[Central toxic keratopathy and fibromyalgia: a case report]. / Kératopathie centrale toxique et fibromyalgie : à propos d'un cas.

INTRODUCTION: A patient with fibromyalgia after laser refractive surgery presented bilateral diffuse lamellar keratitis complicated by central toxic keratopathy. CLINICAL CASE: A 51-year-old patient, followed for fibromyalgia, consulted for visual loss 1 week after laser in situ keratomileusis. Slit lamp examination revealed stromal infiltrate in both eyes into the flap interface. Confocal microscopy showed an infiltration of inflammatory cells into the anterior stroma and the flap interface. Intensive topical corticosteroid treatment was used and the left eye was treated with flap lifting and interface irrigation. The corneal infiltrates decreased very slowly, and the left eye developed postoperative hyperopia. Diagnosis of central toxic keratopathy was discussed. Visual acuity, highly volatile, was limited to 7/10 (right eye) and 6/10 (left eye). CONCLUSION: Diffuse lamellar keratitis (DLK) is a sterile inflammation after laser in situ keratomileusis. Central toxic keratopathy is characterized by noninflammatory central corneal opacification with a significant hyperopic shift. The cause of central toxic keratopathy is unknown. Fibromyalgia is a widespread, chronic pain disorder that includes a complex constellation of somatic and emotional symptoms. Patients often complain of dry eye sensations. Recent studies have highlighted a reduced corneal sensitivity in patients with fibromyalgia. There could be a relation between fibromyalgia, diffuse lamellar keratitis, and central toxic keratopathy. Some precautions may be used before LASIK in patients with fibromyalgia.

[Severe bacterial keratitis and activity of fluoroquinolones]. / Kératites bactériennes sévères et sensibilité des germes aux fluoroquinolones.

AIM: To study the microbiological characteristics of patients with severe bacterial keratitis in Bordeaux, France, as well as the species' resistance to fluoroquinolones. METHODS: We conducted a retrospective study of 57 patients presenting severe bacterial keratitis over 20 months. The positive bacteriological cultures of the corneal smears, bacteria, and the antibiogram were listed. RESULTS: Fifty-seven patients with severe bacterial keratitis were hospitalized from March 2005 to November 2006. Pseudomonas aeruginosa (n=17), Staphylococcus aureus (n=16), and coagulase-negative Staphylococcus (n=10) were the most frequent species. P. aeruginosa was sensitive in 100% of cases to ciprofloxacin, S. aureus was sensitive in 94% of cases to ciprofloxacin, and coagulase-negative Staphylococcus species were sensitive in 100% of cases to ciprofloxacin. No significant different was noted between ciprofloxacin, levofloxacin, and moxifloxacin on the bacteria studied (p>0.05). CONCLUSION: In this study, except for the Streptococcus species, ciprofloxacin was effective against the species responsible for severe bacterial keratitis.

[Serious bacterial keratitis: a retrospective clinical and microbiological study]. / Kératites bactériennes sévères: étude rétrospective clinique et microbiologique.

AIM: To define clinical and microbiological characteristics of patients with bacterial keratitis hospitalized in the Bordeaux University Hospital Department of Ophthalmology. METHODS: A retrospective study of patients presenting serious bacterial keratitis was conducted over 32 months. Clinical features (age, risk factors, description, and visual acuity), progression, and bacteriological characteristics were statistically analyzed. RESULTS: Seventy-three patients were hospitalized from January 2000 to August 2003. The mean age was 43.6 years old. The mean delay for referral was 6 days. Risk factors were noted in 93.1% of cases: contact lens wear (50% of risk factors); keratopathy (25%); corneal trauma (8.8%); general disease (8.8%); and corneal surgery (7.3%). Bacteriological cultures of corneal smears isolated an organism in 57.7% of cases. Pseudomonas aeruginosa (29.2%) and coagulase-negative Staphylococcus (22.9%) were the most frequent species. Gram-negative bacilli and Gram-positive cocci were also present. Gram-negative bacilli were largely dominant when associated with contact lenses (59.3% of bacteria in contact lens-related keratitis). Visual outcome was significantly correlated with anterior chamber inflammation and initial poor visual acuity. DISCUSSION: In this study, Gram-negative bacilli keratitis appeared to be clearly dominant in cases of contact lens wear. This fact is complementary to the increase in Gram-positive cocci in developed countries, even with contact lens wear.