|Year : 2019 | Volume
| Issue : 3 | Page : 257-258
Amogh Laxman Jambagi, Sharmila Devi Vadivelu, M Sivakami
Department of Cornea, RIO GOH, Chennai, Tamil Nadu, India
|Date of Submission||22-Mar-2019|
|Date of Acceptance||09-Jun-2019|
|Date of Web Publication||11-Nov-2019|
Dr. Amogh Laxman Jambagi
Flat A012 DLF Commanders Court, Ethiraj Salai Egmore, Chennai - 600 008, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jambagi AL, Vadivelu SD, Sivakami M. Journal scan. TNOA J Ophthalmic Sci Res 2019;57:257-8
| Management Algorithm for Fungal Keratitis: the Topical, Systemic, and Targeted Therapy Protocol|| |
Sharma N, Sahay P, Maharana PK, Singhal D, Saluja G, Bandivadekar P, et al. Management algorithm for fungal keratitis: The TST (Topical, systemic, and targeted therapy) protocol. Cornea 2019;38:141-5.
Purpose:The purpose is to evaluate the efficacy of the topical, systemic, and targeted therapy (TST) protocol in the management of fungal keratitis (FK). Methods: All cases of treatment-naive smear- or culture-proven FK presenting between June 2013 and May 2017 were recruited. The TST protocol included initial treatment with topical natamycin 5% with the addition of oral ketoconazole or voriconazole in ulcers with size >5 mm, depth >50%, or impending perforation. Topical voriconazole 1% was included in case of poor response at 7–10 days. Intrastromal or intracameral antifungal injections were administered in case of poor response to combination therapy. Penetrating keratoplasty was performed in case of poor response to any of the regimen. Results: The study included 223 cases of FK with a mean age of 43.6 ± 15.3 years and a male-to-female ratio of 1.8:1. The mean area of the ulcer and infiltrate at presentation was 25.52 ± 19 and 25.7 ± 14.4 mm, respectively. Corrected distance visual acuity at the presentation was 2.05 ± 0.43 logMAR that improved to 1.6 ± 0.4 logMAR at 3 months. Fusarium (42.2%) was the most common microorganism isolated, followed by Aspergillus (32.8%). The mean healing time was 41.5 ± 22.2 days, with a final scar size of 14.6 ± 8.2 mm. The treatment success rate with the TST protocol was 79.8%. Corneal perforation developed in 7% of cases (n = 15), and keratoplasty was performed for 20.2% of cases (n = 45).
Take home message
The TST protocol gives a stepwise treatment algorithm for FK. It gives clear cut indications as to when topical and systemic voriconazole has to be added. It helps reserve keratoplasty for recalcitrant cases.
| Epidemiology, Risk Factors, and Clinical Outcomes in Severe Microbial Keratitis in South India|| |
Chidambaram JD, Venkatesh Prajna N, Srikanthi P, Lanjewar S, Shah M, Elakkiya S, et al. Epidemiology, risk factors, and clinical outcomes in severe microbial keratitis in South India. Ophthalmic Epidemiol 2018;25:297-305.
Purpose: Here, we report risk factors associated with outcome in severe bacterial keratitis (BK), FK, and Acanthamoeba keratitis (AK) in India. Methods: Prospective observational cohort study conducted in Aravind Eye Hospital, India. Adults presenting with severe microbial keratitis (MK) were enrolled (size ≥3 mm) and followed to 21 days' postenrolment. Ulcer clinical features were recorded at presentation. Outcomes by final visit were classified as good (completely healed or reduced infiltrate size) or poor (enlarged infiltrate size, perforated, or surgery performed). Results: Of 252 participants with severe MK, 191 had FK, 18 had AK, 19 had BK, 4 had mixed BK/FK, and 20 were microbiologically negative. The median age was 50 years (interquartile range [IQR]: 37–60 years), 64% were male, 63% were agriculturalists, and 45% had no formal education. Corneal trauma occurred in 72%, and median symptom duration before presentation was 7 days (IQR: 5–15 days). Clinical features associated with FK were feathery margins (P< 0.001), raised profile (P = 0.039), or dry surface (P = 0.007). Hypopyon was more likely in BK (P = 0.001) and ring infiltrate in AK (P< 0.001). Ulcers with poor outcome (n = 106/214) were more likely to be larger (odds ratio [OR]: 1.63, 95% confidence interval [CI]: 1.30–2.05, P < 0.001), involve the posterior cornea at presentation (OR: 2.31, 95% CI: 1.16–4.59, P = 0.017), involve Aspergillus species (OR: 3.23, 95% CI: 1.26–8.25, P = 0.014), or occur in females (OR: 2.04, 95% CI: 1.03–4.04, P = 0.04). Even after treatment, 34% (n = 76/221) had severe visual impairment by the final visit.
Take home message
The study observes that men and agriculturists were at a higher risk of developing MK, most of them being FK. Poor outcome was expected in large ulcers, women, those involving the posterior cornea, and involving Aspergillus species. If the at-risk population is actively diagnosed and treated early, the disease burden can be reduced.
| Corneal Allogenic Intrastromal Ring Segments Combined With Corneal Cross-Linking for Keratoconus|| |
Jacob S, Patel SR, Agarwal A, Ramalingam A, Saijimol AI, Raj JM, et al. Corneal allogenic intrastromal ring segments (CAIRS) combined with corneal cross-linking for keratoconus. J Refract Surg 2018;34:296-303.
Purpose: The purpose is to describe a new technique for the treatment of keratoconus using corneal allogenic intrastromal ring segments (CAIRS). Methods: CAIRS trephined from donor cornea using a double-bladed trephine were implanted into mid-depth femtosecond laser-dissected channels in the cornea of patients with keratoconus in the 6.5-mm optic zone, followed by accelerated corneal cross-linking (CXL) either conventional or contact lens-assisted CXL, depending on minimum corneal thickness. Results: Twenty patients (24 eyes) with Stage 1–4 keratoconus (Amsler–Krumeich grading) were included. The mean follow-up was 11.58 ± 3.6 months (range: 6–18 months). There was significant improvement in uncorrected (2.79 ± 2.65 lines; range: 0–8 lines) and corrected (1.29 ± 1.33 lines; range: 0–5 lines) distance visual acuity, spherical equivalent, simulated maximum keratometry, steepest keratometry, topographic astigmatism, anterior and posterior best fit spheres, and mean power in the 3- and 5-mm zones. No eye showed progression during the entire follow-up. All segments remained well-positioned, and no segment-induced complications were seen. No other major intraoperative or postoperative complications were observed.
The results show that CAIRS combined with CXL for keratoconus is a safe, economical, and effective method to manage keratoconus. There is space for further research to assess the long-term outcomes of the procedure.
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Conflicts of interest
There are no conflicts of interest.