Bacteria commonly isolated from keratitis specimens retain antibiotic susceptibility to fluoroquinolones and gentamicin plus cephalothin.

PURPOSE: Patients presenting with presumed infective keratitis were studied to determine predisposing factors, the current susceptibilities of the bacterial isolates to a range of relevant antibiotics, the success rate of topical antibiotic treatment of keratitis and predictors of failure of topical therapy. METHODS: Corneal scrapings taken from patients who presented between January 2002 and December 2003 to the Sydney Eye Hospital Emergency Department with keratitis were cultured. The minimum inhibitory concentration of selected antibiotics was determined for each bacterial isolate using an agar dilution technique. RESULTS: One hundred and twelve consecutive patients presented with corneal ulcers. Forty-seven of the 112 (42%) patients had a growth from the corneal scraping. Potential predisposing factors were identified in 64% of patients, most frequently contact lens wear (36% of patients). Coagulase-negative staphylococci were the most common species isolated. Other common organisms isolated include Pseudomonas aeruginosa, Corynebacterium spp., Staphylococcus aureus and Streptococcus spp. CONCLUSIONS: Most microorganisms isolated from patients with bacterial keratitis showed susceptibility to ciprofloxacin and aminoglycosides. Cephalothin plus aminoglycoside constituted an effective initial broad-spectrum antibiotic combination. The success rate of topical antibiotic treatment of corneal abscess is 89%. Predictors of failure include older age group, medium or large ulcer, culture-negative keratitis, hypopyon and poor visual acuity.

Six-year review of Acanthamoeba keratitis in New South Wales, Australia: 1997-2002.

AIM: To assess the incidence and risk factors for Acanthamoeba keratitis (AK), the diagnostic interval, and the efficacy and outcome of current treatment among the population of New South Wales, Australia. METHODS: A retrospective review was carried out of all cases of AK treated at the Sydney Eye Hospital between January 1997 and December 2002. RESULTS: Twenty patients were identified with a mean follow up of 24.8 +/- 21.5 months. Acanthamoeba keratitis constitutes 4.7% of severe infective keratitis treated at Sydney Eye Hospital. The mean interval from first presentation to diagnosis was 26.6 +/- 35.1 days overall; 17.2 +/- 33.1 days for those presenting directly to our unit (69% being diagnosed within 72 h of presentation), and 44.1 +/- 34.0 days for those first presenting elsewhere. Of those with a diagnostic delay >1 month, 57% had been mistakenly diagnosed with Herpes simplex keratitis. Sixteen (80%) wore contact lenses, and eight (40%) had additional risk factors including poor lens hygiene. Complications occurred in 16 (80%), with seven (35%) requiring surgical intervention. Visual acuity improved in 18 (90%), worsened in two patients (10%), and 75% achieved 6/12 or better at last follow up. CONCLUSIONS: Acanthamoeba keratitis is a rare infection, and contact lens wear remains the commonest association, with poor hygiene constituting significant additional risk. The visual outcome has improved with the availability of effective amoebicidal agents, but patients with a diagnostic delay and non-contact lens wearers are at increased risk of recurrent disease. A high index of clinical suspicion remains the most effective strategy in implementing early treatment, and enabling a favourable outcome.

Long-term follow-up results of lamellar keratoplasty as a treatment for recurrent pterygium and for scleral necrosis induced by beta-irradiation.

PURPOSE: To evaluate the efficacy and safety of lamellar keratoplasty (LK) in the treatment of recurrent pterygium and of scleral necrosis induced by beta-irradiation. METHODS: A retrospective review of patients who, between 1988 and 2001, underwent LK for the above indications. Recurrence rates, tectonic outcomes, pre- and postoperative visual acuities, and complications were analyzed. RESULTS: In the recurrent pterygium group, LK was performed on 68 eyes. The mean age (mean +/- SD) at presentation was 45.1 +/- 13.7 years (range 17 to 77). The recurrence rate following LK was 5.9%, with a mean time to recurrence of 6.2 +/- 2.9 months (range 3 to 10). In all cases, the recurrence occurred above or below the lamellar grafts, and a second LK prevented any further recurrence. The mean length of follow-up was 27.1 +/- 26.6 months (range 3 to 132). The best-corrected visual acuity (BCVA) improved or remained unchanged in 65 of the 68 eyes (95.6%) but was reduced in the remaining three eyes (4.4%). In the scleral radionecrosis group, LK was performed on 30 eyes. The mean age at presentation was 67.7 +/- 10.3 years (range 37 to 85). Tectonic restoration was achieved in all patients. The mean length of follow-up was 49.0 +/- 45.1 months (range 8 to 120). The BCVA improved or remained unchanged in all patients. No significant complications were identified. CONCLUSION: Lamellar keratoplasty is a safe and effective treatment option for both recurrent pterygium and beta-irradiation-induced scleral necrosis. In our opinion, LK is the treatment of choice for multiple or aggressive recurrences of pterygium and a successful management option for scleral radionecrosis.