Antimicrobial susceptibility of isolated pathogens from patients with contact lens-related bacterial keratitis in Crete, Greece: A ten-year analysis.

PURPOSE: To evaluate the bacterial spectrum and antimicrobial susceptibilities of pathogens isolated from contact lens-related bacterial keratitis cases in a large academic Greek hospital. METHODS: All adult patients with positive corneal scrapings or contact lens culture between 2007 and 2016 at the University Hospital of Heraklion, Greece, were retrospectively identified through a local microbiology database and their medical records were reviewed. RESULTS: A total of 240 isolates were recovered from 131 patients with culture-proven contact lens-associated bacterial keratitis. The most common microorganism identified was Serratia marcescens (17.1% of total isolates), followed by Pseudomonas aeruginosa, Klebsiella spp. and coagulase-negative staphylococci (CoNS). Rates of aztreonam-resistant P. aeruginosa and erythromycin-resistant CoNS decreased in recent years, while the decrease in oxacillin-resistant CoNS was statistically significant (p=0.009). More than 90% of the isolated organisms (S. marcescens, P. aeruginosa, Klebsiella spp. and CoNS) were susceptible to ciprofloxacin or gentamicin. CONCLUSION: Gram-negative microorganisms are the most common causative pathogens of contact lens-related keratitis in the region of Crete. Topical antibacterials containing quinolones or gentamicin represent an effective empirical treatment for the majority of the cases. This is quite encouraging, considering that the present study was conducted in a country characterised by high antimicrobial resistance rates. However, culture-driven antimicrobial treatment is mandatory for this sight-threatening infection.

Descemet stripping automated endothelial keratoplasty in a child after failed penetrating keratoplasty.

Use of Descemet stripping automated endothelial keratoplasty (DSAEK) has been reported in children for the treatment of postoperative endothelial decompensation and Descemet membrane break after forceps delivery. Rapid visual recovery and minimally induced postoperative astigmatism make DSAEK preferable to penetrating keratoplasty for the management of isolated endothelial disorders in this age group. We present a case of DSAEK in a 4-year-old boy for the management of irreversible endothelial rejection after penetrating keratoplasty. Three months after the procedure, the cornea remained clear with the donor button in place.

One-year follow-up of corneal confocal microscopy after corneal cross-linking in patients with post laser in situ keratosmileusis ectasia and keratoconus.

PURPOSE: To investigate corneal tissue alterations after corneal collagen cross-linking in patients with post laser in situ keratosmileusis (LASIK) keratectasia and keratoconus. DESIGN: Prospective comparative case series. METHODS: Five patients (5 eyes) with iatrogenic keratectasia after LASIK and 5 patients (5 eyes) with progressive keratoconus were included. All eyes underwent corneal cross-linking and were assessed by corneal in vivo confocal microscopy. Three normal/healthy and 3 post-LASIK without ectasia corneas were also examined as controls. RESULTS: All corneas revealed normal epithelial thickness before and after surgery. Images of both keratoconic and post-LASIK corneal ectasia eyes revealed similar morphologic alterations. The subepithelial nerve plexus was absent immediately after treatment; regeneration of nerves was evident after the third postoperative month. Keratocytes were absent from the anterior 300 mum of the stroma in the first 3 months while the posterior stromal density of keratocytes was increased. Corneal collagen fibers in the anterior stroma were distributed unevenly in a net-like formation. Full-thickness keratocyte repopulation in the anterior and mid-corneal stroma was detected 6 months after treatment. The corneal endothelium did not undergo any significant changes, since the cell density and hexagonality was not found altered during the follow-up period. CONCLUSIONS: Keratocyte nuclei apoptosis in the anterior and intermediate corneal stroma along with collagen alterations were observed during the first 3 postcorneal cross-linking months. Gradual keratocyte repopulation was demonstrated over the following months. Corneal alterations after corneal cross-linking were similar in both keratoconic and post-LASIK corneal ectasia eyes.