The effect of climatic and seasonal factors on the microbial keratitis profile.

PURPOSE: To compare retrospective data on microbial keratitis (MK) from two different climatic regions in Turkey over 11 years. STUDY DESIGN: Retrospective cohort. METHODS: This retrospective cohort study included patients diagnosed with presumed MK at two referral centers. Center A was located in the subtropical region of Turkey, whereas Center B was located in a continental temperate climate zone. Clinical and laboratory data were also recorded. The results were evaluated for seasonal variations. RESULTS: This study included data from 665 patients with presumed MK (351 and 314 patients from centers A and B, respectively). The most common predisposing factors were ocular trauma in Center A, prior ocular surgery, and systemic disease in Center B. Severe keratitis was related to prior ocular surgery, presence of systemic disease, and fungal infection at presentation. The culture positivity rate was higher in spring and lower in summer at both centers. Gram-positive bacteria were the most commonly isolated bacteria in both centers in all seasons. The fungal and mixed keratitis ratios were higher in Center A than in Center B. In Center A, filamentous fungi were common pathogens that were found year-round, and peaks were observed in July and October. CONCLUSION: The results of this study show that climatic and seasonal factors may affect the microbial profile of keratitis. Fungal keratitis appears to be a climatic disease. Understanding the regional profile of MK can aid clinicians in their disease management.

Safety and efficacy of fortified antibiotics and fluoroquinolones for the treatment of bacterial keratitis: A meta-analysis.

PURPOSE: To compare the safety and efficacy of fortified antibiotics and fluoroquinolones in the treatment of bacterial keratitis. METHODS: PubMed, EMBASE, Cochrane Library, CNKI, Wanfang database and VIP database were systematically searched for randomized controlled trials (RCT) of treatment of bacterial keratitis with fortified antibiotics and fluoroquinolones. Rev Man 5.3 software was used to analyze outcome index cure rate, time to cure, and adverse events in a meta-analysis. RESULTS: After literature search and screening, 9 randomized controlled trials were included in this study. Compared with traditional fortified antibiotic therapy, fluoroquinolones show consistency in terms of cure rate and incidence of adverse events: cure rates (OR=0.99, 95% CI: 0.75, 1.30) and incidence of adverse events (OR=0.75, 95% CI: 0.48, 1.17). However, the time to cure for fluoroquinolones was shorter than that of fortified antibiotics (MD=0.96, 95% CI: 0.50, 1.41). CONCLUSION: The cure rate and safety of fluoroquinolones are equivalent to those of fortified antibiotics, so it seems reasonable to use fluoroquinolones as the preferred treatment for bacterial keratitis.

[High energy proton therapy for extraocular tumors, neurotrophic keratitis and functional consequence: A series of 3 cases]. / Protonthérapie haute énergie des tumeurs extra-oculaires, kératite neurotrophique et conséquence fonctionnelle : une série de 3 cas.

INTRODUCTION: High energy proton therapy (HEP) is a form of radiation therapy using protons for extraocular tumors. Its ballistic properties are theoretically advantageous, but the real impact on the surrounding ocular tissues during cerebral and ENT irradiation is poorly documented. We describe three consecutive patients with corneal damage following such irradiation. MATERIALS/METHODS: Post-proton therapy neurotrophic keratitis (NK) is defined as corneal hypo/anesthesia responsible for an alteration of corneal trophicity and graded according to the Mackie classification, in terms of a prospective ophthalmological follow-up protocol for all patients with extraocular tumors treated with HEP. RESULTS: Among 193 patients treated with HEP between 2018 and 2021 for extraocular tumors, three patients developed severe neurotrophic keratitis, i.e. 1.6% of treated patients. According to the Mackie classification, the three patients showed grade 3 NK less than one year after the conclusion of their HEP. These three patients underwent amniotic membrane grafting. They were placed on autologous serum eye drops. Two of the three patients had to be eviscerated. The dose to the cornea was greater than 50 Gray (Gy)_Relative biological effectiveness (RBE) in the three cases. DISCUSSION: The diagnosis and etiological origin of neurotrophic keratitis are often difficult to establish. In these cases, the imputability of radiation therapy, proton therapy in our cases, in the development of neurotrophic keratitis was plausible based on the dosimetry of the patients, all of whom had anterior tumors with a poor prognosis requiring high tumoricidal doses. CONCLUSION: Further studies to establish the impact of proton therapy on corneal sensitivity are necessary. However, this feedback and the multidisciplinary management of tumors can help to limit the risk of some complications of radiation therapy. Early diagnosis allows for appropriate management and could possibly minimize the anatomical and functional ocular complications of neurotrophic keratitis.

3-month post-procedural evaluation of a combined intense pulsed light and photo-biomodulation system in the treatment of meibomian gland dysfunction.

PURPOSE: Meibomian gland dysfunction (MGD) is the leading cause of dry eye syndrome. It is a frequent and underdiagnosed condition with a significant socioeconomic impact. We propose here the evaluation of a platform combining intense pulsed light and photo-biomodulation in the treatment of Meibomian gland dysfunction. METHODS: We conducted a retrospective study at Brest University Hospital analyzing a cohort of 74 eyes (37 patients) at 1 month and 3 months after a protocol of 3 Eye-Light® (Espansione Group, Italy) sessions 14 days apart between January 2019 and April 2020. The primary outcome was the change in OSDI quality of life score. Secondary outcomes were the SPEED questionnaire score; tear break-up time (BUT), Oxford score, non-invasive break-up time (NIBUT), lipid layer thickness, lacrimal meniscus height and Meibomian gland atrophy rate. Tolerance of the treatment was also evaluated. RESULTS: We found a significant improvement in OSDI scores at 1 month (-17.32; 95% CI (-25.84; -8.79), P<0.0001) and 3 months (-16.95; 95% CI (-25.26; -8.64), P<0.0001). The SPEED score, BUT, Oxford score, Meibomian gland atrophy and NIBUT were also statistically significantly improved. Tolerance to treatment was very good despite two cases of herpetic keratitis, which resolved on treatment. CONCLUSION: Treatment with the Eye-Light® in three sessions every two weeks significantly reduced symptoms and ocular surface damage in patients with MGD. This data suggests that the use of Eye-Light® may represent a good option for patients with MGD.

Physicochemical and microbiological stability of insulin eye drops in an artificial tear vehicle used in the treatment of refractory neurotrophic keratopathy.

Neurotrophic keratopathy (NK) is a degenerative corneal disease with a loss of corneal sensitivity and impairment of corneal healing. Low dose insulin eyedrops have been shown to be a simple and effective treatment for refractory NK when the response to the usual treatment is incomplete. At present, there are no commercially available forms, and there is no data regarding the stability of these products as prepared by compounding pharmacies. In this work, we studied the physicochemical and microbiological stability of an insulin ophthalmic formulation obtained by mixing insulin lispro in artificial tears with a polyethylene and propylene glycol base. The stability of this 1IU/mL insulin ophthalmic formulation was analysed for 12 months in low-density polyethylene (LDPE) multidose eye droppers at 4°C. The studied parameters of physicochemical stability were: visual inspection, turbidity, UV spectral absorption, osmolality and pH. In addition, insulin and m-cresol concentrations and quantification of impurities (insulin covalent aggregates and insulin fragments) were studied thanks to the development of a new Size Exclusion Chromatographic method. For unopened eye droppers, all tested physicochemical parameters remained stable for 12 months at 4°C, and excellent microbiological stability was obtained. In conditions of simulated use, these parameters also remained stable for one month at 4°C, and no impact of potential temperature rises on the insulin and m-cresol concentrations in the insulin eyedropper was observed.

[Virological diagnosis of anterior herpetic ocular disease on tear sample: A simple and non-invasive technique]. / Diagnostic virologique des atteintes oculaires herpétiques antérieures sur prélèvement lacrymal : une technique simple et non invasive.

INTRODUCTION: Virological diagnosis of anterior ocular herpetic disease (AOHD) is essential for the management of these often-chronic pathologies that may require long-term therapy. PCR has become the gold standard, but the type of sampling (tears, corneal scraping, aqueous tap) has not been standardized. In this study, we studied the technique of tear sampling for the diagnosis of AOHD. MATERIALS AND METHOD: We retrospectively analyzed the medical files of patients with a positive tear sample (Schirmer strip) for herpes simplex 1 virus (HSV-1) in the Department of Ophthalmology of Paris-Saclay Bicêtre Hospital between January 2018 and December 2020. We studied the clinical and virological characteristics (viral loads) of these cases of proven AOHD. RESULTS: Thirty-six samples (33 patients) were included: 12 epithelial keratitis, 9 stromal HSK with ulceration, 5 uveitis, 4 stromal HSK without ulceration, 3 blepharitis, 1 endothelial HSK, 1 neurotrophic keratitis, and 1 conjunctivitis. The mean viral load was 3.9×105 copies/mL. Viral load was higher in cases of corneal ulceration (5.2×105±9.4×105 versus 1.2×102±1.7×102 copies/mL, P<1×10-4). There was no significant difference between primary episodes and relapses. CONCLUSION: Tear sampling using Schirmer strips is a simple, non-invasive method that can be useful for the virological diagnosis of various clinical forms of AOHD.

[Ocular manifestations of viral diseases]. / Atteintes ophtalmologiques des infections virales.

Viral infections may involve all ocular tissues and may have short and long-term sight-threatening consequences. Among them, ocular infections caused by herpesviruses are the most frequent. HSV-1 keratitis and kerato-uveitis affect approximately are the leading cause of infectious blindness in the Western world, mainly because of corneal opacification caused by recurrences. For this reason, they may warrant long-term antiviral prophylaxis. Herpes zoster ophthalmicus, accounts for 10 to 20% of all shingles locations and can be associated with severe ocular involvement (keratitis, kerato-uveitis) of which a quarter becomes chronic/recurrent. Post herpetic neuralgias in the trigeminal territory can be particularly debilitating. Necrotizing retinitis caused by herpesviruses (HSV, VZV, CMV) are seldom, but must be considered as absolute visual emergencies, requiring urgent intravenous and intravitreal antiviral treatment. Clinical pictures depend on the immune status of the host. Adenovirus are the most frequent cause of infectious conjunctivitis. These most often benign infections are highly contagious and may be complicated by visually disabling corneal lesions that may last over months or years. Some arboviruses may be associated with inflammatory ocular manifestations. Among them, congenital Zika infections may cause macular or optic atrophy. Conjunctivitis is frequent during the acute phase of Ebola virus disease. Up to 15% of survivors present with severe chronic inflammatory ocular conditions caused by viral persistence in uveal tissues. Finally, COVID-19-associated conjunctivitis can precede systemic disease, or even be the unique manifestation of the disease. Utmost caution must be taken because of viral shedding in tears.

Comparison of two methods for obtaining and transporting corneal samples in suspected infectious keratitis.

BACKGROUND AND PURPOSE: The purpose of this study is to compare two alternative methods of collecting and transporting media for the diagnosis of corneal ulcers, as not all clinical settings have conventional culture materials and transport media available. METHODS: In this open-label, prospective, comparative, and randomized study, patients with clinical suspicion of infectious keratitis with high risk of loss of vision had corneal specimens collected using two methods and transport media: Eswab scraping with Amies transport medium and 23-gauge needle scraping in BACTEC Peds broth. The order of each collection method was randomized. The samples were processed by standard methods, comparing the positivity frequencies for both by parametric and nonparametric tests, according to normality criteria. RESULTS: Corneal infiltrates from 40 eyes of 40 patients were analyzed. Culture positivity rate was 50% for Eswab and 35% for 23-gauge needle (P=0.258). The overall growth rate of the two methods combined was not higher than with the swab alone. The results obtained with a swab were not influenced by the collection sequence (P=0.112); however, the positivity rate was significantly higher when the sample taken with the needle was performed first (P=0.046). CONCLUSIONS: The single sample Eswab method of collection and transportation for the diagnosis of high risk corneal ulcers is a valid alternative and can be used in cases in which, for various reasons, there is no access to the full set of traditional culture materials.

[Ocular manifestations of measles in adults: About three cases]. / Manifestations oculaires de la rougeole chez l'adulte : à propos de trois cas.

Measles is a contagious viral infection that usually affects children. The disease is caused by morbillivirus, a virus of the family Paramyxoviridae. The clinical picture is characterized by four phases: incubation, invasion, eruption and desquamation. Ophthalmologic manifestations in measles are rare, dominated by conjunctivitis and keratitis. Corneal involvement is the main concern; it varies from simple superficial punctate keratitis to corneal perforation. We report three cases of acute keratitis in young adults during an epidemic. The epithelial involvement was peripheral, central or diffuse. The outcome was favorable under symptomatic topical treatment.

In vitro activity of isavuconazole against three species of Acanthamoeba.

Acanthamoeba keratitis due to a genus of free-living amoebae is a severe corneal infection. Treatment of this disease is based on the combined use of antiseptics and other drugs, including azoles. We tested isavuconazole, the latest marketed azole, in vitro, against A. castellanii, A. lenticulata and A. hatchetti. Our results show that isavuconazole presents slight amoebistatic activity against A. castellanii trophozoites but no cysticidal activity. Isavuconazole could be used only in association for management of AK due to A. castellanii.

[Interstitial keratitis diagnosis and treatment (French translation of the article)]. / Kératites interstitielles : prise en charge diagnostique et thérapeutiques.

Interstitial keratitis is a non-ulcerative, non-suppurative, more or less vascularized inflammation of the corneal stroma. The corneal lesions result from the host response to bacterial, viral (40% of cases) or parasitic antigens, or from an autoimmune response (1% of cases) without active corneal infection. The natural history of the disease is divided into two phases : acute and cicatricial. This type of keratitis is less common than ulcerative bacterial keratitis, but it is a non-negligible cause of visual loss. It is associated with systemic or infectious disease and requires early diagnosis and appropriate treatment to optimize visual prognosis and avoid other complications.

Sterile keratitis following standard corneal collagen crosslinking: A case series and literature review.

Standard corneal collagen crosslinking (S-CXL) is a safe, approved procedure, but it may result in severe pain, early vision loss and possible complications, such as infectious or sterile keratitis, in some cases. We describe four cases of sterile infiltrates after uneventful S-CXL for keratoconus, from diagnosis to medical management with six months of follow-up, reporting their pathophysiological features, and comparing our findings with published reports. We discuss various possibilities for diagnosing sterile infiltration more rapidly. In terms of the pathophysiology of sterile infiltrate formation, we separated our patients into two types, one with sterile infiltrate from an antigen reaction and the other with sterile infiltrate due to excessive scarring. Early local steroid treatment resulted in a good visual outcome in our cases.

[Tacrolimus ointment in the management of atopic keratoconjunctivitis]. / Tacrolimus pommade dans la prise en charge de la kératoconjonctivite atopique.

INTRODUCTION: Atopic keratoconjunctivitis is associated with eyelid eczema. It may require the use of local corticosteroids which if prolonged can be a source of ocular complications. Tacrolimus is an immunosuppressant used in cutaneous application in atopic dermatitis. The aim of this study was to measure the efficacy and tolerance of tacrolimus 0.1% ointment in palpebral application in atopic keratoconjunctivitis. PATIENTS AND METHODS: This retrospective, single-center study was conducted between June 2014 and February 2017. Patients with atopic keratoconjunctivitis not controlled by first-line medical treatments were included. The primary endpoint was the evolution of functional signs as assessed by the NEI-VFQ25 and OSDI quality of life scores. Secondary endpoints were visual acuity and local corticosteroid use. RESULTS: Among the 18 patients included, the mean age was 37.9±16.8 years. The first follow-up visit was on average 68.3±55.3 days after initiation of treatment. The NEI-VFQ25 score was significantly improved for seven of its sub-scores (P<0.05) and the mean OSDI decreased significantly from 52.3±26.2 to 22.0±27.0 (P<0.001) showing a decrease in eye discomfort. A significant reduction was observed in the number of patients using local corticosteroids. There was no significant change in visual acuity. CONCLUSION: Tacrolimus ointment 0.1% in palpebral application appears to be an effective treatment for the management of atopic keratoconjunctivitis.

[Corneal collagen cross-linking to treat infectious keratitis]. / Le cross-linking du collagène dans le traitement des infections cornéennes.

Infectious keratitis are a frequent cause of ocular morbidity. Today, new treatments are necessary to combat the emergence of antibiotic resistant germs. Corneal collagen cross-linking has been suggested to treat corneal infectious (PACK-CXL). Its action would be both antimicrobial and protective for the cornea, increasing its biochemical resistence to proteolytic enzymes. In vivo, PACK-CXL might demonstrate good efficacy against bacterial keratitis, contrary to herpetic keratitis for which it is contraindicated. For fungal or amoebic keratitis, results are uncertain regarding its safety and efficacy. The purpose of this paper is to clarify the use of corneal collagen cross-linking to treat infectious keratitis.

[Fungal keratitis: A 5-year monocentric retrospective study on Reunion Island]. / Kératites fongiques : étude rétrospective monocentrique sur 5ans à l'île de la Réunion.

OBJECTIVES: Fungal keratitis is rare in France, but could be a severe sight-threatening condition. Here, we aimed to describe the epidemiology of fungal keratitis in Réunion Island. METHODS: In a retrospective study, we analyzed 13 culture-proven keratitis episodes, occurred between January 2013 and July 2017 in the ophthalmology ward of a University Hospital, Saint-Pierre. Twelve isolates were genotyped and antifungal susceptibility testing was performed. RESULTS: Corneal abrasion caused by vegetable matter was the main predisposing factor. Stromal infiltration was observed in 12 patients. Six patients did not response to medical treatment, requiring surgical care, including two enucleations surgery. Fusarium solani (n = 6) and Fusarium dimerum (n = 4) were the main fungal species involved in fungal keratitis. Clinical failures were more prevalent with F. solani infections. The lowest minimal inhibitory concentrations for Fusarium sp. were observed with voriconazole and amphotericin B. CONCLUSION: In Reunion Island, the epidemiology of fungal keratitis is characterized by the predominance of Fusarium species, potentially involved in visual loss. This pattern is consistent with the epidemiology usually observed in tropical areas.

Susceptibilidade antibiótica de isolados bacterianos em diferentes tipos de ceratites ulcerativas de cães na cidade de Cuiabá / Antibiotic susceptibility of bacteria isolated from different types of ulcerative keratitis of dogs in the city of Cuiabá, Brazil

Objetivou-se identificar microrganismos isolados de diferentes tipos de ceratite ulcerativa em cães, juntamente com a sua susceptibilidade a antimicrobianos. O resultado do tratamento médico e cirúrgico também foi correlacionado com o tipo de isolado. Amostras para microbiologia foram obtidas com auxílio de swab estéril em 104 olhos de 72 pacientes sem histórico prévio de tratamento com antibióticos tópicos, atendidos no período de maio de 2012 a março de 2015. Os antibióticos testados foram: neomicina, gentamicina, tobramicina, cloranfenicol, polimixina B, ciprofloxacino, ofloxacino e moxifloxacina. No total, 131 bactérias foram isoladas de 96/104 olhos estudados, sendo o gênero Staphylococcus (48,09%) predominante, seguido por Pseudomonas aeruginosa (16,01%). O Shih Tzu foi a raça mais prevalente (33,33%) e o número de isolados gram-negativos foi significativamente maior nessa raça, comparativamente aos Pinschers (p=0,003), aos Filas, aos Poodles e aos sem raça definida (p=0,046). As bactérias isoladas neste estudo apresentaram maior susceptibilidade ao ofloxacino (84,55%), que foi significativamente mais eficaz em relação a neomicina e a polimixina B (p<0,0001), ao cloranfenicol (p=0,0001), a tobramicina (p=0,0007), a gentamicina (p=0,0021) e as outras fluorquinolonas, ciprofloxacino (p=0,0004) e moxifloxacino (p<0,0001). Os organismos gram-positivos foram isolados de um número significativamente maior de olhos que apresentavam ceratite ulcerativa não complicada, comparativamente àqueles com olhos acometidos por ceratite ulcerativa complicada (p=0,011). Igualmente, o número de bactérias gram-positivas foi maior que o de gram-negativas, tanto nos casos que receberam tratamento médico, como nos que foram operados, sem significativa estatística (p=0,745). Na presente pesquisa, Staphylococcus sp. foi a bactéria mais encontrada nas ceratites ulcerativas não complicadas. Já nos olhos com ceratites complicadas, embora a Pseudomonas aeruginosa tenha sido a bactéria mais predominante, o tratamento clínico foi suficiente para cura da afecção corneal na maior parte dos casos. O ofloxacino e a gentamicina foram os agentes mais eficazes contra a maioria dos isolados, com exceção do Streptococcus sp., onde o cloranfenicol se mostrou o mais eficaz. Ceratites ulcerativas sem complicações que apresentem culturas negativas podem evoluir para ceratites ulcerativas complicadas, salientando a necessidade de tratamento anti-colagenolítico em todos os casos.

The purpose of the present study was to analyze antibiotic susceptibility of bacteria associated with different types of ulcerative keratitis in dogs. The outcome of medical or surgical treatment was also correlated with the type of isolate. Samples for microbiology were obtained by means of sterile swab from 104 eyes of 72 canine patients with ulcerative keratitis without previous history of antibiotic treatment, seen from May 2012 to March 2015. Only patients with no previous treatment with antibiotics were included in the study. Bacterial isolates were identified and the antibiotic susceptibility was tested to neomycin, gentamicin, tobramycin, chloramphenicol, polymyxin B, ciprofloxacin, ofloxacin and moxifloxacin. In total, 131 species of bacteria were isolated from 96/104 eyes, and Staphylococcus sp. predominated (48.09%), followed by Pseudomonas aeruginosa (16.01%). Shih Tzus were over represented (33.33%) and the number of gram-negative isolates were significantly higher in this breed, in comparison to Pinchers (P=0.003), Filas, Poodles, and other mixed-breeds (P=0.046). All species isolated in this study were more sensitive to ofloxacin (84.55%), that was significantly most efficient than neomycin and polymyxin B (P<0.0001), chloramphenicol (P=0.0001), tobramycin (P=0.0007), gentamicin (P=0.0021) and the other fluoroquinolones, ciprofloxacin (P=0.0004) and moxifloxacin (P<0.0001). Gram-positive organisms were isolated in a significant larger number of eyes with uncomplicated ulcerative keratitis, in comparison to those eyes with complicated ulcerative keratitis (P=0.011). Likewise, gram-positive were isolated in a larger number than gram-negatives microorganisms in cases that received either medically or surgical treatment, without statistical significance (P=0.745). In the present research, Staphylococcus sp. was the bacteria most commonly isolated in the eyes with uncomplicated ulcerative keratitis. Although Pseudomonas aeruginosa was the most common isolate in the eyes with complicated ulcerative keratitis, the majority of cases managed clinically had a successful outcome. Ofloxacin and gentamicin were found to be effective against the majority of isolates, with the exception of Streptococcus. sp, in which chloramphenicol was the most effective antibiotic. Uncomplicated ulcerative keratitis presenting negative culture may evolve to complicated ulcerative keratitis, warring the necessity of anti-collagenolytic treatment in all cases.(AU)

[Induced drug uveitis and drug side effects in ophthalmology]. / Uvéite médicamenteuse et effets indésirables des médicaments en ophtalmologie.

Ocular drug side effects are very varied and can affect all the structures of the eye. The purpose of this review is to help clinicians: (i) to evoke this drug-induced toxicity yearly in the course of an unexplained ocular injury, before its damage become irreversible, (ii) to be able to recognize induced paradoxical ocular inflammation, mimicking an inflammatory pathology flare-up, especially in patient under anti-TNF regimen and (iii) to propose a more in-depth knowledge on recently described ocular toxicities from targeted cancer therapy, mainly the tyrosine kinase inhibitors.

[Fungal keratitis]. / Kératites fongiques.

Fungal keratitis, or keratomycoses, are corneal infections which must be considered in cases of corneal trauma, prior corneal surgery, chronic ocular surface disease, topical corticosteroids or contact lens wear. Filamentous fungi or yeasts may be involved. Presenting clinical features such as corneal infiltrates with feathery edges and/or raised surface, intact epithelium with deep stromal involvement, satellite lesions, endothelial plaques, lack of improvement with antibiotics and worsening with steroids are suggestive of fungal keratitis. Corneal scraping for laboratory examination is mandatory. Medical management with antifungal eye drops and systemic agents should be started as soon as possible. Surgical interventions are required in a significant number of cases to control the infection. The prognosis of fungal keratitis is worse than that of bacterial keratitis.

[Diagnostic and therapeutic contribution of microbiological analysis in severe microbial keratitis at Reims University Hospital between 2012 and 2014]. / Apport diagnostique et thérapeutique des prélèvements microbiologiques des abcès de cornées avec critères de gravité au CHU de Reims entre 2012 et 2014.

PURPOSE: To investigate the contribution of microbial analysis in the diagnosis and management of severe microbial keratitis. MATERIAL AND METHOD: This is a monocentric retrospective study at the University Hospital of Reims from January 2012 to December 2014. Corneal scrapings with infectious keratitis were subjected to routine bacterial and fungal culture. PCR was also performed to detect various viral DNA (VZV, CMV, EBV, HSV 1 & 2, adenovirus) and Acanthamoeba sp. DNA. All contact lens cases were analyzed if available. RESULTS: One hundred and six patients were hospitalized, including 30 contact lens wearers (28.3%). Sixty-four bacterial cultures were positive (68%). Twenty-five different bacterial species were identified with a majority of gram-positive bacteria (67.92%). Among contact lens wearers, the initial VA was better than non-wearers (P=0.0004) and 37% of bacteria identified (a plurality) were gram positive. Of 11 contact lens case analyzed, in only one case (3.3%) did the result correlate with the corneal culture. Only 9 samples from the 323 viral DNA extractions and real time PCR were positive (2.8%); 7 were HSV1. No prior antiviral therapy had been started. Fungal culture was positive in 2 of the 97 corneal samples taken and 63.6% of the contact lens cases (7/11 cases). Only one of the 40 Acanthamoeba sp. PCR's was positive. CONCLUSION: The systematic performance of microbiological investigations is a good diagnostic approach given the polymorphism of clinical presentations of corneal ulcers, which can sometimes be extremely misleading. Culture of contact lens cases appears ineffective for the detection and determination of the causative microorganism. The high incidence of Staphylococcus in bacterial keratitis and the prevalence of infections with gram-positive bacteria in contact lens wearers were noted.