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Query: UMLS:C0022568 (keratitis)
 5,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two cases of infectious crystalline keratopathy located in the posterior stroma after penetrating keratoplasty are presented. Topical steroids and suture removal were risk factors in both cases. In the first case, a moderate anterior chamber reaction was present. Crystalline infiltrates persisted on topical and systemic steroid therapy. In the second case, deep corneal ulceration, hypopyon, and vitreitis were noted. A vitreous aspirate showed rare gram-positive cocci in pairs. The corneal ulceration and crystalline keratopathy persisted despite intravitreal and topical antibiotics. Therapeutic penetrating keratoplasty was performed in both cases. Staphylococcus epidermidis sensitive to vancomycin was isolated from corneal tissue. Light microscopy documented aggregates of gram-positive bacteria anterior to Descemet's membrane, with an overlying keratitis. Electron microscopy in the second case showed all bacteria within stromal keratocytes. No clinical recurrence was seen using topical vancomycin. As demonstrated in the cases presented, infectious crystalline keratopathy can occur exclusively in the deeper layers of the cornea. Isolation of S. epidermidis, associated inflammation, and intraocular spread of organisms are rare findings.
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PMID:Posterior infectious crystalline keratopathy with Staphylococcus epidermidis. 225 18

We reviewed the records of 22 patients whose corneal ulcers were associated with therapeutic soft contact lens wear. The patients required hospitalization on the Cornea Service at Wills Eye Hospital between January 1, 1978 and September 1, 1988. A majority of the ulcers were associated with pseudophakic or aphakic bullous keratopathy (9 of 22 cases; 41%); neurotrophic/exposure keratitis was the second most common diagnosis (7 of 22; 32%). Most patients used topical antibiotics (15 of 22; 68%) and/or corticosteroids (13 of 22; 59%). Cultures were positive in 15 of 22 cases (68%). Gram-positive organisms were isolated in 60% the culture-positive cases (9 of 15). Streptococcus was the most common organism isolated (6 of 15 culture positive-cases; 40%). Gram-negative organisms were found in four of 15 culture-positive ulcers (27%). There was only one Pseudomonas infection in the series. Uncommon organisms--including Candida, atypical mycobacteria, Achromobacter, Acinetobacter and Micrococcus--were isolated in five cases. Therapeutic soft contact lens wearers are at risk for developing corneal ulcers; most often these are caused by gram-positive bacteria, especially streptococci, and uncommon organisms.
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PMID:Microbial keratitis and corneal ulceration associated with therapeutic soft contact lenses. 230 53

Unilateral trigeminal denervation can render the cornea hypoesthestic and lead to neuroparalytic keratitis. A patient presented to the clinic with a unilateral hypoesthestic compromised cornea which was subsequently diagnosed as neuroparalytic keratitis. The evaluation and management of this case will be presented with a discussion of neuroparalytic keratitis. Other synonyms include trigeminal neurotrophic keratopathy and neurotrophic keratitis.
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PMID:Neuroparalytic keratitis. 233 6

Infectious keratitis may be unsuspected preoperatively in patients undergoing penetrating keratoplasty. We have diagnosed five cases of previously unknown corneal infection discovered only after post-keratoplasty histopathologic examination using specific stains. These cases of preoperatively unsuspected infectious keratitis illustrate examples where histopathologic examination using specialized stains may alert the physician to the need for appropriate postoperative antimicrobial therapy. Furthermore, these cases illustrate the ability of soft contact lenses to mask symptoms of infectious keratitis. Additionally, the clinical appearance of advanced bullous keratopathy may mask signs of infectious keratitis.
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PMID:Unsuspected infectious keratitis in host corneal buttons. 247 Jan 59

Experimentally induced ocular feline herpesvirus 1 (FHV-1) infection was studied in 30 specific pathogen-free cats. In ten cats, the ability of five field isolates of FHV-1 to replicate in the epithelium and substantia propria of cornea and conjunctiva was demonstrated by histochemical techniques. Feline herpesvirus 1 was found to preferentially infect and induce necrosis of conjunctival epithelium. Although significant histologic lesions were not induced, all FHV-1 strains were observed to replicate in corneal epithelium; minimal viral antigen was detected in the corneal stroma. The course and clinical features of ocular FHV-1 infection were then studied over a period of 60 days in two groups of ten cats: in one group, infection was preceded by administration of subconjunctival betamethasone. In each of these groups, a distinct clinical syndrome developed. In cats not receiving corticosteroids, a course of epithelial keratitis, characterized by the formation of punctate and dendritic epithelial lesions, persisted for up to 24 days postinfection. In the corticosteroid treated group, a chronic (greater than 60 days) stromal keratitis developed, characterized by geographic epithelial ulceration, interstitial edema and deep vascularization. Other complications observed in corticosteroid-treated animals included decreased tear production, calcific-band keratopathy and a unique stromal disorder of cats termed corneal sequestration. The results of this study indicate that while epithelial keratitis may occur during primary infection, stromal keratitis does not, unless immune responsiveness to FHV-1 is concomitantly suppressed. This feature is similar to naturally occurring HSV-1 keratitis of humans, but contrasts to other animal model systems in which stromal keratitis predictably occurs during primary infection. Study of this animal model, therefore, may allow unique insights into the events preceding the establishment of stromal keratitis.
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PMID:Experimental ocular herpesvirus infection in the cat. Sites of virus replication, clinical features and effects of corticosteroid administration. 247 18

Acquired immune deficiency syndrome (AIDS) is associated with a wide spectrum of systemic and ocular infectious diseases. Little information is known about herpes simplex virus type 1 (HSV-1) keratoconjunctivitis in association with AIDS. The authors present six cases of recurrent HSV keratitis occurring in AIDS patients. Features of the herpetic keratitis in these patients included unilateral dendritic or geographic epithelial keratopathy; predilection for peripheral versus central corneal involvement; one to three recurrences per patient over a mean observation period of 17 months, with a median dendrite-free interval of 7 months; and a moderately prolonged clinical course with a median healing time of 3 weeks using topical antiviral therapy. Only one of six cases had stromal infiltrative involvement. These cases raise the question of whether the immunologic abnormalities associated with AIDS may affect the clinical characteristics and course of HSV keratitis.
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PMID:Herpes simplex keratitis in patients with acquired immune deficiency syndrome. 255 61

One of the most common indications for the fitting of therapeutic contact lenses is bullous keratopathy, a painful condition often iatrogenic in origin and more usually encountered in elderly patients. A retrospective study of 30 patients fitted with therapeutic lenses for the condition and followed up for at least a year showed that the symptoms of bullous keratopathy were reduced in most cases. There was a higher incidence of suppurative keratitis (13 per cent) than has been reported in previous series. The prescribing of prophylactic antibiotics was haphazard in the series, and the authors suggest further study is needed to determine their precise role.
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PMID:The bandage lens in bullous keratopathy. 259 81

Evidence is presented which supports the centripetal movement of epithelial cells in the normal corneal epithelium. This movement is not, however, uniform and is influenced by various factors including corneal topography, surface disease states and lid shearing forces. We have studied epithelial morphology with corneal specular microscopy and have demonstrated altered morphology in keratoconjunctivitis sicca, neurotrophic keratitis, and contact lens wearing. Following penetrating keratoplasty, we found a vortex keratopathy in 70 per cent of patients up to two years after surgery. We also found pallisading of epithelial cells around sutures which indicated centripetal movement of epithelial cells around islands of stability created by obstructions. The eyelid also alters epithelial migration and turnover by increasing exfoliation from shearing forces. We advance a new hypothesis that the driving force in the central epithelial cell movement is the preferential loss of surface cells by exfoliation from the central apex secondary to the shearing forces of the upper lid.
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PMID:Corneal epithelial cell movement in humans. 260 18

Herpes simplex virus (HSV)-induced ocular disease is occurring in epidemic proportions throughout the world, and is the number one cause of unilateral corneal blindness in all developed countries. We have found, in a mouse model of herpes simplex keratitis (HSK), that products encoded by the Igh-1 locus on chromosome 12 exert a profound influence on the immune/inflammatory response in the cornea after HSV inoculation in the cornea. Thus, mice with Igh-1c or Igh-1d phenotype routinely develop extreme keratopathy and loss of corneal clarity after HSV encounter in the eye, while congenic strains expressing other Igh-1 phenotypes develop substantially less keratopathy. We examined the effect of previous subcutaneous immunization with the mutant, less virulent, MP strain of HSV on the development of keratitis and encephalitis after secondary corneal inoculation with strains MP, mP, F, and KOS. A/J mice (Igh-1c), 5-6 weeks old, were injected sc with live HSV-1 strain MP. Controls were injected with culture media without virus. Three weeks later both immunized and control nonimmunized animals were challenged in the cornea with HSV-1, strains MP, mP, F, and KOS. The animals were clinically scored for keratitis and encephalitis at regular intervals for 21 days following corneal challenge. None of the immunized animals challenged in the cornea with strain MP, 5 X 10(4) plaque-forming units (PFU), developed clinical signs of encephalitis compared to 86% of unimmunized controls. Of the immunized animals challenged in the cornea with strain MP, 5 X 10(4) PFU, only 18% developed a mild keratitis, while 96% of unimmunized controls developed severe keratitis. Mice immunized subcutaneously with MP and subsequently challenged corneally with other HSV-1 strains (mP, F, or KOS) were also protected from development of severe keratopathy.
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PMID:Previous immunization of mice with herpes simplex virus type-1 strain MP protects against secondary corneal infection. 301 76

The results of 62 repeat penetrating keratoplasties (41 eyes) over a 10-year period are presented. The common indications for the primary graft include herpes simplex keratitis, pseudophakic bullous keratopathy, aphakic bullous keratopathy, Fuch's endothelial dystrophy, and chronic ulceration. All cases of pseudophakic bullous keratopathy had the iris-clip type of intraocular lens. Graft failure was attributed to rejection, endothelial failure, recurrent ulceration, herpes simplex keratitis, melting, trauma, and recurrent dystrophy. At the end of the study period 28 grafts (68%) were clear and 13 (32%) were opaque. Visual improvement occurred in 28 eyes (68%), deterioration in four (10%), and six (15%) remained unchanged (visual result was not available in three eyes). These data are encouraging in terms of visual outcome and graft clarity in cases of repeat penetrating keratoplasty. Comparison is made between the primary indications and outcome of these re-grafts and eyes requiring only one graft. Initial indications for grafting in both groups were similar, other than keratoconus, which was a significantly more common indication in eyes that required only one graft. Final visual results were better in those eyes undergoing only one graft, compared with those that required multiple surgery.
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PMID:Corneal re-graft: indications and outcome. 305 3


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