Keratitis caused by Verticillium species

PURPOSE: To report a case of fungal keratitis caused by Verticillium species. METHODS: A 50-year-old man developed pain, redness, and an infiltrate in his left eye and had no history of trauma. The cornea showed superficial, white, stromal infiltrates and epithelial ulceration with a dendritic margin. The clinical features suggested herpetic keratitis, and the patient was treated with topical antiviral medication. Two weeks later, his condition deteriorated. Examination of the left eye showed stromal infiltrates with a feathery margin and epithelial ulceration with its covering white exudates. Corneal scrapings were taken for direct microscopic examination and culture. RESULTS: Corneal scraping showed the presence of fungal filaments. The fungus was identified as Verticillium species. Topical amphotericin B and systemic fluconazole were started after discontinuing the antiviral treatment. Clinically, the inflammation subsided during the 3 weeks after treatment. CONCLUSION: This is a rare case of infectious keratitis caused by Verticillium species. Rare species of fungal infection should be considered in the differential diagnosis of stromal keratitis refractive to conventional medical treatment.     

Acanthamoeba Keratitis

Acanthamoeba species are an important cause of microbial keratitis that may cause severe ocular inflammation and visual loss. The first cases were recognized in 1973, but the disease remained very rare until the 1980s, when an increase in incidence mainly associated with contact lens wear was reported. There is an increased risk when contact lens rinsing and soaking solutions are prepared with nonsterile water and salt tablets. The clinical picture is often characterized by severe pain with an early superficial keratitis that is often treated as herpes simplex infection. Subsequently a characteristic radial perineural infiltration may be seen, and ring infiltration is common. Limbitis and scleritis are frequent. Laboratory diagnosis is primarily by culture of epithelial samples inoculated onto agar plates spread with bacteria. Direct microscopy of samples using stains for the cyst wall or immunostaining may also be employed. A variety of topically applied therapeutic agents are thought to be effective, including propamidine isethionate, clotrimazole, polyhexamethylene biguanide, and chlorhexidine. Various combinations of these and other agents have been employed, often resulting in medical cure, especially if treatment is commenced early in the course of the disease. Penetrating keratoplasty is preferably avoided in inflamed eyes, but may be necessary in severe cases to preserve the globe or, when the infection has resolved, to restore corneal clarity for optical reasons. (Surv Ophthalmol 42:493–508, 1998.     

Mikrobielle Keratitis

PURPOSE: To determine the risk factors and the influence of complementary/alternative medicines (CAM) for infectious keratitis in a monsoon-free region of the Sultanate of Oman. STUDY DESIGN: Retrospective single center cohort study. OUTCOME MEASURES: Demographic data, risk factors, and pathogens. METHODS: Patients with purulent stromal keratitis admitted from 2001-2004 were evaluated for clinical and microbiological data, CAM use, duration of hospitalization, and outcome of treatment. STATISTICS: chi(2)-test, Z-test. RESULTS: A total of 320 patients (326 eyes) out of 7,524 admissions had severe infectious stromal keratitis requiring inpatient treatment. The average age was 35.1+/-2.5 years (range 1.5-63 years), the male:female ratio was 2:3 in the age group >or=13 years and 2:1 in the age group 相似文献