Keratomycosis after incidental spillage of vegetative material into the eye: report of two cases

Fungal corneal ulcers mostly occur after incidental corneal trauma by plant leaves in farm lands or the use of topical corticosteroids or antibiotics. The infection is more prevalent among farmers and harvesters and in some parts of the world is considered as an occupational disease; however, there have been a few reports on the occurrence of such ulcers in healthy individuals after incidental spillage of vegetative material into the eye. The importance of these ulcers is their long-term and refractory course, which makes the visual prognosis unfavorable in most patients, even after appropriate antifungal therapy or ocular interventions. Herein, we present two rare cases of fungal ulcers caused by incidental spillage of vegetative material into the eye while eating nuts and corn. We also discuss the diagnostic and therapeutic approaches, as well as visual outcome reviewing the relevant literature.

Antibiotic susceptibility patterns of pseudomonas corneal ulcers in contact lens wearers

To evaluate the resistance or susceptibility of Pseudomonas aeruginosa, the most common pathogen in contact lens keratitis and corneal ulcer, to different antibiotic regimens. This cross-sectional study included all patients with recently diagnosed contact lens corneal ulcer whose culture results were positive for P. aeruginosa, from March 2009 to March 2010. The empirical antibiotic therapy was changed to appropriate antibiotics according to the culture results, provided that satisfactory clinical improvement was not achieved with the initial antibiotic regimen. The overall sensitivity or resistance of P. aeruginosa to the most commonly used antibiotics was assessed based on the results of the antibiograms. Fifty-two patients [43 females and 9 males] were included. Forty-five patients [86%] were wearing cosmetic contact lenses, while 7 patients [14%] were using therapeutic contact lenses. Thirty-nine patients [75%] were hospitalized and13 patients [25%] were followed up through an outpatient clinic. Thirty patients [58%] had central ulcers, whereas 22 patients [42%] had peripheral ulcers. Twelve patients [23%] had hypopyon in their first exam. The mean time to diagnose the ulcer after the last time wearing was 2 days [range: 12 hours to 5 days]. AMT was required for 10 patients [19%]. Based on the antibiograms, PA was shown to be sensitive in 100% of cases to ceftazidime and ciprofloxacin. Amikacin, imipenem, and gentamicin were the second most effective antibiotics. P. aeruginosa was highly sensitive to ceftazidime, ciprofloxacin, and amikacin. All cases were resistant to cefazolin. Resistance to multiple antibiotics might be a significant concern in patients with corneal ulcers. In referral centers dealing with corneal ulcers, the initial antibiotic regimens should be changed from time to time to prevent this phenomenon