Ocular mycosis at a referral center in Saudi Arabia: a 20-year study

To review the clinical experience of fungal keratitis cases at King Khaled Eye Specialist Hospital [KKESH] in Riyadh, Saudi Arabia. Retrospective observational review and analysis of 124 patient charts with confirmed diagnosis of fungal keratitis between 1984 and 2004. One hundred and twenty four eyes of 124 patients had proven fungal infection; 101 eyes had fungal keratitis and 23 eyes had fungal endophthalmitis complicating keratitis. Estimated proportion of fungal keratitis and endophthalmitis was 10.3%. Mean age was 55 years with male predominance [79.0%]. Commonly associated factors were previous intraocular surgery [38.7%] and trauma [20.9%]. Major risk factor for progressing to endophthalmitis was previous intraocular surgery [65.2%], p < 0.001. Initial laboratory results were fungal positive only in 30.6% [p < 0.001]. Commonest organisms isolated were Aspergillus spp. [29.8%] followed by Trichophyton sp. [16.1%], then Candida and Fusarium sp. Comparison of both phases of the study showed improvement in the rate of successfully treated cases from 34.6% to 58.3%, and a decline in cases progressing to endophthalmitis from 25.0% to 13.9%. Therapeutic penetrating keratoplasty increased from 26.9% to 73.6% [p < 0.001]. Thirteen eyes required enucleation or evisceration. In contrast to other studies on fungal keratitis, Aspergillus spp. and Trichophyton sp. were the most commonly isolated fungal pathogens; the former carries the worst prognosis. Risk factors included previous intraocular surgery and trauma. Poor outcome was associated with Aspergillus spp., delayed presentation, previous intraocular surgery and late surgical intervention. This study recommends early surgical intervention to improve the outcome

Spontaneous attachment of detached donor-corneal graft following Descemet's stripping automated endothelial keratoplasty

This case report presents a case that had Descemef s stripping automated endothelial keratoplasty complicated postoperatively by detached donor grafts. The patient had a well centered partially detached graft that attached spontaneously the next day without the need to re-bubble. Postoperatively he had a clear cornea, improved uncorrected visual acuity with good endothelial cell count. It is worth waiting for a partially detached well centered graft to adhere spontaneously; this would lower the possible risks of repeated anterior chamber air injections. Cases should be selected to eliminate any mechanical factor that would prevent the attachment

Long-term corneal complication of retained anterior chamber-angle foreign body

A 33-year-old patient referred to the cornea and anterior segment department to evaluate inferior corneal edema related to a retained intraocular foreign body [IOFB] in the anterior chamber-angle. The foreign body, which was a single piece of glass caused by an exploded light bulb twenty years back, was surgically removed; edema resolved and vision improved to 20/30. In the presence of an anterior chamber IOFB; long-term adverse effects should be considered. We would advise removal of the FB regardless of the inertness and location facts, as long as the risk and benefits of the surgical intervention are carefully evaluated

Fungal keratitis: a review

Keratomycosis is a vision-threatening fungal corneal infection. The dramatic increase in the number of cases over the past three decades is attributable not only to better diagnostic recognition, improved laboratory techniques and greater awareness by the ophthalmic society as a whole, but is also due to a true increase in the incidence of keratitis related to the indiscriminate use of topical broad-spectrum antibiotics, corticosteroids and immunosuppressive drugs, as well as surgical trauma. Corneal trauma has remained the main predisposing factor over the years, though in recent years HIV-positive cases and AIDS are taking the lead in certain areas. Aspergillus, Fusarium and Candida species remains the commonest 'organisms' isolated worldwide. Although the approach to this form of keratitis is similar to other types of microbial keratitis, it remains the most difficult in terms of diagnosis and management. Early recognition, prevention, prompt treatment and timely keratoplasty are crucial for a better outcome