The Status of Infectious Keratitis in Gwang-ju, Jeonnam, Republic of Korea

Purpose@#To investigate the clinical characteristics of infectious keratitis in Gwang-ju, Jeonnam Province, Korea. @*Methods@#We retrospectively reviewed the medical records of 260 eyes of 260 patients diagnosed with infectious keratitis at the Chosun University Hospital from January 2015 to February 2020. @*Results@#The mean age of disease onset was 58.9 years; 132 (50.8%) of all patients were male and 128 (49.2%) female. The culture positivity rate was 24.6%. Gram-negative bacteria were cultured from 38 eyes (59%), Gram-positive bacteria from 21 (33%), and fungi from five (8%). The most commonly isolated microorganism was Stenotrophomonas (xanthomonas) maltophilia (a Gram-negative rod; 17 cases [26.6%]). Prior use of topical antibiotics was significantly more prevalent in the culture-negative than -positive group. In the latter group, the initial visual acuity was poor (p = 0.015) and the frequency of epithelial defects ≥5 mm2 in area was higher than in the culture-negative group (p = 0.001). Trauma caused by vegetable matter (44 eyes, 16.9%) was the most common predisposing factor. The risk factors for a poor visual outcome were such trauma (p = 0.013), previous ocular surgery (p = 0.006), an epithelial defect area greater than 5 mm2 (p < 0.001), and a follow-up period <10 months (p = 0.005). @*Conclusions@#The Gwangju Jeollanam-do community is more rural than urban, contains a large older population, and features few hospitals. Staphylococcus epidermidis and Pseudomonas aeruginosa are considered to be the most frequent causes of infectious keratitis in Korea. However, in our study Stenotrophomonas maltophilia was the organism most frequently cultured.

Risk Factors Associated with the Recurrence of Amblyopia after Successful Treatment

PURPOSE: We sought factors affecting amblyopia recurrence after successful treatment.METHODS: We included 117 patients with amblyopia. Patients were divided into recurrence and non-recurrence groups. We analyzed sex, age, amblyopia type, treatment duration, visual acuity, and binocular status.RESULTS: Of the 117 patients, 25 (21.4%) experienced recurrences. In that group, 60.0% of patients (compared to 14.1% of the no-recurrence group) exhibited high-frequency strabismus (p < 0.001). The recurrence group were younger than the no-recurrence group at both the beginning and end of treatment (p < 0.05). None of visual acuity at treatment commencement or end, stereoacuity, or suppression affected amblyopia recurrence.CONCLUSIONS: Recurrent amblyopia is frequent after initial successful treatment if the patient exhibits strabismus or is young.

The Effect of Topical 10% N-acetylcysteine on Refractory Filamentary Keratitis

PURPOSE@#To analyze the effects of topical 10% N-acetylcysteine on patients with refractory filamentary keratitis.@*METHODS@#The present study included 29 eyes from 20 patients diagnosed with filamentary keratitis. We analyzed the cause of filamentary keratitis, types of treatments, symptom scores, number of filaments, fluorescein staining, degrees of remission, and recurrence of the disease.@*RESULTS@#A total of 19 eyes treated with filament removal, therapeutic contact lenses, topical antibiotics, topical steroids, topical 0.05% cyclosporine, artificial tears, and punctal plugs showed improvements. Topical 10% N-acetylcysteine was added to 10 patients who did not respond to the usual treatment for more than 1 month. Seven eyes showed a complete remission of disease at an average of 56.22 ± 24.52 days. Two eyes showed a partial remission with less than 1–2 fillaments. One eye stopped 10% N-acetylcysteine treatment because of an irritable sensation.@*CONCLUSIONS@#Topical 10% N-acetylcysteine was an effective treatment for refractory filamentary keratitis.

Endogenous Endophthalmitis by Hypervirulent Klebsiella Pneumoniae Invasive Syndrome

PURPOSE@#To report a case of endogenous endophthalmitis with an elbow abscess spread from a liver abscess in a patient with hypervirulent Klebsiella pneumoniae (hvKP) invasive syndrome.CASE SUMMARY: A 33-year-old healthy male presented with painless visual loss in his right eye. He experienced pain, a febrile sensation, and swelling in his right elbow for 1 week prior. He had no trauma history. Many inflammatory cells, hypopyons, and cyclitic membranes were present in the anterior chamber of the eye but no ocular injection was performed. With a provisional diagnosis of panuveitis, topical antibiotics, steroid, and cycloplegics were administered and subtenon triamcinolone was injected. After orthopedic consultation, an elbow abscess was suspected and surgery was performed. Two days after the surgery, the patient experienced ocular pain and an injection was performed. Fever, chill, and acute deterioration of his general condition were noted which suggested infective endophthalmitis. Emergency vitrectomy was performed but because subretinal and choroidal abscesses were observed during surgery, the surgery was changed to enucleation. A liver abscess was observed using abdominal computed tomography after transfer to the infection medical department and hvKP was positive in the blood, liver, elbow, and eye cultures.@*CONCLUSIONS@#A primary liver abscess caused by hvKP occurred in a healthy young man and metastatic infection occurred with endogenous endophthalmitis and a rare elbow abscess. Because hvKP endogenous endophthalmitis has a poor prognosis, rapid diagnosis followed by appropriate treatment is required.

Cryotherapy on Refractory Fungal Corneal Ulcer: A Case Report

PURPOSE: We report a case of cryotherapy for fungal corneal ulcers that did not respond to antifungal agents. CASE SUMMARY: A 58-year-old man was transferred to our hospital with a left eye corneal ulcer due to pain and visual impairment in his left eye for two weeks, and he was suspected to have a history of fungal infection. At the time of admission, corneal opacity and progressive ulcerative lesions were observed at 5 o'clock in the left eye and visual acuity was 0.025, uncorrected. The corneal ulcer marginal resection, bacterial culture, and potassium hydroxide preparation (KOH) test were performed on lesion sites. Cultures of Candida albicans were reported to grow, topical antibiotics (Fortified tobramycin, Fortified cefazolin, moxifloxacin), and anti-fungal agents (fortified amphotericin B, 0.5%, Natamycin) were administered, but no improvement was observed for 2 weeks. On the 14th day after admission, Cryotherapy was performed. After surgery, eye drops were equally applied, and there was no other discomfort other than pain for 3 days after the operation. He discharged 10 days after surgery, the corneal lesion was healed and the visual acuity was improved to 0.32, uncorrected. CONCLUSIONS: We report a case of cryotherapy for fungal corneal ulcers that did not react with topical antifungal drugs and improved visual acuity and symptom improvement.