Bacterial keratitis: perspective on epidemiology, clinico-pathogenesis, diagnosis and treatment.

Bacterial keratitis is an acute or chronic, transient or recurrent infection of the cornea with varying predilection for anatomical and topographical parts of the cornea like marginal or central. It is a potentially sight-threatening corneal infection in humans that is generally found in eyes with predisposing elements, the most common of which is contact lens wear. The epidemiological data reveals the universal occurrence of this disease. With advances in the understanding of its pathogenesis, laboratory investigations like immunohistochemistry, fluorescent microscopy, enzyme immunoassays and molecular biology, and the availability of fourth generation antibiotics, the overall visual outcome in bacterial keratitis has improved with time. Particular attention should be given to this condition as it can progress very rapidly with complete corneal destruction occurring within 24-48 hours. Early diagnosis, which is primarily clinical and substantiated largely by microbiological data, and prompt treatment are needed to minimise the possibility of permanent visual loss and reduce structural damage to the cornea.

Quantitative and qualitative corneal endothelial morphology of omani patients with pseudoexfoliation syndrome.

OBJECTIVE: Pseudoexfoliation (PEX) syndrome is one of the leading causes of secondary open angle glaucoma and blindness. This study explored whether in PEX eyes, preoperative changes in corneal endothelial cell morphology might be a risk factor for postoperative corneal decompensation. METHODS: One hundred twenty six eyes of 69 preoperative cataract patients (43 males, 26 females) were enrolled in this cross-sectional study from the Ophthalmology Department at Sultan Qaboos University Hospital between 2003-2005. All patients were subjected to confocal biomicroscopy. RESULTS: The mean age of patients with PEX eyes was 63.2 years. One hundred and eight (85.7%) eyes with PEX had endothelial cell counts within the normal range (1650-3500/mm(2)). The qualitative morphology of the endothelium of PEX corneas was highly abnormal in term of polymegathism and pleomorphism. Twelve eyes had endothelial cell counts higher than normal for that age group. Only 6 eyes had endothelial cell counts lower than normal. The mean value for the pleomorphism was found to be significantly lower than normal and for polymegathism significantly more than normal. The relationship between pleomorphism and polymegathism was stronger for males than for females and stronger for patients under 60 years than patients over 60 years. The same relationship between pleomorphism and polymegathism showed a stronger relationship for the glaucoma group as compared to the non-glaucoma group. CONCLUSION: This study revealed that corneal decompensation in PEX eyes can occur in presence of abnormalities in polymegathism and pleomorphism, even when the endothelial cell counts may be normal.

The successful use of mycophenolate mofetil in a patient with active birdshot chorio-retinopathy refractory to azathioprine therapy: case report

Relato da eficácia da terapia com micofenolato mofetil (MMF) no tratamento de paciente com coriorretinopatia do tipo "birdshot" (CB), no qual o processo inflamatório intra-ocular foi refratário ao uso de azatioprina (AZA) apos um ano de terapia. Paciente de 62 anos de idade e com CB desenvolveu edema macular cistóide e vasculite retiniana em ambos os olhos. No intuito de controlar a inflamação intra-ocular, a terapia com azatioprina oral (2 mg/kg) foi iniciada. Como a terapia com AZA não se mostrou eficaz a médio prazo, esse medicamento foi substituido pelo MMF, o qual controlou controlou o processo inflamatório com conseqüente melhora da acuidade visual do paciente. Após 3 anos de tratamento com MMF, nenhuma recorrência foi observada. Neste paciente com CB refratária ao tratamento com AZA, o MMF foi eficaz em debelar a inflamação intra-ocular.