Mischinfektionen bei kontaktlinsenassoziierter mykotischer Keratitis mit Pseudomonas oder Akanthamöben

Farah, Christian Joe; Seitz, Berthold; Hamon, Loïc; Sourlis, Chrysovalantis; Daas, Loay

doi:10.1007/s00347-020-01207-1

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…19 This allows a fast adjustment of the therapy to the fungal species. 20,21 Case no. 21 in our cohort is a perfect example of the role of IVCM as a diagnostic tool.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Severe Fungal Keratitis Using in vivo Confocal Microscopy and Early Therapeutic Penetrating Keratoplasty

Sourlis¹,

Seitz²,

Roth³

et al. 2022

OPTH

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Purpose The purpose of this study was to assess the impact of early diagnosis using in vivo confocal microscopy and early therapeutic penetrating keratoplasty (TPK) on the outcomes of severe cases of fungal keratitis. Methods This retrospective single-center study included 38 patients (40 eyes) with fungal keratitis who presented between December 2013 and February 2020. Preoperative, intraoperative, and postoperative parameters were recorded to assess the role of early correct diagnosis and early surgical therapy on visual acuity outcome and enucleation rate during follow-up. Results The mean patient age was 51 years (71% females). The initial external diagnosis was correct in 20 cases (50%). The mean time from symptom onset until admission to our department was 46.8 ± 68.0 (median 28.5) days. The mean time to correct diagnosis after admission to our department was 1 day with in vivo confocal microscopy (IVCM). IVCM was performed in 38 cases, of which 36 (sensitivity: 94.7%) were positive for fungal infection. Twenty-seven out of 40 (67.5%) eyes received a TPK 4.2 ± 3.9 days after admission, with a mean graft size of 8.9 ± 1.9 mm. Three eyes (7.5%) were enucleated. The corrected distance visual acuity of the entire study population increased from 2.0 ± 1.2 LogMAR to 0.96 ± 1.17 LogMAR. Conclusion In vivo confocal microscopy is a powerful tool for the early detection of fungal organisms in infectious keratitis. An early TPK with a large graft helps to eradicate the infection timely and results in a favorable visual acuity outcome and lower enucleation rate, especially when treating filamentous fungi.

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“…19 This allows a fast adjustment of the therapy to the fungal species. 20,21 Case no. 21 in our cohort is a perfect example of the role of IVCM as a diagnostic tool.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Severe Fungal Keratitis Using in vivo Confocal Microscopy and Early Therapeutic Penetrating Keratoplasty

Sourlis¹,

Seitz²,

Roth³

et al. 2022

OPTH

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“…Fungal keratitis is one of the most severe eye diseases worldwide and can lead to blindness. For uncontrollable infections, a surgical approach is required [11,16]. The prognosis for disease recurrence after keratoplasty is influenced by factors such as misdiagnosis, previous steroid treatment, presence of hypopyon, corneal perforation, and involvement of the limbus or the lens.…”

Section: Discussionmentioning

confidence: 99%

Large-Diameter Penetrating Keratoplasties are Mostly Due to Very Severe Infectious Keratitis and Cannot Always Prevent Secondary Enucleation

Rangel

Szentmáry

Lepper

et al. 2021

Klin Monbl Augenheilkd

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Purpose To report the indications and outcomes of penetrating keratoplasties with a graft diameter > 8.5 mm in severe corneal diseases at the Department of Ophthalmology at Saarland University Medical Centre. Study Design Retrospective (6 years), descriptive, and observational. Methods Thirty-five large-diameter penetrating keratoplasties (LDPKPs) in 27 patients (mean age, 62 ± 22 years) were performed from March 2010 to December 2016. The indication for surgery, number of previous corneal transplantations, best-corrected visual acuity (BCVA) before surgery, intraocular pressure, graft status, and BCVA at last follow-up were recorded. Results Infectious keratitis represented 83% of the indications (of those, 45% fungal). The mean corneal graft diameter was 10.8 ± 1.7 (min 8.75, max 15.0) mm. Twenty-three eyes (65% absolute) had at least one previous penetrating keratoplasty (mean graft size, 9.2 ± 1.6 mm). The mean pre-surgery BCVA was 1.96 ± 0.23 logMAR. With a mean follow-up period of 20.2 ± 13.4 months, the mean BCVA was 1.57 ± 0.57 logMAR at last follow-up. Overall, 12 grafts (35%) remained clear until the last follow-up, and in 23 grafts (65%), the primary disease recurred, or corneal decompensation developed. Up to the last follow-up, 6 eyes (17%) had to be enucleated. Conclusions In complex cases of infectious keratitis requiring a LDPKP to remove the complete pathology and preserve eye integrity, the visual outcomes are generally expected to be poor, not only because of the well-known risks of LDPKP but also because of the consequences of the infectious disease itself. This knowledge is important for adequate counselling of the patient preoperatively.

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“…Im Frühstadium kann eine mykotische Keratitis klinisch nicht sicher von anderen mikrobiellen Keratitiden unterschieden werden [ 6 ]. Da eine verzögerte Diagnose die Prognose einer visuellen Erholung deutlich reduzieren kann, spielen zur frühzeitigen Differenzialdiagnose paraklinische Untersuchungen eine wichtige Rolle, hier v. a. die in vivo konfokale Mikroskopie.…”

Section: Diskussionunclassified

Purpureocillium lilacinum

et al. 2021

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Purpureocillium lilacinum Atypischer Erreger einer mykotischen Keratitis bei einer immunkompetenten Patientin Anamnese Eine 73-jährige Patientin stellte sich notfallmäßig aufgrund seit einigen Tagen bestehender Augenschmerzen und zunehmender Visusminderung am linken Auge in unserer Klinik vor. Die Patientin hatte bis auf eine mit Brille gut korrigierte Hyperopie keine ophthalmologischen und systemischen Vorerkrankungen. Anamnestisch verneinte sie ein Trauma oder eine Verletzung am betroffenen linken Auge. Die Patientin trug keine Kontaktlinsen und war seit mehreren Jahren Rentnerin.

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Mischinfektionen bei kontaktlinsenassoziierter mykotischer Keratitis mit Pseudomonas oder Akanthamöben

Cited by 7 publications

References 11 publications

Outcomes of Severe Fungal Keratitis Using in vivo Confocal Microscopy and Early Therapeutic Penetrating Keratoplasty

Outcomes of Severe Fungal Keratitis Using in vivo Confocal Microscopy and Early Therapeutic Penetrating Keratoplasty

Large-Diameter Penetrating Keratoplasties are Mostly Due to Very Severe Infectious Keratitis and Cannot Always Prevent Secondary Enucleation

Purpureocillium lilacinum

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