Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 1987 to 2001

Chen, Wei-Li; Wu, Chunying; Hu, Fung‐Rong; Wang, I‐Jong

doi:10.1016/j.ajo.2003.11.010

Cited by 68 publications

(88 citation statements)

References 25 publications

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“…Therefore topical and intrastromal voriconalzole drops (1%) have been used successfully in 3 cases with resistant Acanthamoeba keratitis. Surgical management via epithelial debridement, corneal graft surgery (keratoplasty) and/or DALK (deep lamellar keratoplasty) may be required in some cases where the corneas are permanently scarred or where the topical and oral treatments have failed [25,74,81,144,173]. Recently, photorefractive surgery seems to be a very promising modality and have been used in four cases of early stage Acanthamoeba keratitis, where the patients developed large corneal abscesses in the upper third thickness of stroma [85].…”

Section: Treatmentmentioning

confidence: 99%

Pathogenesis of microbial keratitis

Lakhundi

Siddiqui

Khan

2017

Microbial Pathogenesis

181

121

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Microbial keratitis is a sight-threatening ocular infection caused by bacteria, fungi, and protist pathogens. Epithelial defects and injuries are key predisposing factors making the eye susceptible to corneal pathogens. Among bacterial pathogens, the most common agents responsible for keratitis include Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumonia and Serratia species. Fungal agents of corneal infections include both filamentous as well as yeast, including Fusarium, Aspergillus, Phaeohyphomycetes, Curvularia, Paecilomyces, Scedosporium and Candida species, while in protists, Acanthamoeba spp. are responsible for causing ocular disease. Clinical features include redness, pain, tearing, blur vision and inflammation but symptoms vary depending on the causative agent. The underlying molecular mechanisms associated with microbial pathogenesis include virulence factors as well as the host factors that aid in the progression of keratitis, resulting in damage to the ocular tissue. The treatment therefore should focus not only on the elimination of the culprit but also on the neutralization of virulence factors to minimize the damage, in addition to repairing the damaged tissue. A complete understanding of the pathogenesis of microbial keratitis will lead to the rational development of therapeutic interventions. This is a timely review of our current understanding of the advances made in this field in a comprehensible manner. Coupled with the recently available genome sequence information and high throughput genomics technology, and the availability of innovative approaches, this will stimulate interest in this field.

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Section: Treatmentmentioning

confidence: 99%

Pathogenesis of microbial keratitis

Lakhundi

Siddiqui

Khan

2017

Microbial Pathogenesis

181

121

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“…In severe cases of corneal infections refractory to maximal medical therapy, treatment of microbial keratitis may require corneal transplantation [52,[54][55][56]. Of note, survival rates of grafts performed for this indication tend to be significantly lower than comparable rates for other conditions [56].…”

Section: Complications Of Exposure Keratopathymentioning

confidence: 99%

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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Exposure keratopathy (EK) is a frequently overlooked complication seen in nearly 60% of sedated or intubated intensive care unit (ICU) patients. Signs and symptoms of EK often start as mild subjective complaints of eye pain and irritation, but can progress to vision loss in the most severe cases. For many critically ill patients, the presence of sedation effectively precludes their ability to communicate clinical complaints typically associated with EK. This, combined with the potentially severe sequelae, makes EK a potentially preventable complication and a patient safety issue. Clinical management of EK can be challenging for both providers and patients due to the nature of treatment with eye drops and ointments as well as the burden and expense of associated procedural interventions. Risk factors for EK have been extensively described in the literature, and wider dissemination of this knowledge should facilitate education of physicians and nurses regarding EK prevention. The most common risk factors include lagophthalmos, chemosis, Bell's palsy, and congenital deformities. Additionally, critically ill patients are less likely to be promptly diagnosed due to the focus of staff on life-threatening problems over ocular prophylaxis. However, the potential severity of complications associated with EK mandates that prevention remains a crucial component of the care of at-risk patients. The reader will explore the broad category of adverse medical occurrences included under the umbrella term, "errors of omission" (EOO): an error category that is most likely to culminate in EK. The most critical preventive measure is education of health care providers, although this may not be enough by itself. To this end, universal precautions against EK in combination with education may be used to help combat the relatively high incidence of this easily preventable ocular pathology.

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“…Although the use of keratoplasty to treat pathological corneas has been replaced almost entirely by penetrating keratoplasty (PKP) using viable donor corneas, [5][6][7][8][9][10][11] the supply of high-quality corneas is limited in many countries due to unreliable transportation, inconsistent distribution, and limited tissue shelf life. Glycerol preservation is a simple, effective technique that facilitates long-term storage of acellular corneal tissue for up to 5 years.…”

Section: Introductionmentioning

confidence: 99%

Eye preservation tectonic graft using glycerol-preserved donor cornea

Hc¹,

Sj²,

Chao³

2012

Eye

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Aims To report the surgical outcome of tectonic graft using glycerol-preserved donor corneas to treat perforated keratitis. Methods The medical records were reviewed of all patients treated for perforated keratitis using glycerol-preserved corneas at a single institution between 1 July 2004 and 31 June 2010. The clinical features, precipitating factors, adjuvant therapies, and therapeutic outcomes were analyzed. Success was defined as re-epithelialization of the ocular surface without evisceration. Results Fourteen eyes from 14 patients (6 male and 8 female) were included. Age ranged from 58 to 84 years (average, 70.71±8.52 years) and the follow-up time ranged from 7 to 56 months (mean, 25.35 ± 16.84 months). The culture results showed five bacterial infections, five cases of fungal keratitis, and one mixed infection; the culture results were negative for three patients. Satisfactory anatomical integrity was obtained in eight grafts (57.14%) that healed with neovascularization. Six grafts (48.85%) showed delayed re-epithelialization and were repaired with conjunctival flaps to maintain ocular surface integrity. Three patients developed secondary glaucoma and received trans-scleral cyclophotocoagulation. Thirteen patients had satisfactory anatomical integrity without evisceration or exenteration, while one patient received evisceration at 39-month follow-up because of intractable glaucoma. Conclusions Glycerol-preserved donor corneas combined with anterior vitrectomy with or without conjunctival flaps may be effective substitutes for evisceration surgery in patients with perforated keratitis.

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Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 1987 to 2001

Cited by 68 publications

References 25 publications

Pathogenesis of microbial keratitis

Pathogenesis of microbial keratitis

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Eye preservation tectonic graft using glycerol-preserved donor cornea

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