Posters

Brevundimonas species keratitis managed with amniotic membrane graft and topical colistine

Poster Details

First Author: P. Neves PORTUGAL

Co Author(s):    I. Matias   M. Ornelas   M. Santos   D. Martins           

Abstract Details

Purpose:

Bacterial keratitis is a dreaded ocular disease. Risk factors for complicated corneal infection cases include both local and systemic factors that impair corneal immunity. Different pathogens may pose unique challenges to the ophthalmologist. The authors present the case of a perforating infectious keratitis caused by multi-resistant bacteria in a diabetic patient with neurotrophic keratitis, managed with an amniotic graft and topical colistine.

Setting:

Patient treated in Setubal Hospital Center - Ophthalmology department

Methods:

Case report of a 73-year old female diabetic patient, with a 6 month history of a persistent epithelial defect in the left eye after a severe episode of epithelial herpetic keratitis, that presented to our department with a perforating corneal infectious ulcer. She had previously been submitted to topical therapy with lubricants, vitamin A, cloramphenicol, tobramycin, gentamycin and a TRGA (Tissue ReGenerating Agent - cacicol®) with no effect. On admission, she had a paracentral corneal infectious ulcer, with severe thinning and impending iris herniation, as well as posterior synechiae and extensive purulent exsudate.

Results:

We decided to collect samples for microbiological study and perform an amniotic graft the next day. We then started with topical vancomycin and ceftazidime. The graft was successful in restoring corneal thinckness, measured after 2 weeks to have a minimal thickness of 450microns. Cultures were positive for Bradymonas species, resistant to all tested antibiotics except colistine. The patient was then subjected to topical therapy every 2 hours with colistine 0.1% for 1 week. We observed a progressive disappearance of all signs of infections and resolution of the epithelial defect. The patient was then discharged with a topical lubricant alone, and referred to a corneal transplant centre.

Conclusions:

Perforated infectious ulcers are urgent corneal conditions, that pose a threat to the entire globe. Complicated cases in imunossupressed patients, particularly those submitted to multiple topical therapies, may result in the selection of multiresistant pathogens. To our knowledge, this was the first documented case of Bradymonas species keratitis. Amniotic membrane graft and topical colistine were effective for the treatment of our patient, with a successful anatomical outcome.

Financial Disclosure:

NONE