Clinical course and management of postoperative methicillin-resistant Staphylococcus aureus keratitis in immunocompromised patients: two case reports.

We describe the clinical course and successful treatment of two cases of methicillin-resistant Staphylococcus aureus (MRSA) keratitis. In case 1, MRSA keratitis occurred 5 days after cataract extraction, associated with endophthalmitis; in case 2, diagnosis was made 19 months after penetrating keratoplasty. Treatment in both cases consisted of topical fortified vancomycin and fortified bacitracin. A third topical antibiotic, polymyxin B-trimethoprim, was added to the therapeutic regimen in case 2, one month into the treatment. Oral doxycycline was prescribed to reduce collagenase activity and treat blepharitis. Mupirocin nasal ointment and skin antiseptics were used to decrease and eliminate potential MRSA colonization. Topical prednisolone acetate 1% was applied conservatively to mitigate inflammation in both cases. In case 2, topical cyclosporine A was also used for similar purposes. Keratitis may have worsened while on these immune-modulating drops, especially in case 2, and eradication of infection may have been slowed. Eventually both patients achieved full resolution of infection. Duration of keratitis was 3 and 1.5 months, respectively. Polyantimicrobial therapy is effective in eradicating MRSA-related postoperative keratitis. Topical fortified vancomycin and fortified bacitracin were used in both cases, with a third topical antibiotic, polymyxin B-trimethoprim, also required in case 2. Oral doxycycline, nasal mupirocin, and antiseptic soap may be useful adjuncts in management. Treatment time to achieve full resolution may be prolonged relative to other types of bacterial keratitis. Alterations in immune status may have lengthened the time of treatment. Our two patients were immune compromised and were also susceptible to endophthalmitis. It is possible that topical immune-modulating drops such as prednisolone acetate may potentiate MRSA infection, and if used, should be only done so with great caution.

Ischemic central retinal vein occlusion and neovascular glaucoma as a result of optic nerve head drusen.

PURPOSE: The purpose of this study was to report a case of ischemic central retinal vein occlusion (CRVO) caused by optic nerve head drusen. METHODS: Case report and review of the literature. RESULTS: A healthy 13-year-old boy was diagnosed with bilateral optic nerve head drusen. Two years later, he developed an ischemic CRVO and secondary neovascular glaucoma. A full medical workup was negative. Despite treatment, his vision eventually declined to no light perception from a funnel detachment. CONCLUSION: Nonischemic CRVO or venous stasis retinopathy is a well-known entity associated with optic nerve head drusen. The authors report a case of ischemic CRVO in a patient with no underlying risks for this other than the observed drusen. This report clearly shows that optic nerve drusen may not be entirely benign and that they can precipitate ischemic CRVO.