Surgical management of infectious keratitis.

The successful management of infectious keratitis is usually achieved with a combination of tools for accurate diagnosis and targeted timely antimicrobial therapy. An armamentarium of surgical interventions is available in the acute stage which can be resorted to in a step wise manner or in combination guided by the response to treatment. Simple surgical modalities can facilitate accurate diagnosis e.g. corneal biopsy and alcohol delamination. Surgery to promote epithelial healing can vary from tarsorrhaphy, amniotic membrane transplantation or conjunctival flaps depending on the extent of infection, visual prognosis, availability of tissue and surgeon's experience. Collagen crosslinking has been increasingly utilized with successful results to strengthen the cornea and reduce the infective load consequently the need for further elaborate surgical interventions. It has shown encouraging results specially in superficial bacterial and fungal keratitis but for deeper infections, viral and acanthamoeba keratitis, its use remains questionable. When globe integrity is compromised, corneal gluing is the most commonly used procedure to seal small perforations. In larger perforations/fulminant infections a tectonic/therapeutic graft is advisable. Partial thickness grafts are increasingly popular to treat superficial infection or internally tamponade perforations. Peripheral therapeutic grafts face challenges with potential requirement for a manually fashioned graft, and increased risk of rejection due to proximity to the limbal vessels. Late stage visual rehabilitation is likely to require further surgical interventions after complete resolution of infection and inflammation. A preliminary assessment of corneal sensation and integrity of the ocular surface are key for any successful surgical intervention to restore vision.

Manifestation of Herpetic Eye Disease after COVID-19 Vaccine: A UK Case Series.

PURPOSE: To highlight the potential risk of herpetic eye disease (HED) reactivation following COVID-19 vaccine. METHODS: Retrospective analysis of all patients who presented with HED within 28 days post-first dose COVID-19 vaccination. RESULTS: Eleven eyes (n = 10 patients) were included. The mean interval between COVID-19 vaccination and ocular symptoms/signs was 12.3 ± 10.3 days. Four (40%) patients presented with HSV keratitis, and six (60%) patients presented with VZV keratitis (five had concurrent other signs of herpes zoster ophthalmicus). Common ocular signs included multiple scattered dendritic/pseudodendritic corneal epitheliopathy (90.9%), anterior uveitis (63.6%), and endothelitis (27.3%). All cases were successfully treated with topical and systemic antiviral treatment and/or topical corticosteroids (mean healing time = 3.9 ± 1.6 weeks). CONCLUSIONS: Our case series highlights the potential temporal association between HED and COVID-19 vaccine. Prophylactic antiviral treatment is recommended in patients with a history of HED prior to COVID-19 vaccination.

Evaluation of the corneal collagen cross-linking demarcation line profile using anterior segment optical coherence tomography.

PURPOSE: To evaluate the depth of the stromal demarcation line after corneal collagen cross-linking (CXL) using anterior segment optical coherence tomography. METHODS: In this prospective, interventional case series, 23 patients (27 eyes) with progressive keratoconus were enrolled. All patients underwent uneventful CXL treatment. Corneal stromal demarcation line depth was measured centrally, 3 mm temporally, and 3 mm nasally by 2 independent observers using anterior segment optical coherence tomography at 1 month postoperatively in all patients. RESULTS: Mean depth of the corneal stromal demarcation line measured by the first observer was 310.67 ± 31.04 µm (range, 258-364 µm) centrally, 212.07 ± 24.5 µm (range, 178-279 µm) nasally, and 218.04 ± 21.91 µm (range, 191-261 µm) temporally. Mean depth of the corneal stromal demarcation line measured by the second observer was 308.78 ± 29 µm (range, 262-381 µm) centrally, 211.04 ± 23.93 µm (range, 180-277 µm) nasally, and 217.22 ± 25.51 µm (range, 179-271 µm) temporally. There was a statistically significant difference (P < 0.001) between central and both nasal and temporal depths of the corneal stromal demarcation line (paired samples t test) for both observers. There was no statistically significant difference between nasal and temporal corneal stromal demarcation line depths (paired samples t test, P > 0.05) for each observer. CONCLUSIONS: Mean depth of the corneal stromal demarcation line after CXL treatment is greater centrally in comparison with nasal and temporal depths.

Interface lamellar keratitis induced by a post-Descemet stripping automated endothelial keratoplasty corneal trauma.

A 78-year-old female patient suffering from Fuchs endothelial dystrophy had uneventful Descemet stripping automated endothelial keratoplasty (DSAEK) on the right eye. One and a half months postoperatively, she underwent a corneal foreign body trauma and was referred to our clinic, complaining about vision deterioration. Slit-lamp examination revealed a severe and diffuse interface lamellar keratitis between the DSAEK graft and the recipient's cornea without any signs of graft dysfunction. Intensive treatment with local corticosteroids was applied immediately, resulting in prompt improvement of both visual acuity and clinical condition. A new clinical entity, described as interface lamellar keratitis after corneal trauma in a DSAEK patient, is presented. Early diagnosis and appropriate intensive treatment with local corticosteroids are essential to successfully address this uncommon post-DSAEK complication.

Transepithelial phototherapeutic keratectomy for recurrent corneal erosions in a patient with previous corneal collagen cross-linking.

PURPOSE: To report the significant visual and topographic improvement of a patient who had corneal collagen cross-linking (CXL) performed and was subsequently treated with transepithelial phototherapeutic keratectomy (t-PTK) for recurrent corneal erosions. METHODS: A 36-year-old woman presented with recurrent corneal erosions in the right eye due to foreign body corneal trauma 1 month prior to presentation. The patient had undergone CXL treatment for keratoconus on the same eye 1 year prior to presentation. After failed conservative treatment consisting of epithelial debridement and lubrication with artificial tears, the patient underwent t-PTK. RESULTS: Four months after t-PTK, corneal erosions did not recur and the patient remained asymptomatic. Slit-lamp examination revealed a clear cornea. The patient showed significant visual and topographic improvement after t-PTK. CONCLUSIONS: Transepithelial PTK for recurrent corneal erosions in a postoperative CXL patient successfully treated the corneal pathology, and visual and topographic improvement were observed.