Comparative study on the incidence and outcomes of pigmented versus non pigmented keratomycosis.

Purpose: To determine the incidence, outcomes and establish factors determining visual prognosis of keratomycosis due to pigmented fungi in comparison with nonpigmented fungi. Materials and Methods: All culture-proven cases of fungal keratitis from January 2006 to August 2008 were drawn from a computerized database and cases with adequate documentation were analyzed for predisposing factors, clinical characteristics, microbiology and treatment methods. Outcomes of keratitis due to pigmented and nonpigmented fungi were compared using t-test and χ2 test. Results: Of 373 cases of keratomycosis during the study period, pigmented fungi were etiological agents in 117 eyes (31.3%) and nonpigmented fungi in 256 eyes (68.7%). Eyes with nonpigmented keratitis had significantly larger ulcers (14.96 mm2 ) and poorer vision (1.42 logMAR) at presentation compared to those with keratomycosis due to pigmented fungi (P=0.01). The characteristic macroscopic pigmentation was seen in only 14.5% in the pigmented keratitis group. Both groups responded favorably to medical therapy (78.1% vs. 69.1%) with scar formation (P=0.32) and showed a significant improvement in mean visual acuity compared with that at presentation (P<0.01). Visual improvement in terms of line gainers and losers in the subgroup of eyes that experienced healing was also similar. Location of the ulcer was the only factor that had significant predictive value for visual outcome (P=0.021). Conclusion: Incidence of keratomycosis due to pigmented fungi may be increasing as compared to previous data. These eyes have similar response to medical therapy and similar visual outcome compared to nonpigmented keratitis. Central ulcers have a poor visual outcome.

Queratotoxon o anillos cornéales / Corneal rings

Los anillos cornéales habitualmente no son completos, pueden representar desde cambios fisiológicos (anillo limbar ) hasta enfermedades que, si no son diagnosticadas y tratadas oportunamente, pueden terminar con la visión, el ojo e, incluso, con la vida del paciente (anillo limbar, embriotoxon anterior, embriotoxon posterior), de la segunda a cuarta década de la vida (arco juvenil, anillo de Fleisher, anillo de Kayser-Fleisher, queratoconjutivitis alérgica, distrofia corneal anular, desgeneración marginal de Terrien) y seniles (gerotoxon). La distrofia corneal de Schnyder puede presentarse tan precozmente como al año y medio de edad. El anillo por anestésico local, lo hemos visto desde la adolescencia en adelante. Los anillos cornéales intraestromales se implantan, en general, a partir de la tercera o cuarta década de la vida. El anillo de Wessely, el anillo por queratoplastía y el anillo blanco de Cotas pueden presentarse en cualquier etapa de la vida. Respecto a su ubicación pueden ser paracentrales, paralimbares y perilesionales.

Queratitis infecciosa no viral: factores predisponentes, agentes etiológicos y diagnóstico de laboratorio / Non viral infectious keratitis: predisposing factors, etiologic agents and laboratory diagnosis

Las queratitis infecciosas poseen una elevada morbilidad, poniendo en riesgo la visión en casos graves. Dada la eficaz protección que brinda el epitelio corneal, para que ocurra una infección se requiere la presencia de factores condicionantes. El principal predisponente para las queratitis infecciosas es el uso de lentes de contacto, seguido por traumatismos y cirugías oculares y luego diversas afecciones locales o generales. Los agentes etiológicos abarcan una enorme diversidad de microorganismos, incluyendo bacterias, micobacterias, virus, hongos y parásitos. Para poder instaurar un tratamiento acotado se necesita un diagnóstico etiológico, lo que requiere una correcta toma de muestra y un exhaustivo análisis microbiológico.

Infectious keratitis cause significant morbidity and, if it is not promptly and appropriately treated, can lead to severe ocular disability. Almost all cases of keratitis are associated to predisposing conditions. In occident, the main risk factor is contact lens wear, but previous ocular surgery or trauma are also important, as well as various ocular surface diseases. An enormous diversity of etiologic agents for infectious keratitis exist, including virus, bacteria, mycobacteria, fungi and parasites. This review provides literature and personal based information about main predisposing factors, etiologic agents and pathophysiology of infectious keratitis, excluding those of viral origin. Focus is made on microbiologic procedures, describing stains and media that should be used, and highlighting their utility. A special mention on particular situations is made, including laboratory diagnosis of Acanthamoeba keratitis, utility of lens cases analysis, keratitis in patients with previous treatment, as well as molecular biology techniques described in ophthalmology.

Ictiose lamelar com complicaçöes oculares: relato de um caso / Lamelar ictiosis with ocular complications: a case report

A ictiose lamelar é uma doença caracterizada por hiperceratäo da pele, ectrópio palpebral, conjuntivite e ceratite. Apresentamos um caso de úlcera corneana por exposiçäo, com infecçäo bacteriana e micótica secundária, em um paciente portador desta patologia. Säo descritas alternativas para terapêutica ocular bem como para correçäo do ectrópio

Síndrome do olho vermelho: diagnóstico e tratamento clínico / Red eye syndrome: diagnosis and clinical treatment

A síndrome do olho vermelho possui inúmeras causas. O conhecimento do diagnóstico diferencial por parte do médico clínico facilitará a correta terapêutica até a avaliaçäo pelo especialista, principalmente no pronto-socorro. Os autores expöem, de forma simplificada, as principais causas, quadros clínicos e tratamento desta síndrome