S. apiospermum and Acanthamoeba may co-infect immune privilege sites, such as the cornea, in immunocompetent hosts. Compromised corneal surface, e.g., after trauma by sewage-contaminated objects, may increase the susceptibility for such devastating coinfection. Prevention may be possible by use of protective eyewear by high-risk individuals. Treatment should be initiated promptly with broad-spectrum antimicrobial agents after ocular injury by sewage-contaminated objects. Repeated corneal cultures and biopsies, if the cultures are negative, are warranted. Corticosteroids should be withheld until the causative agents are identified and targeted treatment is initiated.

Background/Aims: Simultaneous ureteric and rectal stricture due to pelvic actinomycosis is very rare and only a few cases of either rectal or ureteric stricture have been reported. Our aim is to report a case of stricture of the rectum and the right ureter due to pelvic actinomycosis infection in a 63-year-old man. Methods: Explorative laparotomy and biopsies of the inflammatory pelvic mass were the only procedures that led to the definitive diagnosis of actinomycosis. Temporary diverting colostomy, drainage of the right ureter by a pigtail catheter and postoperative treatment with appropriate antibiotics were successful in eradicating the inflammatory process. Conclusions: Extensive pelvic masses involving pelvic viscera should be biopsied before undertaking any major surgery because of the possibility of pelvic actinomycosis.

A 30-year-old patient with keratoconus, a stable refraction, and normal central corneal thickness had laser in situ keratomileusis (LASIK). Six months later, she had uneventful penetrating keratoplasty for keratectasia. The lamellar LASIK interface could not be clearly identified by light microscopy. The corneal wound site did not stain for methyl metalloproteinase 1 or 2. Both the corneal flap undersurface and the stromal bed were devoid of interconnections and cells. Throughout the lamellar incision, including the laser-ablated zone, the surface was smooth on scanning electron microscopy. The collagen fibrils on both sides of the incision remained well aligned with one another, indicating good flap apposition. Under higher magnification transmission electron microscopy, some collagen fragments were found in the interface, especially adjacent to the hinge. The diameter of the collagen fibrils along the lamellar wound were identical to those farther from the incision. The absence of bridging collagen fibrils and cells between the flap undersurface and the stromal bed confirms the clinically known lack of wound repair at the interface and explains the easy separation of the flap from the stromal bed months after LASIK and the possible formation of an interface fluid pocket.