Cornea
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Comparative Study
Sequential therapeutic penetrating keratoplasty with cryopreserved and fresh corneal tissue for severe infectious keratitis: a case-control study.
Sequential therapeutic penetrating keratoplasty (TPK) using a cryopreserved cornea followed soon after by a fresh optical grade cornea for severe infectious keratitis may improve the survival of the optical graft. The aim of this study was to compare the therapeutic efficacy, visual outcomes, and graft survival for sequential TPK against TPK using a fresh optical grade cornea alone. ⋯ Sequential TPK is an effective surgical therapy for active severe infectious keratitis and also helps to conserve valuable optical grade corneal tissue.
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To identify potential donor, recipient, surgical, and postoperative factors that may influence survival and visual outcome of penetrating keratoplasty (PKP). ⋯ Several independent risk factors were identified that significantly influenced PKP first year survival outcome. This information is valuable to patients and surgeons with respect to determining prognosis and clinical decision making.
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To report the beneficial properties of subconjunctival amphotericin B as an adjunctive therapy in patients with severe fungal keratitis. ⋯ Subconjunctival injections of amphotericin B are useful as an adjunctive treatment of advanced fungal keratitis. This treatment assures compliance and may be an alternative to avoid a surgical intervention in an acute stage of advanced fungal keratitis. More cases are needed to validate our findings.
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Comparative Study
Clinical aspects and prognosis of mixed microbial (bacterial and fungal) keratitis.
To investigate the predisposing factors, clinical presentations, treatment results, and prognosis of keratitis caused by mixed infectious agents (bacteria and fungi). ⋯ The most common risk factor for mixed bacterial and fungal keratitis was ocular trauma, and the most common combination was Staphylococcus epidermidis and Fusarium species. Usually, patients with mixed bacterial and fungal keratitis have poor prognosis. Thus, when the infectious keratitis is running an atypical course or found unresponsive to the initial medical treatment, the possibility of a mixed infection by bacterial and fungal organisms should be considered.
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Case Reports
Subconjunctival injections and povidone-iodine washings for the treatment of giant fornix syndrome.
Giant fornix syndrome is a chronic copiously purulent conjunctivitis seen in elderly patients with dehiscence of the levator palpebrae superioris aponeurosis. We report a case of giant fornix syndrome secondary to methicillin-resistant Staphylococcus aureus conjunctivitis that was recalcitrant to standard treatment modalities, and we describe 2 novel interventions for this condition, which succeeded in eradicating the infection. ⋯ In patients with giant fornix syndrome who are recalcitrant to or intolerant of aggressive topical and systemic therapy, supratarsal subconjunctival injections of antibiotics and corticosteroids and sweeping of the conjunctival fornices with povidone-iodine are 2 local treatments which may be useful in eradicating the infection.