摘要:

Purpose.To report the successful treatment of a patient withPaecilomyces lilacinusendophthalmitis infection after foreign body (FB) trauma to the cornea.Methods.A 30-year-old man presented to us with a corneal abscess and iritis 2 months after removal of a metal corneal FB. Initial corneal biopsy culture was negative. Treatment with topical 5% natamycin, 0.9% fortified gentamycin, and 5% cephalothin hourly was commenced. As a result of developing signs of endophthalmitis, two more biopsies were taken, a week apart, from the vitreous and anterior chamber, successively. The last biopsy yielded positive microbiologic results of the speciousPaecilomyces lilacinus. Intravitreal injection of 50 &mgr;g/0.5 mL of amphotericin was administered during the vitreal biopsy. Soon after isolating the speciousPaecilomyces lilacinus, the following treatment was administered: 200 mg of itraconazole bd by mouth, 5% topical natamycin every hour, 2 mg/mL of topical fluconazole every 2 hours, three anterior chamber injections of 0.35 mL of 0.1% fluconazole and two amphotericin B injections to the anterior chamber of 50 &mgr;g/0.5 mL each.Results.There appeared to be no sign of infection 6 months after initial treatment. A large, dense scar existed in the medial part of the cornea only. The pupil was secluded. The patient's visual acuity was 6/21. The eye was comfortable and all topical antifungal medication was ceased.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To describe a corneal co-infection with the fungusScedosporium apiospermumandAcanthamoebathat result in spontaneous corneal perforation.Methods.A 27-year-old man presented due to severe ocular pain in his left eye caused by a corneal ulcer. The patient was injured 7 days before presentation by metallic thread contaminated by sewage. Corneal scrapping and deep stromal biopsy were obtained and stained for microscopic evaluation with periodic acid-Schiff, Giemsa, and Gomori's methenamine silver stains. Samples were sent for aerobic and anaerobic bacterial and fungal cultures.Results.Corneal biopsy and corneal scrapping showed viableAcanthamoebacysts in the corneal stroma andS. apiospermummicelle, respectively. The fungal culture was sensitive to ketoconazole, miconazole, econasole, and traconazole. Devastating corneal perforation occurred despite aggressive antifungal and antiamoebic topical and systemic treatment initiated after diagnosis. The corneal button showed a necrotic tissue devoid of inflammatory cells and microorganisms.Conclusion.S. apiospermumandAcanthamoebamay co-infect immune privilege sites, such as the cornea, in immunocompetent hosts. Compromised corneal surface, e.g., after trauma by sewage-contaminated objects, may increase the susceptibility for such devastating co-infection. Prevention may be possible by use of protective eyewear by high-risk individuals. Treatment should be initiated promptly with broad-spectrum antimicrobial agents after ocular injury by sewage-contaminated objects. Repeated corneal cultures and biopsies, if the cultures are negative, are warranted. Corticosteroids should be withheld until the causative agents are identified and targeted treatment is initiated.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective.To report a patient with a rare clinical presentation of marginal keratitis and pyoderma gangrenosum (PG) that responded to the steroid-sparing agent azathioprine.Design.Interventional case report.Methods.Case report and MEDLINE review of the medical literature on PG-associated peripheral ulcerative keratitis (PUK) and its treatment.Results.A patient with a biopsy-proven history of PG developed an explosive episode of PUK. The ocular inflammation was minimally responsive to topical therapy and required significant long-term oral steroids for control. The patient's active skin lesions and marginal keratitis responded dramatically to systemic oral azathioprine. Since the initiation of treatment with azathioprine, there have been no subsequent recurrences of PG or marginal keratitis.Conclusions.PUK may be associated with other inflammatory conditions, such as PG and arthritis. Systemic azathioprine may successfully control ocular and extraocular conditions and should be considered in the clinical setting of topical therapy failure and/or extraocular inflammatory conditions.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To report five cases of insect wing case foreign body.Methods.Clinical presentation, investigations, management, and outcome of these cases are discussed.Results.Five patients, four males and one female, in the age group from 4 to 55 years presented with an insect wing case embedded in the cornea or peripheral limbus. All patients were relatively asymptomatic, and the foreign body was associated with vascularization and infiltration. Culture of the foreign body after removal showedStaphylococcus epidermidisin two cases andCorynebacteriumspecies andMycobacterium fortuitumin one case each. All patients responded to removal of the wing case foreign body and treatment with topical ciprofloxacin (0.3%).Conclusion.Insect wing case is an unusual foreign body and produces minimal symptoms and may be associated with infective agents in some patients.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID