glabrata showed reduced susceptibility (0.5 μg/mL) and 1 C. albicans was resistant to amphotericin B (≥ 1 μg/mL). Kerasave was not cytotoxic, irritating, or sensitizing according to the ISO standards.

CONCLUSIONS:

Kerasave showed high antifungal efficacy against susceptible fungal strains at 4°C in the presence and absence of corneal tissue. Resistant strains to amphotericin B were not eliminated by Kerasave. Kerasave is not cytotoxic, irritating, or sensitizing.

PMID:
31335527
DOI:
10.1097/ICO.0000000000002068
[Indexed for MEDLINE]
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12.
Rom J Ophthalmol. 2019 Apr-Jun;63(2):178-183.

Endogenous endophthalmitis: A case of a presumed mixed intraocular opportunistic infection by a fungal species and cytomegalovirus.

Author information

1
Department of Ophthalmology, University of Crete, Heraklion, Greece.

Abstract

Endogenous endophthalmitis is a serious sight-threatening disease. Common causes include immunocompromised state and intravenous drug use, permitting opportunistic pathogens to reach the eye through the blood stream. We reported a rare case of a presumed simultaneous opportunistic intraocular fungal and cytomegalovirus (CMV) infection. Case presentation: A 67-year-old male patient with a recent history of hospitalization due to pneumonia, presented to our department with bilateral loss of vision. Ocular examination revealed low visual acuity, signs of vitritis with chorioretinal infiltrations and cotton ball colony-like lesions, bilaterally. A bilateral endogenous fungal endophthalmitis was suspected and topical and systemic antifungal treatment was initiated. Nevertheless, vitreous and blood cultures were negative for fungi and other bacteria, while serological examinations revealed primary infection with CMV. Following vitrectomy, polymerase chain reaction (PCR) of vitreous washings confirmed the intraocular infection with CMV. Treatment was modified, including intravenous administration of Gancyclovir. In the following days, the patient's clinical signs and visual acuity improved remarkably. Conclusions: A case of a presumed mixed fungal and CMV intraocular infection was presented. High level of suspicion with prompt diagnosis and aggressive combination treatment led to a favorable result.

KEYWORDS:

cytomegalovirus; endogenous fungal endophthalmitis; mixed intraocular infection; opportunistic intraocular infection

PMID:
31334398
PMCID:
PMC6626934
[Indexed for MEDLINE]
Free PMC Article
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13.
Medicine (Baltimore). 2019 Jul;98(27):e16063. doi: 10.1097/MD.0000000000016063.

A case report of infectious scleritis with corneal ulcer caused by Scedosporium aurantiacum.

Author information

1
Department of Ophthalmology, Gyeongsang National University Hospital.
2
Department of Ophthalmology, School of Medicine and Institute of Health Science, Gyeongsang National University, Jinju.
3
Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.

Abstract

RATIONALE:

Scedosporium species is rare pathogen of ocular infection. The accurate diagnosis is delaying in many cases and the clinical prognosis is poor due to its resistance to antifungal agents. This report describes a patient with infectious scleritis and corneal ulcer caused by Scedosporium auranticum infection who required enucleation to control the infection.

PATIENT CONCERNS:

A 70-year-old woman visited our clinic after experiencing ocular discomfort in her right eye for 4 days after minor ocular trauma, with soil exposure.

DIAGNOSES:

Scedosporium species was isolated from a culture of corneal tissue, Scedosporium aurantiacum was identified in a culture of necrotic tissue.

INTERVENTIONS:

She was started on treatment with antifungal agents, including topical amphotericin B and systemic fluconazole, but her ocular condition did not improve. Although the lesion showed temporary improvement, ocular pain and corneal ulcer recurred 3 months later. Evisceration was performed due to corneal perforation, and enucleation was also performed for dehiscence of the conjunctiva and scleral necrosis.

OUTCOMES:

After enucleation, postoperative systemic voriconazole treatment controlled the infection without recurrence.

LESSONS:

S aurantiacum keratitis is difficult to eradicate, even with several months of treatment with systemic and topical antifungal agents, and tends to progress to scleritis. The infection can be terminated by the orbital enucleation. Infection with this rare organism should be included in the differential diagnosis of patients with severe infectious keratitis.

PMID:
31277100
PMCID:
PMC6635299
DOI:
10.1097/MD.0000000000016063
[Indexed for MEDLINE]
Free PMC Article
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14.
Cornea. 2019 Aug;38(8):943-947. doi: 10.1097/ICO.0000000000001994.

Anterior Segment Optical Coherence Tomography Images in Microsporidial Keratoconjunctivitis.

Author information

1
Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Abstract

PURPOSE:

To describe the findings of anterior segment optical coherence tomography (AS-OCT) in patients with microsporidial keratoconjunctivitis.

METHODS:

The observational study included 13 eyes from 13 patients. Slit-lamp photography and AS-OCT were performed using the Swept source OCT before corneal scraping. All cases were positive for Gram-chromotrope (modified trichrome) staining for Microsporidia spp.

RESULTS:

Three significant AS-OCT findings were observed. First, hyperreflective dots were limited to the epithelial layers of the cornea, and second, there were no extensions into the stromal layer in all cases. Last, hyperreflective dots slightly raised above the epithelial surface were observed in most cases (12/13%, 92.3%).

CONCLUSIONS:

AS-OCT represents an alternative, noninvasive tool to diagnose microsporidial keratoconjunctivitis, especially if corneal scraping is not possible.

PMID:
31276457
DOI:
10.1097/ICO.0000000000001994
[Indexed for MEDLINE]
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15.
16.
Indian J Ophthalmol. 2019 Jul;67(7):1053-1054. doi: 10.4103/ijo.IJO_359_19.

Commentary: Dematiaceous fungal keratitis: Importance of ocular microbiology.

Author information

1
Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India.
PMID:
31238407
PMCID:
PMC6611302
DOI:
10.4103/ijo.IJO_359_19
[Indexed for MEDLINE]
Free PMC Article
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17.
Indian J Ophthalmol. 2019 Jul;67(7):1048-1053. doi: 10.4103/ijo.IJO_1612_18.

Causative fungi and treatment outcome of dematiaceous fungal keratitis in North India.

Author information

1
Department of Cornea and Refractive Error, C L Gupta Eye Institute, Ram Ganga Vihar, Phase 2(Ext) Moradabad, Uttar Pradesh, India.
2
Department of Microbiology, C L Gupta Eye Institute, Ram Ganga Vihar, Phase 2(Ext) Moradabad, Uttar Pradesh, India.
3
Department of Clinical Research, C L Gupta Eye Institute, Ram Ganga Vihar, Phase 2(Ext) Moradabad, Uttar Pradesh, India.

Abstract

Purpose:

The aim of the study is to identify risk factors, clinical characteristics, causative fungi, and treatment outcome of dematiaceous fungal keratitis in North India.

Methods:

Consecutive cases of culture-proven dematiaceous fungal keratitis between January 2012 and June 2017 were retrieved from the medical record department. Risk factors, clinical signs, and outcome were registered.

Results:

Eighty-three patients were included. Identified dematiaceous fungal organism were Curvularia sp. (n = 55/83; 66.3%), Alternaria sp. (n = 12/83; 14.5%), Ulocladium sp. (n = 5/83; 6%), Bipolaris sp. (n = 5/83; 6.1%), Scedosporium sp. (n = 3/83; 3.6%), Acremonium sp. (n = 2/83; 2.4%), and Epicoccum sp. (n = 1/83; 1.2%). Male preponderance was reported. The most common predisposing factor was corneal trauma (67.4%). In cases associated with corneal trauma due to vegetative matter, sugarcane was the most common cause. In all, 89% of the patients were more than 30 years of age. The median infiltrate size was 8 mm2. The median time of antifungal therapy was 4.2 weeks (interquartile range [IQR]: 1-25 weeks). Complications were seen in 14 (n = 14/65; 21.5%) patients. Complete resolution of dematiaceous fungal keratitis was present in 27 (n = 27/65; 41.5%) eyes.

Conclusion:

Curvularia sp. and Alternaria sp. were the predominant pathogenic genera causing dematiaceous fungal keratitis. Among the causative fungi, infections due to Scedosporium sp. were associated with the worst outcomes. Ulocladium sp. and Epicoccum sp. were also identified. Both the species are not reported previously as a causal organism of dematiaceous fungal keratitis from North India.

KEYWORDS:

Alternaria; Curvularia; Epicoccum; Ulocladium; Uttar Pradesh; dematiaceous fungi; keratitis

PMID:
31238406
PMCID:
PMC6611278
DOI:
10.4103/ijo.IJO_1612_18
[Indexed for MEDLINE]
Free PMC Article
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18.
BMJ Case Rep. 2019 Jun 22;12(6). pii: e229660. doi: 10.1136/bcr-2019-229660.

Rare Kodamaea ohmeri keratitis following a trivial vegetative trauma.

Author information

1
Department of Ophthalmology, University Sains Malaysia - Health Campus, Kubang Kerian, Malaysia.

Abstract

Kodamaea ohmeri keratitis is an opportunistic pathogen seen in patients who have undergone invasive procedures and immunocompromised state. It has been identified in septicemia patients, resulting in mortality. To the best of our knowledge, we identified the first case of K. ohmeri keratitis following an injury with vegetative material. A 57-year-old woman with underlying, poorly controlled diabetes mellitus was gardening when a tree leaf accidentally poked her in the eye. Two weeks later, the patient presented with right eye pain, redness and progressive blurring of vision due to a traumatised right cornea. Slit-lamp examination showed a small inferior paracentral corneal stromal infiltrate with overlying epithelial defect. A corneal scraping sample yielded K. ohmeri from Analytical Profile Index (API) 20C yeast identification system. She was treated with intensive topical amphotericin B and fluconazole. After 6 weeks of treatment, the keratitis resolved with faint scar tissue, and her visual acuity improved.

KEYWORDS:

anterior chamber; ophthalmology

PMID:
31229985
DOI:
10.1136/bcr-2019-229660
[Indexed for MEDLINE]
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19.
Medicine (Baltimore). 2019 Jun;98(24):e15910. doi: 10.1097/MD.0000000000015910.

Incidence of recurrent fungal keratitis after primary keratoplasty and visual outcome and prognosis after intervention for the recurrence.

Author information

1
Shandong University, Jinan.
2
Department of Ophthalmology, Binzhou Medical University Hospital, Binzhou.
3
Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China.

Abstract

There are no standardized protocols or guidelines for the treatment of recurrent fungal keratitis after therapeutic keratoplasty. This study aimed to investigate the incidence of recurrent fungal keratitis after the primary keratoplasty and the visual outcome and prognosis after intervention for the recurrence.This was a retrospective study. Patients with recurrent fungal keratitis after lamellar keratoplasty (LK) or penetrating keratoplasty (PK) were treated with different antifungal regimens at Shandong Eye Hospital and Qingdao Eye Hospital between Januray 2004 and December 2015. The operative techniques included PK, focal excision, tectonic keratoplasty with a patch graft, lensectomy and vitrectomy, and combined operation. Patients were followed at 1, 2, and 3 months, and then every 6 months after surgery for 2 years. Best corrected visual acuity was assessed and recurrence was recorded. Good prognosis was defined as the presence of visual acuity.Fungal keratitis recurred in 112 of 1448 patients (112/1448, 7.7%) treated initially with PK or LK. The good prognosis rates for different sites of recurrent fungal keratitis were: overall, 93 of 112 (83.0%); recipient bed, 64 of 69 (92.8%); anterior chamber, 14 of 14 (100%); posterior segment, 10 of 16 (62.5%); and atypical, 5 of 13 (38.5%). There was no significant difference in the timing of recurrence between the good and poor prognosis groups (P = .518). Recurrence rates were similar between patients with PK (8.6%) and those with LK (6.0%; P > .05), but the good prognosis rate in patients with post-LK recurrence (96.8%) was higher than that in patients with post-PK recurrence (77.8%, P = .017).Individualized treatment according to recurrent sites of fungal keratitis can achieve a good prognosis in most patients.

PMID:
31192926
PMCID:
PMC6587617
DOI:
10.1097/MD.0000000000015910
[Indexed for MEDLINE]
Free PMC Article
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20.
Cornea. 2019 Sep;38(9):1093-1096. doi: 10.1097/ICO.0000000000002006.

Increasing Povidone-Iodine Exposure in Endothelial Keratoplasty Tissue Processing and Fungal Infection Impact.

Author information

1
Cornea Service, Eye Consultants of Atlanta and Piedmont Hospital, Atlanta, GA.
2
Kirk Eye Center, Chicago, IL.
3
Georgia Eye Bank, Atlanta, GA.
4
Woolfson Eye Institute, Atlanta, GA.

Abstract

PURPOSE:

To evaluate the effect on donor rim cultures and postoperative infections of doubling the povidone-iodine exposure time during corneal tissue recovery before its use in keratoplasty.

METHODS:

Consecutive donor cornea recoveries were evaluated for positive donor corneal rim cultures and postoperative infections before and after a protocol change of doubling the exposure time of povidone-iodine during donor preparation.

RESULTS:

In 631 consecutive cornea donor recoveries, 18 (2.9%) had positive fungal rim cultures and 41 (6.5%) had positive bacterial rim cultures. Three (0.48%) developed postoperative fungal infections, and no bacterial infections occurred. After doubling the povidone-iodine exposure time during the recovery process, 725 consecutive corneas were reviewed. Four (0.6%) had positive fungal rim cultures, and 29 (4.0%) had positive bacterial rim cultures. No postoperative fungal or bacterial infections occurred. No noticeable increase in epithelial toxicity developed between the 2 groups.

CONCLUSIONS:

Increasing the povidone-iodine exposure time during the donor cornea recovery process decreased the rate of positive donor corneal rim fungal cultures (P = 0.001), positive donor corneal rim bacterial cultures (P = 0.04), and postoperative fungal infections (P = 0.06).

PMID:
31169604
DOI:
10.1097/ICO.0000000000002006
[Indexed for MEDLINE]
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