Surgical management of corneal infections

Tuli, Sonal S.; Gray, Matthew P.

doi:10.1097/icu.0000000000000274

Cited by 24 publications

(10 citation statements)

References 49 publications

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“…Surgical treatment for small and superficial ulcers involves debridement of infected tissues, superficial keratectomy and tarsorrhaphy. In the presence of severe injuries at the risk of major complications, conjunctival overlay, or perforating keratoplasty are needed, especially when the responsible agents do not answer to medical therapy [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

A Novel Vitamin E TPGS-Based Formulation Enhances Chlorhexidine Bioavailability in Corneal Layers

et al. 2020

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Keratitis is a severe condition characterized by inflammation of the cornea following a local trauma. The most common ocular disease is the bacterial one, which requires an antibiotic treatment. The major limitation of this therapy is the resistance of the antibiotic. For this reason, alternative procedures have been developed and consist of antimicrobial molecules. One of the most used is the chlorhexidine gluconate, which has shown activity versus Gram-positive and Gram-negative bacteria and fungi. In addition to its efficiency, chlorhexidine shows low toxicity levels for mammalian cells and is a low-cost molecule. Despite its multiple benefits, chlorhexidine, if used at concentrations higher than 0.02% (w/w), can cause local eye irritation. Additionally, its poor penetrability through the cornea makes necessary frequent instillation of eye drops for a prolonged time. Due to these limitations, alternative drug delivery strategies are required. Here, we report a novel formulation based on the combination of d-alpha-tocopherol polyethylene glycol 1000 succinate with chlorhexidine, which results in higher accumulation of the drug in human corneas measured by liquid chromatography and strong antimicrobial activity. Moreover, this formulation does not cause any toxic effect on human cells and is well tolerated by rabbit eyes. Therefore this novel formulation represents a good candidate for the treatment of keratitis that overcomes the risk of antibiotic resistance.

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Section: Introductionmentioning

confidence: 99%

A Novel Vitamin E TPGS-Based Formulation Enhances Chlorhexidine Bioavailability in Corneal Layers

et al. 2020

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“…Severe PsK cases that require surgical transplantation of donor corneal tissue are often at potential risk of graft tissue rejection (Rush and Rush, 2016). Moreover, constant paucity of transplant tissue and recent emergence of multi-drug resistant (MDR) P. aeruginosa (MDRP) has further added to the challenge to manage PsK (Willcox, 2011; Morita et al, 2014; Vazirani et al, 2015; Tuli and Gray, 2016; Chojnacki et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Cathelicidin-Derived Synthetic Peptide Improves Therapeutic Potential of Vancomycin Against Pseudomonas aeruginosa

et al. 2019

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Pseudomonas aeruginosa (PA) is the leading cause of corneal blindness worldwide. A constant increase in multi-drug resistant PA strains have heightened the challenge of effectively managing corneal infections with conventional antibiotics. Antimicrobial peptides are promising antibiotic analogs with a unique mode of action. Cathelicidin-derived shorter peptides (FK13 and FK16) have previously been shown to kill a range of pathogens in both in vitro and in vivo systems. Here, our aim was to exploit the potential of FK13 or FK16 to enhance the anti-Pseudomonas activity of vancomycin, which normally has low clinical efficacy against PA. Our results have demonstrated that FK16 is more potent than FK13 against different PA strains including a clinical isolate from a patient’s ocular surface. FK16 was shown to enhance the membrane permeability of PAO1 at sub-inhibitory concentrations. Moreover, FK16 at lower concentrations was shown to increase the antibacterial susceptibility of vancomycin against PA strains up to eightfold. The bactericidal synergism between FK16 and vancomycin was shown to be stable in the presence of physiological tear salt concentration and did not cause toxic effects on the human corneal epithelial cells and human red blood cells. Our results have revealed that sub-inhibitory concentration of FK16 could augment the antimicrobial effects of vancomycin against PA. It is anticipated that the future exploitation of the peptide design approach may enhance the effectiveness of FK16 and its application as an adjuvant to antibiotic therapy for the treatment of multi-drug resistant infections.

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“…[ 53 ] Surgical intervention may be required for severe infectious keratitis in the form of keratoplasty or amniotic membrane transplant. [ 36 ] Recommending appropriate antimicrobial therapy also necessitates the knowledge of evolving local susceptibility patterns. A retrospective cross-sectional study spanning 12 years analyzing AMR trends in 3,685 bacterial keratitis isolates from a large tertiary eyecare hospital in south India established that the two most common organisms presenting resistance were S. pneumoniae (33%) and P. aeruginosa (24%).…”

Section: Common Bacterial Ocular Infections: Diagnosis and Managementmentioning

confidence: 99%

Emerging antimicrobial resistance and need for antimicrobial stewardship for ocular infections in India: A narrative review

Biswas¹,

Batra²,

Gurha

et al. 2022

Indian Journal of Ophthalmology

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Patients with ocular infections are at increased risk of vision impairment and may require immediate medical care to preserve their vision. Management of ocular bacterial infections has evolved in recent years and includes a pragmatic selection of broad-spectrum antibiotics based on the causative bacteria. Nevertheless, the treatment of bacterial ocular infections is increasingly becoming a challenge, as the causative bacterium acquires resistance to antibiotics through intrinsic and acquired methods. From an Indian perspective, along with the challenges of antibiotic resistance, there are other factors such as lack of knowledge on epidemiology, and lack of data on local susceptibility patterns of ocular pathogens that have significant impact on the management of ocular infections. This narrative review summarizes the available knowledge on prescribing antibiotics for five common ocular infections in India. It further highlights the significance of the understanding of antimicrobial susceptibility patterns across India as a cornerstone to promote rational use of ocular antibiotics. This review indicates that large-scale antimicrobial resistance surveillance studies can facilitate the synchronization of ophthalmic antimicrobial prescription policies with local antibiotic resistance patterns. Further, establishment of an antimicrobial stewardship program in ophthalmology can potentially increase the efficacy of diagnostic tools, and implement earlier adoption of effective antibiotics. Overall, this review provides consolidated information and key considerations for treatment decision-making of common ocular infections in India.

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Surgical management of corneal infections

Cited by 24 publications

References 49 publications

A Novel Vitamin E TPGS-Based Formulation Enhances Chlorhexidine Bioavailability in Corneal Layers

A Novel Vitamin E TPGS-Based Formulation Enhances Chlorhexidine Bioavailability in Corneal Layers

Cathelicidin-Derived Synthetic Peptide Improves Therapeutic Potential of Vancomycin Against Pseudomonas aeruginosa

Emerging antimicrobial resistance and need for antimicrobial stewardship for ocular infections in India: A narrative review

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