ABSTRACT
PURPOSE: To report successful therapy with gatifloxacin 0.3% ophthalmic solution (Zymar) in a patient with atypical mycobacterium keratitis after penetrating keratoplasty. METHODS: A 58-year-old patient was referred for evaluation of microbial keratitis after penetrating keratoplasty. RESULTS: Clinical examination of the patient revealed an infiltrate at the inferior graft-host junction with a satellite lesion with a mild inflammatory reaction in the anterior chamber. Microbiologic evaluation confirmed the diagnosis of atypical mycobacteria keratitis. The corneal abscess was completely eradicated with a topical course of gatifloxacin 0.3% with preservation of graft clarity and good visual acuity. Topical treatment with gatifloxacin 0.3% was continued for an additional period of 5 months. CONCLUSION: Topical gatifloxacin 0.3% may be successfully used to treat microbial keratitis resulting from atypical mycobacteria.
Subject(s)
Anti-Infective Agents/therapeutic use , Corneal Ulcer/etiology , Eye Infections, Bacterial/etiology , Fluoroquinolones/therapeutic use , Keratoplasty, Penetrating/adverse effects , Mycobacterium Infections, Nontuberculous/etiology , Administration, Topical , Corneal Ulcer/diagnosis , Corneal Ulcer/drug therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Gatifloxacin , Humans , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium chelonaeABSTRACT
PURPOSE: To describe the clinical characteristics, diagnosis, treatment, and visual outcome of 61 cases of Fusarium keratitis in Mexico. METHODS: Retrospective, comparative study of 61 patients with clinically and culture-confirmed Fusarium keratitis, who were attended at an eye hospital in Mexico City from 1981 to 2001. RESULTS: Fusarium solani was the main causal agent in 83.6% of cases. Trauma history was observed in 57.4% and a history of agricultural activity in 34.4%. Signs were redness (100%), epithelial defects (98.3%), superficial corneal ulcer (95.1%), anterior chamber inflammation (91.8%), and satellite infiltrates (75.4%). In 50% of cases, the treatment was topical ketoconazole 2%; in 34.2% of cases, additional topical antifungal preparations were used. A total of 77% of patients improved and 23% worsened. Conjunctival flap was indicated in 4 of 61 patients (6.5%), and 14 of 61 patients (23%) underwent penetrating keratoplasty. Two of 61 patients were treated with tectonic keratoplasty. Evisceration surgeries were practiced in 14 of 61 patients (22.9%). The final visual acuity after medical or medical/surgical therapy, was no light perception (NLP) in 19 patients (33.33%), light perception (LP) to hand movements (HM) in 18 patients (31.57%), 20/400 to 20/200 in 1 patient (1.75%), 20/150 to 20/60 in 5 patients (8.77%), and 20/40 to 20/20 in 14 patients (24.56%). Four patients were lost to follow-up. CONCLUSIONS: Fusarium is the most common cause of fungal keratitis in Mexico. Most cases (43/54, 79.6%) improved with topical antifungal therapy (either monotherapy or combined). We suggest surgical therapy with conjunctival flap or penetrating keratoplasty in advanced cases, when there has been poor response to medical therapy or a very low final visual acuity.
Subject(s)
Eye Infections, Fungal , Fusarium , Adolescent , Adult , Aged , Agriculture , Antifungal Agents/therapeutic use , Child , Corneal Ulcer/microbiology , Eye Infections, Fungal/complications , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/etiology , Eye Infections, Fungal/therapy , Female , Humans , Keratitis/microbiology , Keratitis/pathology , Keratoplasty, Penetrating/statistics & numerical data , Male , Mexico , Middle Aged , Ophthalmologic Surgical Procedures/statistics & numerical data , Surgical Flaps/statistics & numerical data , Treatment Outcome , Young AdultABSTRACT
La degeneración corneal marginal de Terrien es un raro adelgazamiento corneal periférico. La descripción clásica es la de un adelgazamiento corneal progresivo que comienza superiormente con una excavación periférico presentando un infiltrado lípido en su borde central y vascularizado en su base; el epitelio que lo recubre está siempre intacto. La enfermedad es generalmente bilateral, pero puede ser asimétrica, ocurre predominantemente en pacientes de edad media y no está asociada a inflamación. Presentamos un caso de la enfermedad que inició en 1987 cuando la paciente tenía 8 años de edad y ha permanecido en observación hasta el presente
