Atypical mycobacterial keratitis: Clinical outcome in nonrefractive surgery cases.

PURPOSE: To identify the predisposing factors, clinico-microbiological profiles, and treatment responses in patients with atypical mycobacterial keratitis. METHODS: The study retrospectively analyzed patients who presented at a tertiary eyecare center in eastern India with atypical mycobacterial keratitis between 2008 and 2021. The diagnostic criteria included cases positive for acid-fast bacilli on Ziehl-Nielsen stain or culture. The antibiotic susceptibility pattern was observed, and treatment was initiated accordingly. RESULTS: Out of the 29 cases, ocular predisposing factors were present in 62.1% with an antecedent history of trauma, and vegetative matter was the most common risk factor. There was no predisposing association with systemic conditions in any case. A long lag time was observed between the onset of corneal infection and presentation in 79.3% of cases, with the average time being 43.7 days. Clinical signs mimicked fungal keratitis in most cases. Typical cracked windshield appearance was only observed in two cases. Two patients presented with clinical pictures like peripheral ulcerative keratitis. Topical amikacin was used as treatment in 28 cases. Based on disk diffusion assay, 28 (96.5%) isolates were sensitive to amikacin. Twelve (41.3%) were sensitive to vancomycin, six (20.6%) to gatifloxacin, six (20.6%) to ciprofloxacin, and four (13.7%) to moxifloxacin. Twelve participants showed good final visual acuity posttreatment, which improved to over two lines of Snellen's visual acuity chart (44.5%). CONCLUSION: Atypical mycobacteria keratitis may not present with classically described clinical features. The duration of presentation, clinical presentation, special microbiological stains, targeted therapy, and antibiotic susceptibility patterns are the key to successfully managing these intractable infections and obtaining favorable outcomes.

Safety and Efficacy Profile of Corneas Harvested From Donors of Drowning Victims.

PURPOSE: The aim of this study was to analyze the tissue quality and outcomes of corneal transplants from donor corneal tissues harvested from drowning victims. METHODS: This retrospective study was conducted on corneal tissues harvested from drowning victims between March 2018 and September 2022. Details of the tissue quality and outcomes after keratoplasty were collected from the eye bank and outpatient records. RESULTS: Thirty-four donor corneas were collected from drowning victims during the study period. The mean age of the donors was 37.1 ± 20.3 years. The mean donor-to-preservation time was 4.9 ± 2.6 hours. The mean endothelial cell density was 3025 ± 271 cells/mm 2 . Twenty donor corneas (58.8%) were used at our institute, 2 were stored in glycerol for future use, and 12 were transported to other transplant centers. The overall utilization was 94.1% (32/34 corneas). Of the 20 corneas used at our institute, 17 were used for optical grafts and 3 for therapeutic indications. Of the 17 optical grafts, 10 were used for optical penetrating keratoplasty, 6 for endothelial keratoplasty, and 1 for anterior lamellar keratoplasty. The most common indication for keratoplasty was regrafting the previously failed grafts (25%). None of the transplanted eyes developed an infection in the immediate postoperative period. Eight eyes had clear grafts after 3 months. Of the 12 tissues transferred to other keratoplasty centers, 10 were used for optical grafts and 2 for therapeutic/tectonic grafts. CONCLUSIONS: Donor corneas retrieved from drowning victims may be considered safe for transplantation. The postoperative outcomes of the tissues obtained from these donors were satisfactory. Hence, these donor corneas can be optimally used in routine transplantation procedures.

Assessment of SARS-CoV-2 virus in the tear secretion of conjunctivitis patients during COVID-19 pandemic.

Purpose: : To determine the presence of SARS-CoV-2 virus in the tear secretion of conjunctivitis patients during the COVID-19 pandemic. Methods: This observational, cross-sectional study was conducted in clinically diagnosed patients with conjunctivitis attending the outpatient services of our institute from July 2021 to December 2021. The tear samples were collected from patients using Schirmer's strips or capillary tubes to detect the presence of SARS-CoV-2 by real-time PCR assay. COVID-19 vaccination and infection status, visual acuity, and clinical features were documented in all cases. Results: A total of 111 patients with symptoms of conjunctivitis were included during the study period. The mean age was 41.1 ± 13.1 years, and the mean duration of symptoms was 7.1 ± 4.4 days, with 74% males. Conjunctival congestion was mild in 69 (62.1%) patients, moderate in 30 (27%) patients, and severe in 12 (10.8%) patients. All except four had superficial punctate keratitis (SPK). Five (4.3%) patients were positive for SARS-CoV-2 RNA in their tear samples. All had mild-moderate conjunctival congestions with variable papiliofollicular reaction and SPKs, superficial hemorrhages were seen in three and pseudomembrane in one patient. They were followed up with telemedicine and three of them developed mild COVID-19-related symptoms and recovered after in-home quarantine. None of them had a previous history of COVID-19 infection and all had received COVID-19 vaccination within 2 weeks to 2 months. Conclusion: SARS-CoV-2 transmission through ocular secretion of conjunctivitis patients cannot be ignored and appropriate COVID-19-preventive behavior should be followed in ocular settings.