[Long-term follow-up of a case series of therapeutic corneal transplant]. / Transplante terapêutico de córnea: resultados prolongados de série de casos.

PURPOSE: To describe the results of therapeutic penetrating keratoplasty in patients with impending perforation or perforated infectious keratitis. METHODS: Fifty-nine charts of patients with infectious keratitis who were submitted to therapeutic penetrating keratoplasty were retrospectively reviewed at the Department of Ophthalmology of the Santa Casa of São Paulo from January 2000 to December 2004. Pre- and post operative visual acuity, biomicroscopy, echography, culture and bacterioscopy were analyzed. Patients with a minimum 9-month follow-up were included and were divided into 5 groups: herpetic, bacterial, fungal, bacterial-fungal keratitis and keratitis with negative culture bacterioscopy. RESULTS: Eradication of infection and restoration of ocular integrity were obtained in 95.2% of all bacterial keratitis; 100% fungal; 25.0% bacterial-fungal; 95.2% negative culture and 100% of all herpetic keratitis. Complications included: 2 rejections, 6 recurrences, 13 glaucomas and 1 perforation. CONCLUSION: In infectious keratitis with perforation or impending perforation that did not respond to conservative clinical therapy, therapeutic penetrating keratoplasty must be considered an alternative to eradicate infection and restore the ocular integrity.

Transplante terapêutico de córnea: resultados prolongados de série de casos / Long-term follow-up of a case series of therapeutic corneal transplant

OBJETIVO: Analisar os resultados dos transplantes terapêuticos realizados no tratamento de ceratites infecciosas. MÉTODOS: Foi feito estudo retrospectivo de 59 prontuários de pacientes com ceratite infecciosa submetidos a transplante terapêutico no Departamento de Oftalmologia da Santa Casa de São Paulo de janeiro de 2000 a dezembro de 2004. Foram obtidos dados de identificação do paciente (idade, sexo e raça), acuidade visual pré e pós-operatória, biomicroscopia pré e pós-operatória, ecografia, resultados de cultura e bacterioscopia. Foram incluídos apenas os pacientes com seguimento mínimo de 9 meses. Os pacientes foram divididos em cinco grupos: ceratite bacteriana, fúngica, mista, aquelas com cultura e/ou bacterioscopia negativa e herpética. RESULTADOS: A erradicação da infecção e o restabelecimento da integridade do bulbo ocular dentre as ceratites bacterianas foi de 95,2 por cento; nas fúngicas de 100 por cento; nas mistas de 25 por cento; naquelas com cultura e/ou bacterioscopia negativa de 95,2 por cento e nas herpéticas de 100 por cento. Dentre as complicações, foram encontrados 2 casos de rejeição, 6 de recidiva, 13 de aumento da pressão intra-ocular e 1 de perfuração. CONCLUSÃO: Nas ceratites infecciosas perfuradas ou com risco de perfuração que não respondem ao tratamento clínico conservador, o transplante terapêutico deve ser considerado importante alternativa para erradicação da infecção e restabelecimento da integridade do bulbo ocular.

PURPOSE: To describe the results of therapeutic penetrating keratoplasty in patients with impending perforation or perforated infectious keratitis. METHODS: Fifty-nine charts of patients with infectious keratitis who were submitted to therapeutic penetrating keratoplasty were retrospectively reviewed at the Department of Ophthalmology of the Santa Casa of São Paulo from January 2000 to December 2004. Pre- and post operative visual acuity, biomicroscopy, echography, culture and bacterioscopy were analyzed. Patients with a minimum 9-month follow-up were included and were divided into 5 groups: herpetic, bacterial, fungal, bacterial-fungal keratitis and keratitis with negative culture bacterioscopy. RESULTS: Erradication of infection and restoration of ocular integrity were obtained in 95.2 percent of all bacterial keratitis; 100 percent fungal; 25.0 percent bacterial-fungal; 95.2 percent negative culture and 100 percent of all herpetic keratitis. Complications included: 2 rejections, 6 recurrences, 13 glaucomas and 1 perforation. CONCLUSION: In infectious keratitis with perforation or impending perforation that did not respond to conservative clinical therapy, therapeutic penetrating keratoplasty must be considered an alternative to erradicate infection and restore the ocular integrity.

Subretinal abscess due to Nocardia farcinica resistant to trimethoprim- sulfamethoxazole in a patient with systemic lupus erythematosus.

PURPOSE: To report a case of subretinal abscess due to Nocardia farcinica resistant to trimethoprim-sulfamethoxazole in a patient with systemic lupus erythematosus on immunosuppressive therapy. DESIGN: Observational case report. METHODS: We retrospectively studied the medical record of a patient with nocardiosis. RESULTS: The microorganism disseminated from the lungs (pneumonia) to the eye and brain. The ocular lesion appeared to be a yellowish, lobulated subretinal abscess with irregular surface and superficial retinal hemorrhages. As it was not responding to empiric therapy for nocardia, pars plana vitrectomy and aspiration of the subretinal material was performed to confirm the etiology. CONCLUSION: In an immunocompromised patient with pulmonary involvement and a subretinal abscess with a characteristic aspect, one should consider nocardia as a possible etiology taking into account its possible antibiotic resistances.

Infectious keratitis in the corneal graft: treatment with partial conjunctival flaps.

BACKGROUND AND OBJECTIVE: The infection of the corneal graft is one of the most serious complications following keratoplasty. In many instances, it can be treated successfully with intensive topical and subconjunctival antibiotics. However, when this therapy is ineffective, a surgical approach must be considered. The usefulness of partial conjunctival flaps that spare the visual axis for managing corneal graft infections is reported. PATIENTS AND METHODS: Retrospective review of four cases. All patients were males between 12 and 85 years old. The four abscesses developed in the penetrating corneal graft during the first year after keratoplasty. The organisms found were Propionibacterium acnes, Candida albicans, Staphylococcus aureus, and Streptococcus pneumoniae. After failure of medical therapy, they were operated on using the partial, thick conjunctival flap technique. RESULTS: Resolution of the infection and maintenance of a clear graft was achieved in all patients. The follow-up ranged from 5 to 8 years. CONCLUSION: The partial conjunctival flap is an effective surgical procedure for the treatment of abscesses in penetrating keratoplasties when medical treatment has failed.

Corneal infections after implantation of intracorneal ring segments.

PURPOSE: To report risk factors, clinical course, and outcome in patients with infectious keratitis following implantation of intracorneal ring segments (ICRS). METHODS: The records of 8 patients with culture-proven infectious keratitis after ICRS (Ferrara or Intacs) implantation were retrospectively reviewed. Age, gender, corneal findings, ocular abnormalities, the condition that led to ICRS implantation, immediate prior use of a contact lens, elapsed time between implantation and the onset of symptoms, previous medications, and systemic disorders were noted. RESULTS: Culture-positive infectious keratitis developed in 7 eyes of 7 patients (2 men and 5 women) with a mean age of 35 years who underwent Ferrara implantation for the treatment of keratoconus and in a 29-year-old man who underwent Intacs implantation for correction of low myopia. Contact lens use, diabetes, and trauma were factors possibly associated with the risk of infection in three cases. Microorganisms, identified in all cases, included Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae, Pseudomonas sp, Nocardia sp, Klebsiella sp, and Paecylomices sp. Onset of symptoms of infection varied from less than 1 week to 22 months postoperatively, depending on the infecting organism. CONCLUSIONS: Infectious keratitis following ICRS implantation is a sight-threatening complication for which early recognition and rapid institution of appropriate treatment may result in a better visual outcome.

Inhibición de crecimiento bacteriano en aspirado de cámara anterior, usando gentamicina en la solución de irrigación en facoemulsificación con implante de lente intraocular / Bacterial grouth inhibition in the anterior chamber aspiration using gentamicine in the irrigation solution during phacoemulsification and IOL implantation

Se efectuó cultivo del líquido aspirado de CA, en el postoperatorio inmediato de facoemulsificación +LIO en 109 ojos; se usaron medios para bacterias aerobias y anaerobias; se determinó la sensibilidad a la gentamicina de las bacterias aisladas y se cuantificaron las unidades formadoras de colonias (UFC). De forma aleatoria, en 54 casos se agregó gentamicina a la solución de irrigación y en 55 no se les adicionó. Se obtuvieron 18 cultivos positivos, 5 de ellos en pacientes con antibiótico y en 13 sin antiobiótico. La prueba de Xi² fue de 0.043. Excepto por un caso con Flavobacterium spp y uno con Cardiobacterium hominis, los microorganismos aislados correspondieron a flora conjuntival habitual. Todos los UFC fueron bajos

Mycobacterium chelonae keratitis following laser in situ keratomileusis.

Corneal infection after laser in situ keratomileusis (LASIK) is rare. However, surgical trauma or breakdown of epithelium increases the risk of surface infection. We present the case of a 45 year old woman who developed keratitis due to Mycobacterium chelonae 1 month after LASIK with the Mini-Laser Sight 2000 excimer laser. After an initial improvement following antibiotic therapy the infection progressed until it was necessary to perform penetrating keratoplasty, with a successful result.