Update on fungal keratitis from 1999 to 2008.

PURPOSE: To report trends in fungal keratitis from a single institution between 1999 and 2008. METHODS: Retrospective chart review of the patients presenting to the cornea service with fungal keratitis from April 1999 to December 2008. RESULTS: Seventy-eight eyes of 76 patients were identified. The most common predisposing factors included contact lens use (35.9%), trauma (21.8%), and history of penetrating keratoplasty (15.4%). There was a significant increase in the rate of contact lens-related Fusarium infections over time, which peaked in 2005 and 2006 (P = 0.021). Almost 40% of fungal keratitis cases [11 of 28 eyes (39.3%)] were soft contact lens-related Fusarium infections in 2005 and 2006, and this decreased to less than 10% [2 of 25 eyes (8%)] in 2007 and 2008. The odds of having a contact lens-related Fusarium infection in 2005-2006 compared with 2007-2008 was 4.40 (95% confidence interval of 0.60-32.50) (P = 0.178). Despite the decrease in contact lens-related Fusarium infections, the number of fungal infections remained elevated in 2007 (10 eyes) and 2008 (14 eyes), including contact lens-related infections (3 in 2007 and 6 in 2008). CONCLUSIONS: A definite increase in the number of fungal keratitis cases began in 2004 and continued through 2006 during the Fusarium outbreak associated with ReNu with MoistureLoc. Despite the decrease in contact lens-related Fusarium infections, the overall number of fungal keratitis cases remained high through 2008. Fungal keratitis was more often associated with contact lens use than with trauma in this time.

In vitro susceptibility patterns of methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus corneal isolates to antibiotics.

PURPOSE: To determine the in vitro susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) isolates to various antibiotics. METHODS: All cases of bacterial keratitis caused by Staphylococcus species during 2006 and 2007 were identified. The isolates were divided according to species and susceptibility to methicillin into 4 groups: methicillin-susceptible S. aureus, methicillin-susceptible coagulase-negative Staphylococcus, MRSA, and MRCNS. Routine susceptibility testing for Staphylococcus species to methicillin and 19 other antibiotics was performed using the MicroScan POS Breakpoint Combo Panel Type 20. RESULTS: One hundred fifty-seven isolates were identified. Forty isolates were S. aureus, including 21 MRSA, and 117 isolates were coagulase-negative Staphylococcus, including 29 MRCNS. All MRSA isolates were susceptible to gentamicin, linezolid, rifampin, tetracycline, and vancomycin and were resistant to penicillin, cefazolin, cefepime, azithromycin, erythromycin, and ofloxacin. Ninety percent of MRSA isolates were resistant to fourth-generation fluoroquinolones. All MRCNS isolates were susceptible to vancomycin, chloramphenicol, linezolid, and rifampin and were resistant to penicillin, cefazolin, cefepime, and azithromycin. Sixty-five percent of the MRCNS isolates were susceptible to fourth-generation fluoroquinolones and gentamicin. CONCLUSIONS: All MRSA and MRCNS isolates were sensitive to vancomycin, linezolid, and rifampin. MRSA isolates were generally sensitive to gentamicin and tetracycline and resistant to fourth-generation fluoroquinolones. MRCNS isolates were not consistently sensitive to gentamicin, tetracycline, or fourth-generation fluoroquinolones.

Excimer laser phototherapeutic keratectomy for keratoconus nodules.

PURPOSE: To report the outcomes of contact lens-intolerant patients with keratoconus (KCN) with subepithelial nodules treated with excimer laser phototherapeutic keratectomy (PTK). METHODS: The charts of all contact lens-intolerant patients with KCN who underwent excimer laser PTK for subepithelial nodules were identified using a computer database and were retrospectively reviewed. Preoperative and postoperative visual acuity and method of correction, surgical treatment, epithelial healing, complications, and KCN nodule recurrence were all analyzed. RESULTS: Fifteen eyes of 15 patients with a minimum follow-up of 3 months were reviewed. Mean follow-up time was 23.1 months (SD +/- 42.5 months, range 3-143 months). In 9 eyes, the epithelial defect healed by postoperative day 3 and all eyes healed by postoperative day 6. There was no infection or corneal melting in any of the eyes. After PTK, 11 patients were refit successfully with rigid gas-permeable contact lenses and 4 wore glasses. Three patients had a recurrence of the KCN nodule at 3, 8, and 23 months postoperatively. One of them had a repeat PTK 23 months after the initial surgery, improving to 20/40 with contact lenses at 55 months postoperatively. Another patient decided to have a penetrating keratoplasty, and the third patient is considering repeat PTK or penetrating keratoplasty. CONCLUSION: PTK effectively removed KCN nodules without recurrences in most patients and can be a successful modality to improve contact lens tolerance and delay or avoid more invasive surgery.