Recent trends: Medical management of infectious keratitis.

This review article highlights the newer diagnostic modalities and approaches in the medical management of infectious keratitis. A Medline literature search conducted to March 2014 has been included. Recent studies or publications were selected from international indexed journals using suitable key words. Development of specular microscopy and polymerase chain reaction (PCR) has a promising role as diagnostic modalities in infectious keratitis, especially in refractory cases. Previously fortified antibiotics have been the mainstay of treatment for bacterial keratitis. Recently, the advent of fourth-generation fluoroquinolones monotherapy has shown promising results in the management of bacterial keratitis. Corneal collagen cross-linking is being considered in the refractory cases. Topical natamycin and amphotericin B should be considered as the first choice anti-fungal agents in suspected filamentous or yeast infection respectively. Voriconazole and newer routes of administration such as intrastromal and intracameral injection of conventional anti-fungal agents have demonstrated a positive clinical response. Ganciclovir is a newer anti-viral agent with promising results in herpes simplex keratitis. Thus, introduction of newer diagnostic modalities and collagen cross-linking along with fourth-generation fluoroquinolones and newer azoles have a promising role in the management of infectious keratitis.

Acanthamoeba keratitis with Curvularia co-infection.

We report a case of Acanthamoeba keratitis with Curvularia co-infection. Acanthamoeba and fungal co-infection have been uncommonly reported in literature, worldwide. A classical history with a strong clinical suspicion and experienced laboratory personnel with systematic examination of corneal scrapings for bacterial, viral, parasitic and fungal causes are imperative for accurate diagnosis. Early diagnosis of Acanthamoeba keratitis or fungal infection followed by aggressive and appropriate treatment with effective agents is critical for the retention of good vision. Acanthamoeba keratitis is difficult to diagnose and, despite improvement in treatment options, may culminate in prolonged morbidity and significant loss of visual acuity. This case emphasizes the important role played by clinical microbiologists in making prompt diagnosis which can ultimately reduce visual morbidity.

Supratarsal injection of corticosteroids in the treatment of refractory vernal keratoconjunctivitis.

PURPOSE: To study and compare the efficacy of supratarsal injection of dexamethasone sodium phosphate, triamcinolone acetonide and hydrocortisone sodium succinate in treating refractory vernal keratoconjunctivitis (VKC). METHODS: Prospective randomized, double-masked, case control trial, including 90 eyes of 45 patients with refractory VKC. Both eyes of each patient were randomly assigned to receive supratarsal injection of one of three compounds under study: dexamethasone sodium phosphate (2 mg), triamcinolone acetonide (10.5 mg), and hydrocortisone sodium succinate (50 mg). RESULTS: All the three drugs were equally effective with no statistically significant difference in the time of resolution of cobblestone papillae, lid oedema, conjunctival discharge and chemosis, Tranta's dots and shield ulcers. There was no statistically significant difference in the severity and rate of recurrence of disease following supratarsal injection of all the three drugs. But recurrence of disease to same severity was seen within 6 months of injection in all cases irrespective of compounds used. CONCLUSION: Supratarsal injection of corticosteroids is very effective for temporary suppression of severe inflammation associated with VKC.