Ozonoterapia como tratamiento coadyuvante en la úlcera corneal grave bacteriana / Ozone therapy as adjunctive treatment in severe bacterial corneal ulcer / Ozonoterapia como tratamento adjuvante em úlcera bacteriana da córnea grave

Introducción: La evolución espontánea o los casos mal tratados de la úlcera corneal conllevan el riesgo de extensión de la infección, con severa afectación visual e integridad estructural del ojo. Objetivo: Describir las características clínico-epidemiológicas de pacientes con úlcera corneal grave bacteriana tratada con ozonoterapia local coadyuvante al tratamiento protocolizado. Método: Se realizó un estudio observacional, descriptivo y transversal con 48 pacientes ingresados en el servicio de Oftalmología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", de Santiago de Cuba, en el periodo de enero de 2017 a diciembre de 2019. Las variables del estudio fueron: edad, sexo, factores predisponentes, microorganismos, signos de mejoría clínica, resultados al tratamiento y complicaciones. Para la validación estadística se utilizó prueba Chi-cuadrado. Resultados: La edad promedio de los pacientes fue de 54,1 años, el 62,5 % eran hombres. Predominó el trauma ocular (63,3 %) en el sexo masculino y enfermedades oculares (44,4 %) en el femenino. La mejoría de los signos fue más representativa a los 14 días. Se logró resultados satisfactorios en el 100 % de los pacientes con microorganismos grampositivos. El 10,4 % presentó perforación corneal. Conclusiones: La ozonoterapia es una terapia válida como tratamiento en la úlcera corneal grave de etiología bacteriana y responde a la búsqueda de alternativas para pacientes con resistencia a los tratamientos antibacterianos que se ofertan en el cuadro básico de salud.

ABSTRACT Introduction: Spontaneous evolution or poorly treated cases of corneal ulcer carry the risk of extension of the infection, with severe visual impairment and damage to the structural integrity of the eye. Objective: To describe the clinical-epidemiological characteristics of patients with severe bacterial corneal ulcer treated with local ozone therapy as an adjunct to the standard protocol treatment. Method: An observational, descriptive and cross-sectional study was carried out on 48 patients admitted to the Ophthalmology service of the Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", from Santiago de Cuba, in the period from January 2017 to December 2019. The study variables were: age, gender, predisposing factors, microorganisms, signs of clinical improvement, treatment results and complications. Chi-square test was used for statistical validation. Results: The average age of the patients was 54.1 years; 62.5% of them were men. Ocular trauma (63.3%) predominated in males, and ocular diseases (44.4%) in females. The improvement of the signs was more common after 14 days. Satisfactory results were achieved in 100% of patients with gram-positive organisms. 10.4% presented corneal perforation. Conclusions: Ozone therapy is valid as a treatment for severe corneal ulcer of bacterial etiology, and responds to the search for alternatives for patients with resistance to the antibacterial treatments that are offered in the basic health system.

RESUMO Introdução: A evolução espontânea ou casos mal tratados de úlcera de córnea trazem o risco de extensão da infecção, com comprometimento visual grave e integridade estrutural do olho. Objetivo: Descrever as características clínico-epidemiológicas de pacientes com úlcera bacteriana de córnea grave tratados com ozonioterapia local como coadjuvante ao tratamento protocolizado. Método: Foi realizado um estudo observacional, descritivo e transversal com 48 pacientes internados no serviço de Oftalmologia do Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", de Santiago de Cuba, no período de janeiro de 2017 a dezembro de 2019. As variáveis do estudo foram: idade, sexo, fatores predisponentes, microrganismos, sinais de melhora clínica, resultados do tratamento e complicações. O teste do qui-quadrado foi usado para validação estatística. Resultados: A idade média dos pacientes foi de 54,1 anos, 62,5% eram homens. O trauma ocular (63,3%) predominou no sexo masculino e as doenças oculares (44,4%) no feminino. A melhoria da sinalização foi mais representativa aos 14 dias. Resultados satisfatórios foram alcançados em 100% dos pacientes com organismos gram-positivos. 10,4% apresentaram perfuração corneana. Conclusões: A ozonioterapia é uma terapia válida como tratamento para úlcera de córnea grave de etiologia bacteriana e responde à busca de alternativas para pacientes com resistência aos tratamentos antibacterianos que são oferecidos no quadro básico de saúde.

Clinical analysis of 0.01% hypochlorous acid eye drops in the treatment of bacterial corneal ulcer / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the role of 0.01% hypochlorous acid in the treatment of bacterial corneal ulcer. <p>METHODS: A total of 60 eyes of 60 patients with bacterial corneal ulcer who were admitted to the Department of Ophthalmology, the Affiliated Hospital of Xuzhou Medical University from August to December 2018 were randomly divided into control group and combined treatment group, 30 cases in each group. The control group was treated with antibiotic eye drops. The combined treatment group was treated with 0.01% hypochlorous acid aqueous solution on the basis of conventional treatment. The therapeutic effects of the two groups were observed and compared. <p>RESULTS: The ulcer healing time was significantly shortened in the combination group(<i>P</i>=0.005). However, there was no significant difference between the two groups in cure rate(<i>P</i>=0.643)and final visual acuity(<i>P</i>=0.787). There was a small number of patients with iridocyclitis in both groups, and the incidence was not statistically different(<i>P</i>=0.643). There were no complications such as corneal perforation and corneal neovascularization in both groups. Patients in the combination group had no obvious corneal irritation with 0.01% HOCI eye drops.<p>CONCLUSION: 0.01% hypochlorous acid eye drops can accelerate the healing rate of bacterial corneal ulcer without serious complications, indicating a promising future in the field of corneal ulcer treatment.

Úlcera de córnea bacteriana: agentes etiológicos, sensibilidad antimicrobiana y tratamiento instituido / Bacterial corneal ulcer: ethiological agents, antimicrobial susceptibility and treatment

La úlcera de córnea bacteriana o queratitis es una condición seria que puede llevar a la pérdida de la visión. La selección del tratamiento se basa en estudios microbiológicos y en el patrón de sensibilidad en un área geográfica determinada. El objetivo de este estudio fue conocer la sensibilidad y la mejor terapia empírica para el tratamiento de pacientes con queratitis bacteriana; de la Cátedra de Oftalmología del Hospital de Clínicas, y cuyas muestras fueron tomadas en el laboratorio de Microbiología del Instituto de Investigaciones en Ciencias de la Salud. Se revisaron las fichas de todos los pacientes con queratitis en cuyos cultivos se aislaron bacterias, desde julio de 2003 a diciembre de 2006. De 175 pacientes con queratitis, se encontró que 73 eran de origen bacteriano, encontrándose más de una bacteria en algunas muestras. De las 87 bacterias,; estafilococos coagulasa negativo (Scn: 27,6%) fueron predominantes, seguido de Staphylococcus aureus (Sau: 11,2%), Streptococcus pneumoniae (Spn: 10,3%), Pseudomonas aeruginosa (Pae: 12,6%) y Acinetobacter sp Ac - 8%). El 100% de los aislados de Scn y Sau, fue sensible a ciprofloxacina y a oxacilina, 89% y 100% a gentamicina, 80% y 88% a tobramicina, respectivamente. Todos los aislados de Spn fueron sensibles a eritromicina, de igual manera todos los aislados de Pae y Ac- a ciprofloxacina y tobramicina; 73% y 100% a gentamicina, respectivamente. El 93% de los pacientes recibió tratamiento empírico de colirio antibiótico reforzado (CAR) de cefazolina 50 mg/ml y gentamicina 16mg/ml; y 7% ciprofloxacina al 0,3%. En esta serie, para las úlceras de córnea debidas a estafilococos y a bacilos gramnegativos no fermentadores, la droga de elección es la ciprofloxacina, y debida a S. pneumoniae, eritromicina. En base a los datos obtenidos se concluye que la combinación de cefazolina y ciprofloxacina es un esquema terapéutico empírico que puede ser recomendado para las queratitis bacterianas.

Bacterial corneal ulcer or keratitis is a serious condition that can lead to visual loss. Treatment selection is based on microbiologic studies and in susceptibility pattern of the especific geographical area. The objective of this study was to determine the susceptibility and best empirical treatment of patients with bacterial keratitis of the Chair of Ophthalmology of the Hospital de Clinicas whose samples were collected in the Microbiology Laboratory of the Instituto de Investigaciones en Ciencias de la Salud. A retrospective review of the medical records of all culture-positive bacterial keratitis seen from July 2003 to December 2006 was performed. Out of 175 patients with keratitis 73 were found to be of bacterial ethiology. Of the 87 bacteria, coagulase-negative staphylococci (Scn: 27.6%) was predominant followed by Staphylococcus aureus (Sau: 11.2%), Streptococcus pneumoniae (Spn: 10.3%), Pseudomonas aeruginosa (Pae: 12.6%) and Acinetobacter sp (Ac- 8%). All Scn and Sau isolates showed susceptibility to ciprofloxacin and oxacillin, 89% and 100% to gentamicin and 80% and 88% to tobramycin, respectively. All Spn isolates were susceptible to eritromicin; all Pae and Ac- isolates were susceptible to ciprofloxacin and tobramycin, 73% and 100% to gentamicin, respectively. Ninety three percent of the patients received an empirical treatment with a reinforced antibiotic eyedrops of cefazolin 50 mg/ml and gentamicine 16mg/ml; and 7% with ciprofloxacine 0.3%. In this series, for the corneal ulcer due to Staphylococcus species and non-fermenting Gram-negative rods, the drug of choice is ciprofloxacin and for S. pneumoniae is eritromicin. Based in the results of this study, it can said that cefazolin and ciprofloxacin combination is an empirical therapeutic scheme that could be recommended for bacterial keratitis.