RESUMEN
PURPOSE: To report a case of Paecilomyces lilacinus keratitis, initially misdiagnosed as Penicillium sp., in a patient with a long-standing history of herpes simplex virus (HSV) keratitis. METHODS: A retrospective case report. RESULTS: A 62-year-old man developed P. lilacinus keratitis. He was treated with topical steroids for immune stromal keratitis secondary to HSV before developing the fungal keratitis. Initial corneal cultures were positive for Penicillium sp., but subsequent cultures identified P. lilacinus to be the causative organism. The patient later developed an anterior chamber abscess. Three penetrating keratoplasties, as well as intravitreal injection of amphothericin B, topical miconazole, subconjunctival miconazole, and systemic fluconazole, were required to eradicate the infection. CONCLUSION: To our knowledge, this is a first report of P. lilacinus keratitis in a patient with a previous history of HSV keratitis. The causative organism was initially reported as Penicillium sp. on 2 occasions, before the correct diagnosis was made. Paecilomyces keratitis progressed to an anterior chamber abscess in this eye. Aggressive treatment, including a therapeutic penetrating keratoplasty, intravitreal amphothericin B injection, topical miconazole, and systemic fluconazole can be successful in eradicating this extremely difficult-to-treat infection.
Asunto(s)
Infecciones Fúngicas del Ojo/terapia , Queratitis Herpética/microbiología , Queratitis Herpética/terapia , Micosis/terapia , Paecilomyces/aislamiento & purificación , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Terapia Combinada , Córnea/microbiología , Quimioterapia Combinada , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/microbiología , Fluconazol/uso terapéutico , Humanos , Queratitis Herpética/diagnóstico , Queratoplastia Penetrante , Masculino , Miconazol/uso terapéutico , Persona de Mediana Edad , Micosis/diagnóstico , Micosis/microbiología , Reoperación , Estudios RetrospectivosRESUMEN
PURPOSE: To report a case of conjunctival-corneal intraepithelial neoplasia (CCIN) in an elderly African American patient treated with topical mitomycin C and the subsequent complication of limbal stem cell deficiency. DESIGN: Interventional case report. METHODS: A 92-year-old African American woman was diagnosed with CCIN in the right eye. Following incisional biopsy, the patient received five 1-week courses of 0.04% mitomycin C and was followed over a period of 10 months. RESULTS: The CCIN regressed completely following mitomycin C therapy. Three months later, the patient developed recurrent nonhealing epithelial defects in the right cornea. CONCLUSIONS: Conjunctival-corneal intraepithelial neoplasia may occur in the African American population. Although MMC is effective in eradicating CCIN, a limbal stem cell deficiency may complicate the treatment.
Asunto(s)
Carcinoma in Situ/tratamiento farmacológico , Neoplasias de la Conjuntiva/tratamiento farmacológico , Enfermedades de la Córnea/inducido químicamente , Enfermedades de la Córnea/tratamiento farmacológico , Epitelio Corneal/efectos de los fármacos , Mitomicina/efectos adversos , Células Madre/efectos de los fármacos , Administración Tópica , Anciano , Anciano de 80 o más Años , Antibióticos Antineoplásicos/efectos adversos , Carcinoma in Situ/patología , Neoplasias de la Conjuntiva/patología , Enfermedades de la Córnea/patología , Epitelio Corneal/patología , Neoplasias del Ojo/tratamiento farmacológico , Neoplasias del Ojo/patología , Femenino , Humanos , Limbo de la Córnea/efectos de los fármacos , Limbo de la Córnea/patología , Recurrencia , Células Madre/patologíaRESUMEN
PURPOSE: To report a severe case of keratitis caused by Scopulariopsis brevicaulis and its response to treatment with natamycin. METHODS: A 28-year-old farmer suffered a corneal perforation with a piece of wire in the right eye. Two months later, he developed severe infectious keratitis in that eye. RESULTS: S. brevicaulis was cultured from the patient's cornea on Sabouraud agar. The keratitis responded to treatment with topical natamycin 5%. A debridement of the corneal ulcer was also performed. CONCLUSIONS: S. brevicaulis is a rare cause of fungal keratitis. The infection can be difficult to eradicate. This is the first case report of keratitis caused by S. brevicaulis treated successfully with natamycin.
Asunto(s)
Antifúngicos/uso terapéutico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Queratitis/tratamiento farmacológico , Queratitis/microbiología , Hongos Mitospóricos/aislamiento & purificación , Micosis/tratamiento farmacológico , Natamicina/uso terapéutico , Adulto , Lesiones de la Cornea , Infecciones Fúngicas del Ojo/microbiología , Lesiones Oculares Penetrantes/complicaciones , Lesiones Oculares Penetrantes/cirugía , Humanos , Masculino , Micosis/microbiologíaRESUMEN
A 55-year-old woman had bilateral laser in situ keratomileusis (LASIK). An epithelial defect was observed in the left eye after the flap was cut. Postoperatively, the patient developed recurrent corneal erosion in the left eye related to the traumatic epithelial defect sustained during LASIK. The erosion led to secondary diffuse lamellar keratitis (DLK). Anterior stromal puncture was required to treat the erosion after conventional treatment failed. The secondary DLK resolved quickly after the erosion healed, without the need for topical corticosteroids. Anterior stromal puncture may be a useful treatment for recurrent corneal erosions that do not respond to conventional therapy.
Asunto(s)
Enfermedades de la Córnea/cirugía , Sustancia Propia/cirugía , Queratomileusis por Láser In Situ/efectos adversos , Punciones/métodos , Enfermedades de la Córnea/etiología , Sustancia Propia/patología , Epitelio Corneal/patología , Femenino , Humanos , Persona de Mediana Edad , Recurrencia , Agudeza VisualRESUMEN
PURPOSE: To report unusual bilateral corneal opacity and inferior corneal thinning in a patient with idiopathic multicentric osteolysis. METHODS: A 17-year-old girl with a history of idiopathic multicentric osteolysis was evaluated for corneal opacities. RESULTS: She was found to have bilateral, linear, posterior corneal opacity and inferior corneal thinning. Her vision did not appear to be affected. No progression of the corneal findings was noted over a period of 2 years. CONCLUSION: Posterior corneal opacity and inferior corneal thinning may be associated with idiopathic multicentric osteolysis, a rare disorder of unknown etiology characterized by bony abnormalities and nephropathy. Patients with idiopathic multicentric osteolysis should be evaluated by an ophthalmologist for the presence of corneal opacities.
Asunto(s)
Opacidad de la Córnea/complicaciones , Osteólisis Esencial/complicaciones , Adolescente , Córnea/patología , Opacidad de la Córnea/patología , Opacidad de la Córnea/fisiopatología , Femenino , Pie/diagnóstico por imagen , Mano/diagnóstico por imagen , Humanos , Osteólisis Esencial/diagnóstico por imagen , Radiografía , Visión OcularRESUMEN
PURPOSE: To report a case of Mycobacterium chelonae keratitis associated with soft contact lens wear. METHODS: A 17-year-old boy who wore frequent replacement soft contact lenses developed keratitis in the right eye. There was no history of trauma to the right eye. The patient was treated initially with topical ciprofloxacin but without improvement. On presentation, visual acuity in his right eye was 20/40. A Gram-stained scraping of the corneal infiltrate revealed beaded filamentous rods, and the organisms were acid-fast positive. The patient's right eye was treated with intensive topical amikacin, 20 mg/mL, and 10 % sulfacetamide. Eventually, Mycobacterium chelonae was cultured on Sabourard's agar, topical sulfacetamide was stopped, and amikacin was continued. RESULTS: The patient's keratitis responded well to amikacin and resolved over a period of 4 weeks. Visual acuity in the right eye improved to 20/25. CONCLUSIONS: Mycobacterium chelonae is a rare cause of keratitis in soft contact lens wearers. We have identified fewer than five cases of Mycobacterium chelonae keratitis associated with soft contact lenses in the literature. Prompt and accurate diagnosis of the organism using comeal scraping can lead to appropriate therapy and resolution of the keratitis.
Asunto(s)
Lentes de Contacto Hidrofílicos/efectos adversos , Queratitis/microbiología , Infecciones por Mycobacterium no Tuberculosas/etiología , Adolescente , Amicacina/uso terapéutico , Antibacterianos/uso terapéutico , Humanos , Queratitis/fisiopatología , Masculino , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Mycobacterium chelonae , Agudeza VisualRESUMEN
PURPOSE: To describe a case of peripheral keratitis in a patient with an acute exacerbation of chronic myelomonocytic leukemia (CMML). METHOD: Case report and review of the literature. RESULTS: This is the second reported case of peripheral keratitis in a patient with CMML. The previously reported patient presented with peripheral keratitis that led to the diagnosis of leukemia. Our patient had an established diagnosis of CMML, and peripheral keratitis occurred during an acute exacerbation of his chronic leukemia. The keratitis resolved with topical corticosteroids in our patient. CONCLUSION: Leukemia should be included in the differential diagnosis of peripheral keratitis. Elevated white blood cell count with abnormal differential in a patient with peripheral keratitis may help to establish a diagnosis of leukemia or identify an acute exacerbation of chronic leukemia.
Asunto(s)
Queratitis/etiología , Leucemia Mielomonocítica Crónica/complicaciones , Administración Tópica , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Anciano , Diagnóstico Diferencial , Humanos , Iritis/tratamiento farmacológico , Iritis/etiología , Queratitis/diagnóstico , Queratitis/tratamiento farmacológico , Leucemia Mielomonocítica Crónica/diagnóstico , MasculinoRESUMEN
PURPOSE: We evaluated whether laser in situ keratomileusis (LASIK) was a safe and effective treatment for myopia and astigmatism after penetrating keratoplasty (PK). METHODS: We performed a retrospective review of medical records of all the patients who underwent LASIK following PK at the University of Minnesota between January 1999 and March 2000. RESULTS: Seventeen patients (20 eyes) underwent LASIK following PK between January 1999 and March 2000. Mean age of the patients at the time of LASIK was 37 years (range, 20-62). Keratoconus was the indication for PK in the majority of the eyes (73.7%). Anisometropia and/or contact lens intolerance was the indication for LASIK following PK. No intraoperative complications occurred. Following LASIK, the best spectacle-corrected visual acuity remained within 1 line of preoperative visual acuity in 94.7% of the eyes. The mean sphere was reduced by 3.93 diopters (80.0%) and the mean cylinder was reduced by 2.83 diopters (69.9%) from the preoperative values at the last follow-up visit. Uncorrected visual acuity became 20/40 or better in 73.7% of the eyes after LASIK. CONCLUSIONS: LASIK is a safe procedure in eyes in which PK has previously been performed. LASIK is effective in the treatment of myopia and astigmatism following PK.