Use of new-generation hybrid contact lenses for managing challenging corneas.

INTRODUCTION: To evaluate the safety and efficacy of new-generation hybrid contact lenses (HCL) among patients with irregular astigmatism. METHODS: Medical records of 25 patients fit with new-generation HCL (Eyebrid® and AirFlex®) were retrospectively reviewed. The data collected included etiology of irregular astigmatism, uncorrected visual acuity, manifest refraction, spectacle-corrected visual acuity (S-CDVA), steep / flat keratometric values, corneal astigmatism, records of rigid / soft CL fitted before HCL, all parameters of the trial lenses, and the final prescribed HCL parameters and HCL-CDVA. RESULTS: The study included 34 eyes from 25 patients (nine females and 16 males) with an average age of 29 ± 13 (ranging from 8-56) years. In total, 25 eyes with keratoconus, four with post - keratoplasty astigmatism, three with irregular astigmatism due to corneal trauma and two with residual astigmatism after radial keratotomy were fit with HCL. The mean S-CDVA (logMAR) improved significantly from 0.76 ± 0.41 to 0.14 ± 0.15 with HCL (p < 0.01). The most common indication for HCL was inability to fit with rigid gas permeable (RGP) lenses (22 eyes). The average number of lenses to successful fit was 1.4 (mode, 1; median, 1) and ideal fit was achieved with the first trial lens in 25 eyes (73%). Seven patients (nine eyes, 36%) discontinued lens use within the first 6 months because of discomfort (six eyes, 24%), ocular allergy (two eyes, 8%) and tearing of contact lens (one eye, 4%). DISCUSSION: New-generation HCL may be a suitable option for fitting challenging corneas with irregular astigmatism that cannot be rehabilitated efficiently with rigid lenses.

Atypical herpes simplex keratitis: frequency, clinical presentations and treatment results.

AIMS: To determine herpes simplex virus (HSV) DNA positivity in corneal scraping samples obtained from patients with microbial keratitis whose findings were not specific for HSV keratitis and to evaluate these particular cases with respect to clinical features and antiviral treatment results. METHODS: Records of patients with microbial keratitis treated in a tertiary eye care hospital within the 3-year period were evaluated retrospectively. Real-time polymerase chain reaction (PCR) was used to identify HSV DNA. Smear slides were evaluated by light microscopy. Patients with typical presentations and histories of HSV keratitis were excluded. RESULTS: Two hundred and seventy-six eyes of 276 patients were included in the study. HSV-1 DNA was detected in 25 eyes (9%). In these 25 eyes, the initial diagnosis was fungal or bacterial keratitis. The mean symptom duration was 20 ± 14 days (2-60 days). The risk factors were ocular surgery (20%), blepharitis (16%), trauma (8%) and contact lens wear (4%); however, the majority of patients did not have any specific cause for keratitis (52%). Clinical features were variable and not typical for any particular etiology. Culture and microscopic examinations revealed bacteria and/or fungi in 6 patients in addition to herpes infection. Antiviral treatment was successful in 72% of patients. CONCLUSION: Herpetic corneal infections can present without typical dendritic or geographic ulcers and may be masked by other infections. Real-time PCR is a useful method for rapid and definitive diagnosis. HSV infection should be considered for microbial keratitis without specific risk factors, with negative culture results and poor response to antimicrobial agents.

Corneal Collagen Cross-Linking for the Management of Mycotic Keratitis.

PURPOSE: To evaluate the efficiency of corneal collagen cross-linking (CXL) in addition to topical voriconazole in cases with mycotic keratitis. DESIGN: Retrospective case series in a tertiary university hospital. PARTICIPANTS: CXL was performed on 13 patients with mycotic keratitis who presented poor or no response to topical voriconazole treatment. METHODS: The clinical features, symptoms, treatment results and complications were recorded retrospectively. The corneal infection was graded according to the depth of infection into the stroma (from grade 1 to grade 3). The visual analogue scale was used to calculate the pain score before and 2 days after surgery. MAIN OUTCOME MEASURES: Grade of the corneal infection. RESULTS: Mean age of 13 patients (6 female and 7 male) was 42.4 ± 17.7 years (20-74 years). Fungus was demonstrated in culture (eight patients) or cytological examination (five patients). Seven of the 13 patients (54%) were healed with topical voriconazole and CXL adjuvant treatment in 26 ± 10 days (15-40 days). The remaining six patients did not respond to CXL treatment; they initially presented with higher grade ulcers. Pre- and post-operative pain score values were 8 ± 0.8 and 3.5 ± 1, respectively (p < 0.05). CONCLUSIONS: The current study suggests that adjunctive CXL treatment is effective in patients with small and superficial mycotic ulcers. These observations require further research by large randomized clinical trials.

Aspergillus flavus Keratitis: Experience of a Tertiary Eye Clinic in Turkey.

We investigated the clinical and mycological characteristics of four cases of mycotic keratitis caused by Aspergillus flavus that occurred from July 2014 to May 2015 at Çukurova University Hospital, Adana, Turkey. In a 10-month period, a total of 64 corneal smear/scrapings were examined from patients with suspected mycotic keratitis. Fungal cultures were positive in six of these patients, indicating a 9.4% incidence of mycotic keratitis in this region, including four cases of A. flavus and two cases of Fusarium spp. The predisposing factors, clinical presentation, and success of the therapeutic approaches were further evaluated. For all cases, topical voriconazole was the first choice of treatment. Surgical procedures were required to control infection in 3 of the 4 cases, including intrastromal voriconazole injection for two cases and keratoplasty for one case. Predisposing factors included trauma (two cases, 50%), contact lens use (one case, 25%), and previous ocular surgery (one case, 25%). The clinical presentations also differed, including a well-limited ulcer (one case), an ulcer with an irregular feathery margin (one case), and ulcers with satellite lesions (two cases). The mean duration between the time of presentation and definitive diagnosis by culture was 14 days (8-25 days). We observed that A. flavus keratitis can present with different underlying factors and clinical conditions. A combination of antifungal therapy and supportive surgical intervention may resolve infections caused by A. flavus in the cornea.

Polymicrobial Infection of the Cornea Due to Contact Lens Wear.

A 38-year-old male presented with pain and redness in his left eye. He had a history of wearing contact lenses. His ophthalmic examination revealed a large corneal ulcer with surrounding infiltrate. Cultures were isolated from the contact lenses, lens solutions, storage cases, and conjunctivae of both eyes and also corneal scrapings of the left eye. Fortified vancomycin and amikacin drops were started hourly. Culture results of conjunctivae of each eye and left cornea were positive for Pseudomonas aeruginosa; cultures from the contact lenses, lens solution and storage case of both eyes revealed Pseudomonas aeruginosa and Alcaligenes xylosoxidans. Polymerase chain reaction of the corneal scraping was positive for Acanthameoba. The topical antibiotics were changed with ones that both bacteria were sensitive to and anti-amoebic therapy was added. The patient had two recurrences following initial presentation despite intensive therapy. Keratitis occurred due to multiple pathogens; the relapsing course despite adequate therapy is potentially associated with this polymicrobial etiology.

Umbilical cord blood serum therapy for the management of persistent corneal epithelial defects.

AIM: To evaluate the role of umbilical cord blood serum (CBS) therapy in cases with persistent corneal epithelial defects (PED). METHODS: Sixteen eyes of 14 patients with PED who were resistant to conventional treatment were treated with 20% umbilical cord serum eye drops. Patients were followed-up weekly until epithelization was complete. The collected data included the grade of corneal lesion (Grade I: epithelial defect+superficial vascularization, Grade II: epithelial defect+stromal edema, Grade III: corneal ulcer+stromal melting), the size of epithelial defect (pretreatment, 7(th), 14(th) and 21(st) days of treatment), and follow-up time was evaluated retrospectively. RESULTS: The mean size of epithelial defect on two perpendicular axes was 5.2×4.6-mm(2) (range: 2.5-8×2.2-9 mm(2)). Mean duration of treatment was 8.3±5wk. CBS therapy was effective in 12 eyes (75%) and ineffective in 4 eyes (25%). The epithelial defects in 4 ineffective eyes were healed with amniotic membrane transplantation and tarsorrhaphy. The rate of complete healing was 12.5% by 7d, 25% by 14d, and 75% by 21d. The healing time was prolonged in Grade III eyes in comparison to eyes in Grade I or Grade II. CONCLUSION: The results of the current study indicated the safety effectiveness of CBS drops in the management of PED. The grade of disease seems have a role on the healing time.

Non-contact lens use-related Acanthamoeba keratitis in southern Turkey: evaluation of risk factors and clinical features.

PURPOSE: To assess the diagnostic methods, risk factors, and clinical features of Acanthamoeba keratitis cases in patients who do not wear contact lenses. METHODS: Medical records of 26 consecutive patients with non-contact lens-related Acanthamoeba keratitis, who were followed up at the tertiary eye care center between May 2010 and May 2012, were analyzed. Laboratory, demographic, and clinical findings were evaluated pertaining to the patients. RESULTS: Twenty-six non-contact lens-related Acanthamoeba keratitis cases were included in the study. The main risk factors were trauma (group 1, n = 13 patients) and ocular surface disease (group 2, n = 12 patients). One patient had both of the risk factors mentioned above. Overall test results showed that Acanthamoeba positivity rates were 15.3% for direct microscopy, 46.1% for culture, 92.3% for conventional polymerase chain reaction (PCR), and 100% for real-time PCR. The rates of full-thickness corneal involvement and ring-shaped infiltrations were higher in group 2, whereas superficial keratitis and radial keratoneuritis were higher in group 1. The final visual acuities were significantly better in group 1 than group 2 (p<0.025). CONCLUSIONS: This study is the first regional report from Turkey about Acanthamoeba keratitis in non-contact lens users. A majority of cases admitted to a tertiary eye care center were related to trauma or ocular surface disease. Physician suspicion is critically important for the timely diagnosis of these cases. At this point, molecular diagnostic tests (PCR or real-time PCR) seem to support the clinical diagnosis of Acanthamoeba keratitis with the help of fast and reliable results.

Posttraumatic keratitis caused by Elizabethkingia meningosepticum.

OBJECTIVE: To present a case of bacterial keratitis caused by Elizabethkingia meningosepticum in an eye after trauma. METHOD: Case report. RESULT: A 45-year-old woman was referred to our cornea clinic for keratitis, which had developed following nonpenetrating eye trauma from a tree branch. Cultures from a corneal smear demonstrated heavy growth of E. meningosepticum. Treatment with a combination of topical moxifloxacin and topical trimethoprim/polymyxin B effectively controlled the corneal ulcer. Corneal infection resolved within 2 months, but a central corneal scar and vascularization remained. CONCLUSIONS: E. meningosepticum is an opportunistic bacterium and gives rise to severe systemic infections in immunocompromised patients. Ocular infections caused by this bacterium are extremely rare in the literature. To our knowledge, this is the first report of posttraumatic keratitis caused by E. meningosepticum.

Topical anesthetic eye drops abuse: are we aware of the danger?

OBJECTIVE: To investigate the clinical results of topical anesthetic drug (TAD) abuse and to evaluate the results in terms of preventive medicine and public health. METHODS: Patients who had been followed in a cornea unit between March 2009 and November 2011 for TAD abuse keratopathy were included in the study. The demographics, duration of TAD use, symptoms, ocular findings, treatment modalities, visual acuities, complications and accompanying psychiatric problems data were obtained from medical records. RESULTS: Twelve eyes of 8 patients (3 females and 5 males) were evaluated retrospectively. One of the patients was provided the drug with a primary care pratitioner's prescription and for the other 7 patients, it was available from pharmacies without prescription. According to their clinical history, 4 patients were suffering from exposure to welding flash with a corneal foreign body, 2 from lagophthalmus-related keratopathy, 1 from traumatic corneal abrasion, and 1 from exposure to silica dust at work. The mean duration of TAD usage was 14.8 ± 7.78 days. Slit-lamp examination revealed corneal epithelial defect in all eyes, stromal opacity in 11 eyes and ring-shaped infiltrates in 8 eyes. CONCLUSION: Uncontrolled overuse of TAD can lead to serious ocular morbidities. Similarity of the clinical signs of this abuse to those of infectious keratitis together with the fact practitioners and managers to take measures to prevent the ready supply of these drugs from pharmacies and to raise public awareness with education programs.

Successful medical management of recalcitrant Fusarium solani keratitis: molecular identification and susceptibility patterns.

Fungal keratitis is a rare but sight-threatening infection of the cornea that may be caused by several fungal pathogens. A delay in diagnosis and inadequate treatment may even lead to loss of the affected eye. Fungal keratitis is often misdiagnosed as bacterial keratitis because isolation and identification of the fungal pathogen is difficult and requires experience, and fungal growth in culture requires time. In this report, a 14-year-old boy with recalcitrant Fusarium solani keratitis, unresponsive to initial therapy, is presented. CLSI M38-A2 in vitro antifungal susceptibility tests demonstrated that only amphotericin B (0.5 µg/ml) had potent activity against F. solani; however, fluconazole (>64 µg/ml), itraconazole (>16 µg/ml), voriconazole (8 µg/ml), and posaconazole (>16 µg/ml) had high minimum inhibitory concentrations. In addition, caspofungin (>16 µg/ml) and anidulafungin (>16 µg/ml) exhibited high minimum effective concentrations. Repeated intrastromal voriconazole injections, topical voriconazole, and caspofungin combined with systemic antifungal agents improved of the corneal lesion with a significant increase in visual acuity. Intrastromal voriconazole injection may be used as an adjunctive treatment method for recalcitrant fungal keratitis with no prominent complications. The intrastromal route could be an effective route of administration of antifungal agents, especially for F. solani keratitis, as in this case. A combination of various antifungal agents administered by different routes prevented loss of the eye.

Sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft for pterygium.

To study the efficacy and safety of sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft and to investigate the clinical outcomes. Thirty eyes of 30 patients with primary pterygia were treated in this institutional study with excision followed by sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft using fibrin glue tissue adhesive. The main outcome measures were the operating time for ocular surface reconstruction, the size of the pterygium and of the conjunctival autograft, postoperative complications, subjective complaints, and recurrences. The mean pterygium size was 3.12 ± 0.92 mm and the mean operating time was 4.58 ± 1.10 min. Twenty-nine patients (96.7%) had no complaints after first postoperative week. Twenty-eight (93.3%) patients had no recurrences after 1 year follow-up. The sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft is an effective procedure with low rate of recurrence. This technique can be considered as a preferred grafting procedure for primary pterygium but further randomized controlled studies including larger populations are needed.