Cromoforo fotoactivado con crosslinking como tratamiento para la queratitis por Acanthamoeba / Photoactivated chromophore with crosslinking as treatment for Acanthamoeba keratitis

RESUMEN Se reporta el uso del crosslinking como tratamiento de la queratitis por Acanthamoeba en una serie de 7 pacientes quienes acudieron al Servicio de Córnea por queratitis multitratadas. Se les realizó biopsia corneal, la cual se cultivó en solución de Page. Los pacientes fueron tratados con un protocolo de PACK-CXL durante más de 5 minutos y fueron sometidos a la exposición a la luz UV-A. El edema del nuevo epitelio era de 2 cruces a las 24 horas, y desapareció a las dos semanas del procedimiento en todos los casos. El porcentaje de desepitelización basal al momento del diagnóstico fue de 75,7 por ciento. La agudeza visual mejor corregida fue de entre 20/20 y 20/30. Se concluye que el uso de crosslinking en pacientes con Acanthamoeba en fases inicales pudiera ser una opción terapéutica segura y efectiva(AU)

ABSTRACT A report is presented of the use of crosslinking as treatment for Acanthamoeba keratitis in a series of 7 patients attending the Cornea Service for multitreated keratitis. Corneal biopsy was performed, which was cultured in Page solution. The patients were treated with a PACK-CXL protocol for more than 5 minutes and subjected to UV-A light exposure. Edema of the new epithelium was 2 crosses at 24 hours and disappeared 2 weeks after the procedure in all cases. Basal de-epithelialization percentage at diagnosis was 75.7 percent. Best corrected visual acuity ranged between 20/20 and 20/30. It is concluded that the use of crosslinking in patients with Acanthamoeba keratitis in its initial stages could be a safe and effective therapeutic option(AU)

Infectious keratitis in southern Brazil: a comparison culture negative and culture positive patients / Ceratite infecciosa no sul do Brasil: comparação entre pacientes com cultura negativa e positiva

Abstract Purpose: To compare clinical-epidemiological profile and treatment outcome between culture negative and culture positive keratitis patients. Methods: Patients with suspected infectious keratitis seen at two ophthalmic hospitals in Curitiba, Brazil, between June 2014 and April 2016, were prospectively studied. Ophthalmological exam with corneal scraping and microbiological tests were performed. Data regarding follow up, surgical interventions and treatment outcome were collected after 12 weeks of the first visit trough medical chart review. From the results of the culture, two groups were formed: culture negative keratitis (CNK) and culture positive keratitis (CPK). Results: According to inclusion criteria 21 patients were classified as culture negative keratitis and 20 patients as culture positive keratitis. The number of patients on antibiotic drops at the first visit was greater in CNK group (90.5% versus 60%; p=0.032). Surgical procedures were necessary in 3 patients (15%) in CNK group and in 7 patients (36,8%) in CPK group (p=0.155). Treatment success was achieved by 85% (17/20) of the patients in CNK group and by 61% (11/18) of the patients in CPK group (p=0.144). There was no significant difference between groups regarding age, gender, place of residence, presence of comorbidities, risk factors for infectious keratitis, duration of symptoms and characteristics of corneal ulcer. Conclusions: Previous treatment with antibiotics correlates with negative culture results. There was no significant difference in treatment outcome between culture negative and culture positive keratitis patients.

Resumo Objetivo: Comparar os perfis clinico-epidemiológicos e os desfechos entre pacientes com ceratite com cultura positiva e pacientes com ceratite com cultura negativa. Métodos: Pacientes com ceratite infecciosa, atendidos em dois hospitais oftalmológicos em Curitiba, Brasil, entre junho de 2014 e abril de 2016, foram estudados prospectivamente. Exame oftalmológico, raspado de córnea e exames microbiológicos foram realizados no primeiro atendimento. Os dados quanto a seguimento e desfecho foram coletados após 12 semanas do primeiro atendimento através de revisão de prontuário. A partir dos resultados das culturas, dois grupos foram formados: ceratite com cultura negativa e ceratite com cultura positiva. Resultados: Vinte e um pacientes foram classificados como ceratite com cultura negativa e 20 como ceratite com cultura positiva. O número de pacientes em uso de colírio antibiótico no primeiro atendimento foi maior no grupo de cultura negativa (90,5% versus 60%; p=0,032). Sete pacientes (37%) no grupo cultura positiva precisaram de procedimentos cirúrgicos no manejo da ceratite, versus 3 pacientes (15%) do grupo cultura negativa (p=0,155). Oitenta e cinco por cento (17/20) dos pacientes do grupo cultura negativa alcançaram sucesso no tratamento, contra 61% (11/18) dos pacientes no grupo cultura positiva (p=0,144). Não houve diferença entre os grupos quanto a idade, gênero, local de procedência, presença de comorbidades, fatores de risco, duração dos sintomas e características da úlcera de córnea. Conclusão: Tratamento prévio com colírio de antibiótico correlaciona-se com resultados negativos de cultura. Não houve diferença no desfecho após tratamento entre os pacientes com cultura negativa e cultura positiva.

Keratitis by Acanthamoeba triangularis: Report of Cases and Characterization of Isolates

Three Acanthamoeba isolates (KA/E9, KA/E17, and KA/E23) from patients with keratitis were identified as Acanthamoeba triangularis by analysis of their molecular characteristics, a species not previously recognized to be a corneal pathogen. Epidemiologic significance of A. triangularis as a keratopathogen in Korea has been discussed. Morphologic features of Acanthamoeba cysts were examined under a microscope with differential interference contrast (DIC) optics. Mitochondrial DNA (mtDNA) of the ocular isolates KA/E9, KA/E17, and KA/E23 were digested with restriction enzymes, and the restriction patterns were compared with those of reference strains. Complete nuclear 18S and mitochondrial (mt) 16S rDNA sequences were subjected to phylogenetic analysis and species identification. mtDNA RFLP of 3 isolates showed very similar patterns to those of SH621, the type strain of A. triangularis. 16S and 18S rDNA sequence analysis confirmed 3 isolates to be A. triangularis. 18S rDNA sequence differences of the isolates were 1.3% to 1.6% and those of 16S rDNA, 0.4% to 0.9% from A. triangularis SH621. To the best of our knowledge, this is the first report, confirmed by 18S and 16S rDNA sequence analysis, of keratitis caused by A. triangularis of which the type strain was isolated from human feces. Six isolates of A. triangularis had been reported from contaminated contact lens cases in southeastern Korea.

Molecular characterization of Acanthamoeba isolated from amebic keratitis related to orthokeratology lens overnight wear

In an effort to characterize, on the molecular scale, the Acanthamoeba initially isolated from the cornea of an amoebic keratitis patient associated with overnight-wear orthokeratology lens in Korea, we conducted mitochondrial DNA restriction fragment length polymorphism, 18S rDNA sequencing, and drug sensitivity analyses on the isolate (KA/PE1). The patient was treated with polyhexamethylene biguanide, chlorhexidine and oral itraconazole, which resulted in resolution of the patient's ocular inflammation. The majority of the molecular characteristics of the KA/PE1 were determined to be identical, or quite similar, to those of A. castellanii Ma strain, which had been isolated also from amoebic keratitis. The risk of Acanthamoeba keratitis as a potential complication of overnight orthokeratology is briefly discussed.

Acanthamoeba keratitis in Pondicherry.

Acanthamoeba keratitis is a potentially devastating infection of the cornea caused by the free-living amoebae, Acanthamoeba species. During the period from 1997 to 2000, a total of 136 corneal scrapings from clinically suspected cases were screened and examined for the presence of the Acanthamoeba. On examination of the direct smear by microscopy, 11 out of 136 cases were positive for Acanthamoeba. Eight patients were males and 3 were females. The age of these patients ranged from 15 to 57 years. All of these cases were agricultural workers who did not use contact lens. Four cases gave a history of injury to the eye and 1 patient gave a history of applying cow dung on the eye after the injury. Rest of the patients did not give any history of trauma or wearing contact lenses. The patients were treated with topical application of neosporin ointment. Many of our cases had complications such as poor vision (all 11 cases had 6/60 or less), scar formation (3 cases), opacity (5 cases) and corneal perforation (2 cases). This report documents for the first time the cases of Acanthamoeba keratitis in Pondicherry.

Therapy of acanthamoeba keratitis--an experimental study.

The study was conducted to determine the efficacy of various drugs/agents in the treatment of experimentally induced Acanthamoeba Keratitis (A. keratitis). Thirty rabbits were divided into 5 equal treatment groups and polyhexamethylene biguanide (PHMB) 0.02%, fluconazole 0.2%, povidone iodine 5%, aprotinin 40 IU/ml and normal saline were administered in a double blind manner, at a dose of one drop, 5 times/day. Neomycin 1700 U/ml was used as a common drug in all groups, with same frequency. Post therapy subsidence of lid oedema, mucopurulent discharge, conjunctival congestion, corneal epithelial defect and anterior chamber reactions were noted. Average healing time in days (Mean +/- S.D.) were 13.67 +/- 1.21, 22 +/- 1.41, 23.5 +/- 1.05, 17.0 +/- 1.41 and 28.0 +/- 1.90 for PHMB, fluconazole, povidone iodine, aprotinin and normal saline respectively. Lid oedema, mucopurulent discharge and conjunctival congestion improved faster in PHMB and aprotinin treated eyes. The results of this study suggest that PHMB is a better drug for A. keratitis, while aprotinin may be used as an adjuvant drug in the management of A. keratitis.

Ceratite por Acanthamoeba: relato de casos no Rio Grande do Sul / Acanthamoeba keratitis: report of cases in Rio Grande do Sul

Relato de três primeiros casos comprovados de ceratite por Acanthamoeba sp no Rio Grande do Sul. Todos os pacientes eram usuários de lentes rígidas gás-permeáveis, usando água corrente para higiene das mesmas. Um paciente teve resoluçäo do quadro clínico após 4 meses de tratamento intensivo com neomicina, biguanida, metronidazol e dexametasona tópicos. Os outros pacientes necessitaram de ceratoplastia penetrante, um após 2 meses e o outro após 14 meses de tratamento clínico intensivo (neomicina, biguanida, propamidine e dexametasona tópicos) sem sucesso. Näo houve recidiva da infestaçäo por Acanthamoeba em nenhum dos casos durante o período de seguimento (16,5 e 22 meses). O diagnóstico etiológico foi realizado pela identificaçäo de cistos e trofozoítos de Acanthamoeba no exame direto do raspado da úlcera de córnea em dois pacientes e no exame anátomo-patológico dos botöes corneanos dos que se submeteram ao transplante de córnea