Intrastromal injection is a novel method of delivering an antibiotic agent directly to the site of keratitis. Although intrastromal antifungal agents have been used to manage refractory fungal keratitis, the experience with intrastromal antibiotic agents for bacterial keratitis is more limited. We report a case of refractory bacterial keratitis treated with an intrastromal antibiotic agent and discuss the potential for the clinical use of this modality.

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ABSTRACT.Purpose: To describe a new syndrome of tight orbit and intractable glaucoma with a poor visual prognosis. Methods: A retrospective observational case series of six patients seen at two centres between 2001 and 2007 assessing intraocular pressure (IOP), best-corrected visual acuity and visual field. Results: Three men and three women, ranging in age at diagnosis from 14 to 53 years, demonstrated similar orbital features and progressive visual field loss despite intensive management with medication and laser and operative surgery. Highest IOPs ranged from 30 to 50 mmHg. Trabeculectomy and ⁄ or glaucoma drainage devices were attempted in five patients but all failed. One patient underwent orbital decompression with achievement of IOP control. Final IOP at last follow-up was variable; only two patients achieved IOP in the normal range, with the rest ranging from 25 to 40 mmHg. All patients had advanced visual field loss. Conclusion: Tight orbit syndrome presents a serious clinical challenge. Despite maximum medical therapy and surgical intervention IOP is difficult to control, resulting in progressive visual field loss.