Scedosporium Keratitis: An Experience From a Tertiary Eye Hospital in South India.

PURPOSE: To determine the clinical profile and prognosis of Scedosporium keratitis. METHODS: All culture-proven cases were retrospectively analyzed for demographics, clinical characteristics, treatment offered, and resolution time with sequel. RESULTS: Among the 1792 culture-proven fungal keratitis cases in the study period, 10 (0.6%) were the result of Scedosporium. The mean age of patients was 44.2 years. Eight patients were male. A history of trauma was present in 8 patients. The infiltrate involved the center of the cornea in 5 patients, whereas 4 patients had paracentral involvement and 1 patient had limbal involvement. The mean maximum diameter of infiltrate was 3.4 mm. Five cases were prescribed topical natamycin alone: 4 patients were successfully treated with this monotherapy, whereas 1 patient was lost to follow-up, but the records of the last visit revealed healing. Three patients were treated with a combination therapy of topical natamycin and 1% voriconazole: 2 patients showed complete healing of the ulcer, and 1 patient progressed to corneal perforation necessitating penetrating keratoplasty. CONCLUSIONS: To our knowledge, this is the largest case series on Scedosporium keratitis to date. This is the first study to report successful treatment of this infection with topical natamycin monotherapy. The outcome may improve if appropriate medical therapy is started early.

Outcomes After Auro Keratoprosthesis Implantation: A Low-Cost Design Based on the Boston Keratoprosthesis.

PURPOSE: To evaluate outcomes after Auro keratoprosthesis (kpro) implantation. METHODS: Retrospective observational case series. The records of all patients who were implanted with Auro kpro from December 2012 to August 2015 at a single institute were retrospectively analyzed to evaluate preoperative characteristics, postoperative outcomes, and complications. RESULTS: Fifteen cases were included in the study. Failed graft was the most common indication for the surgery (n = 14; 93.3%). The mean BCVA (Log MAR) improved from 2.20 ± 0.43 in the preoperative period to 1.46 ± 1.12 (P = 0.0247) at the mean final follow-up of 13.5 months. The best corrected visual acuity (BCVA) improved to 20/200 or better in 9 patients (60%) at the final follow-up. Postoperative complications included retroprosthetic membrane formation (n = 7; 46.7 %), graft infection (n = 4; 26.7%), sterile corneal melt (n = 3; 20%), and spontaneous optic extrusion (n = 1; 6.7%). Eleven patients retained prosthesis at the final follow-up (retention rate = 73.3%). CONCLUSIONS: Auro kpro seems to be effective in treating end-stage corneal diseases. The outcomes are comparable to Boston kpro in terms of visual acuity, postoperative complications, and retention rates.

Case of Late-Onset Fluid-Filled Descemet Membrane Detachment After Cataract Surgery and Its Management Using the Nd: YAG Laser.

PURPOSE: To report a case of late-onset fluid-filled Descemet membrane detachment (DMD) after cataract surgery. METHOD: A case report with review of literature. SUMMARY: The patient presented with DMD with turbid fluid accumulation, 19 months after cataract surgery. The DMD was successfully treated by draining the fluid into the anterior chamber via openings made in Descemet membrane using Nd:YAG laser (Neodymium-doped Yttrium Aluminum Garnet). To our knowledge, this is the first case report of fluid-filled DMD treated with the help of Nd:YAG laser.

Fungal Keratitis Caused by Exserohilum, An Emerging Pathogen.

PURPOSE: To determine the epidemiology, risk factors, clinical features, and prognosis of fungal keratitis caused by Exserohilum. METHODS: All culture-proven cases of keratomycosis caused by Exserohilum presented from January 2012 to December 2014 were retrospectively analyzed using a computerized database. RESULTS: Among 1542 cases of keratomycosis, 47 (3%) were due to Exserohilum. The mean age of presentation was 50.4 years. Males (n = 32; 68%) were more commonly affected than females (n = 15; 32%). A history of trauma was present in most of the cases (n = 38; 80.9%). The mean time of the first visit to the hospital was 6.2 days after onset of symptoms. Most of the patients (n = 24; 72.3%) had central or paracentral ulcers. The infiltrate was confined to the superficial one-third of the stroma in 39 patients (83%). Most of the patients (89.4%) responded well to topical treatment (natamycin 5% for ulcers <5 mm; voriconazole 1% was added for ulcers >5 mm or with hypopyon); 4 patients (8.5%) required therapeutic penetrating keratoplasty and 1 patient (2.1%) progressed to endophthalmitis, requiring evisceration. The mean best-corrected visual acuity in the medically treated patients improved from 0.89 (logMAR) at presentation to 0.77 at the completion of treatment (P = 0.015). CONCLUSIONS: This study signifies the importance of this new emerging pathogen that was generally regarded as rare in the past. The infection seems to be more prevalent than previously thought, especially in hot and humid areas. Vision is likely to improve if the infection is diagnosed and appropriate topical treatment is started early.