Daytime Orthokeratology Associated With Infectious Keratitis by Multiple Gram-Negative Bacilli: Burkholderia cepacia, Pseudomonas putida, and Pseudomonas aeruginosa

Ying-Cheng, Lin; Lu, Chao-Kung; Chen, Ko-Hua; Hsu, Wen-Ming

doi:10.1097/01.icl.0000167714.53847.8c

Cited by 26 publications

(16 citation statements)

References 7 publications

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“…4,5 Burkholderia is resistant to most of the commonly used antibiotics as seen in our case. Timely diagnosis, complete microbiological work-up, and appropriate management can help in the treatment of keratitis caused by organisms that present rarely and are resistant to multiple drugs.…”

mentioning

confidence: 77%

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Successful Management of Burkholderia cepacia keratitis After LASIK

Reddy¹,

Tibbetts²,

Hammersmith³

et al. 2013

J Refract Surg

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Cataract surgery after corneal transplant must minimize endothelial cell damage because postoperative transplant cell counts are lower than those of normal corneas. As the femtosecond laser was successfully introduced in cataract surgery, 1,2 we applied this technology in an eye that had a previous penetrating corneal transplant.A 33-year-old man had a 7.0-mm diameter penetrating keratoplasty in his right eye 6 years prior to presentation. He later developed posterior polar cataract. The cornea was clear and corrected distance visual acuity (CDVA) was 20/40. Femtosecond laser-assisted cataract surgery (Alcon LenSx, Aliso Viejo, California) was performed as described previously.1,2 The corneal scar was peripheral to the planned capsulotomy. Centration was assessed using the pupillary edge. A 4.8-mm capsulorrhexis was performed with the femtosecond laser and the nucleus was liquefi ed.Corneal wounds were created with a 2.8-mm and 15° blade so as not to interfere with the transplant scar. The anterior chamber was fi lled with viscoelastic material, and the edge of the capsulorrhexis was identifi ed with a cystotome and removed with a capsulorrhexis forceps. After hydrodissection, the lens nucleus and cortex were aspirated with the irrigation-aspiration handpiece. A ϩ12.00-diopter (D) hydrophobic acrylic posterior chamber intraocular lens (Acrysof; Alcon Laboratories Inc, Ft Worth, Texas) was implanted in the capsular bag.On postoperative day 1, CDVA was 20/200 because of slight corneal edema, which improved to 20/25 over the next 3 months. Subjective refraction was stable at ϩ1.25 D sphere and Ϫ6.00 D cylinder at 1-year followup, with CDVA of 20/20. Corneal thickness measured with a Scheimpfl ug camera (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany) was 609 μm preoperatively and 598 μm 1 month postoperatively.We report the fi rst patient having successful laser refractive cataract surgery after penetrating keratoplasty. The curved interface aligned perfectly along the transplanted and donor cornea. Optical coherence tomography identifi ed the scar line of the transplant and the scar did not interfere with the laser capsulotomy. The corneal incisions were created manually because of the peripheral localization of the transplant scar.As reported previously, 1 the use of a femtosecond laser may minimize the ultrasound energy required to remove the nucleus, thereby preserving endothelial cells in postoperative transplant corneas. Graft failure following phacoemulsifi cation and intraocular lens implantation is reported to be between 3% and 8%. 3,4 Endothelial cell loss related to ultrasound use is usually markedly higher in transplanted corneas than in normal, unoperated eyes.5 In our case, most likely due to the use of the femtosecond laser to liquefy the nucleus, no ultrasound was required to remove the lens and endothelial cell count did not change up to 1 year after surgery.Zoltán Z. Nagy, MD, DSC Ágnes I. Takács

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confidence: 77%

“…3,4 Endothelial cell loss related to ultrasound use is usually markedly higher in transplanted corneas than in normal, unoperated eyes. 5 In our case, most likely due to the use of the femtosecond laser to liquefy the nucleus, no ultrasound was required to remove the lens and endothelial cell count did not change up to 1 year after surgery.…”

mentioning

confidence: 98%

Successful Management of Burkholderia cepacia keratitis After LASIK

Reddy¹,

Tibbetts²,

Hammersmith³

et al. 2013

J Refract Surg

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“…58 Reports of infection in orthokeratology patients in Hong Kong and elsewhere reveal that the most common pathogen is P. aeruginosa . 59 – 64 There has been one in vivo study examining the changes of ocular flora of overnight orthokeratology patients and the contamination of orthokeratology lenses and lens accessories. Boost and Cho 55 examined 41 newly fitted orthokeratology subjects before and after 12 weeks after initiation of orthokeratology treatment in Hong Kong.…”

Section: Special Circumstances Of CL Bioburdenmentioning

confidence: 99%

Microbial Contamination of Contact Lenses, Lens Care Solutions, and Their Accessories: A Literature Review

Szczotka-Flynn

Pearlman

Ghannoum

2010

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

210

155

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Purpose A contact lens (CL) can act as a vector for microorganisms to adhere to and transfer to the ocular surface. Commensal microorganisms that uneventfully cohabitate on lid margins and conjunctivae and potential pathogens that are found transiently on the ocular surface can inoculate CLs in vivo. In the presence of reduced tissue resistance, these resident microorganisms or transient pathogens can invade and colonize the cornea or conjunctiva to produce inflammation or infection. Methods The literature was reviewed and used to summarize the findings over the last 30 years on the identification, enumeration, and classification of microorganisms adherent to CLs and their accessories during the course of normal wear and to hypothesize the role that these microorganisms play in CL infection and inflammation. Results Lens handling greatly increases the incidence of lens contamination, and the ocular surface has a tremendous ability to destroy organisms. However, even when removed aseptically from the eye, more than half of lenses are found to harbor microorganisms, almost exclusively bacteria. Coagulase-negative Staphylococci are most commonly cultured from worn lenses; however, approximately 10% of lenses harbor Gram-negative and highly pathogenic species, even in asymptomatic subjects. In storage cases, the incidence of positive microbial bioburden is also typically greater than 50%. All types of care solutions can become contaminated, including up to 30% of preserved products. Conclusions The process of CL-related microbial keratitis and inflammation is thought to be preceded by the presence or transfer or both of microorganisms from the lens to the ocular surface. Thus, this detailed understanding of lens-related bioburden is important in the understanding of factors associated with infectious and inflammatory complications. Promising mechanisms to prevent bacterial colonization on lenses and lens cases are forthcoming, which may decrease the incidence of microbially driven CL complications.

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“…There are very few cases reported in literature describing microbial keratitis associated with rigid gas permeable contact lenses in orthokeratology. 24,25,26 Pseudomonas aeruginosa and acanthamoeba trophozoites organisms are more common pathogens involve in microbial keratitis related to Orthokeratology. 24,25,26 Microbiological investigation should include contact lenses and contact lenses cleaning solutions, as this offer a clue for diagnosis and appropriate treatment of microbial keratitis.…”

Section: IIImentioning

confidence: 99%

Rigid Gas permeable (RGP) contact lens induced microbial keratitis in a keratoconus patient: A case report.

Mandal¹

2012

IOSR-JDMS

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Daytime Orthokeratology Associated With Infectious Keratitis by Multiple Gram-Negative Bacilli: Burkholderia cepacia, Pseudomonas putida, and Pseudomonas aeruginosa

Abstract: Improper fitting of lenses and contamination of lenses or solutions in orthokeratology therapy are risk factors for a corneal ulcer, even when patients wear orthokeratology lenses only during the day.

Cited by 26 publications

References 7 publications

Successful Management of Burkholderia cepacia keratitis After LASIK

Successful Management of Burkholderia cepacia keratitis After LASIK

Microbial Contamination of Contact Lenses, Lens Care Solutions, and Their Accessories: A Literature Review

Rigid Gas permeable (RGP) contact lens induced microbial keratitis in a keratoconus patient: A case report.

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