Ozonoterapia como tratamiento coadyuvante en la úlcera corneal grave bacteriana / Ozone therapy as adjunctive treatment in severe bacterial corneal ulcer / Ozonoterapia como tratamento adjuvante em úlcera bacteriana da córnea grave

Introducción: La evolución espontánea o los casos mal tratados de la úlcera corneal conllevan el riesgo de extensión de la infección, con severa afectación visual e integridad estructural del ojo. Objetivo: Describir las características clínico-epidemiológicas de pacientes con úlcera corneal grave bacteriana tratada con ozonoterapia local coadyuvante al tratamiento protocolizado. Método: Se realizó un estudio observacional, descriptivo y transversal con 48 pacientes ingresados en el servicio de Oftalmología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", de Santiago de Cuba, en el periodo de enero de 2017 a diciembre de 2019. Las variables del estudio fueron: edad, sexo, factores predisponentes, microorganismos, signos de mejoría clínica, resultados al tratamiento y complicaciones. Para la validación estadística se utilizó prueba Chi-cuadrado. Resultados: La edad promedio de los pacientes fue de 54,1 años, el 62,5 % eran hombres. Predominó el trauma ocular (63,3 %) en el sexo masculino y enfermedades oculares (44,4 %) en el femenino. La mejoría de los signos fue más representativa a los 14 días. Se logró resultados satisfactorios en el 100 % de los pacientes con microorganismos grampositivos. El 10,4 % presentó perforación corneal. Conclusiones: La ozonoterapia es una terapia válida como tratamiento en la úlcera corneal grave de etiología bacteriana y responde a la búsqueda de alternativas para pacientes con resistencia a los tratamientos antibacterianos que se ofertan en el cuadro básico de salud.

ABSTRACT Introduction: Spontaneous evolution or poorly treated cases of corneal ulcer carry the risk of extension of the infection, with severe visual impairment and damage to the structural integrity of the eye. Objective: To describe the clinical-epidemiological characteristics of patients with severe bacterial corneal ulcer treated with local ozone therapy as an adjunct to the standard protocol treatment. Method: An observational, descriptive and cross-sectional study was carried out on 48 patients admitted to the Ophthalmology service of the Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", from Santiago de Cuba, in the period from January 2017 to December 2019. The study variables were: age, gender, predisposing factors, microorganisms, signs of clinical improvement, treatment results and complications. Chi-square test was used for statistical validation. Results: The average age of the patients was 54.1 years; 62.5% of them were men. Ocular trauma (63.3%) predominated in males, and ocular diseases (44.4%) in females. The improvement of the signs was more common after 14 days. Satisfactory results were achieved in 100% of patients with gram-positive organisms. 10.4% presented corneal perforation. Conclusions: Ozone therapy is valid as a treatment for severe corneal ulcer of bacterial etiology, and responds to the search for alternatives for patients with resistance to the antibacterial treatments that are offered in the basic health system.

RESUMO Introdução: A evolução espontânea ou casos mal tratados de úlcera de córnea trazem o risco de extensão da infecção, com comprometimento visual grave e integridade estrutural do olho. Objetivo: Descrever as características clínico-epidemiológicas de pacientes com úlcera bacteriana de córnea grave tratados com ozonioterapia local como coadjuvante ao tratamento protocolizado. Método: Foi realizado um estudo observacional, descritivo e transversal com 48 pacientes internados no serviço de Oftalmologia do Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", de Santiago de Cuba, no período de janeiro de 2017 a dezembro de 2019. As variáveis do estudo foram: idade, sexo, fatores predisponentes, microrganismos, sinais de melhora clínica, resultados do tratamento e complicações. O teste do qui-quadrado foi usado para validação estatística. Resultados: A idade média dos pacientes foi de 54,1 anos, 62,5% eram homens. O trauma ocular (63,3%) predominou no sexo masculino e as doenças oculares (44,4%) no feminino. A melhoria da sinalização foi mais representativa aos 14 dias. Resultados satisfatórios foram alcançados em 100% dos pacientes com organismos gram-positivos. 10,4% apresentaram perfuração corneana. Conclusões: A ozonioterapia é uma terapia válida como tratamento para úlcera de córnea grave de etiologia bacteriana e responde à busca de alternativas para pacientes com resistência aos tratamentos antibacterianos que são oferecidos no quadro básico de saúde.

Streptococcus pneumoniae endophthalmitis: clinical settings, antibiotic susceptibility, and visual outcomes.

Streptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.

Contact topical anesthesia for strabismus surgery in adult patients.

OBJECTIVE: To analyze the effectiveness and usefulness of contact topical anesthesia in strabismus surgery in adult patients. MATERIAL AND METHODS: A prospective study was conducted on 20 patients undergoing strabismus surgery using contact topical anesthesia and sedation with remifentanil. The intensity of pain was recorded using a numeric pain rating scale at the time of anesthesia implementation, during the surgical procedure, 30 min afterwards, and during the first postoperative day. The incidence of oculocardiac reflex, postoperative nausea and vomiting, corneal ulcers, patient satisfaction (numerically from 0 to 10) and the degree of residual ocular deviation were also assessed. RESULTS: The operation was performed successfully in all patients. Average pain intensity was 1.40 ± 1.73 during anesthesia implementation, 4.20 ± 2.57 during the surgical procedure, 2.50 ± 2.54 30 min after surgery, and 3.55 ± 2.89 during the first postoperative day. Oculocardiac reflex was observed in 7 patients (35%), postoperative nausea and vomiting in 4 (20%), and corneal ulcer in 4 (20%). The patient satisfaction was 9.53 ± 2.51. More than two-thirds (70%) of patients had a residual ocular deviation less than 10 prism diopters. CONCLUSIONS: Contact topical anesthesia is a safe and effective alternative for strabismus surgery in adult patients. Contact topical anesthesia provides adequate pain control, lower incidence of postoperative nausea and vomiting and oculocardiac reflex, and optimal setting of ocular alignment.

Ocular cicatricial pemphigoid, keratomycosis, and intravenous immunoglobulin therapy.

PURPOSE: To report the case of a patient developing fungal keratitis in the context of uncontrolled ocular cicatricial pemphigoid (OCP), which, despite intravenous immunoglobulin (IVIg) and other immunomodulatory therapy, progressed to end-stage pemphigoid, with corneal opacification, ankyloblepharon, and xerosis. Keratoprosthesis (KPro) restored functional vision for the patient. METHODS: A 39-year-old man presented with uncontrolled CP and corneal ulcer in the left eye. Conjunctival biopsy diagnosed OCP; corneal scraping and biopsy diagnosed the cause of the corneal ulcer. OCP was treated with systemic steroids, immunosuppressive drugs, and IVIg. Visual rehabilitation was accomplished with Ahmed valve and a type II Dohlman KPro. RESULTS: Immunohistology of the biopsied conjunctiva showed IgG at the epithelial basement membrane zone, confirming the clinical diagnosis of OCP. Microbiologic studies of the corneal biopsy specimen were negative for Acanthamoeba and herpes but positive for Aspergillus niger. The patient's keratomycosis resolved with topical antifungal therapy. Treatment with Dapsone, intravenous-pulse steroid, oral cyclophosphamide, and intravenous immunoglobulin (IVIg) failed to control the OCP, with resultant complete conjunctivization of the cornea. Keratoprosthesis improved the patient's visual acuity from hand movements to 20/20. CONCLUSIONS: Patients with uncontrolled OCP are at increased risk of corneal infection. The difficulty in diagnosing keratomycosis and the relatively rare occurrence of OCP explain the uniqueness of our reported case. OCP may progress to "end-stage" disease despite therapy. Keratoprosthesis can restore vision in selected otherwise seemingly hopeless cases.

Red eye unresponsive to treatment.

Red eyes that fail to respond quickly and completely to topical antibiotic treatment require more extensive evaluation to relieve the symptoms and avert possible sight-threatening complications. The initial differential diagnosis of red eye, which includes iritis, acute glaucoma, keratitis and corneal ulcer, and rarer disorders, must be reexamined. A commonly misdiagnosed cause of red eye is the dry eye syndrome. As a primary or secondary problem, the dry eye syndrome must be treated appropriately to avert sight-threatening complications and to alleviate substantial discomfort. The dry eye syndrome may represent the presenting sign of Sjögren's syndrome or it may be due to medication use, with important systemic and ocular implications.

Pseudomonas aeruginosa keratitis treated with ticarcillin and tobramycin.

A corneal ulcer, infected with Pseudomonas aeruginosa and complicated by conjunctivitis and endophthalmitis, was treated successfully with systemic administration of ticarcillin and topical application of tobramycin. It is unlikely that carbenicillin, to which the organism was much less sensitive, would have attained sufficient tissue levels to control the infection.

Keratomalacia in the cachectic hospitalized patient.

Keratomalacia occurred in two cachectic hospitalized patients, each with severe vitamin A-protein deficiency secondary to a lethal disease. Prompt therapy with parenteral and topical vitamin A, protein supplementation, and a soft contact lens restored corneal integrity and prevented visual loss in one patient. Keratinization of the conjunctiva did not occur in either patient. Patients with severe protein deficiency may develop keratomalacia in the absence of a severely decreased serum level of vitamin A.