Clinical Effects of Intracameral Voriconazole Injection in Patients with Fungal Keratitis Refractory to Conventional Treatment

PURPOSE: To evaluate clinical effects of intracameral voriconazole injection in fungal keratitis refractory to conventional therapy. METHODS: Thirty-eight eyes of 38 patients with fungal keratitis were included in this study. The patients were divided into 3 groups: 13 patients with intracameral voriconazole injection (50 microg/0.1 ml; group A), 11 patients with intracameral amphotericin B injection (10 microg/0.1 ml; group B), and 14 patients with conventional therapy only (group C). Clinical factors including treatment success rate and time to successful treatment were evaluated. RESULTS: Treatment success was accomplished in 12 eyes in group A (92.3%), 10 eyes in group B (90.9%), and 12 eyes in group C (85.7%). Time to treatment success in group A, B, and C was 36.1 +/- 10.4 days (p = 0.04), 34.2 +/- 7.8 days (p = 0.03), and 49.5 +/- 16.7 days, respectively. Patients who had received intracameral voriconazole injection or amphotericin B showed faster fungal keratitis improvement than patients who received conventional treatment. Time to re-epithelialization and time to disappearance of hypopyon showed a similar clinical course. CONCLUSIONS: Intracameral voriconazole injection, which has a similar therapeutic effect as intracameral amphotericin B injection in the management of fungal keratitis, can be helpful in the treatment of intractable fungal keratitis.

The Changes in the Clinical Features of Pediatric Ocular Trauma

PURPOSE: To review the recent changes in the clinical features of ocular trauma in pediatric patients younger than 15 years of age. METHODS: We performed a retrospective study using clinical records of 147 patients from 1993 to 1998, and those of 175 pediatric patients younger than 15 years old from 2003 to 2007. RESULTS: The most common cause of pediatric ocular trauma in the 2000's was fist blow (66 patients, 37.7%), while that in the 1990's was trauma by stick or branch (20 patients, 13.6%) (p < 0.001). The number of patients with perforating ocular trauma decreased to 25 patients (14.3%) in the 2000's, from 55 patients (37.4%) in the 1990's (p < 0.001). The number of patients who received surgery due to ocular trauma was 87 (59.2%) in the 1990's, decreasing to 53 (30.3%) in the 2000's (p < 0.001). The number of orbital wall reconstructions increased from 6 patients (6.9%) in the 1990's to 20 patients (37.7%) in the 2000's, a statistically significant increase (p < 0.001). CONCLUSIONS: Perforating ocular trauma decreased in children in the studied age range, but non-perforating injuries caused by fist blow were increased in the years studied. These results indicate that management or establishment of preventive for pediatric violence will be helpful to lower the frequency of pediatric ocular traumas.

A Case of Herpes Simplex Keratitis after Descemet Stripping Automated Endothelial Keratoplasty

PURPOSE: To report a case of herpes simplex keratitis after descemet stripping automated endothelial keratoplasty (DSAEK). CASE SUMMARY: A 66-year-old male underwent DSAEK in his right eye due to bullous keratopathy after cataract surgery. The corneal epithelium which was removed during surgery was healed, but the patient was experiencing pain and decreased visual acuity in his right eye 1 month after surgery. Increasing corneal epithelial defects and corneal edema were observed on slit-lamp examination. Therapeutic soft contact lenses and artificial tears were used for treatment but were not effective, thus amniotic membrane transplantation was performed. Three months after transplantation, the epithelial defect appeared as a geographic ulcer suspecting to be herpes simplex keratitis; therefore, ganciclovir ophthalmic ointment and oral acyclovir were administered. Six months after antiviral therapy, the epithelial lesion of herpes simplex keratitis completely disappeared, leaving only mild corneal opacity. CONCLUSIONS: If corneal epithelial defects are persistent after DSAEK in patients even with no past history of herpes simplex keratitis, herpes simplex keratitis should be considered in the differential diagnosis.

Analysis of Long-Term Change in Corneal Sensitivity after Penetrating Keratoplasty and Associated Tear Film Parameters

PURPOSE: To evaluate the long-term changes in the corneal sensitivity and to analyze which tear film parameters correlate with corneal sensitivity after penetrating keratoplasty (PKP). METHODS: Twenty-eight eyes of 28 patients who underwent PKP were included in the present study. Corneal sensitivity, Schirmer test, tear break-up time, tear clearance rate, and keratoepitheliopathy were evaluated at 1, 3, 6, 12, and 24 months postoperatively. Then, which tear film parameters correlated with corneal sensitivity during the follow-up period were analyzed. RESULTS: Corneal sensitivity was 5.18 +/- 3.96 mm at one month postoperatively and increased to 29.64 +/- 12.39 mm (p < 0.05) at 24 months postoperatively but was still not in the normal range. Tear break-up time and keratoepitheliopathy improved at postoperative three months and six months, respectively, compared with one month postoperatively, and both measures normalized at 24 months postoperatively. Schirmer test results and tear clearance rate were in the normal range during the follow-up period. Corneal sensitivity was correlated with tear break-up time from three to 24 months postoperative and with tear clearance rate from one month to 24 months postoperative (p < 0.05). CONCLUSIONS: Change in corneal sensitivity after penetrating keratoplasty correlates with tear break-up time and tear clearance rate; therefore, tear break-up time and tear clearance rate can be used as parameters for management of dry eye after PKP.