Corneal Ulcer Management

The matrix metalloproteinases (MMPs) have been implicated in a number of diseases involving inflammation or cellular invasion.' GM 6001 is an inhibitor of most of these enzymes with Ki's in the low nanomolar range. Though potent in vitro, this molecule is short-lived in circulation with a half-life of a few minutes.

To determine the clinical efficacy and safety of moxifloxacin (1.0%) in patients with bacterial keratitis compared with patients treated with ofloxacin (0.3%) or fortified tobramycin (1.33%)/cephazolin (5%). Prospective randomized trial. A total of 229 patients diagnosed with bacterial keratitis were enrolled in the study; 78 patients were randomized to the fortified tobramycin/cephazolin group, 77 patients to the moxifloxacin group, and 74 patients to the ofloxacin group. A total of 225 patients were evaluable for safety and 198 patients were included in the efficacy analysis. After corneal specimens were obtained, the assigned study medication was instilled every hour, day and night, for 48 hours and on the third day, every hour by day and every 2 hours at night. For days 4 and 5, 1 drop every 2 hours by day and every 4 hours at night, and for days 6 and 7, 1 drop every 4 hours. After day 7, the antibiotic was tapered to every 6 hours and stopped when appropriate. Resolution of keratitis and healing of ulcer, time to cure, mean time to discharge, clinical sign score, adverse reactions to study medication, and treatment failures. Of the 186 nonexiting patients, resolution of the keratitis and healing of the ulcer occurred in 175 (94%) nonexiting patients. In the 175 patients in whom the corneal ulcer was cured, there were no statistically significant differences between the treatment groups for the mean time to cure (P = 0.25). There were no statistically significant differences between the 3 treatment groups in the various sign parameters including the sign score. A positive bacterial corneal culture was obtained in 190 (83%) of the 229 enrolled patients. The distribution of the species of bacterial organisms was similar in each treatment group and no significant difference in the percentage of isolates between the groups was observed. Twelve (5.2%) of the treated patients had serious complications (perforation or enucleation). No serious events attributable to therapy occurred during the study and all treatments were safe and well tolerated. No difference in healing rate, cure rate, or complications between fortified cephazolin and tobramycin, ofloxacin, or moxifloxacin was seen in this study.

Methods: In this interventional case series, the medical records of 6 patients with Mooren's ulcer who had cataract surgery were retrospectively reviewed. Five patients had uneventful extracapsular cataract extraction with intraocular lens (IOL) implantation, and 1 patient had phacoemulsification with IOL implantation. The visual acuity and postoperative course of the patients were reviewed. The patients were followed to detect, and if present treat, a recurrence of Mooren's ulcer.

Objetivo: Averiguar la fracción de pacientes intervenidos de un neurinoma del acústico que recuperan la función normal del nervio facial tras una parálisis facial completa postoperatoria, atendiendo a las complicaciones oftalmológicas asociadas a la falta de recuperación y sus opciones terapéuticas. Material y método: Se realiza un estudio retrospectivo de 30 pacientes intervenidos de neurinomas del acústico en nuestro servicio que, con preservación anatómica del nervio facial, presentaron una parálisis facial completa (grado VI de House-Brackmann [HB]) postoperatoria. Se analiza la evolución de la parálisis en función del tamaño tumoral, la edad del paciente, el abordaje quirúrgico y la localización del neurinoma. También se estudian las complicaciones oftalmológicas surgidas y su tratamiento. Resultados: De los 30 pacientes estudiados, sólo 5 (16,6 %) recuperaron la función normal facial (grado I de HB). Se observó una tendencia a una peor recuperación en los casos con tamaño tumoral mayor de 2 cm, de sexo masculino, edad mayor de 65 años y abordados por vía translaberíntica. Sólo un paciente presentó complicaciones oftalmológicas graves. Conclusiones: Nuestro análisis revela que un escaso porcentaje de pacientes recupera de forma completa su función facial, y que es necesario estar alerta ante posibles complicaciones oculares en este espectro de pacientes.

Purpose: To report the use of autologous serum eyedrops (ASE) for resolution of a corneal ulcer secondary to bullous keratopathy. Methods: Case report. Results: A 66-year old patient presented with an infected ulcer and hypopyon while using a bandage contact lens for bullous keratopathy. Staphylococcus warneri infection was treated with systemic and topical antibiotics, and ASE were subsequently administered to enhance re-epithelialisation and to avoid the need for a bandage contact lens. ASE treatment lead to closure of the epithelium layer within three weeks and it was subsequently tapered over the next three months. The clinical picture remained stable subjectively and objectively during the seven months of follow-up. Discussion: To the best of our knowledge this is the first report of successful use of autologous serum eyedrops in treating and preventing recurrence of ulcers in the context of bullous keratopathy.

We report the successful management of a rare case of bilateral post-laser in situ keratomileusis (LASIK) Fusarium oxysporum keratitis and propose a therapeutic strategy. A 19-year-old white man with no systemic diseases was referred to our emergency service 3 days after microkeratome-assisted myopic bilateral LASIK correction. He complained of blurred-vision, photophobia, and ocular pain. Clinical findings (satellite lesions, hypopyon) suggested fungal keratitis. Flaps were immediately lifted and rinsed with povidone-iodine 10%, and intensive topical and systemic and combined antifungal and antibacterial treatment was introduced. Topical cortisone drops were administered after 3 days. Despite initial deterioration of the clinical picture, all symptoms resolved quickly. Polymerase chain reaction indicated F oxysporum. Relapse occurred in the left eye, which was successfully managed. The final uncorrected distance visual acuity was 20/20 in both eyes. Fusarium oxysporum post-LASIK keratitis may occur in the early phase. Prompt diagnosis, interface irrigation with povidone-iodine solution, and intensive long-term treatment contribute to a favorable outcome.

Purpose: To evaluate the clinical and epidemiological aspects of contact lensrelated infectious corneal ulcers requiring hospitalization. Methods: A retrospective analysis was performed on the files of patients hospitalized for contact lens-induced corneal ulcer in the eight Belgian university hospitals over a 7-year period (January 1997 to December 2003. Diagnoses for all hospitalized patients are obligatorily registered using the ICD-9 code. Results: A total of 107 patients with contact lens-related corneal ulcers were documented: the number increased from five in 1997 to 22 in 2003. A total of 99 subjects used soft contact lenses, of whom nine used disposables, 73 planned replacement and 17 conventional lenses. Only six patients used extended wear lenses. Three patients used daily disposable lenses. The most frequently cultured organisms were Pseudomonas and other Gram-negative germs (70%) and Acanthamoeba (16%). The majority (77%) of the corneal ulcerations were centrally located and resulted in an average visual loss of four lines. Conclusion: During the study period, the number of patients hospitalized rose, which is only partially explained by the increasing prevalence of lens wearers: 3.5% and 6.5% of the Belgian population used lenses in 1995 and 2003, respectively. These factual data highlight the need for improvements in patient education.

Purpose: To examine predisposing factors, treatment costs, and visual outcome of microbial keratitis in an ophthalmic casualty and inpatient population. Design: Retrospective medical records review. Participants: Fifteen-to 64-year-olds with microbial keratitis treated at the Royal Victorian Eye and Ear Hospital between May 2001 and April 2003 (n ϭ 291). Methods: Risk factors were identified from patient files. Demographic, clinical, and microbiological data; severity; outpatient visits; hospital bed days; and vision loss were examined. Main Outcome Measures: Cost to treat (Australian dollars), vision loss, and factors influencing these outcomes. Results: Ocular trauma (106/291 [36.4%]) and contact lens (CL) wear (98/291 [33.7%])