Post-corneal transplant Candida keratitis – Incidence and outcome

Purpose: To report the risk factors, clinical characteristics, and outcomes of Candida keratitis following corneal transplantation in India. Methods: On retrospective review of medical records of 789 patients, 31 eyes developed a graft infection following corneal transplantation or keratoprosthesis and we could identify the Candida infection in only five. These cases were operated at two tertiary care centers in India. These five records were reviewed for demographics, risk factors (local and systemic) for graft infection, characteristics of infective lesion, corneal scraping results, treatment plan, and the final outcome following management. Results: The median age of the subjects with the Candida graft infection was 62.4 ± 10.33 years (range, 62–71 years). All patients were males. The predominant risk factors included repeat corneal transplantation (5/5), prolonged usage of topical steroids (5/5), and epithelial defects (4/5). The clinical characteristics included infiltrates of variable configuration like powdery deposits, white plaque, fluffy white infiltrate, and crystalline keratopathy. The smear showed budding yeasts in all five cases whereas culture was positive in four out of five cases. The final outcome with antifungals (systemic [4/5] and topical [5/5]) is variable. Two eyes underwent evisceration, two eyes had scar formation in the failed grafts, and one patient succumbed to the systemic disease 1?month post?corneal infection. Conclusion: Candida keratitis, in India, seems to be an emerging pathology following corneal transplantation and has a varied presentation. Though the outcomes following management seem to be grim, however, such infection can easily be avoided by a timely reduction of the risk factors.

Role of punctal plugs as a primarily treatment modality in moderate to severe dry eye

Background:In dry eye syndrome tear film disrupts which lead to ocular discomfort. Treatment of dry eye is very challenging and time consuming.Multiple treatment options are available for treating dry eye and one of them is punctal plugs.It blocks the drainage of tear by occluding puncta which helps in the preservation of natural tears on the ocular surface and relieve dry eye symptoms.This study was conducted to assess the safety and efficacy of punctal plugs as a primary treatment modality in moderate to severe dry eye.Methods:Fifty patients were included in this study and they were divided into two groups.In group A which included 25 patients punctal plugs were inserted and in group B (25 patientsor 50 eyes) artificial tear drop was prescribed.The primary treatment outcome was the improvement in dry eye symptoms and secondary outcome was Schirmer test score,tear break up time and rose bengal staining score.Results:There was drastic improvement in dry eye symptoms in group A (punctal plugs) compared to group B(artificial tear group).Schirmer test score,tear break up and rose bengalstaining score also improved in punctal plug group. Conclusions: This study has shown that punctal plug can be used as a primary treatment modality in moderate to severe dry eye as it improves greater symptomatic relief and also improves the condition ofdamaged ocular surface