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1.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(1): 16-24, abr. 2019. tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1007865

ABSTRACT

Las úlceras corneales de origen infeccioso son una emergencia oftalmológica que amenaza la visión y la integridad estructural del ojo, causando ceguera en 1,5 a 2 millones de casos al año por lo que requiere tratamiento inmediato. El objetivo fue determinar el patrón epidemiológico, factores de riesgo y efectividad del tratamiento en pacientes con úlcera corneal en la Fundación Visión en el periodo 2015-2017. Estudio de cohorte prospectivo donde se evaluó 53 pacientes con úlcera corneal de causa infecciosa que consultaron en la Fundación Visión en el periodo 2015-2017, y tuvieron un seguimiento mínimo de 4 meses. Se encontró un predominio del sexo masculino (69,8%), edad 45-65 años (49,1%), casados (54,7%), de condición socioeconómica baja (56,6%), agricultores (26,4%), con antecedente de traumatismo corneal (69,8%) o uso de lentes de contacto (17%). El agente etiológico fue bacteriano en el 49,1% y micótico en el 37,7%; para los de origen bacteriano el tratamiento más empleado fueron colirios fortificados de Cefazolina + Gentamicina y Natamicina/Fluconazol en caso de ser micótico. La evolución fue favorable en 90,9% y 80,0% de los bacterianos y micóticos, respectivamente. Los grupos de riesgo detectados fueron pacientes varones, agricultores, de condición socioeconómica baja, con antecedente de traumatismo corneal o uso de lentes de contacto. La efectividad del tratamiento utilizado fue mayor al 80%, siendo en su mayoría patógenos bacterianos(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Corneal Ulcer/drug therapy , Corneal Ulcer/epidemiology , Gentamicins/therapeutic use , Visual Acuity , Fluconazole/therapeutic use , Cefazolin/therapeutic use , Corneal Ulcer/microbiology , Natamycin/therapeutic use , Prospective Studies , Risk Factors , Treatment Outcome , Keratitis/complications , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use
2.
Arq. bras. oftalmol ; 82(1): 2-5, Jan.-Feb. 2019. tab
Article in English | LILACS | ID: biblio-973875

ABSTRACT

ABSTRACT Purpose: To determine whether a correlation exists between pathogenic species and clinical findings, disease severity, and visual outcome in patients with keratitis and fungal growth in microbiological culture. Methods: A retrospective study of patients with fungal growth in the microbiological culture of corneal scrapings. Patients were treated at an ophthalmologic reference center in Southeastern Brazil from January 1992 to October 2015. Results: Medical records of 181 patients (131 males and 50 females) with a mean age of 47 ± 18 years were analyzed. The three most common etiologies were Fusarium sp. (38.7%), Aspergillus sp. (15%), and Candida sp. (13.2%). Among these, Fusarium sp. was the most frequent in patients aged £50 years (p=0.002) and in those with a recent history of a foreign body and/or ocular trauma (p=0.01). Candida sp. was the most frequent etiology in patients aged >50 years (p=0.002), in those with postoperative ocular surgery (p=0.002); in those with a previous ocular pathology (p=0.0007); and in immunodepressed patients (p=0.0004). Conclusion: Fusarium sp. was predominant in patients aged £50 years and those with a recent history of foreign body and/or ocular trauma, whereas Candida sp. was predominant in older adults, in those with a postoperative ocular surgery, in those with a previous ocular pathology, and in immunodepressed patients.


RESUMO Objetivo: Determinar se existe uma correlação entre espécies patogênicas e achados clínicos, gravidade da doença e resultado visual em pacientes com ceratite e crescimento de fungos em cultura microbiológica. Métodos: Estudo retrospectivo de pacientes com crescimento de fungos na cultura microbiológica de raspado de córnea. Os pacientes foram tratados em um centro de referência oftalmológica no Sudeste do Brasil de janeiro de 1992 a outubro de 2015. Resultados: Foram analisados registros médicos de 181 pacientes (131 homens e 50 mulheres) com idade média de 47 ± 18 anos. As três etiologias mais comuns foram Fusarium sp. (38,7%), Aspergillus sp. (15%) e Candida sp. (13,2%). Entre estas, Fusarium sp. foi a mais frequente em pacientes com idade £50 anos (p=0,002) e naqueles com história recente de corpo estranho e/ou trauma ocular (p=0,01). Candida sp. foi a etiologia mais frequente em pacientes com idade >50 anos (p=0,002), naqueles com cirurgia ocular pós-operatória (p=0,002); naqueles com patologia ocular prévia (p=0,0007); e em pacientes imunodeprimidos (p=0,0004). Conclusão: Fusarium sp. foi predominante em pacientes com idade £50 anos e naqueles com história recente de corpo estranho e/ou trauma ocular; enquanto Candida sp. foi predominante em adultos mais velhos, naqueles com cirurgia ocular pós-operatória, naqueles com patologia ocular prévia e em pacientes imunodeprimidos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Eye Infections, Fungal/microbiology , Eye Infections, Fungal/pathology , Corneal Ulcer/microbiology , Corneal Ulcer/pathology , Aspergillus/pathogenicity , Severity of Illness Index , Candida/pathogenicity , Visual Acuity , Eye Infections, Fungal/drug therapy , Corneal Ulcer/drug therapy , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/pathology , Retrospective Studies , Risk Factors , Corneal Injuries/microbiology , Corneal Injuries/pathology , Fusarium/pathogenicity , Antifungal Agents/therapeutic use
3.
Rev. medica electron ; 40(2): 270-281, mar.-abr. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-902288

ABSTRACT

Introducción: la úlcera corneal es una inflamación supurada que puede tener múltiples etiologías y manifestaciones clínicas. Es una entidad potencialmente grave que amenaza la visión del paciente y puede causar ceguera. Objetivos: describir los fundamentos teóricos que sustentan el uso de los colirios fortificados en el tratamiento de la úlcera grave de la córnea, identificar las variables clínico epidemiológicas del grupo de estudio, establecer el diagnóstico clínico y etiológico de la úlcera corneal y evaluar la evolución de la enfermedad y la incidencia de complicaciones. Materiales y métodos: se realizó una investigación descriptiva, transversal, en el período entre enero del 2015 y enero del 2016. Se tuvo en consideración los pacientes con diagnóstico de úlcera grave de la córnea que ingresaron en el centro hospitalario .La muestra estuvo conformada por 23 pacientes con diagnóstico de úlcera grave de la córnea. Resultados: de los 23 pacientes diagnosticados la úlcera grave de la córnea predominó en el sexo masculino y mayores de 60 años de edad. Predominó la etiología bacteriana y la úlcera central profunda. Dentro de los factores de riesgo ocular los resultados señalan como principal factor el trauma ocular (56,5%), el uso de antibiótico tópico y sistémico por tiempo prolongado. Todos los pacientes recibieron tratamiento tópico con colirio fortificado, entre las complicaciones se presentó el descematocele en un 30,4 % de los casos. Conclusiones: La fundamentación teórica de los colirios fortificados y los resultados obtenidos en esta investigación, demuestran la eficacia del uso en la úlcera grave de la córnea (AU).


Introduction: the corneal ulcer is a suppurated inflammation that may have several etiologies and clinical manifestations. It is a potentially serious entity endangering the patient´s vision and could cause blindness. Objective: to describe the theoretical fundaments supporting the use of fortified eye drops in the treatment of severe corneal ulcer; to identify the clinic-epidemiological variables of the studied group; to arrive to the clinical and etiological diagnosis of the corneal ulcer and to assess disease evolution and complications incidence. Materials and methods: a descriptive, cross-sectional research was carried out in the period from January 2015 to January 2016. The patients diagnosed with severe corneal ulcer who were admitted in the hospital were taken into consideration. The sample was formed by 23 patients diagnosed with severe corneal ulcer. Results: among the 23 patients diagnosed with severe corneal ulcer predominated male sex and people aged more than 60 years. The bacterial etiology and deep central ulcer predominated. As for the ocular risk factors, the results show ocular trauma as main factor (56.5 %) and the use of systemic and topical antibiotic for a long time. All the patients were topically treated with fortified eye drops. Descematocele was found among the complications in 30.4 % of the cases. Conclusions: the theoretical fundament of the fortified eye drops and the results obtained in this research show the efficacy of their use in the severe corneal ulcer (AU).


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Ophthalmic Solutions/administration & dosage , Corneal Ulcer/complications , Corneal Ulcer/diagnosis , Corneal Ulcer/etiology , Corneal Ulcer/drug therapy , Corneal Ulcer/epidemiology , Endophthalmitis , Risk Factors , Epidemiology, Descriptive , Cross-Sectional Studies
4.
Rev. bras. oftalmol ; 76(6): 319-324, nov.-dez. 2017.
Article in Portuguese | LILACS | ID: biblio-1042371

ABSTRACT

Resumo Esta revisão tem por objetivo elencar as condições oftalmológicas em que tem sido utilizado o concentrado de plaquetas (CP), assim como as suas propriedades bioquímicas e fisiológicas. O CP possui tanto o potencial anticatabólico, presente no soro autólogo, quanto substâncias com propriedades anabólicas, que em conjunto são responsáveis pelos seus benefícios no tratamento de doenças da superfície ocular. Atualmente há um lapso de ensaios clínicos neste tema, tanto na oftalmologia como em outras áreas médicas, existindo mais estudos e relatos sobre o uso de soro autólogo. Em oftalmologia, o CP tem sido usado no tratamento do olho seco sintomático, úlceras corneanas, queimaduras oculares dentre outras aplicações, sendo uma alternativa eficaz em diversas patologias oculares; portanto, é evidente a importância de mais estudos nesse tema, para comprovar a efetividade do produto.


Abstract The aim of this review is to list the ophthalmological conditions in which platelet concentrate (CP) has been used, as well as its biochemical and physiological properties. The CP has both anticatabolic potential, present in autologous serum, and substances with anabolic properties, which together are responsible for its benefits in the treatment of ocular surface diseases. There is currently a shortage of clinical trials in this area, both in ophthalmology and other medical areas, with more studies and reports on the use of autologous serum. In ophthalmology, CP has been used in the treatment of symptomatic dry eye, corneal ulcers and ocular burns, among other applications, being an effective alternative in several ocular pathologies; therefore, it's evident the importance of more studies in this topic to prove the efficiency of this product.


Subject(s)
Platelet-Derived Growth Factor/therapeutic use , Dry Eye Syndromes/drug therapy , Corneal Ulcer/drug therapy , Platelet-Rich Plasma , Eye Diseases/drug therapy , Lubricant Eye Drops/therapeutic use
5.
Rev. bras. reumatol ; 55(3): 310-312, May-Jun/2015.
Article in Portuguese | LILACS | ID: lil-752087

ABSTRACT

Ceratite ulcerada periférica é causada por um processo inflamatório e destrutivo da córnea periférica perilimbar. Essa inflamação se deve à deposição de imunocomplexos nessa região da córnea e nos vasos adjacentes a ela. Pode ser idiopática ou uma manifestação de doença sistêmica como artrite reumatoide, vasculites de pequenos vasos associadas ao ANCA, à policondrite recidivante, ao lúpus eritematoso sistêmico e à doença de Crohn. O tratamento inclui o uso de corticoide em dose alta e em alguns casos o uso concomitante de imunossupressores, como metotrexate, azatioprina, micofenolato mofetil, ciclofosfamida ou ciclosporina. O uso de agentes imunobiológicos pode ser uma estratégia nos casos de difícil controle. Os autores descrevem o tratamento de três pacientes que após falha ao uso de corticoide ou imunossupressores apresentaram boa resposta após o uso de infliximabe.


Peripheral ulcerative keratitis is caused by an inflammatory and destructive process of the perilimbal peripheral cornea. This inflammation is due to immune complex deposition in this region of the cornea and in adjacent vessels. It can be idiopathic, or a manifestation of systemic disease such as rheumatoid arthritis, vasculitis of small vessels associated with ANCA, relapsing polychondritis, systemic lupus erythematosus and Crohn's disease. Its treatment includes the use of high-dose corticosteroids and, in some cases, the concomitant use of immunosuppressants such as methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide or cyclosporine. The use of immunobiological agents can be a strategy in cases of difficult control. The authors describe the treatment of three patients who, after failure with the use of corticosteroids or immunosuppressants, showed good response after the use of infliximab.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Corneal Ulcer/drug therapy , Infliximab/therapeutic use , Remission Induction
6.
Arq. bras. oftalmol ; 78(1): 53-55, Jan-Feb/2015. tab, graf
Article in English | LILACS | ID: lil-741158

ABSTRACT

Sweet syndrome (acute febrile neutrophilic dermatosis) is characterized by fever, neutrophilic leukocytosis, and abrupt appearance of painful erythematous nodules and plaques, particularly on the face, neck, and limbs. In this study, we report a very rare case of Sweet syndrome in which the patient presented nodular scleritis and peripheral ulcerative keratitis during the dermatologically inactive period of the disease.


A síndrome de Sweet (dermatose neutrofílica febril aguda) é caracterizada por febre, leucocitose neutrofílica, aparecimento abrupto de nódulos eritematosos dolorosos e placas, principalmente na face, pescoço e membros. Neste artigo, relatamos um caso muito raro de síndrome de Sweet, que tinha esclerite nodular e ceratite ulcerativa periférica no período dermatologicamente inativo da doença.


Subject(s)
Female , Humans , Middle Aged , Corneal Ulcer/etiology , Scleritis/etiology , Sweet Syndrome/complications , Biopsy , Corneal Ulcer/drug therapy , Fluorometholone/therapeutic use , Ofloxacin/therapeutic use , Scleritis/drug therapy , Sweet Syndrome/diagnosis
7.
Biomédica (Bogotá) ; 34(supl.1): 23-33, abr. 2014. tab
Article in Spanish | LILACS | ID: lil-712418

ABSTRACT

Introducción. La resistencia bacteriana es crítica para la selección de los antibióticos en el tratamiento de las infecciones, por ello es vital conocer su estado actual en nuestro medio. Objetivo. Determinar la sensibilidad antibiótica bacteriana in vitro obtenida de los cultivos de queratitis e infecciones intraoculares. Materiales y métodos. Se llevó a cabo un estudio retrospectivo en la Fundación Oftalmológica de Santander (FOSCAL), entre junio de 2011 y enero de 2012. Resultados. Se examinaron 92 muestras. Se identificaron 110 bacterias, 27 hongos y 12 amebas de vida libre. Del total de bacterias Gram positivas, 1,1 %, 0 %, 1,1 %, 16,9 %, 29,3 % y 85 % fue resistente a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina, respectivamente, mientras que la resistencia a estos mismos fármacos se presentó, respectivamente, en 0 %, 8,3 %, 0 %, 0 %, 18,2 % y 27,3 % de las bacterias Gram negativas. Los porcentajes de resistencia de los estafilococos positivos para coagulasa resistentes a la meticilina fueron 0 %, 0 %, 0 %, 7 %, 17 % y 100 %, respectivamente, y los porcentajes de los estafilococos negativos para coagulasa resistentes a la meticilina fueron 3 %, 0 %, 0 %, 24 %, 44 % y 100 %, respectivamente. Los porcentajes de resistencia bacteriana globales (tanto para bacterias Gram positivas como para Gram negativas) a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina fueron 1 %, 1 %, 1 %, 15,1 %, 28 % y 64,5 %, respectivamente. Conclusiones. Los niveles de resistencia bacteriana para imipenem, moxifloxacina y gatifloxacina fueron menores que para levofloxacina, ciprofloxacina y tobramicina. Los niveles de resistencia para la tobramicina fueron muy altos, lo que pone en duda su utilidad clínica en las infecciones oculares en nuestro medio.


Introduction: Bacterial resistance is critical for the selection of antibiotics in the treatment of infections, so it is vital to know its current status in our geographical area. Objective: To determine in vitro antibiotic susceptibility of bacterial isolates obtained from keratitis and intraocular infections. Materials and methods: A retrospective study of microbiological tests in Fundación Oftalmológica de Santander (FOSCAL) was carried out between June, 2011, and January, 2012. Results: A total of 92 samples were examined and 110 bacteria, 27 fungi and 12 free-living amoebae were identified. Polymicrobial infections constituted 50% of the total; 1.1%, 0%, 1.1%, 16.9%, 29.3% and 85% of Gram-positive bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively, while 0%, 8.3%, 0%, 0%, 18.2% and 27.3% of Gram-negative bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively. For methicillin-resistant coagulase-positive staphylococci, resistance percentages to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin were 0%, 0%, 0%, 7%, 17% and 100%, respectively. For methicillin-resistant coagulase-negative staphylococci, resistance percentages to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin were 3%, 0%, 0%, 24%, 44% and 100%, respectively. Overall bacterial resistance to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, for both Gram-positive and Gram-negative, was 1%, 1%, 1%, 15.1%, 28% and 64.5%, respectively. Conclusions: The levels of bacterial resistance to imipenem, moxifloxacin and gatifloxacin were lower than for levofloxacin, ciprofloxacin and tobramycin. The levels of resistance to tobramycin were very high, which calls into question its usefulness in this region of our country.


Subject(s)
Humans , Corneal Ulcer/microbiology , Drug Resistance, Multiple, Bacterial , Endophthalmitis/microbiology , Eye Infections, Bacterial/microbiology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Acanthamoeba Keratitis/epidemiology , Acanthamoeba Keratitis/microbiology , Acanthamoeba/isolation & purification , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/pharmacology , Aqueous Humor/microbiology , Colombia/epidemiology , Cornea/microbiology , Corneal Ulcer/drug therapy , Corneal Ulcer/epidemiology , Disk Diffusion Antimicrobial Tests , Endophthalmitis/drug therapy , Endophthalmitis/epidemiology , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/epidemiology , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/microbiology , Eye Infections, Parasitic/epidemiology , Eye Infections, Parasitic/parasitology , Foundations , Fluoroquinolones/pharmacology , Fungi/isolation & purification , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Retrospective Studies , Vitreous Body/microbiology
8.
Rev. bras. oftalmol ; 72(6): 366-372, nov.-dez. 2013. ilus, graf, tab
Article in Portuguese | LILACS | ID: lil-704737

ABSTRACT

OBJETIVO: Avaliar o efeito do crosslinking (CXL) no tratamento de ceratite infecciosa, resistente ao tratamento clínico, e investigar a relação com o agente etiológico. MÉTODOS: Foram incluídos 11 pacientes com diagnóstico de ceratite infecciosa de etiologia bacteriana (sete olhos) e fúngica (quatro olhos) na Fundação Altino Ventura (FAV) no período de outubro de 2011 a maio de 2012. Os pacientes incluídos estavam em uso de colírios há pelo menos sete dias e não apresentavam melhora da infecção. Estes foram avaliados antes da realização do CXL e no período pós-operatório até cicatrização da úlcera. Para realização do CXL foram instiladas gotas de riboflavina a 0,1% e dextrano a 20%, a cada cinco minutos em um período de 30 minutos antes do procedimento, e durante a aplicação da luz ultravioleta A (UVA). A córnea foi exposta à UVA com comprimento de onda de 370ηm ± 5ηm e uma irradiância de 3mW/cm2. RESULTADOS: Os pacientes com infecção bacteriana obtiveram cura do processo infeccioso após o CXL e nenhum paciente com ceratite fúngica apresentou cicatrização. Observou-se associação significante (p = 0,003) entre o agente etiológico e a cicatrização. CONCLUSÃO: O CXL mostrou-se eficaz no tratamento da ceratite bacteriana resistente ao tratamento clínico, evitando a realização de transplante tectônico. Em relação à ceratite fúngica, este procedimento não influenciou na melhora do processo infeccioso.


PURPOSE: To evaluate the effect of corneal crosslinking (CXL) in the treatment of infectious keratitis resistant to medical treatment, and investigate the relation with the CXL outcome to the etiologic agent. METHODS: The study included 11 patients who were diagnosed with bacterial (seven eyes) or fungal keratitis (four eyes) at Altino Ventura Foundation from october 2011 to may 2012. All patients were using antibiotic eye drops for at least 7 days and have had no infection improvement. Patients were evaluated prior to CXL and the postoperative period until healing of the keratitis. For CXL, eyes were first instilled with a solution containing 0.1% riboflavin and 20% dextran for 30 min at a 5-minutes interval. Riboflavin-soaked eyes were then irradiated with UVA light (370ηm ± 5ηm) at 3mW/cm2 for 30 minutes. RESULTS: Eyes with bacterial infection exhibited improvement of infectious symptoms after CXL whereas eyes with fungal keratitis showed no improvement. Thus, there was a statistically significant correlation (p = 0.003) between the etiologic agent and the effectiveness of healing. CONCLUSION: CXL was effective in the treatment of bacterial keratitis resistant to clinical treatment, eliminating the need for surgery. However, CXL was not effective in managing fungal keratitis.


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Middle Aged , Keratitis/drug therapy , Eye Infections, Bacterial/drug therapy , Eye Infections, Fungal/drug therapy , Cross-Linking Reagents/therapeutic use , Corneal Ulcer/diagnosis , Corneal Ulcer/drug therapy , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Visual Acuity
9.
Mediciego ; 18(n.esp)dic. 2012. tab
Article in Spanish | LILACS | ID: lil-710871

ABSTRACT

Las úlceras corneales constituyen una de las entidades de más incidencias en los servicios de urgencias, se realiza un estudio observacional descriptivo para evaluar la eficacia del uso de los colirios antibióticos fortificados en pacientes con diagnóstico de úlcera de la córnea en el departamento de oftalmología del hospital de Morón en el período comprendido de enero del 2011 hasta enero del 2012. El universo estuvo constituido por 10 pacientes de los cuales el sexo masculino fue la mayoría, predominó el grupo de más de 30 años de edad, la úlcera de etiología bacteriana y micótica fueron las más frecuentes, el tiempo de evolución previo estuvo comprendido alrededor de los 3 días, la mayoría no recibió tratamiento médico previo, las úlceras graves tuvieron una mayor incidencia así como estadía hospitalaria, el tratamiento más utilizado fue el de colirios fortificados e inyecciones subconjuntivales en los casos graves , se redujo los costos con el uso de los mismos al disminuir la utilización de los antibióticos por vía sistémica.


Subject(s)
Humans , Male , Female , Anti-Bacterial Agents/therapeutic use , Corneal Ulcer/drug therapy , Observational Studies as Topic
11.
Article in English | WPRIM | ID: wpr-221045

ABSTRACT

A healthy 27-year-old woman with a corneal ulcer underwent fibrin gluing with a bandage contact lens twice, due to an impending perforation. The ulcer lesion slowly progressed, unresponsive to topical antibiotics and amphotericin B. We removed the gluing patch and performed a corneal or scraping or biopsy with multiple amniotic membrane grafts to seal the thinned or perforated cornea. Three days after the surgery, the corneal cultures grew Fusarium, as well as Enterococcus faecalis. Three weeks after surgery, the outermost layer of amniotic membranes, serving as a temporary patch, was removed. The anterior chamber was clear without cells. The signs of infection clinically and symptomatically cleared up four weeks later. Two months after surgery, the lesion became enhanced by amniotic membranes. The use of fibrin glue in infectious keratitis should be avoided, because it not only masks the underlying lesion, but it also interferes with drug penetration into the underlying lesion.


Subject(s)
Adult , Corneal Perforation/drug therapy , Corneal Ulcer/drug therapy , Eye Infections, Fungal/microbiology , Female , Fibrin Tissue Adhesive/therapeutic use , Fusariosis/microbiology , Fusarium/isolation & purification , Humans
12.
SQUMJ-Sultan Qaboos University Medical Journal. 2009; 9 (1): 59-62
in English | IMEMR | ID: emr-92857

ABSTRACT

To study the incidence, identify the risk factors and determine the predominant microorganisms and treatment regimen of fungal corneal ulcers. This was a retrospective analysis of corneal ulcers treated in the Ophthalmology Department of Sur Hospital, Oman, undertaken from January 2004 to December 2007. Medical and microbiology records of thirty two culture proven cases of fungal keratitis were reviewed for risk factors, laboratory findings and response to treatment. Out of the total 242 corneal ulcers, 13.22% were fungal. Among the 102 culture positive cases, 31.38% were fungal isolates. Fusarium spp [50%] and Aspergillus spp [34.4%] predominated in the hyaline fungal spectrum. The important risk factors were topical steroid usage in 31.25% of cases and ocular injury in 25%. The majority of cases [90.62%] responded to 2% ketoconazole alone or in combination with 0.15% amphotericin B. Fungal ulcer remains one of the leading causes of visual disability. Indiscriminate use of topical steroids and ocular trauma are the most important risk factors. Filamentous fungi are common aetiological agents in this region. Topical ketoconazole and amphotericin B were very effective for most of the cases


Subject(s)
Humans , Keratitis/etiology , Fungi/pathogenicity , Corneal Ulcer/drug therapy , Retrospective Studies , Risk Factors
13.
Indian J Ophthalmol ; 2008 May-Jun; 56(3): 215-20
Article in English | IMSEAR | ID: sea-71567

ABSTRACT

This section provides guidelines on medical therapy of patients with infectious keratitis. In addition to initial empirical therapy, preferred medications, once the organisms responsible are isolated, are discussed. Atypical mycobacterial keratitis following lasik is described. General guidelines for supportive therapy and follow-up, of these patients are presented. Clinical response to treatment and indications for intervention are discussed. Possible causes and approach to cases refractory to medical therapy are discussed.


Subject(s)
Anti-Infective Agents/therapeutic use , Corneal Ulcer/drug therapy , Eye Infections/drug therapy , Humans , Practice Guidelines as Topic
14.
Indian J Ophthalmol ; 2008 May-Jun; 56(3): 243-5
Article in English | IMSEAR | ID: sea-70393

ABSTRACT

We report a case of Aspergillus fumigatus keratitis in a 53-year-old, well-controlled diabetic female who did not respond to standard antifungal treatment. She was started on topical natamycin eye drops, but the infiltrate continued to progress. Topical amphotericin B and systemic ketoconazole was added, however, there was no response and the infiltrate increased further. She was then switched to topical and systemic voriconazole. Steady resolution of the infiltrate was noted within 2 weeks of therapy.


Subject(s)
Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillus fumigatus/isolation & purification , Corneal Ulcer/drug therapy , Eye Infections, Fungal/drug therapy , Female , Humans , Middle Aged , Pyrimidines/therapeutic use , Triazoles/therapeutic use
15.
Article in English | IMSEAR | ID: sea-40112

ABSTRACT

OBJECTIVE: To assess the efficacy of 2% fluconazole subconjunctival injection as an adjunctive treatment in severe recalcitrant fungal corneal ulcer. DESIGN: Retrospective, non-comparative interventional case series. MATERIAL AND METHOD: From January 2007 to August 2007, the present study included six eyes of six patients with severe fungal corneal ulcer that did not respond to therapy with topical antifungal drugs, oral itraconazole (200 mg) twice a day and 10 microg intracameral amphotericin B. All of them were treated with 0.5 ml of 2% fluconazole subconjunctival injection twice a day as adjunctive therapy for 5 days then once a day till 14 days RESULTS: Three patients were successfully treated within 14 days. Two patients partially responded, and one of them underwent evisceration. The last patient did not respond to treatment and enucleation was done. Severe local and systemic side effects were not found. CONCLUSION: 0.5 ml of 2% Fluconazole subconjunctival injection can be a very useful treatment as adjunctive therapy for severe fungal keratitis, with a few mild complications, especially in cases of impending perforation or post operative such as glue application for ruptured cornea.


Subject(s)
Adult , Aged , Antifungal Agents/administration & dosage , Corneal Ulcer/drug therapy , Female , Fluconazole/administration & dosage , Health Status Indicators , Humans , Male , Middle Aged , Mycoses/drug therapy , Retrospective Studies , Treatment Outcome
16.
Arq. bras. oftalmol ; 70(5): 884-889, set.-out. 2007.
Article in English | LILACS | ID: lil-470112

ABSTRACT

PURPOSE: To report a specific line of research developed at the University of São Paulo/Brazil on fibrin glue used for sealing corneal perforations and the perspectives of use on non-perforated corneal ulcers and photorefractive keratectomy-operated corneas. METHODS: To describe fibrin glue manufacture, development of a device to test the glued perforated corneal area resistance, subsequent experimental investigations of the use of the fibrin glue in corneal perforations, reporting its efficacy, mechanical resistance experiments and histological study. Finally, the medical literature basis is searched to propose studies on the use of fibrin as a temporary basal membrane on non-perforated corneal surfaces like non-infectious corneal ulcers and on post-photorefractive keratectomy corneal surfaces. RESULTS: The development of fibrin glue, the device for resistance experiments, the efficacy, resistance and histological studies on fibrin glue used for sealing corneal perforations are reported as well as the scientific literature basis for the proposed studies on the use of fibrin as a temporary basal membrane on non-perforated corneas like non-perforated corneal ulcers and photorefractive keratectomy corneal surfaces. CONCLUSION: A specific line of research was reported on fibrin glue to seal corneal perforations at the University of São Paulo/Brazil and the theoretical perspectives for the use of fibrin in non-perforated corneal ulcers and on photorefractive keratectomy-operated corneas in an attempt to reduce corneal haze.


OBJETIVO: Relatar uma linha de pesquisa desenvolvida no Brasil (Universidade de São Paulo) em cola de fibrina para tamponamento de perfuração corneana e a perspectiva de seu uso em úlceras corneanas não perfuradas e em córneas operadas de ceratectomia fotorrefrativa. MÉTODOS: Relatar a fabricação da cola de fibrina, desenvolvimento de instrumentação para ensaio de resistência da área colada, estudo experimental da eficácia, da resistência e histológico e levantada a literatura médica para embasar proposta de estudo da cola de fibrina como membrana basal provisória sobre superfícies corneanas não perfuradas como úlceras corneanas tróficas e superfícies corneanas operadas de ceratectomia fotorrefrativa. RESULTADOS: O desenvolvimento da cola de fibrina, do equipamento para seu ensaio de resistência, os estudos experimentais de eficácia, resistência e histológico da área corneana colada com fibrina são relatados. É mostrada a base na literatura científica para a proposição de estudos com o uso de fibrina como membrana basal provisória sobre superfícies corneanas não perfuradas como úlceras tróficas e superfícies corneanas pós-ceratectomia fotorrefrativa. CONCLUSÃO: Foi relatada uma linha de pesquisa em cola de fibrina para tamponamento de perfuração corneana no Brasil (Universidade de São Paulo) e suas perspectivas teóricas de uso em úlceras corneanas não perfuradas e sobre córneas operadas de ceratectomia fotorrefrativa com intenção de reduzir "haze".


Subject(s)
Animals , Dogs , Humans , Corneal Diseases/drug therapy , Corneal Ulcer/drug therapy , Fibrin Tissue Adhesive/therapeutic use , Membranes, Artificial , Research Design , Tissue Adhesives/therapeutic use , Brazil , Cornea/injuries , Corneal Diseases/surgery , Intraocular Pressure/drug effects , Lasers, Excimer , Models, Animal , Photorefractive Keratectomy
18.
Arq. bras. oftalmol ; 68(6): 828-832, nov.-dez. 2005. tab, graf
Article in Portuguese | LILACS | ID: lil-420194

ABSTRACT

OBJETIVO: O objetivo do presente estudo é determinar os aspectos microbiológicos da ceratite infecciosa em crianças (0-18 anos) atendidas no Departamento de Oftalmologia do Hospital de Clínicas da Universidade Nacional de Assunção - Paraguai, em período de 14 anos (1988-2002). MÉTODOS: Estudo retrospectivo por análise de prontuários de 146 crianças cuja idade variou de 0 a 18 anos com úlceras de córnea de etiologia infecciosa, atendidas no Departamento de Oftalmologia do Hospital de Clínicas da Universidade Nacional de Assunção - Paraguai, no período compreendido entre março de 1988 a agosto de 2002. Todas as crianças foram submetidas a colheita de material da úlcera infecciosa e este foi encaminhado para análise microbiológica. RESULTADOS: As culturas foram positivas em 113 pacientes (77 por cento) e destas 78 (70 por cento) foram de etiologia bacteriana e 35 (30 por cento) foram de etiologia fúngica. Das bactérias isoladas, as principais foram: 18 (23,1 por cento) estafilococos coagulase-negativo, 15 (19,2 por cento) Staphylococcus aureus, 10 (12,8 por cento) Pseudomonas aeruginosa e 10 (12,8 por cento) Streptococcus pneumoniae. Foram isolados 35 fungos dos quais os principais foram: 9 (25 por cento) Acremonium ssp, seguidos de 5 (14 por cento) Fusarium ssp, 5 (14 por cento) Aspergillus fumigatus. CONCLUSÕES: A ceratite infecciosa em crianças atendidas em um Hospital Universitário (referência terciária) na cidade de Assunção - Paraguai é com maior freqüência bacteriana, com predomínio de gram-positivos.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Corneal Ulcer/microbiology , Gram-Positive Bacteria/isolation & purification , Mitosporic Fungi/isolation & purification , Age Distribution , Acremonium/isolation & purification , Anti-Bacterial Agents/therapeutic use , Colony Count, Microbial , Corneal Ulcer/drug therapy , Corneal Ulcer/epidemiology , Ophthalmic Solutions/therapeutic use , Paraguay/epidemiology , Retrospective Studies , Risk Factors , Rural Population , Sex Distribution , Staphylococcus/isolation & purification
19.
Indian J Pediatr ; 2005 Oct; 72(10): 881-2
Article in English | IMSEAR | ID: sea-83195

ABSTRACT

A 40-day-old male child was admitted with complaints of not opening eyes from 2-3 days after birth. A diagnosis of X3-B keratomalacia was made. The treatment was done with vitamin-A to which the patient had responded. The mother of the baby had a history of night blindness throughout the pregnancy for which she was also treated. Keratomalacia secondary to vitamin-A deficiency is rare in neonates, although in children it is reported form developing countries.


Subject(s)
Adult , Age Factors , Corneal Diseases/drug therapy , Corneal Opacity/etiology , Corneal Ulcer/drug therapy , Female , Humans , Infant , Male , Night Blindness/drug therapy , Photophobia/etiology , Pregnancy , Pregnancy Complications , Time Factors , Treatment Outcome , Vitamin A/administration & dosage , Vitamin A Deficiency/drug therapy
20.
Indian J Med Microbiol ; 2005 Jul; 23(3): 168-71
Article in English | IMSEAR | ID: sea-53847

ABSTRACT

PURPOSE: To assess the changing trends in the antibiotic susceptibility of Pseudomonas spp . isolated from bacterial keratitis over a nine year period with special emphasis on fluoroquinolone susceptibilities. METHODS: All corneal scraping cultures positive for Pseudomonas spp. (n=585) isolated from patients with bacterial keratitis at the Aravind Eye Hospital, Madurai from 1995-2003 were evaluated. Cultures were performed in liquid and solid media and susceptibility testing was done against amikacin, gentamicin, tobramycin, ciprofloxacin and ofloxacin by Kirby-Bauer disc diffusion method. RESULTS: The susceptibility of Pseudomonas spp. was over 90% from 1995-1998 to ciprofloxacin which decreased to 83% from 1999-2003. The total number of isolates resistant to ciprofloxacin was 51 (9.4%). No statistically significant increase in the number of isolates resistant to ciprofloxacin was noted. Ofloxacin showed 54% susceptibility from 1995-1998 but increased to 64% from 1999-2003. Analysis of in vitro activity of amikacin reveals that there was 43% sensitivity from 1995-1998 but later it increased to 76% from 1999-2003. In case of gentamicin, the sensitivity decreased marginally from 80% to 70% through the years. Tobramycin showed 45% sensitivity from 1995-1998 but increased to 75% from 1999-2003. CONCLUSIONS: The fluoroquinolones remain a good choice in the treatment of ocular infections, with high susceptibility of Pseudomonas spp. Among the aminoglycosides, gentamicin was found to be highly effective against Pseudomonas corneal ulcers when compared to amikacin and tobramycin. The results show a need for continuous monitoring of bacterial resistance trends.


Subject(s)
Anti-Bacterial Agents/pharmacology , Corneal Ulcer/drug therapy , Drug Resistance, Bacterial , Humans , Microbial Sensitivity Tests , Pseudomonas/drug effects , Pseudomonas Infections/drug therapy , Retrospective Studies
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