Tags

Type your tag names separated by a space and hit enter

Chronic recalcitrant bacterial infection in steroid modified interstitial (stromal) keratitis: presentation and management.
J Med Assoc Thai. 2012 Nov; 95(11):1425-32.JM

Abstract

OBJECTIVE

To report histopathologically proven bacterial infection manifested multifocal interstitial (stromal) keratitis (IK) with definite previous history of prolong topical steroid use. Standard managements of bacterial keratitis did not provoke enough benefit.

MATERIAL AND METHOD

A retrospective analysis of 19 eyes in 15 patients referred to Siriraj Hospital between 2004 and 2010.

RESULTS

Multifocal intrastromal infiltration, with relatively quiet ocular reaction and mild inflammation were initially presented in all eyes. They all previously had been diagnosed of presumed viral keratitis, and had been given topical corticosteroid treatment for a prolonged period of time without healing. Autoimmune disease workups were all negative. Corneal scrapings showed negative culture results in all eyes. However, bacteria within stromal lamellae with absent or minimal inflammatory cells were demonstrated in all eyes by corneal biopsies. In addition, cytology results obtained from 16S rDNA sequencing revealed Stenotrophomonas maltophilia in one eye and coagulase-negative staphylococci in two eyes. No case responded well to intensive topical and systemic antibiotics. However they were successfully treated with penetrating keratoplasty (11 eyes, 57.9%) or intrastromal antibiotic injections (8 eyes, 42.1%).

CONCLUSION

Bacterial infection should be a concern in prolonged chronic IK. This was considered as primary bacterial IK or bacterial superinfection in immunocompromised cornea. Early recognition and appropriately aggressive managements contribute to successful outcome. Corneal biopsy is always essential and 16S rDNA sequencing is useful in this distinct clinical entity.

Authors+Show Affiliations

Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sisuksri@mahidol.ac.thNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23252209

Citation

Chotikavanich, Suksri, et al. "Chronic Recalcitrant Bacterial Infection in Steroid Modified Interstitial (stromal) Keratitis: Presentation and Management." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 95, no. 11, 2012, pp. 1425-32.
Chotikavanich S, Tesavibul N, Uiprasertkul M, et al. Chronic recalcitrant bacterial infection in steroid modified interstitial (stromal) keratitis: presentation and management. J Med Assoc Thai. 2012;95(11):1425-32.
Chotikavanich, S., Tesavibul, N., Uiprasertkul, M., Leelaporn, A., & Prabhasawat, P. (2012). Chronic recalcitrant bacterial infection in steroid modified interstitial (stromal) keratitis: presentation and management. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 95(11), 1425-32.
Chotikavanich S, et al. Chronic Recalcitrant Bacterial Infection in Steroid Modified Interstitial (stromal) Keratitis: Presentation and Management. J Med Assoc Thai. 2012;95(11):1425-32. PubMed PMID: 23252209.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic recalcitrant bacterial infection in steroid modified interstitial (stromal) keratitis: presentation and management. AU - Chotikavanich,Suksri, AU - Tesavibul,Nattaporn, AU - Uiprasertkul,Mongkol, AU - Leelaporn,Amornrut, AU - Prabhasawat,Pinnita, PY - 2012/12/21/entrez PY - 2012/12/21/pubmed PY - 2013/2/13/medline SP - 1425 EP - 32 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 95 IS - 11 N2 - OBJECTIVE: To report histopathologically proven bacterial infection manifested multifocal interstitial (stromal) keratitis (IK) with definite previous history of prolong topical steroid use. Standard managements of bacterial keratitis did not provoke enough benefit. MATERIAL AND METHOD: A retrospective analysis of 19 eyes in 15 patients referred to Siriraj Hospital between 2004 and 2010. RESULTS: Multifocal intrastromal infiltration, with relatively quiet ocular reaction and mild inflammation were initially presented in all eyes. They all previously had been diagnosed of presumed viral keratitis, and had been given topical corticosteroid treatment for a prolonged period of time without healing. Autoimmune disease workups were all negative. Corneal scrapings showed negative culture results in all eyes. However, bacteria within stromal lamellae with absent or minimal inflammatory cells were demonstrated in all eyes by corneal biopsies. In addition, cytology results obtained from 16S rDNA sequencing revealed Stenotrophomonas maltophilia in one eye and coagulase-negative staphylococci in two eyes. No case responded well to intensive topical and systemic antibiotics. However they were successfully treated with penetrating keratoplasty (11 eyes, 57.9%) or intrastromal antibiotic injections (8 eyes, 42.1%). CONCLUSION: Bacterial infection should be a concern in prolonged chronic IK. This was considered as primary bacterial IK or bacterial superinfection in immunocompromised cornea. Early recognition and appropriately aggressive managements contribute to successful outcome. Corneal biopsy is always essential and 16S rDNA sequencing is useful in this distinct clinical entity. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/23252209/Chronic_recalcitrant_bacterial_infection_in_steroid_modified_interstitial__stromal__keratitis:_presentation_and_management_ DB - PRIME DP - Unbound Medicine ER -