Diagnostics and treatment of polymicrobial keratitis and endophthalmitis

Session Details

Session Title: Inflammation in Ocular Infections

Session Date/Time: Wednesday 17/09/2014 | 08:00-09:30

Paper Time: 08:30

Venue: Capital Hall A

First Author: : N.Jiraskova CZECH REPUBLIC

Co Author(s): :    P. Rozsival   V. Buchta           

Abstract Details

Purpose:

To report a case of polymicrobial keratitis and endophthalmitis successfully treated with topical and systemic antibacterial and antifungal agents, collagen cross-linking (CXL) and penetrating keratoplasty.

Setting:

1Department of Ophthalmology, University Hospital and Charles University Medical Faculty, Hradec Králové, Czech Republic 2Department of Clinical Microbiology, University Hospital and Charles University Medical Faculty, Hradec Králové, Czech Republic

Methods:

Case report

Results:

A 59-year-old woman presented with a corneal ulcer. Multiple samplings of the corneal lesion were used for microbiological investigations by standard protocol that repeatedly revealed coagulase–negative Staphylococcus sp. (CoNS); mycotic tests were negative. She was treated with topical and systemic antibiotics and an emergency therapeutic keratoplasty was performed. Four months later she was readmitted for ulcerative keratitis and endophthalmitis. Laboratory work up on corneal corneal scraping and aqueous humor cultures showed a Fusarium species, CoNS and Bacillus species. She was treated with topical and systemic voriconazole, antibacterials, and the corneal cross-linking (CXL) procedure. Complete resolution of the infection was observed but a large vascular leucoma developed. A penetrating keratoplasty and anterior segment reconstruction surgery with very good results were performed seven months later.

Conclusions:

Voriconazole, antibacterial antibiotics and CXL were effective in the management of a severe polymicrobial corneal ulcer progressing to endophthalmitis with no side-effects observed. Key words: keratitis, endophthalmitis, coagulase–negative Staphylococcus, Fusarium, diagnostics, treatment

Financial Interest:

NONE