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Review
. 2016 Jul;27(4):340-7.
doi: 10.1097/ICU.0000000000000274.

Surgical management of corneal infections

Sonal Tuli  1 , Matthew Gray
Affiliations
Review

Surgical management of corneal infections

Sonal Tuli et al. Curr Opin Ophthalmol. 2016 Jul.

Abstract

Purpose of review: The purpose of this review is to discuss the options for, and recent developments in, the surgical treatment of corneal infections. Although the mainstay of treatment of corneal infections is topical antimicrobial agents, surgical intervention may be necessary in a number of cases. These include advanced disease at presentation, resistant infections, and progressive ulceration despite appropriate treatment. Prompt and appropriate treatment can make the difference between a good outcome and loss of vision or the eye.

Recent findings: There are a number of surgical therapies available for corneal infections. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the tissue to allow healing. Although there are no completely novel therapies that have been developed recently, there have been incremental improvements in the existing treatment modalities making them more effective, easier, and safer.

Summary: Several options are available for surgically managing corneal infections. Ophthalmologists should select the optimal procedure based on the individual patient's situation.

Video abstract: http://links.lww.com/COOP/A20.

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Conflict of interest statement

Conflicts of Interest: Neither speaker has any conflicts of interest

Figures

Figure 1
Figure 1
Severe pseudomonas keratitis with large hypopyon that required a therapeutic penetrating corneal transplantation as it perforated despite appropriate antimicrobial therapy
Figure 2
Figure 2
A. Perforated peripheral corneal ulcer with iris prolapse and flat anterior chamber B. Ulcer status post glue application with arrow pointing to the edge of the circular drape patch and formed anterior chamber.
Figure 3
Figure 3
Multilayer amniotic membrane transplant for severe corneal thinning with descemetocele. The overlay membrane was secured with a running 10-0 Nylon suture.
Figure 4
Figure 4
Various keratoplasty techniques used in the management of severe corneal ulceration and perforation. (A) Keratolimbal graft due for a "wall to wall" fungal ulcer. (B) Crescent shaped graft for peripheral melt. (C) Oversized penetrating keratoplasty for large corneal ulcer. (D) Circular patch graft for fungal ulcer in clear corneal cataract incision.
See this image and copyright information in PMC

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References

    1. Lim M, Goldstein MH, Tuli S, Schultz GS. Growth factor, cytokine and protease interactions during corneal wound healing. OculSurf. 2003;1(2):53–65. - PubMed
    1. Hernandez-Camarena JC, Graue-Hernandez EO, Ortiz-Casas M, Ramirez-Miranda A, Navas A, Pedro-Aguilar L, et al. Trends in Microbiological and Antibiotic Sensitivity Patterns in Infectious Keratitis: 10-Year Experience in Mexico City. Cornea. 2015;34(7):778–785. - PubMed
    1. Duan R, de Vries RD, Osterhaus AD, Remeijer L, Verjans GM. Acyclovir-resistant corneal HSV-1 isolates from patients with herpetic keratitis. J Infect Dis. 2008;198(5):659–663. - PubMed

    1. Fernandes M, Vira D, Dey M, Tanzin T, Kumar N, Sharma S. Comparison Between Polymicrobial and Fungal Keratitis: Clinical Features, Risk Factors, and Outcome. Am J Ophthalmol. 2015;160(5):873–881. e2. This article demonstrated that polymicrobial keratitis was not only more common but more challenging to treat and frequently required early penetrating keratoplasty. This is important to remind treating ophthalmologist to consider a co-infection with bacteria and fungus in patients who are responding poorly to medical management alone.

    1. Pinheiro R, Panfil C, Schrage N, Dutescu RM. The Impact of Glaucoma Medications on Corneal Wound Healing. J Glaucoma. 2016;25(1):122–127. This article showed that Xalatan and BAC had deleterious effects on the corneal surface while Monoprost delayed corneal healing

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