To study the clinico-microbiological profile, outcomes and prognostic factors of post penetrating keratoplasty (PKP) infectious keratitis.Retrospective review of medical records of 78 patients with post PKP infectious keratitis presenting between January 2014 and December 2018. Demographic, clinical and microbiological profile was documented and predictors of treatment and graft success were evaluated using univariate and subsequent multivariate logistic regression analysis.Mean age of patients was 52.17 ± 15.51 years and mean infiltrate size was 19.39 ± 19.68 mm2. Mean duration of presentation with infection post PKP was 11.66 ± 10.65 months. Culture positivity was seen in 64 eyes (82.05%). Bacterial growth was observed in 47 eyes (60.25%), fungal growth in 17 (21.79%) and no microbiological growth in 14 eyes (17.94%). At 3 months the visual acuity (VA) improved in 37 eyes (47.44%), did not change in 27 (34.62%) and deteriorated in 14 (17.95%). Graft failure was noted in 53 eyes (73.08%). Surgical intervention was needed in 47 (60.25%) eyes of which most common was therapeutic PKP in 32 eyes (41.02%). Treatment failure was noted with fungal infection (p = 0.05), poorer vision at presentation (p = 0.02), larger infiltrate area (p = 0.002) and graft infection developing before 1 year (p = 0.02). Graft failure was noted with associated endophthalmitis (p = 0.02), poorer VA at presentation (p = 0.01) and larger infiltrate area (p = 0.02).Post PKP infectious keratitis is a sight threatening ocular condition. It is associated with high incidence of graft failure and frequently requires surgical intervention. Fungal etiology, larger infiltrate size, poorer vision at presentation and associated endophthalmitis carries a poorer prognosis.
This study was conducted to examine microbiological profile with their antibiotic sensitivity in cases of bacterial keratitis in north and central India to ensure appropriate use of antibiotics.The microbiology laboratory records of 228 patients with culture-proven bacterial keratitis from 1st January to 31st December 2019 were analyzed. Cultured bacterial isolates were subjected to antimicrobial susceptibility testing to antibiotics commonly used in the treatment of corneal ulcer. Chi-squared or Fisher's exact test were applied to check the significance of difference between the susceptibility levels of antibiotics.The prevalence of Staphylococcus aureus and Pseudomonas aeruginosa-induced keratitis was higher in northern India, whereas that by Streptococcus pneumoniae was more prevalent in central India. In central India, 100% of S. pneumoniae isolates were found to be sensitive to ceftriaxone compared to 79% in northern India (P = 0.017). In comparison to 67% of isolates from north India, 15% of S. aureus isolates from central India were found to be sensitive to ofloxacin (P = 0.009). Similarly, 23% of isolates from central India were found sensitive to amikacin compared to 65% of isolates from north India (P = 0.012). P. aeruginosa isolates from central India were found to be sensitive to ceftazidime in 63% of cases compared to 21% of isolates from north India (P = 0.034).Prevalence of bacteria and their susceptibility to antibiotics are not uniform across geography. Vancomycin remained the most effective drug in all gram-positive coccal infections. S. aureus susceptibility to amikacin was significantly greater in north India. P. aeruginosa showed less susceptibility as compared to previous reports.
Case Report A 7-year-old girl presented with redness of the left eye since the past 4 months [Fig. 1a]. She was diagnosed elsewhere with left eye conjunctival chemosis and prescribed topical steroids and lubricants. Her best-corrected visual acuity was 20/20 in both eyes. There was left upper eyelid ptosis and a diffuse, pale pink thickening of the inferior and nasal bulbar conjunctiva, extending from the limbus to the inferior fornix with intrinsic blood vessels and small punctate hemorrhages within the lesion [Fig. 1b]. Proptosis was absent, ocular motility was full and free, and the rest of the anterior segment and fundus examination were normal in both the eyes.Figure 1: Clinical photograph showing left upper eyelid ptosis and conjunctival chemosis left eye (a). High magnification photograph showing pale pink thickening of the inferior and nasal bulbar conjunctiva with areas of punctate haemorrhages (b). Histopathology of the conjunctival incision biopsy specimen showing dense infiltrate of malignant cells with prominent plasmacytic features and large atypical lymphoblasts (yellow arrow) (H and E, ×40) (c). Immunohistochemistry showing positive staining with terminal deoxynucleotidyl transferase (Tdt) (d)What is Your Next Step Start the patient on systemic steroids Consider an orbital computed tomography scan Get a complete blood count done including a peripheral smear Do an incision biopsy from the conjunctival thickening. Findings Incision biopsy from the conjunctival lesion revealed polymorphous infiltrate of lymphoid cells with large atypical lymphoblastic cells in the background [Fig. 1c]. Immunohistochemistry identified the cells to be highly positive for terminal deoxynucleotidyl transferase and CD20, CD79a, and CD34 and negative for CD3, CD117, and MPO [Fig. 1d]. Her blood investigations showed a total leucocyte count of 8000 cells/mm3 with 27% lymphocytes and 8%–10% atypical lymphoblasts. Bone marrow biopsy showed replacement of the marrow with predominant lymphoblasts. Cerebrospinal fluid cytology was normal. Systemic examination revealed left preauricular lymphadenopathy and no organomegaly. Diagnosis Conjunctival Extramedullary B-Lymphoblastic Lymphoma/leukemia. Correct Answer: C Discussion Ocular involvement is an uncommon extramedullary manifestation of acute leukaemia and is usually limited to retina, choroid, vitreous, optic nerve, orbit, or sclera.[1] Leukemic infiltration of the conjunctiva is rare and appears as fleshy erythematous thickening giving the appearance of a “solid chemosis” as it was in our patient.[23] Acute lymphocytic leukemia (ALL), the most common acute leukemia subtype in children, commonly presents with nonspecific symptoms of anemia and generalized weakness. In our patient, “solid chemosis” was the initial manifestation of ALL. Peripheral blood smear showed immature lymphoblastic cells and it should be part of initial evaluation for an early diagnosis in such cases. Surgery can be avoided in these patients if a peripheral blood smear is performed primarily and detects the presence of blast cells. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Fixed drug eruption (FDE) is a type of drug-induced cutaneous disorder that characteristically presents with recurrence of similar lesion at the same skin or mucosal site as a result of systemic exposure to a drug. Paracetamol is commonly prescribed analgesic-antipyretic agent in all age group of patients. FDE due to paracetamol is not very common but it is well reported in literature for all age groups. We report a case of a 7-year-old male with FDE due to paracetamol involving upper eyelid and presenting as an eyelid skin necrosis.
AbstractBackground: We report a unique case of Stenotrophomonas maltophilia-related pediatric endogenous endophthalmitis. Case presentation: A 10-year-old male presented with redness and loss of vision in his right eye for two weeks. Clinical examination and ultrasound features were suggestive of endophthalmitis, most likely endogenous due to the absence of a history of trauma or intraocular intervention. Following vitrectomy and appropriate intravitreal antibiotics, the vision improved to 20/80. Vitreous culture revealed a gram-negative bacillus Stenotrophomonas maltophilia. Conclusion: Timely recognition of this pathogen and management as per antibiotic sensitivity can help salvage functional vision in this condition.
Pythium insidiosum(PI) can cause sight threatening keratitis which is managed commonly by performing penetrating keratoplasty. This article is a retrospective review to assess outcomes of keratoplasty performed in patients diagnosed with PI keratitis. (2) Methods: Pre-operative, intra operative and post-operative data of patients diagnosed with PI keratitis and who underwent keratoplasty for their condition from January 2020 to December 2021 were col-lected from the central patient database of a tertiary eye care hospital in India. The data were an-alyzed for anatomic success, elimination of infection, graft survival, incidence of repeat kerato-plasty, final visual acuity and varied complications. (3) Results: In total, 16 eyes underwent pene-trating keratoplasty for PI keratitis during the study period. Mean time to keratoplasty from on-set of symptoms was 31.3 days and mean graft size was 10.4 mm. Nine out of the 16 cases had recurrence of infection following surgery, six of which required a repeat keratoplasty for elimina-tion of infection. Out of these 6 patients, one patient underwent 2 repeat keratoplasties. Mean graft size for repeat keratoplasty performed in recurrent cases was 11.7 mm. Globe was successfully salvaged in 14 out of 16 patients (87.5 %). Endo-exudates, graft infiltration, graft dehiscence, secondary glaucoma and retinal detachment were the various complications noted after kerato-plasty. (4) Conclusion: Keratoplasty remains the choice of treatment in PI keratitis, however re-currence of disease and graft failure are common. Large sized grafts, meticulous per-operative removal of infection, adjuvant cryotherapy, and intraoperative and post-operative use of antibi-otics can help in improving outcome of keratoplasty in these patients.
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