Unveiling the landscape of post-keratoplasty keratitis: a comprehensive epidemiological analysis in a tertiary center.

PURPOSE: The present study aimed to epidemiologically evaluate patients with infectious keratitis following corneal transplantation. METHODS: This retrospective study analyzed medical records of patients who underwent keratoplasty from March 2014 to March 2022 at a tertiary center. A total of seventy-five patients were evaluated. The data were classified based on culture results, the type of microorganisms involved, treatment requirements, and the type of primary keratoplasty performed. RESULTS: Seventy-five patients were evaluated in this study, with a mean age of 45.9 years (22-95 years). The mean duration between the first surgery and the incidence of infectious keratitis was 1.43 years, and most cases occurred in the first year (56.2%). Bacterial and fungal keratitis in 2.17%, 1.39%, and 1.26% of cases undergoing penetrating keratoplasty (PK), endothelial keratoplasty (EK), and anterior lamellar keratoplasty (ALK) occurred, respectively. Streptococcus viridans (9.3%) and Staphylococcus aureus (6.6%) had the highest prevalence. Across various smear and culture results (gram-positive, gram-negative, fungal, and negative culture), no significant differences were found in endophthalmitis rates (P = 0.797) and the necessity for tectonic grafts (P = 0.790). Similarly, the choice of surgical method (PK, ALK, EK) showed no significant impact on the need for tectonic grafts (P = 0.45) or the rate of endophthalmitis (P = 0.55). CONCLUSIONS: The incidence of keratitis after a corneal graft was 1.7%, with Streptococcus viridans and Staphylococcus aureus the most common microorganisms. The rate of endophthalmitis associated with post-keratoplasty keratitis was 0.053%. There was no correlation between the necessity for a tectonic graft or the incidence of endophthalmitis and the type of microorganisms involved.

Design and simulation of a novel integrated microfluidic chip for cell isolation and culture.

The lab on a chip is utilized as a background and a substrate for creating a proper flow for cellular processes in medicine. In this study, the concepts of cell isolation and cell transfer methods have been discussed. After that, the device of separation and transfer systems has been designed, simulated, and verified by placing the frequency of particle separation and droplet formation, which is tried to introduce a new device that can be used in cellular studies. The optimal operation conditions for the problem have also been investigated. High separation efficiency (99%) could be achieved when the velocity of the sample inlet in the microchannel separator is 180 µm/s. Also, a microfluidic device for droplet generation has been designed to transfer the isolated cells to the culture medium. For this purpose, the frequency of droplet production must be synchronized with particle ejection frequency and equals 9.09 Hz.

Early and complete vitrectomy versus tap and inject in acute post cataract surgery endophthalmitis presenting with hand motion vision; a quasi-experimental study.

BACKGROUND: Based on endophthalmitis vitrectomy study, intravitreal injection of antibiotics is preferred for initial management of cases of acute post cataract surgery endophthalmitis (APCE) with presenting vision of hand motions (HM). This study aimed to compare outcomes of early and complete vitrectomy (VIT) and vitreous tap and antibiotic injection (T&I) in cases of APCE presented with vision of HM. METHODS: In this prospective study, cases of APCE with vision of HM between 2018 and 2020 were enrolled. According to the time of presentation, the patients were arranged into two groups (VIT vs. T&I). Demographic data, elapsed time to developing endophthalmitis, past medical history, microbiology results, complications, and final visual acuity were recorded and analyzed. RESULTS: Seventy-six eyes of 76 patients were enrolled. Fifty-three eyes underwent T&I and twenty-three were arranged into the VIT group. Past medical history of 34.2% of patients was significant for diabetes mellitus. There was a statistically significant lower logMAR in VIT group compared to T&I group (diff = 0.14, 95% CI: 0.04 to 0.24, P-value = 0.007). The comparison of the diabetic and non-diabetic patients in both groups showed that the visual outcome was better in non-diabetic cases compared to the diabetic subjects. There was no statistically significant difference between the diabetic and non-diabetic groups regarding the superiority of procedure. CONCLUSION: Based on our results, we could recommend that it's maybe better to do early and complete vitrectomy as the initial management of APCE with the vision of HM. Past medical history of diabetes mellitus is not a determining factor for choosing initial management between vitrectomy and antibiotic injection.

Culture-proven endogenous endophthalmitis: microbiological and clinical survey.

PURPOSE: To report causative organisms, visual outcomes, and associated medical conditions in endogenous endophthalmitis (EE). METHODS: Microbiological and medical reports of patients with culture-proven EE referred to Farabi Eye Hospital, Tehran, Iran, from January 2008 to January 2018 were reviewed. RESULTS: A total of 144 cases (171 eyes) were included in the present study. Candida albicans (30.6%) and Staphylococcus aureus (27.1%) were the most prevalent microbial causes. Diabetes mellitus (43.8%) and IV drug abuse (10.4%) were the leading associated systemic conditions. Age of the patients (P = 0.002) and presenting corrected distance visual acuity (CDVA) (P < 0.001) were correlated with postoperative CDVA. Patients with bilateral involvement had significantly lower mean logMAR (P = 0.002), and patients with hypopyon had significantly higher mean logMAR (P = 0.006). Eyes with gram-negative bacillus cultures had a significantly worse logMAR than eyes with gram-positive cocci (P = 0.009). CONCLUSION: Candida albicans and S. aureus were the most common causes of EE, and diabetes mellitus was the most common associated medical condition. EE is associated with poor visual outcome, especially in older patients, those with worse visual acuity at presentation, and those with positive cultures for gram-negative bacilli.

The use of in vivo confocal microscopy to track treatment success in fungal keratitis and to differentiate between Fusarium and Aspergillus keratitis.

PURPOSE: To evaluate the usefulness of serial in vivo confocal microscopy (IVCM) examinations to measure hyphal density for monitoring the treatment success among patients with fungal keratitis, and to compare the hyphal diameter as well as branching angle as a way of differentiation between Aspergillus and Fusarium species observed in IVCM. STUDY DESIGN: Prospective nonrandomized study. PATIENTS AND METHODS: The study was conducted from February 2015 to September 2016. Hyphal diameter, density and branching angle measurements were performed using IVCM at admission and on a weekly basis for at least 2 weeks after the start of treatment. RESULTS: During the period of study, 65 patients with culture-confirmed fungal keratitis were recruited. Of them, 40 were culture-positive for Fusarium spp. and 25 patients for Aspergillus spp. Before the start of treatment, the mean branching angle did not differ between the two species and the mean hyphal diameter was statistically higher for Aspergillus spp. (p = 0.029). Two weeks after the start of treatment, the mean hyphal diameter was statistically lower (p < 0.001) in the treatment failure group. Also the hyphal density significantly decreased with successful treatment (p < 0.05). CONCLUSION: Decreasing hyphal density in serial IVCMs might be used as an indicator to predict the successful response of fungal ulcers to treatment. Branching angle is not different between Aspergillus and Fusarium keratitis. The mean hyphal diameter is significantly lower in the treatment failure group.

The rate of endophthalmitis after pars plana vitrectomy and its risk factors.

PURPOSE: To study the incidence of endophthalmitis after pars plana vitrectomy, its causative organisms, and visual acuity outcomes. PATIENTS AND METHODS: In this retrospective, comparative study, the medical records of patients with acute-onset postoperative endophthalmitis after pars plana vitrectomy at Farabi Eye Hospital, Tehran, Iran, during a 12-year period between January 2004 and November 2015 were reviewed. To compare the endophthalmitis patients with other cases who underwent pars plana vitrectomy at the same day and also the same operating room, a control group was developed by gathering the data from surgical records. RESULTS: In the present study, the incidence rate of pos- vitrectomy endophthalmitis was 0.04% (16/39783). The organisms identified in aqueous or vitreous cultures (culture positive 44%) included Streptococcus pneumoniae (two patients, 12.5%), Pseudomonas aeruginosa (two patients, 12.5%), fungi (two patients, 12.5%), and Streptococcus viridans (one patient, 6.25%). Visual acuity after treatment for endophthalmitis ranged from light perception (7 eyes) to hand motion (1 eye), and evisceration was performed in 8 eyes (50%). When comparing the cases (patients developing endophthalmitis) and controls (patients with no complications operated in the same day and place of operation with the case group), only not using tamponade showed a statistically significant relation with the occurrence of endophthalmitis (p = 0.034). CONCLUSION: Our results indicated low incidence of endophthalmitis after pars plana vitrectomy comparable to previous studies which resulted in poor visual acuity. It seems that not using tamponade might increase the risk of endophthalmitis among these patients.

BIRD ATTACK OCULAR INJURIES.

BACKGROUND/PURPOSE: To report 30 patients with bird attack-related eye injuries. METHODS: This study was performed among patients coming to Farabi Eye Hospital, Tehran, Iran, from 2010 to 2015 with a history of bird attack causing eye injury. The inclusion criteria were a history of bird attack by pecking causing eye injury and having treatment and follow-up record for at least 6 months after treatment. The primary eye examinations included a full ophthalmic examination including evaluation of uncorrected visual acuity and best-corrected visual acuity (BCVA), anterior segment slit lamp biomicroscopy, and photography. For all patients with penetrating injury, primary repair was undertaken. RESULTS: Thirty patients (10 females and 20 males) with a mean age of 23.3 ± 18.5 years entered the study. The most common zone of injury was zone 1 (P < 0.001), and lensectomy was not needed in majority of patients (P < 0.001). The most common bird causing the injury was mynah (P < 0.001). Those patients with baseline BCVA of less than 20/200 or those with endophthalmitis had statistically worse final BCVA after treatment. Patients attacked by mynah bird had significantly better pretreatment uncorrected visual acuity and BCVA. CONCLUSION: The most common bird causing the eye injury among the sample of patients from Iran was mynah, which differs with previous studies indicating the rooster attack as the most common cause of eye injury. The authors also found that the most common zone of injury was zone 1, and the presence of endophthalmitis and lower baseline BCVA were significant risk factors for worse visual outcomes.

Fungal keratitis: An overview of clinical and laboratory aspects.

Mycotic keratitis or keratomycosis is a fungal infection with global distribution. The dominant aetiology of this disease varies based on geographical origin, socioeconomic status, and climatic condition. Generally, Aspergillus spp. and Fusarium spp. are common in tropical and subtropical regions and Candida spp. are dominant in temperate areas. Demonstration of fungal elements in microscopic examination besides the isolation of fungi in culture is the gold standard of laboratory diagnosis. As the culture is a time-consuming procedure, other approaches such as in vivo confocal microscopy which produces real-time imaging of corneal tissue and molecular techniques have been developed to facilitate rapid diagnosis of fungal keratitis. The first choice of treatment is topical natamycin, although topical amphotericin B is the best choice for Aspergillus and Candida keratitis. Regarding the diversity of fungal aetiology and the emergence of drug resistance in some genera and species, proper identification using molecular methods and antifungal susceptibility testing could provide useful data. Furthermore, as the better efficacy of combination therapy in comparison to monotherapy is reported, in vitro determination of interactions between various drugs seem informative. This review aims to provide a general and updated view on the aetiology, risk factors, epidemiology, clinical and laboratory diagnosis, and management of fungal keratitis.

SYSTEMIC ORAL ANTIBIOTICS AS A PROPHYLACTIC MEASURE TO PREVENT ENDOPHTHALMITIS IN PATIENTS WITH OPEN GLOBE INJURIES IN COMPARISON WITH INTRAVENOUS ANTIBIOTICS.

PURPOSE: To compare the use of systemic oral and intravenous antibiotics as a prophylactic measure to prevent endophthalmitis in patients with open globe injuries. METHODS: This prospective study was conducted on 1,255 consecutive patients with open globe injuries due to sharp or blunt trauma in a hospital setting in Tehran, Iran from January, 2011 to May, 2013. The patients were randomly divided into two groups and either received intravenous or oral systemic antibiotics as a measure to prevent endophthalmitis. The patients who developed endophthalmitis were followed for 1 year. RESULTS: In the first group, 12 patients (1.8%) developed endophthalmitis until postoperative Day 3 and 2 more patients (0.3%) developed endophthalmitis until the end of Week 1. These numbers in group receiving oral antibiotics were 8 (1.3%), 5 (0.8%), and 13 patients, respectively, showing no statistically significant difference between the 2 groups. There was also no statistically significant difference in the visual acuity of patients developing endophthalmitis in these 2 groups 1 year postoperatively. CONCLUSION: No statistically significant difference in the occurrence of postoperative endophthalmitis or the visual acuity 1 year after operation among patients with open globe injuries receiving intravenous or oral systemic antibiotics as a prophylactic measure was observed.

Closantel; a veterinary drug with potential severe morbidity in humans.

BACKGROUND: Closantel is a halogenated salicylanilide with a potent anti parasitic activity. It is widely used in management of parasitic infestation in animals, but is contraindicated in humans. CASE PRESENTATION: A 34-year-old man with depression was referred to our center with progressive loss of vision in both eyes 10 days after unintentional ingestion of three 500 mg tablets of Closantel. On fundus examination, left optic disc margin was blurred. His bilateral visual acuity was no light perception (NLP) despite prescribed IV erythropoietin injections 20,000 units daily for 3 days and 1gr intravenous methylprednisolone acetate for 3 days followed by 1 mg/kg oral prednisolone. On macular optical coherence tomography (OCT), a disruption in outer retina was observed. Electroretinogram and visual evoked potential tests showed visual pathway involvement. CONCLUSIONS: Destruction of neurosensory retina and visual pathways after accidental Closantel use is related to severe visual loss. This case alerts us about the destructive effect of this drug on humans even in low dosage which necessitates preventive efforts to reduce the chance of this morbid side effect.

All about traumatic cataracts: narrative review.

Ocular trauma is an important cause of monocular blindness worldwide. Injury to the lens after blunt or penetrating trauma is common and can result in vision impairment. Selecting the most appropriate therapeutic approaches depends on factors such as patients' age, mechanism of trauma, and underlying clinical conditions. Early management, especially within childhood, is essential because of the difficulties involved in examination; anatomical variations; as well as accompanying intraocular inflammation, amblyopia, or vitreoretinal adhesions. The objective of this study was to provide a comprehensive review of the epidemiology and clinical management of traumatic cataract, highlighting the significance of accurate diagnosis and selection of the optimal therapeutic approach.

Infectious keratitis in pediatric population aged less than two years: a tertiary eye institute experience.

BACKGROUND: Infectious keratitis is a serious ocular condition, which can lead to corneal scarring, vision loss, and even blindness. Pediatric infectious keratitis accounts for about 13% of all cases, although there is a lack of comprehensive data regarding keratitis in less than two years of age population group. This study was aimed to determine predisposing factors, clinical characteristics, microbial profile, and management of infectious keratitis in a population of children aged less than two years. MATERIALS AND METHODS: A retrospective study was carried out in a tertiary eye institute over a period of 18 years from July 2005 to December 2022. Collected data was analyzed for demographics, predisposing factors, clinical features, and treatment methods. RESULTS: Fifty-seven cases of keratitis were identified. Age of the patients ranged from 1 to 24 months (Median: 6, interquartile range: 2-10). Thirty cases were male (52.6%). Predisposing factors were identified in 39 cases (68.4%): consisting of prior ocular trauma (n = 15), previous intraocular surgery (n = 11), ocular surface disease (n = 10), nasolacrimal duct obstruction (n = 4), prematurity (n = 3), developmental delay (n = 2), TORCH infection (n = 1), and contact lens (n = 1). Corneal thinning was observed in 29 eyes (50.9%), which progressed to perforation in 13 eyes (22.8%). Three patients developed endophthalmitis (95% CI, 1.5-13.4%). Most eyes had negative smear (60.4%) and culture (59.6%) results. Pseudomonas aeruginosa was the most common microorganism (11 of 21). Candida albicans was isolated in one case. In vitro susceptibility results showed good coverage of the combined ceftazidime and vancomycin regimen (100%). Surgical procedures were carried out in 35 eyes (61.4%) and 15 eyes required tectonic procedures (26.3%). CONCLUSION: Despite good coverage of medical treatment over cultured isolates, surgical tectonic intervention was required in nearly a quarter of cases to resolve the corneal infection. This finding indicates the necessity of prompt patient referring, corneal sampling and initiation of the treatment.

Numerical analysis of pressure drop reduction of bubbly flows through hydrophobic microgrooved channels.

Due to the high performance of hydrophobic surfaces in pressure drop reduction, they have been proposed for various applications. However, despite the extensive uses of two-phase flows in many industries, the effect of hydrophobic surfaces on the pressure drop reduction of two-phase flows has not been well understood yet. Thus, in the present study, by implementing the phase-field and finite element methods, the bubbly flows as an example of two-phase flows are considered for examining the effect of hydrophobic microgrooved microchannels on the pressure drop reduction of these regimes in the laminar state. We found out that hydrophobic microgrooved surfaces not only can be efficient in the bubbly flow but also can even cause a maximum pressure drop reduction of up to 70%, which is almost 3.5 times higher than in single-phase flow. We also studied the influence of each parameter, such as bubbles volume or length, Reynolds number, capillary number, and their combination on this phenomenon. The pressure drop reduction grows by increasing the volume of the bubbles but decreases by increasing the flow velocity or the surface tension coefficient. The combination of these parameters demonstrated different results in some circumstances.

Citrobacter keratitis: predisposing factors and clinical characteristics.

PURPOSE: To report predisposing factors, clinical presentation, antibiotic sensitivity, and management of Citrobacter-caused infectious keratitis. METHODS: We retrospectively reviewed the medical records of culture-proven cases of Citrobacter keratitis in a tertiary referral center for 8 years (from January 2012 to September 2020). Demographic data of the patients, predisposing factors, and presenting signs were extracted. RESULTS: Eighteen cases of microbial keratitis due to Citrobacter spp. were identified. The median age of the patients was 66 years (range: 10-89, interquartile range : 59-81). Thirteen patients were male and 5 were female. Multiple predisposing factors were identified in all eyes, including ocular surface disease (n = 8), previous corneal surgery (n = 6), and history of ocular trauma (n = 6). Five patients were diabetic. Corrected distance visual acuity (CDVA) of patients was light perception (LP) in 8 patients, hand motion (HM) in 7, counting fingers (CF) at 1 m in 1, and CF at 2 m in 2 patients. Thirteen eyes exhibited hypopyon. An area of corneal thinning was observed in 7 eyes (38.9%). Endophthalmitis due to infectious keratitis developed in one patient. In vitro susceptibility testing confirmed high sensitivity to ceftazidime and aminoglycosides. Medical management consisted primarily of topical amikacin (20 mg/ml) combined with topical cefazoline (50 mg/ml) (72.2%). Surgical tectonic procedures were carried out in 7 eyes (38.9%). CONCLUSION: Citrobacter spp. is a rare cause of bacterial keratitis.Previous keratoplasty and ocular surface problems are important risk factors. The prognosis is not good and surgical tectonic intervention is required in many cases to resolve the corneal infection.

Post photorefractive keratectomy (PRK) infectious keratitis; six-year experience of a tertiary eye hospital.

BACKGROUND/OBJECTIVES: As an essential development in the new century, surface ablation procedures have attracted increasing attention. There exists a concern regarding the risk of infectious keratitis. Hence, we aimed to investigate the rate and predisposing factors of infectious keratitis after photorefractive keratectomy (PRK). SUBJECTS/METHODS: This retrospective study was designed in two phases. First, the rate of post-PRK keratitis of Farabi Eye Hospital was investigated. In other words, the targeted population was the patients who developed keratitis after performing procedure at Farabi Eye Hospital. In the second phase, all the patients with the diagnosis of post-PRK keratitis were studied regardless of the centre where surgery was performed. Patients with the diagnosis of infectious keratitis between 2014 and 2020 were enrolled and following information was analyzed: demographics, presentation time after surgery, perioperative medications, culture results, risk factors, medical treatment, complications, and final visual acuity. RESULTS: The total number of PRK procedures in our centre was 24,986 (13,253 patients), in which 6 eyes of 5 patients developed keratitis. Beside these 5 patients, 24 referred patients (24 eyes) from the other centres were enrolled. Finally, a total number of 29 patients (30 eyes) were included. Our analysis revealed that manipulation of contact lens, dry eye, and blepharitis were the essential predisposing factors for keratitis development. CONCLUSION: The overall post-PRK keratitis occurrence rate of our study was 0.02%. Our observation highlighted the importance of preoperative examination and treatment of the lids and dry eye disease.

The effect of povidone-iodine 2% eye drops in the treatment of adenoviral keratoconjunctivitis.

BACKGROUND: Keratoconjunctivitis is one of the most common pathologies worldwide, caused by several infectious and noninfectious factors. This study aimed to determine the effect of povidone-iodine 2% eye drops in treating adenoviral keratoconjunctivitis. METHODS: This analytic cross-sectional study was conducted on patients referred to Farabi Eye Hospital Records of patients with adenoviral keratoconjunctivitis, more than 12 years of age, and no allergy to iodine who were treated by povidone-iodine 2% eye drops four times a day were assessed. Data included demographic characteristics, family history of adenoviral keratoconjunctivitis, follicular conjunctivitis, petechial conjunctival hemorrhages, periauricular lymphadenopathy, and the presence of conjunctival pseudomembrane were collected from the records. Discharge decrease, injection decrease, swelling decrease, pseudomembrane formation, periauricular lymphadenopathy, and subepithelial infiltration on the 7thday of assessment by physical examination were reported. RESULTS: Patients with a mean (±standard deviation) age of 33.77 (11.01) years were assessed. At the baseline, 95 (99.0%) follicular conjunctivitis, 94 (97.9%) petechial conjunctival hemorrhages, 29 (30.2%) periauricular lymphadenopathy, and 5 (5.2%) conjunctival pseudomembrane were recorded. On the 7thday of treatment, the discharge decreased in 92.7% of patients, and the injection decreased in 90.6%. The swelling decrease was also detected in 79.2% of patients. Subepithelial infiltration was only seen in 21.9% of the study population. Results showed that 2.1% of patients had periauricular lymphadenopathy, and only 13 out of 96 patients (13.5%) had pseudomembrane formation after 7 days. CONCLUSIONS: Based on the safety, availability, and tolerability of povidone-iodine and its promising effects on patients with adenoviral keratoconjunctivitis, further clinical trials assessing the impact of this drug in a longer duration of follow-up can be recommended.

Outbreak of methanol-induced optic neuropathy in early COVID-19 era; effectiveness of erythropoietin and methylprednisolone therapy.

BACKGROUND: Methanol is a highly toxic, non-potable alcohol. Outbreaks of methanol toxicity occur due to its fraudulent addition to alcoholic beverages as a cheaper substitute for ethanol. Recently, alongside the coronavirus disease 2019 (COVID-19) pandemic, rumors circulated on social media that consuming alcohol can prevent or cure the virus, leading to a COVID-19 and methanol-induced optic neuropathy (MON) syndemic. AIM: To investigate the impact of erythropoietin (EPO) on the outcomes of patients diagnosed with MON. METHODS: In this prospective study, 105 patients presenting with acute bilateral visual loss secondary to methanol intoxication were enrolled from March to May 2020 at Farabi Eye Hospital. A comprehensive ocular examination was conducted for all participants. Recombinant human EPO and methylprednisolone were administered intravenously to all patients for three consecutive days. RESULTS: The mean age of the participants was 39.9 years (± 12.6). Ninety-four patients were male and eleven were female. The mean pre-treatment best corrected visual acuity (BCVA) improved from 2.0 ± 0.86 to 1.39 ± 0.69 logarithm of the minimum angle of resolution post-treatment (P < 0.001), with significant improvement observed in all age categories and genders (P < 0.001). Visual acuity improvement was also significant regardless of whether the patient presented before or after 72 h (P < 0.001), and the post-treatment BCVA remained significant at all monthly follow-up visits (P < 0.001). CONCLUSION: EPO and methylprednisolone therapy have been shown to be effective in improving visual outcomes in patients with MON when administrated within the first month of exposure. Public awareness efforts are necessary to prevent further outbreaks of methanol toxicity in the current COVID-19 era.

Clinical Features, Risk Factors, and Management of Candida Keratitis.

BACKGROUND/AIMS: To determine the clinical features, predisposing factors, and management of infectious keratitis caused by Candida spp. METHODS: Retrospective chart review. RESULTS: The medical records of 52 patients (54 eyes) with Candida keratitis were available for statistical analysis. Thinning of the corneal stroma was identified in 34 eyes (63.0%), and corneal perforation occurred in 16 eyes (29.6%). Corneal thinning and perforation were more common in Candida albicans compared with non-albicans (P-val < .001, P = .09, respectively). The most common predisposing factors for Candida keratitis were topical steroid use (21 patients, 40.4%), previous corneal transplantation (17 patients, 32.7%), and preexisting ocular surface disease (15 patients, 28.8%). Fourteen eyes (25.9%) required cyanoacrylate glue application and 10 eyes (18.5%) underwent therapeutic penetrating keratoplasty (TPK). CONCLUSION: Local immunosuppression and ocular surface disease play an important role in Candida keratitis. C. albicans appears to be more invasive compared with non-albicans spp.

Post-laser refractive surgery keratitis: A concise narrative review.

Laser refractive surgery (LRS) is a specialized surgical discipline within ophthalmology that focuses on vision correction via laser techniques. LRS requires a high rate of accuracy and exactitude to improve the visual outcome and minimize complications, which may lead to delayed visual recovery. Keratitis, either infectious or noninfectious, is a post-LRS complication that requires early diagnosis and proper interventional measures. In this narrative review, we summarize different aspects of keratitis following LRS. This literature review aims to provide a thorough understanding of the causes of post-LRS infectious keratitis and its appropriate management for successful outcomes.

A Case Series of Infectious Keratitis After Corneal Cross-linking.

PURPOSE: To present the 7-year experience of a tertiary eye hospital while exploring possible risk factors and incidence of infectious keratitis in patients undergoing standard corneal cross-linking (CXL). METHODS: This retrospective cohort study included patients with progressive keratoconus undergoing standard CXL in the Farabi Eye Hospital and all other patients who had undergone CXL in other facilities and were diagnosed as having infectious keratitis in the 7-year period of the study. RESULTS: Among the total of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, yielding an incidence rate of 0.12%. Additionally, 13 eyes from 10 patients with a CXL history in other facilities who developed infectious keratitis were included. The mean age was 23.75 years, and 75% of patients were men and 25% were women. Gram-positive bacteria and Staphylococcus aureus were the most prevalent pathogens. Meibomian gland dysfunction, dry eye disease, or blepharitis were present in 12 patients. Medical treatment did not arrest the disease progress in 5 patients, which eventually required cases to undergo keratoplasty. CONCLUSIONS: This study supports the need for proper patient selection by using a comprehensive medical history. It also highlights the imperative role of rigorous patient education and follow-up, particularly in the first postoperative week. Finally, the study emphasizes aggressive early therapy for patients with suspicious findings. [J Refract Surg. 2023;39(8):564-572.].