Infectious Crystalline Keratopathy

SummaryThirty cases of microbial keratitis after penetrating keratoplasty were reviewed to examine the associated risk factors, the spectrum of pathogens and the prognosis for graft survival and visual outcome.The indications for keratoplasty in this group differed markedly from those for all corneal grafts performed with a much higher incidence of previous microbial kera titis and of herpes simplex keratitis.A positive culture was obtained in 93% of cases and in contrast to microbial kera titis overall, Gram positive organisms predominated particularly streptococcus pneumoniae and staphlycoccus aureus.Risk factors identified were loose or broken sutures, graft decompensation and a poor ocular surface environment.There was a poor prognosis for graft survival with only 23% of cases retaining a clear graft. Overall 53% of cases were regrafted. A positive culture was defined as growth of more than one colony of an organism in the inoculating streak of any culture medium.In most cases multiple colonies were grown. Culture media routinely used were blood agar, Sabouraud's medium, thioglycol late medium, nutrient broths and where indi cated Eschrichia Coli seeded non-nutrient agar for Acanthamoeba.

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“…Case-notes of patients under the care of the [1][2][3][4][5][6][7][8][9][10]. There were eight such cases.…”

Section: Methodsmentioning

confidence: 99%

Microbial keratitis after penetrating keratoplasty

Bates

Kirkness

Ficker

et al. 1990

Eye

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“…Pathological examination revealed the infectious etiology. Meisler et al described 3 patients and called the condition "infectious crystalline keratopathy" [2]. So far a total of 8 patients have been described in the literature.…”

Section: Introductionmentioning

confidence: 99%

Infectious crystalline keratopathy

et al. 1987

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In seven patients white branched crystalline opacities, which grew very slowly, were seen in the corneal stroma. They were associated with very little inflammatory activity, so that the clinical picture at first did not suggest an infectious etiology. Pathological examination, however, demonstrated colonies of bacteria between intact corneal lamellae. On bacterial examination gram-positive commensals were mainly found. All the patients described so far were found to be taking corticosteroids regularly, sometimes in combination with antibiotics. The immunosuppression brought about by corticosteroids is probably an important factor in the development of these crystalline opacities. The therapy for this infectious crystalline keratopathy is difficult and lengthy. It consists of local bactericidal antibiotics and the lowest possible dosage of corticosteroids, if necessary combined with a partial lamellar keratectomy and removal of the affected corneal tissue by fraising.

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“…The typical presentation includes minimal stromal infiltrate, an often intact overlying epithelium, and slow progression. 1 We present an atypical case of infectious crystalline keratopathy caused by Gemella haemolysans that responded exquisitely to topical vancomycin therapy.…”

mentioning

confidence: 98%

“…T he clinical entity of infectious crystalline keratopathy was first named by Meisler et al 1 They described it as a snowflake pattern, anterior, or midstromal keratopathy that occurred most commonly after keratoplasty. The typical presentation includes minimal stromal infiltrate, an often intact overlying epithelium, and slow progression.…”

mentioning

confidence: 99%