The effect of social determinants of health on severity of microbial keratitis presentation at a tertiary eye care hospital in Southern India

Purpose: Understanding the association between social determinants of health (SDoHs) and microbial keratitis (MK) can inform underlying risk for patients and identify risk factors associated with worse disease, such as presenting visual acuity (VA) and time to initial presentation. Methods: This was a cross?sectional study was conducted with patients presenting with MK to the cornea clinic at a tertiary care hospital in Madurai, India. Patient demographics, SDoH survey responses, geographic pollution, and clinical features at presentation were collected. Descriptive statistics, univariate analysis, multi?variable linear regression models, and Poisson regression models were utilized. Results: There were 51 patients evaluated. The mean age was 51.2 years (SD = 13.3); 33.3% were female and 55% did not visit a vision center (VC) prior to presenting to the clinic. The median presenting logarithm of the minimum angle of resolution (logMAR) VA was 1.1 [Snellen 20/240, inter?quartile range (IQR) = 20/80 to 20/4000]. The median time to presentation was 7 days (IQR = 4.5 to 10). The average particulate matter 2.5 (PM2.5) concentration, a measure of air pollution, for the districts from which the patients traveled was 24.3 ?g/m3 (SD = 1.6). Age? and sex?adjusted linear regression and Poisson regression results showed that higher levels of PM2.5 were associated with 0.28 worse presenting logMAR VA (Snellen 2.8 lines, P = 0.002). Patients who did not visit a VC had a 100% longer time to presentation compared to those who did (incidence rate ratio = 2.0, 95% confidence interval = 1.3–3.0, P = 0.001). Conclusion: Patient SDoH and environmental exposures can impact MK presentation. Understanding SDoH is important for public health and policy implications to mitigate eye health disparities in India.

Resultados de los pacientes operados de queratoplastia terapéutica en la provincia de Matanzas

Introducción: la queratoplastia terapéutica se define como un procedimiento cuyo propósito es contribuir a erradicar o reducir la infección cuando la terapia médica máxima no es eficaz para lograr este fin. Objetivo: evaluar la evolución y resultados de los pacientes operados de queratoplastia terapéutica. Materiales y métodos: se realizó un estudio descriptivo transversal en un universo de 15 pacientes con diagnóstico de úlcera grave corneal. Dichos pacientes fueron operados de queratoplastia terapéutica en el Servicio de Córnea del Hospital Universitario Comandante Faustino Pérez Hernández, de la provincia de Matanzas, entre abril de 2017 y febrero de 2020, y dieron su consentimiento informado para participar en la investigación. Resultados: predominó el sexo masculino, con un 53,3 % y una media de edad de 58,8 años. Como factores predisponentes, prevaleció el antecedente de trauma en el 33,3 %, seguido del uso de lentes de contacto y la diabetes mellitus como enfermedad sistémica asociada. Las úlceras de etiología micótica predominaron en el 26,6 % de los casos; la perforación corneal y el descemetocele se presentaron en el 40 % y 26,6 % de los pacientes respectivamente. Durante el primer mes, las complicaciones postoperatorias más frecuentes fueron la recidiva de la sepsis y la necrosis del injerto. Por su parte, la opacidad y vascularización corneal fueron las secuelas más frecuentes. Conclusiones: la demora en iniciar el protocolo de tratamiento adecuado provoca cuadros severos de la enfermedad, realizando queratoplastia "en caliente" en córneas perforadas o con necrosis, que devienen complicaciones postoperatorias y secuelas no alentadoras para los pacientes.

Introduction: therapeutic keratoplasty is defined as a procedure whose purpose is to help eradicate or reduce the infection when maximum medical therapy is not efficacious to achieve this end. Objective: to evaluate the evolution and results of the patients operated on therapeutic keratoplasty. Materials and methods: a cross-sectional, descriptive study was carried out in a universe of 15 patients with a diagnosis of severe corneal ulcer. The patients underwent therapeutic keratoplasty surgeries in the Cornea Service of the Clinical Surgical University Hospital Comandante Faustino Perez Hernandez, in the province of Matanzas, between April 2017 and May 2020, and gave their informed consent to participate in the research. Results: male gender predominated, with 53.3% and a mean age of 58.8 years. As predisposing factors, trauma antecedent predominated in 33.3%, followed by the use of contact lenses and diabetes mellitus as associated systemic disease. Ulcers of mycotic etiology predominated in 26.6% of the cases; corneal perforation and descemetoceles occurred in 40% and 26.6% of the cases respectively. During the first month, the most frequent postsurgery complications were recidival sepsis and graft necrosis. On the other hand, corneal opacity and vascularization were the most frequent sequels. Conclusions: the delay in initiating the adequated protocol treatment causes severe symptoms of the disease that lead to "in hot" keratoplasty in perforated or necrosed corneas, causing postsurgery complications and non-encouraging sequels for patients.

A safer alternative approach to penetrating keratoplasty in opaque corneas

Background: This video demonstrates a useful technique of keratoplasty which can be routinely undertaken by all surgeons when imaging modalities such as anterior segment optical coherence tomography are not available and prior patient history is not forthcoming. Purpose: To demonstrate a technique of lamellar separation and layer by layer removal of host cornea when dealing with keratoplasty in perforated corneal ulcers, adherent leucomas, dense corneal opacities, which obscure visualization of the iris and anterior chamber details. Synopsis: In this video, we demonstrate penetrating keratoplasty in a failed opacified graft with iridocorneal adhesions, with no visualization of anterior chamber details. Lamellar dissection of the host cornea is done starting at its periphery and moving centrally, with gentle peeling of the superficial layers, the epithelium and bulk of stroma, following which, the deeper portion of the cornea is dissected and separated from underlying adherent iris tissue. Layer by layer separation allows better visualization through the remaining thin layers of the cornea. This permits fine dissection and layered removal of the cornea, thereby avoiding injury to iris and lens. Debulking of the host cornea decreases the force that is needed to be applied to separate adherent iris tissue from the host cornea, and reduces the chances of sudden entry into the anterior chamber and subsequent damage to the iris or lens. This also reduces the chance of iris tears, iridodialysis and bleeding from the iris and helps maintain iris integrity, which is essential intraoperatively for protection of lens and anterior chamber formation, and to avoid glare and photophobia postoperatively. Preventing iris damage also reduces the chances of formation of peripheral anterior synechiae (PAS), which can predispose to graft rejection, graft failure and secondary glaucoma. Highlights: Layer by layer corneal separation beginning inside the graft host junction, careful separation of iridocorneal adhesions and PAS is a helpful technique to optimally preserve the anterior segment anatomy during difficult cases of penetrating keratoplasty.

Bacterial Investigation and Antibiogram in Corneal Ulcers in Dogs

Corneal ulcers in dogs usually have a traumatic origin. They cause a break in the continuity of underlying corneal stroma and become rapidly contaminated with bacteria. Twenty eight clinical samples were obtained from corneal ulcer affected dogs for bacterial isolation and anti-microbial susceptibility. Bacterial growth was observed in 100% of the samples (n=28) and Staphylococcus spp. was isolated and characterized by culture, gram staining and various biochemical tests. Antibiogram pattern revealed that gatifloxacin and moxifloxacin antibiotics were found to be highly effective in the treatment of corneal ulcers in dogs. Corneal culture and sensitivity testing provided useful information for the diagnosis, determination of appropriate treatment and antimicrobial therapy for corneal diseases in dogs

Keratomycosis Caused By Pigmented Fungi

Keratomycosis is a major cause of blindness, especially in the developing world. A major proportion of these are caused by fungi, of which pigmented fungi is a good number. Pigmented fungal corneal ulcers may present with surface pigmentation, helping in diagnosis but the presumptive treatment is usually started after evaluation of smears made from scrapping samples. Aggressive treatment with topical anti-fungals help accelerated healing in most of them but few still worsen and need therapeutic keratoplasty. In this study, we evaluated the cases of pigmented Keratomycosis presenting in a tertiary care center for various factors like demographic details, risk factors, clinical characterstics, response to treatment and prognosis

Implante de membrana amniótica en la corrección de úlceras corneales profundas de caninos y felinos / Amniotic membrane implant in the correction of deep corneal ulcers in canines and felines / Implante de membrana amniótica na correção de úlceras corneais profundas de caninos e felinos

Resumen Antecedentes: gran parte de los defectos del epitelio corneal, como las queratitis ulcerativas, no responden al tratamiento convencional y progresan a ulceración estromal y perforación inminente. En busca de nuevas opciones terapéuticas para corregir dichos defectos corneales, se encuentran el uso de membrana amniótica y las plastias corneales, ambos tratamientos quirúrgicos buscan una reepitelización corneal y un adecuado proceso de cicatrización cuando el tratamiento médico no ha tenido éxito. Objetivos: por medio de este trabajo se busca analizar los estudios actualizados referentes a los implantes de membrana amniótica para la resolución de úlceras corneales profundas en caninos y felinos, para poder definir los principios terapéuticos de la membrana amniótica en patologías oculares, determinar un protocolo de preparación de injertos de membrana amniótica y servir de base para estudios prácticos acerca de implantes corneales en caninos y felinos en Colombia. Conclusiones: con base en los resultados obtenidos en el proceso de revisión documental y en la experiencia quirúrgica de los autores, puede concluirse que el uso de la membrana amniótica apoya el crecimiento del epitelio de la superficie ocular y facilita la migración de las células epiteliales, proporciona una barrera a la infección, promueve la revitalización y mejora el dolor. Gracias a sus características únicas ofrece una opción importante en el tratamiento de úlceras corneales. En los últimos años su eficacia ha sido demostrada en el tratamiento de las enfermedades de la superficie ocular, y es ampliamente utilizada en este tipo de patologías.

Abstract Introduction: Most defects of the corneal epithelium, such as ulcerative keratitis, do not respond to conventional treatment and they progress to stromal ulceration and imminent perforation. Among new therapeutic options to correct these corneal defects, there is the use of amniotic membrane and corneal plasties; both surgical treatments seek a corneal reepithelialization and an adequate healing process when medical treatment has not been successful. Objectives: This work seeks to analyze updated studies concerning amniotic membrane implants for the solution of deep corneal ulcers in canines and felines, in order to define the therapeutic principles of amniotic membrane in ocular pathologies, determine a protocol for the preparation of amniotic membrane grafts, and serve as a basis for practical studies about corneal implants in canines and felines in Colombia. Conclusions: Based on the results obtained during the document review process and the surgical experience of the authors, it can be concluded that the use of amniotic membrane supports the growth of the ocular surface epithelium and facilitates the migration of epithelial cells, provides a barrier to infection, promotes revitalization, and ameliorates pain. Thanks to its unique characteristics, it is an excellent option in the treatment of corneal ulcers. In recent years, its effectiveness has been demonstrated in the treatment of ocular surface diseases, and is widely used in this type of pathologies.

Resumo Antecedentes: grande parte dos defeitos do epitélio corneano, como as queratites ulcerativas, não respondem ao tratamento convencional e progridem a ulceração estroma e perfuração iminente. Na busca de novas opções terapêuticas para corrigir estes defeitos corneais, encontram-se o uso de membrana amniótica e as reparações corneais, ambos tratamentos cirúrgicos buscam uma reepitelização da córnea e um adequado processo de cicatrização quando o tratamento médico não foi bem sucedido. Objetivos: por meio deste trabalho se busca analisar os estudos atualizados referentes aos implantes de membrana amniótica para a resolução de úlceras corneais profundas em caninos e felinos, para poder definir os princípios terapêuticos da membrana amniótica em patologias oculares, determinar um protocolo de preparação de enxertos de membrana amniótica e servir de base para estudos práticos sobre os implantes corneais em caninos e felinos na Colômbia. Conclusões: com base nos resultados obtidos no processo de revisão documental e na experiência cirúrgica dos autores, pode concluir-se que o uso da membrana amniótica apoia o crescimento do epitélio da superfície ocular e facilita a migração das células epiteliais, proporciona uma barreira à infecção, promove a revitalização e melhora a dor. Graças a suas características únicas oferece uma opção importante no tratamento de úlceras corneais. Nos últimos anos a sua eficácia tem sido demonstrada no tratamento das doenças da superfície ocular, e é amplamente utilizada neste tipo de patologias.

Caracterización clinicoepidemiológica y microbiológica en úlceras corneales bacterianas y micóticas / Clinical, epidemiological and microbiological characterization of bacterial and mycotic ulcers

Objetivo: describir la asociación entre aspectos clinicoepidemiológicos y los resultados microbiológicos en pacientes con queratitis infecciosa ingresados en el Servicio de Córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período 2010-2014. Métodos: se realizó un estudio observacional descriptivo, de corte transversal, de 39 ojos. Se estudiaron las variables edad, sexo, tiempo de evolución, tratamiento previo con antibióticos, factores predisponentes y concordancia del tratamiento empírico. Se utilizaron medidas de resumen para variables cualitativas y cuantitativas, prueba no paramétrica de probabilidad exacta de Fisher, prueba de Chi cuadrado de Pearson y Prueba U de Mann Whitney. Resultados: en los aislamientos de bacterias, el 42,3 por ciento de los pacientes eran menores de 30 años; 53,8 por ciento pertenecían al sexo femenino y el tiempo de evolución promedio fue de 7 días. Los factores predisponentes fueron: enfermedad ocular previa (23,1 %), uso de lentes de contacto (30,8 por ciento) y enfermedades sistémicas (11,5 por ciento). Los mayores de 69 años (46,5 por ciento), el sexo masculino (92,3 por ciento); el tiempo de evolución promedio de 14,5 días y el antecedente de traumatismo ocular no quirúrgico (15,4 por ciento) se observaron en aislamientos micóticos. La perforación corneal se produjo en el 7,7 por ciento de los crecimientos bacterianos; en crecimientos micóticos el 15,4 por ciento desarrolló descemetocele y el 23,1 por ciento perforación corneal. Se realizó queratoplastia penetrante en el 30,8 por ciento(AU) Conclusiones: los aislamientos bacterianos son más frecuentes en pacientes jóvenes, del sexo femenino y con antecedentes de enfermedad ocular previa y uso de lentes de contacto, mientras que la etiología micótica se produce en pacientes del sexo masculino, mayores de 60 años y con antecedentes de trauma corneal no quirúrgico

Objective: to describe the association of clinical and epidemiological aspects with the microbiological results of patients with infectious keratitis, who were admitted to the corneal service of "Ramon Pando Ferrer" Cuban Institute of Ophthalmology in the period of 2010 to 2014. Methods: cross-sectional, descriptive and observational study of 39 eyes. The analyzed variables were age, sex, time of progression, previous antibiotic treatment, predisposing factors and agreement of the empirical treatment. Summary measures for qualitative and quantitative variables; non-parametric Fisher´s exact probability test, Pearson´s Chi square test, and Mann Whitney's U test. Results: in the bacterial isolates, 42.3 percent of patients were younger than 30 years; 53.8 percent were females and average time of progression of disease was 7 days. The predisposing factors were previous eye disease (23.1 percent), use of contact lenses (30.8 percent) and systemic diseases (11.5 percent). Regarding mycotic isolates, patients aged over 69 years (46.5 percent), males (92.3 percent), average time of progression of 14.5 percent and history of non surgical ocular trauma (15.4 percent) predominated. The corneal perforation occurred in 7.7 percent of bacterial infection whereas 15.4 percent developed descemetocele and 23.1 percent corneal perforation in the mycotic infection group. Penetrating keratoplasty was performed in 30.8 percent of patients. Conclusions: bacterial isolates were more frequent in young female patients with a history of previous ocular diseases and contact lenses whereas mycotic etiology was more commonly observed in males over 60 years and history of non surgical corneal trauma(AU)

Úlceras corneales bacterianas: actualización terapéutica / Bacterial corneal ulcers: update on treatment

Las úlceras corneales constituyen un problema de salud visual frecuente en las consultas de Oftalmología. En ocasiones, su causa puede ser imprecisa, y las consecuencias de un error en el diagnóstico o en el tratamiento pueden ser graves. Esta entidad reviste gran importancia por su repercusión en la visión y las secuelas que suelen acompañar la recuperación del paciente, por lo que realizamos una búsqueda actualizada de los últimos diez años de diversos artículos publicados para profundizar en el diagnóstico clínico-etiológico y en el tratamiento(AU)

Corneal ulcers represent a frequent visual health problem in ophthalmology. The cause may be inaccurate sometimes and the consequences of an error in diagnosis or treatment can be severe. This feature is of great importance because of its impact on the vision and the sequelae that may accompany the patient's recovery; therefore, we made a literature review of several articles for the last ten years to delve into the clinical and etiological diagnosis and into treatment(AU)

Úlceras corneales en usuarios de lentes de contacto / Corneal ulcers in contact lens wearers

El empleo de lentes de contacto se ha incrementado a nivel mundial. En la actualidad su uso no se restringe solamente a la corrección óptica, sino que se utilizan con fines terapéuticos, ya que generan comodidad y estética en múltiples afecciones oculares. Es de esperar el creciente aumento de las complicaciones relacionadas con el uso de estos, por ser la queratitis bacteriana potencialmente grave y devastadora para el globo ocular. Se realizó una revisión bibliográfica acerca de las úlceras corneales en portadores de lentes de contacto con el objetivo de describir su epidemiología y las formas de prevenir esta complicación(AU)

The use of contact lenses has increased worldwide. Their current uses comprise optical correction as well as therapeutic purposes since they bring comfortableness and esthetics in a number of ocular diseases. It is expected that contact lenses-related complications will grow because bacterial keratitis is potentially severe and devastating for the eyeball. A literature review on the presence of corneal ulcers in contact lens wearers was made to describe the epidemiology and the ways of preventing this complication(AU)

Explore the full thick layer of corneal transplantation in the treatment of pseudomonas aeruginosa corneal ulcer infection / 国际眼科杂志(Guoji Yanke Zazhi)

To explore the feasibility, safety and effect of the full-thickness lamellar keratoplasty for the treatment of pseudomonas aeruginosa corneal ulcer.METHODS: Based on a retrospective non-controlled study, 25 patients were given the full-thickness lamellar keratoplasty for clinical diagnosis of pseudomonas aeruginosa infection and corneal ulcer medication conventional anti-gram-negative bacteria. Routine follow-up were carried out at postoperative 1wk; 1, 3, 6, 12, 18mo to observe the situation of corneal epithelial healing, recurrent infection, immune rejection, graft transparency and best corrected visual acuity, etc. At the 6 and 12mo postoperative, corneal endothelial cell density was reexamined. RESULTS: No patients because of Descemet's membrane rupture underwent penetrating keratoplasty surgery: One only in cases of bacterial infection after 1mo, once again did not cultivate a culture of bacteria pseudomonas aeruginosa, and the remaining 24 cases average follow - up 14 ± 6mo, corneal graft were transparent, the cure rate was 96%. At the sixth month after surgery, there were 16 cases of eye surgery best corrected visual acuity ≥4. 5, of which 3 cases ≥4. 8. At the sixth month after surgery, the average corneal endothelial cell density 2 425 ± 278/mm2; At 12mo postoperatively, it was 2257± 326/mm2.CONCLUSlON: Full-thickness lamellar keratoplasty is an effective method of pseudomonas aeruginosa infection in the treatment of corneal ulcers, corneal drying material glycerol can be achieved by visual effects.

Investigation on the effect of topical corticosteroids as adjunctive plan in the therapy of bacterial corneal ulcers / 中国基层医药

Objective To investigate the clinical efficacy and safety of topical corticosteroids as adjunctive plan in the therapy of bacterial corneal ulcers (BCU).Methods 62 eligible patients with confirmed BCU were screened and divided into 2 groups randomly.Both groups were treated with topical tobramycin for 3 weeks,the observation group received topical tobramycin for at least 48 hours and then treated with 0.02％ fluorometholone for 3 weeks,and decrement setp by step.Best spectacle corrected visual acuity(BSCVA),fluctuation of intraocular pressure (IOP) before and after therapy,time to corneal reepithelialization and clarity,severe adverse event were observed.Results After 3 weeks,BSCVA of both groups increased compared to their baselines,however,no significant difference between the two groups.Patients whose IOP exceed 21mm Hg in the control group was statistically more than that in the observation group(x2 =7.272,P ＜ 0.05).Follow up for 3 months,increasing of BSCVA in the observationgroup was significantly higher than the control group(t =2.388,P ＜ 0.05) ;and lOP of both two groups almost recuperated to baselines.Although the time to corneal reepithelialization of the control group (11.3 ± 4.5) d was shorter than observation group [(14.7 ± 5.2) d] (t =2.707,P ＜ 0.05),the recovery of corneal clarity in observation group was superior to control group (x2 =8.207,P ＜ 0.05).In addition,no severe adverse events were observed during this period.Conclusion Although prolong the healing time of corneal epithelium,corticosteroids as an adjunctive plan in the therapy of BCU may reduce immune-mediated damage,decrease scarring,control IOP fluctuation and improve BSCVA,but with no safety concerns.

Frecuencia de ulceras corneales de etiología fúngica en el Hospital Universitario de Caracas 2008-2012 / Frequency coneal ulcers fungal etiology University Hospital 2008-2012 Caracas

La queratitis micótica es una infección de curso subagudo que genera inflamación y ulceración de la córnea. La importancia de las queratitis micóticas en la práctica oftalmológica radica en su dificultad diagnóstica y terapéutica, la falla en el reconocimiento temprano del hongo y la instauración tardía del tratamiento adecuado incrementa la infiltración y ulceración del estroma corneal, lo que puede llegar a tener consecuencias graves en la integridad del globo ocular. Se propuso determinar la frecuencia de ulceras corneales de etiología fúngica en el Hospital Universitario de Caracas durante el periodo julio 2008-julio2012. Se diseñó un estudio retrospectivo, descriptivo, basado en la revisión de las 41 historias médicas de todos los pacientes con cultivo y/o examen directo positivo para hongos en muestras de úlceras corneales. El cultivo fue positivo en 97,56%, representando Fusarium spp el 37,5%, F. solani 20%, F. oxysporum 12,5%, Aspergillus spp 7,5%, y A. terreus, A. fumigatus, A. candidus, Penicillium spp, Candida spp, C. parapsilosis, P. boydii, Curvularia sp y Cladosporium sp representaron 2,5% cada uno. Al 58,54% se les realizo tratamiento quirúrgico. De 41 pacientes 73,17%, eran de sexo masculino, el grupo más afectado estuvo comprendido entre 20 y 59 años representando el 75,61%. El 58,54% procedía de zonas urbanas y el 41,56% de zona rural, y el 78,05% de la población atendida pertenecía al interior del país. Un 48,78% tuvo un evento traumático mientras que el 51,22% no y 87,80% pacientes ya habían recibido tratamiento previo. A pesar de los avances en diagnóstico y tratamiento para las queratomicosis siguen constituyendo un problema en los países subdesarrollados donde el diagnóstico tardío es directamente proporcional al grado de mejoría del paciente.

Fungal keratitis is a subacute infection that produces inflammation and ulceration of the cornea. The importance of fungal keratitis in ophthalmology practice lies in its diagnostic and therapeutic difficulties, failure of the fungus early recognition and appropriate treatment of late-onset increases infiltration and ulceration of the corneal stroma, which can have serious consequences in the integrity of the eyeball. Proposed to determine the frequency of fungal etiology corneal ulcers in Caracas University Hospital during the period July 2008- july 2012. We designed a retrospective descriptive study, based on a review of 41 medical records of all patients with culture and / or direct examination positive for fungal corneal ulcers samples. The culture was positive in 97.56%, representing 37.5% Fusarium spp, 20% F. solani, 12.5% F. oxysporum, Aspergillus spp 7.5%, and A. terreus, A. fumigatus, A. candidus, Penicillium spp, Candida spp, C. parapsilosis, P. boydii, Curvularia sp and Cladosporium sp accounted for 2.5% each. At 58.54% received surgical treatment. Of 41 patients 73.17% were males, the group most affected was between 20 and 59 years old representing 75.61%. , 58.54% were from urban areas and 41.56% in rural area, and 78.05% of the population served came from inside the country. A 48.78% had a traumatic event while 51.22% and 87.80% no patients had received previous treatment. Despite advances in diagnosis and treatment for keratomycosis remains a problem in developing countries where late diagnosis is directly proportional to the degree of patient improvement.

A influência do laboratório no tratamento da ceratite infecciosa / The influence of the laboratory in the treatment of the infectious keratitis

OBJETIVO: Avaliar a resposta terapêutica das ceratites infecciosas e sua correlação com o resultado laboratorial. MÉTODOS: Foram estudados 62 casos retrospectivamente de ceratite infecciosa de moderada à grave, atendidos no Hospitaldo Servidor Público Estadual de São Paulo no período de janeiro de 2000 a dezembro de 2006. Foi avaliada a resposta ao tratamento tópico com colírios antibióticos (Cefalotina 50mg/ml e Gentamicina 14mg/ml ou Ciprofloxacino 0,3 por cento), verificando-se a necessidade de modificação da terapêutica inicial de acordo com a evolução clínica e correlação com os testes microbiológicos pré-tratamento. RESULTADOS: Observou-se que 21 culturas (33,9 por cento) foram positivas e 41 (66,1 por cento) foram negativas. Houve crescimento de fungo em uma amostra (1,6 por cento). Em apenas dois casos (3,5 por cento) houve correlação do exame bacterioscópico com o da cultura. Em 5 casos (8,1 por cento) houve necessidade de modificação da medicação devido à piora clínica e 91,9 por cento dos pacientes cursaram com cura do processo infeccioso com o tratamento inicial instituído. CONCLUSÃO: O uso tópico de antibióticos fortificados ou quinolonas foi eficaz no tratamento das ceratites de provável etiologia infecciosa com culturas positivas e negativas.

PURPOSE: To evaluate the initial treatment of infectious keratitis, evolution and their correlation with laboratory tests. METHODS: 62 cases of infectious corneal ulcers seen in the Hospital do Servidor Público Estadual - São Paulo underwent Gramstaining and culture for bacterial and fungus. Treatment with fortified Cefalotine (50mg/ml) and Gentamicin (14mg/ml) or fluoroquinolone 0,3 percent was started. RESULTS: 21 cultures (33,9 percent) were positive for bacterial infection and 41 (66,1 percent) showed no growth. Just one case was positive for fungus(1,61 percent). In 2 cases (3,5 percent) the Gram staining showed correlation with the culture. Five cases (8,8 percent) did not respond to the initial treatment and had the medications changed and 91,9 percent responded to the initial clinical treatment. CONCLUSION: Ours results showed that combination of fortified eye drops or quinolones was efficient to treat infectious corneal ulcers with positive or negative cultures.

Clinical efficacy of topical homologous fibronectin in persistent corneal epithelial disorders

The clinical efficacy was investigated of topical homologous fibronectin on persistent corneal epithelial defects of various etiologies. Fibronectin was purified from blood bank homologous plasma by gelatin-Sepharose 4B affinity chromatography. Twenty eight eyes of twenty five patients with persistent corneal epithelial defects and sterile corneal ulcers that failed to improve with standard therapy were treated by the instillation of homologous fibronectin eyedrops 5 times a day (500 microgram/ml). Complete reepithelialization was achieved in all patients except two eyes due to uncontrolled glaucoma and the taking of steroids. The healing time tended to be different depending on the duration of persistent corneal epithelial defects and the severity of underlying diseases. The mean +/- standard deviation duration of epithelial defect was 68.18 +/- 77.80 days. Average healing time was 42.07 +/- 17.47 days. Ocular symptoms were relieved significantly and no side effects were observed. Over an average follow-up period of about 8 months, two cases of recurrences were noted. These results show that homologous fibronectin was also effective in patients with persistent corneal epithelial defects and corneal ulcers.