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

During the last year we diagnosed three patients to have Acanthamoeba keratitis. In one patient, who wore soft contact lenses, keratitis had developed after swimming in a contaminated heated swimming pool. Neither a history of trauma was present in two other patients nor did they wear contact lenses. Diagnosis of Acanthamoeba was established by Calcofluor White (cellufluor) staining of the scraped corneal material. Patients were treated with Flagyl (metronidazole) 0.5% eyedrops, Brolene (propamidine isethionate) 0.1% eyedrops, Neomycin eyedrops, topical corticosteroids (including sustain-release corticosteroid subconjunctival injections) and mydriatics. Keratitis in one patient healed within one month with full visual recovery, whereas the disease nearly ameliorated in the second patient. Corneal inflammation subsided markedly in the third patient with medical therapy, but a keratoplasty had to be performed because of a central opaque and ectatic cornea. This patient had already developed severe keratitis with necrosis of the cornea at the time of diagnosis.
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PMID:Acanthamoeba keratitis: report of three cases. 248 46

Contact lens case contamination has become an enigma, both because its role in the pathogenesis of lens-related keratitis has remained uncertain, and because current contact lens disinfection systems have been ineffective in eliminating it. This lecture reviews the evidence regarding the role of lens case contamination in the pathogenesis of keratitis and examines the reasons for the failure of disinfection systems to minimise lens case contamination.
Cont Lens Anterior Eye 1997
PMID:The inside story: why contact lens cases become contaminated. 1630 57

The performance and benefits as well as the risks and complications of disposable soft lenses (single use disposable or re-used 2-4 weeks) are reviewed in relation to corneal physiology. Modern designs and advanced technology have resulted in disposable lenses providing excellent visual performance. Fewer subjective symptoms (e.g. dryness and grittiness), slit-lamp findings (such as injection and tarsal abnormalities), and inflammatory responses (papillary conjunctivitis; contact lens-induced acute red eye) have been reported with disposable lenses than with conventional soft lenses. The risk of contact lens-induced keratitis (CLIK) has been reported to be higher for daily wear of disposable lenses than for other lens types by UK investigators. Other studies have shown the risk of CLIK with disposable lenses to be equal to that with conventional soft lenses, and in two extensive Swedish studies, the incidence of severe keratitis was found to be significantly lower for daily wear (DW) of disposable lenses than for DW of conventional soft and rigid gas permeable lenses. Both the total complication rate and the number of unscheduled visits are found to be significantly lower for disposable lenses than for conventional soft lenses in several studies. Comfort has been reported to be significantly better and overall satisfaction significantly greater with disposable lenses than with conventional soft lenses according to many studies. These may be important reasons why the success rate for disposable lens wear is reported to be fairly high, generally 70-90%. The importance of appropriate care for 're-usable disposable lenses' must be stressed. One day disposable lenses, if used as directed, will eliminate the risk factors of inadequate cleaning and disinfection as well as contaminated lens cases.
Cont Lens Anterior Eye 1997
PMID:Ten years of disposable contact lenses--a review of benefits and risks. 1630 58

The introduction of silicone-hydrogel materials has changed expectations for the response to contact lenses used in extended wear. In keeping with this technology shift, we have re-evaluated the criteria by which practitioners judge the performance of extended wear lenses. Attendees at the 1999 Annual Clinical Conference of the British Contact Lens Association were surveyed. The proportion of respondents who considered it appropriate to fit selected patients with conventional, disposable and silicone-hydrogel soft lenses for extended wear was 63%, 67% and 86%, respectively. Only 11% of respondents did not fit extended wear because of personal experience with infectious keratitis, and over 50% relied on educators' advice in avoiding this practice. Fifteen per cent of practitioners reported fitting extended wear on occasions. Ninety-five per cent of respondents thought that the relative risk of infectious keratitis with daily wear compared with no lens wear should be ten or less, which was reduced to 60% when it was revealed that the current relative risk is estimated to be 60. A strong preference for a relative risk of infection with extended wear compared to daily wear of less than five times was indicated, which is consistent with current estimates. A minority of respondents were prepared to accept an overnight oedema level of over 6% with extended wear, although silicone-hydrogel materials have been shown to induce less than 4%. A wide variety of microcyst responses were considered reasonable, with many respondents accepting up to 40 per cornea; again, this result contrasted with early research data suggesting a level of 10 microcysts or less occurring with silicone-hydrogel materials. Interpretation of these findings has led us to the following proposals for safe extended wear: (i) extended wear fitting should preferably be done with silicone-hydrogel materials, rather than conventional hydrogels, where the available parameter ranges overlap; (ii) the relative risk of corneal infection with extended wear compared to daily wear should be two to five times, providing the relative risk of daily wear compared to the no lens wear'situation is reduced to 20 times, and (iii) extended wear lenses should produce an average of no more than 4% overnight oedema and no more than 10 microcysts per eye in the long term.
Cont Lens Anterior Eye 2000
PMID:Proposed performance criteria for extended wear contact lenses. 1630 45

Although the risk of developing contact lens associated microbial keratitis is small, the potential consequences of this condition, such as vision loss, are serious. This paper presents an analysis of the risk factors that have been identified for contact lens induced microbial keratitis, which include extended wear, hypoxia, non-compliance, blepharitis, diabetes mellitus, epithelial trauma, steroid use, therapeutic lens use, tobacco use, and possibly travel to warm climates. By remaining mindful of these risk factors, practitioners can take action and offer advice to patients so as to optimize the safety of contact lens wear.
Cont Lens Anterior Eye 2002 Mar
PMID:Risk factors for contact lens associated microbial keratitis. 1630 75

High Dk silicone hydrogel lenses have overcome many of the hypoxic problems associated with traditional extended wear and the popularity of continuous wear (up to 30 nights) with these lens types is increasing. Results from clinical trials indicate that the typical physiological changes associated with edema from conventional extended wear of low Dk/t lenses do not occur with continuous wear of silicone hydrogel lenses. These changes include neovascularization, striae, microcysts and an increase in bulbar and limbal hyperemia. It is perhaps not surprising though that a number of adverse events do still occur with silicone hydrogel lenses when they are worn on a continuous wear basis. These include inflammatory conditions such as contact lens-induced peripheral ulcers (CLPU), contact lens-induced acute red eye (CLARE), infiltrative keratitis (IK) and contact lens papillary conjunctivitis (CLPC). Other events such as superior epithelial arcuate lesions (SEAL) and localised CLPC may be due to mechanical influences. While these conditions are not sight threatening, they may be painful and are certainly inconvenient to both the patient and the practitioner. It is therefore very important that the signs and symptoms associated with these events be recognised in order that they may be accurately identified and appropriately managed. The purpose of this review article is to describe the pathophysiology, etiology, and clinical presentation of these adverse events when observed with continuous wear contact lenses and to discuss their associated risk factors and incidence. Clear management and treatment strategies are also presented and a number of approaches to minimize adverse events with continuous wear of silicone hydrogel contact lenses are suggested.
Cont Lens Anterior Eye 2002 Sep
PMID:Adverse events with silicone hydrogel continuous wear. 1630 86

Despite the development of silicone hydrogel lenses, Pseudomonas aeruginosa (PA) continues to be the leading cause of contact lens related microbial keratitis. Understanding the pathogenesis of PA-mediated corneal infection is critical to the development of new prevention and treatment strategies. Recently intracellular invasion of surface corneal epithelial cells by PA has been revisited as an important element in the infection process. This review identifies the mechanisms involved, and examines the roles of the lens, hypoxia alone, PA stain, cystic fibrosis transmembrane receptor protein (CFTR), and membrane lipid rafts in mediating intracellular invasion in both in vitro and in vivo conditions. Non-toxic blockade of raft formation in vitro or in vivo effectively abrogates PA internalization and may represent a unique, new strategy to prevent or ameliorate lens-related PA microbial keratitis.
Cont Lens Anterior Eye 2007 May
PMID:Current concepts: contact lens related Pseudomonas keratitis. 1708 58

A presumed case of fungal keratitis is presented. Confocal images highlight the advantage of using such technology to follow therapeutic progress, particularly when standard laboratory testing is inconclusive. This case also demonstrates the importance of continued patient education regarding overall compliance and lens care.
Cont Lens Anterior Eye 2008 Aug
PMID:A case of fungal keratitis: a clinical and in vivo confocal microscopy assessment. 1859 70

A case of a 59-year-old Spanish patient who presented with severe ocular pain, blurred vision, eyelid swelling and foreign body sensation in the right eye is reported. She was a regular gas permeable contact lens [corrected] wearer who initially claimed to maintain standard lens care. After exploration, conjunctival injection, dendritiform corneal ulcers and stromal edema were observed. She was initially treated for a possible viral keratitis due to herpes simplex virus using 3% topical acyclovir and 0.1% dexamethasone eye drops 5 times a day. The patient did not respond to this treatment and six weeks later, corneal scrapings were positive for Acanthamoeba genotype T11. She was then treated with chlorhexidine 0.02%, propamidine 0.1% and 1% cycloplegic eye drops hourly which resulted in a significant improvement. After a month, ocular pain decreased and the clinical signs of keratitis ameliorated observed as a diminution of the size of the ulcer and also in the extension and opacity of the corneal infiltrates. The patient has been following this treatment for 3 months and it is possible that she will have to carry on with it for a whole year. To the best of our knowledge, this is the first case of severe keratitis due to Acanthamoeba genotype T11 in Spain .
Cont Lens Anterior Eye 2011 Apr
PMID:Acanthamoeba keratitis due to genotype T11 in a rigid gas permeable contact lens wearer in Spain. 2113 Jun 79

We report a case of a 21 year old male who presented with smear-proven fungal corneal ulcer in left eye, refractory to treatment with topical natamycin. Corneal smears and culture were taken along with anterior chamber tap for microbiological investigations and intracameral 1% voriconazole was injected followed by institution of oral as well as topical voriconazole drops. Corneal and aqueous smear as well as culture confirmed the presence of acanthamoeba. The keratitis responded favourably to voriconazole therapy which was instituted along with topical trophicidal drugs and anterior chamber became quiet by 7th day. The patient was slowly tapered from voriconazole and was off the drug by 6 months. At one year follow up, he continues to remain asymptomatic. The possibility exists that the fungal organisms had either partially or completely responded to natamycin eye drops and voriconazole therapy further inhibited their growth along with being highly efficacious in suppressing acanthamoeba trophozoites. Voriconazole may be specifically instrumental in corneal ulcers with coinfection of acanthamoeba and fungal organisms and preventing recrudescence of both. Normal saline wet mount and 10% KOH mount of paracentesis sample for suspicious cases of refractory corneal ulcers to specifically look for trophozoites in order to institute timely treatment are recommended.
Cont Lens Anterior Eye 2011 Dec
PMID:Role of voriconazole in combined acanthamoeba and fungal corneal ulcer. 2173 40


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