Bacterial keratitis early after corneal crosslinking with riboflavin and ultraviolet-A
ABSTRACT We report a case of bacterial keratitis 3 days after corneal crosslinking for keratoconus. The patient complained of increasing pain and redness combined with blurred vision in the treated eye starting on the first postoperative day. Clinical examination showed multiple stromal infiltrations and moderate anterior chamber inflammation. Corneal scraping revealed an Escherichia coli infection, which was successfully treated with fortified tobramycin and cephazolin eyedrops for several weeks. This is the first report of a case of rare postoperative complication resulted in an avascularized corneal scar and permanent reduction of the visual acuity.
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ABSTRACT: Purpose. To report the risk of methicillin-resistant Staphylococcus aureus (MRSA) ocular infection after UVA-riboflavin corneal collagen cross-linking in a patient with atopic dermatitis. Methods. A 22-year-old man, with bilateral evolutive keratoconus and atopic dermatitis, underwent UVA-riboflavin corneal cross-linking and presented with rapidly progressive corneal abscesses and cyclitis in the treated eye five days after surgery. The patient was admitted to the hospital and treated with broad-spectrum antimicrobic therapy. Results. The patient had positive cultures for MRSA, exhibiting a strong resistance to antibiotics. Antibiotic therapy was modified and targeted accordingly. The intravitreal reaction is extinguished, but severe damage of ocular structures was unavoidable. Conclusion. Riboflavin/UVA corneal cross-linking is considered a safe procedure and is extremely effective in halting keratoconus' progression. However, this procedure is not devoid of infectious complications, due to known risk factors and/or poor patients' hygiene compliance in the postoperative period. Atopic dermatitis is a common disease among patients with keratoconus and Staphylococcus aureus colonization is commonly found in patients with atopic dermatitis. Therefore, comorbidity with atopic dermatitis should be thoroughly assessed through clinical history before surgery. A clinical evaluation within three days after surgery and the imposition of strict personal hygiene rules are strongly recommended.03/2015; Volume 2015(Article ID 613273):6 pages. DOI:10.1155/2015/613273
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ABSTRACT: Purpose. To report the profile of microbial keratitis occurring after corneal collagen cross-linking (CXL) in keratoconus patients. Methods. A retrospective analysis of 2350 patients (1715 conventional CXL, 310 transepithelial CXL, and 325 accelerated CXL) over 7 years (from January 2007 to January 2014) of progressive keratoconus, who underwent CXL at a tertiary eye care centre, was performed. Clinical findings, treatment, and course of disease of four eyes that developed postprocedural moxifloxacin resistant Staphylococcus aureus (MXRSA) infectious keratitis are highlighted. Results. Four eyes that underwent CXL (0.0017%) had corneal infiltrates. All eyes that developed keratitis had conventional CXL. Corneal infiltrates were noted on the third postoperative day. Gram's stain as well as culture reported MXRSA as the causative agent in all cases. Polymerase chain reaction (PCR) in each case was positive for eubacterial genome. All patients were treated with fortified antibiotic eye drops, following which keratitis resolved over a 6-week period with scarring. All these patients were on long-term preoperative oral/topical steroids for chronic disorders (chronic vernal keratoconjunctivitis, bronchial asthma, and chronic eczema). Conclusion. The incidence of infectious keratitis after CXL is a rare complication (0.0017%). MXRSA is a potential organism for causing post-CXL keratitis and should be identified early and treated aggressively with fortified antibiotics.BioMed Research International 01/2014; 2014:340509. DOI:10.1155/2014/340509 · 2.71 Impact Factor
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ABSTRACT: In den letzten Jahren hat sich die Hornhautvernetzung (Corneal Crosslinking/CXL) zur Behandlung von ektatischen Hornhauterkrankungen in der Hornhautchirurgie etabliert. Die Effektivität dieses Eingriffs konnte in zahlreichen Studien belegt werden. Rezent wurden unterschiedliche Behandlungsprotokolle vorgestellt, welche die Sicherheit durch eine transepitheliale Behandlung verbessern sollen. Ebenso wurden beschleunigte Verfahren vorgestellt, um die Behandlungsdauer signifikant zu reduzieren. In dieser Übersichtsarbeit werden transepitheliale Behandlungsprotokolle sowie beschleunigte Behandlungsprotokolle beschrieben und der Stand der Evidenz beurteilt. Abstract In the recent years corneal crosslinking has been established as a routine treatment for progressive ectatic corneal diseases. The effectiveness and safety of this intervention has been proven in several trials. Recently, several new treatment protocols have been introduced with the intention to reduce treatment time or the necessity to remove the epithelium. This overview describes some of this new treatment protocols and tries to assess the research evidence in this field.Spektrum der Augenheilkunde 03/2015; 29(1):31-36. DOI:10.1007/s00717-015-0257-6 · 0.18 Impact Factor