A Rare Microsporidial Infection in Lamellar Corneal Tissue, following Transepithelial Photorefractive Keratectomy.

The aim of this study was to report a unique case of microsporidial keratitis over deep anterior lamellar keratoplasty after transepithelial photorefractive keratectomy surgery that was successfully treated with therapeutic lamellar keratoplasty without recurrence at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. The patient presented with recurrent attacks of eye pain, redness, photophobia, and decreased vision. The patient was initially treated as a case of presumed herpetic keratouveitis using antiviral medication and topical steroids with partial improvement. During the last episode, the condition deteriorated and patient underwent therapeutic lamellar keratoplasty. Histopathology indicated an infected graft with evidence of microsporidial infection. The patient was discharged with complete corneal epithelial healing and no signs of recurrence during follow-up. Microsporidial infection is a rare cause of stromal keratitis that affects both immunocompetent and immunosuppressed patients. Microsporidia should be suspected after surface ablation refractive surgery if the patient presents with recurrent symptoms of keratoconjunctivitis or stromal keratitis that are partially responsive to topical steroid therapy.

Post-Keratoplasty Infectious Keratitis Caused by Elizabethkingia meningoseptica.

BACKGROUND Microbial keratitis is a major complication of keratoplasty that is associated with serious ocular sequalae if not adequately treated. The purpose of this case report is to present a case of infectious keratitis following keratoplasty caused by the rare microorganism Elizabethkingia meningoseptica. CASE REPORT A 73-year-old patient presented to the outpatient clinic complaining of a sudden decrease of vision in his left eye. The right eye was enucleated during childhood due to ocular trauma and an ocular prosthesis was placed in the orbital socket. He underwent penetrating keratoplasty 30 years ago for corneal scar and repeated optical penetrating keratoplasty for failed graft in 2016. He was diagnosed with microbial keratitis following optical penetrating keratoplasty in the left eye. Corneal scraping of the infiltrate showed growth of the gram-negative bacteria Elizabethkingia meningoseptica. Conjunctival swab of the orbital socket of the fellow eye was positive for the same microorganism. E. meningoseptica is a rare gram-negative bacterium, which is not part of the normal ocular flora. The patient was admitted for close monitoring and was started on antibiotics. He showed significant improvement after treatment with topical moxifloxacin and topical steroids. CONCLUSIONS Microbial keratitis is a serious complication following penetrating keratoplasty. An infected orbital socket could be a risk factor of microbial keratitis of the fellow eye. A high index of suspicion, along with timely diagnosis and management, may improve the outcome and clinical response and reduce the morbidity associated with these infections. Prevention of infectious keratitis is essential and may be achieved by optimizing the ocular surface and treating the risk factors for infection.

Bipolaris keratitis following photorefractive keratectomy: Case report.

INTRODUCTION: Fungal keratitis is an uncommon condition that can occur after ocular surgery or trauma to the eye. Some cases have been reported after corneal refractive surgery. Most cases of keratitis following refractive surgery are due to gram-positive bacteria. However, there are a few reports in the literature of fungal and protozoal infections. CASE PRESENTATION: A 29-year-old healthy male developed fungal keratitis Five days following photorefractive keratectomy. CLINICAL FINDINGS AND INVESTIGATIONS: The patient was admitted to the hospital, corneal scraping was performed and sent for staining and routine cultures. A corneal swab was also performed and sent for polymerase chain reaction (PCR). On day 10 post-admission, the fungal culture was positive for Bipolaris. INTERVENTION AND OUTCOME: Intensive topical antifungal drops were started initially then tapered when clinical improvement was evident. The patient had good final outcome with preservation of good vision and free of symptoms six months following the infection. RELEVANCE AND IMPACT: Fungal keratitis following corneal refractive surgery is rare. However, it is an infection that can potentially lead to poor outcomes if appropriate management is delayed. Therefore, a high index of suspicion is required especially when multiple risk factors is present.

Incidence and outcome of transplantation of fungal-culture-positive donor corneoscleral tissue in optical keratoplasty.

PURPOSE: This study aims to determine the incidence of fungal-culture-positive corneoscleral donor rim in patients undergoing keratoplasty and evaluate clinical outcomes of eyes that received these contaminated donor tissues. METHODS: Patients who had optical keratoplasty between 2006 and 2016 and were found to have fungal-culture-positive donor rim were included. Microbiological and eye bank records were reviewed to determine the incidence of positive fungal rim cultures. Data were collected on visual and clinical outcomes. The main outcome measures were fungal-culture-positive donor rim and development of fungal keratitis or endophthalmitis post keratoplasty. Long-term clinical outcome and associated complications were the secondary outcome measures. RESULTS: Out of 9620 cases of corneal transplants, 145 (1.5%) had fungal-culture-positive donor rim. Candida was the most common organism, cultured in 127 (87.6%) cases. There were no cases of postoperative fungal keratitis or endophthalmitis. Median follow-up was 4.8 years (interquartile range 3.8-7.2 years). Only eight cases (5.5%) received prophylactic antifungal treatment. There were 34 (23.4%) cases of rejection, 13 (8.9%) developed glaucoma, and 7 (4.8%) developed late bacterial keratitis. At last follow-up, best corrected visual acuity was 20/60 or better in 88 cases (60.7%) and 115 eyes (79.3%) had a clear graft. CONCLUSION: The incidence of fungal-culture-positive donor rim is extremely low. The risk of developing fungal keratitis or endophthalmitis in patients who received contaminated donor tissue was almost negligible. Further studies are warranted to prove whether prophylaxis or adding amphotericin B in Optisol-GS confers any added benefit.

Vitrector induced lens injury during peripheral iridectomy in implantable collamer lens surgery.

A 38-year-old female underwent bilateral implantable collamer lens (ICL) implantation for hyperopic astigmatism. While performing intraoperative peripheral iridectomy (PI), iris and anterior lens capsule was drawn to anterior vitrectomy cutter which result in large PI and injury to anterior lens capsule. Anterior lens capsule injury closed by fibrosis and the patient has 20/20 vision and static traumatic lens changes without any undesirable sequelae at the last follow up. Performing PI preoperatively by laser or alternatively by scissor intraoperatively is advisable to avoid above mentioned complication and a close observation is recommended when lens injury encountered.