Temporary Kerato-Prosthesis to Resolve Traumatic Loss of a Healed Corneal Button

The aim of this study is to report a rare case of traumatic complete loss of a donor corneal button successfully resolved by a 24-h implantation of a temporary kerato-prosthesis. A healthy 30-year-old man with a history of prior penetrating keratoplasty (PKP) presented with an open globe following accidental contusive trauma with a ball, while he was playing football. At slit-lamp evaluation, complete dehiscence of the wound at the graft-host junction and complete corneal button loss was evident. The patient was immediately taken to the operating room, but a donor cornea was not available; therefore, a vitreo-retinal temporary kerato-prosthesis was implanted to close the eyeball until a new donor cornea was available. In case of complete dehiscence of the donor-host junction after PKP with corneal button loss, it is possible to use a temporary kerato-prosthesis to stabilize the eye and contain the intraocular structures. We recommend the availability of temporary vitreo-retinal kerato-prosthesis in the operating theatres of Corneal Surgical Units.

Exophiala Keratitis following Descemet Stripping Automated Endothelial Keratoplasty

Purpose. To report a case with Exophiala spp. keratitis in a Portuguese patient. Methods. A case report with deep corneal brown-pigmented infiltrates that developed 2 months after a Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for pseudophakic bullous keratopathy. Results. Diagnosis was established by positive direct examination and cultures from the surgically obtained corneal button. Slit-lamp images and anterior segment optical coherence tomography (AS-OCT) scans were obtained. Conclusion. This is the first described case of fungal keratitis caused by Exophiala spp. in Portugal and, to our knowledge, the first case following DSAEK in the literature.

Antimicrobial peptides in human corneal tissue of patients with fungal keratitis

BackgroundFungal keratitis (FK) is the leading cause of unilateral blindness in the developing world. Antimicrobial peptides (AMPs) have been shown to play an important role on human ocular surface (OS) during bacterial, viral and protozoan infections. In this study, our aim was to profile a spectrum of AMPs in corneal tissue from patients with FK during the active pase of infection and after healing.MethodsOS samples were collected from patients at presentation by impression cytology and scraping. Corneal button specimens were collected from patients undergoing therapeutic penetrating keratoplasty for management of severe FK or healed keratitis. Gene expression of human beta-defensin (HBD)-1, -2, -3 and -9, S100A7, and LL-37 was determined by quantitative real-time PCR.ResultsMessenger RNA expression (mRNA) for all AMPs was shown to be significantly upregulated in FK samples. The levels of HBD-1 and -2 mRNA were found to be elevated in 18/20 FK samples. Whereas mRNA for HBD-3 and S100A7 was upregulated in 11/20 and HBD9 was increased in 15/20 FK samples. LL-37 mRNA showed moderate upregulation in 7/20 FK samples compared with controls. In healed scar samples, mRNA of all AMPs was found to be low and matching the levels in controls.ConclusionAMP expression is a consistent feature of FK, but not all AMPs are equally expressed. HBD-1 and -2 are most consistently expressed and LL-37 the least, suggesting some specificity of AMP expression related to FK. These results will help to identify HBD sequence templates for designing FK-specific peptides to test for therapeutic potential.

Successful Control of a Co-Infection Caused by Candida albicans and Pseudomonas aeruginosa in Keratitis

Introduction: Nowadays, co-infection by interspecific organisms is major threat in infection control. To identify the effective combination of drugs to control the keratitis caused by Candida albicans with Pseudomonas aeruginosa are attributed in this study. Materilas and Methods: The patient of a 47 years old male farmer with infection in the right eye which showed redness and watering was treated with fortified cefazolin and fortified tobramycin before referral. No pigmentation or vascularisation was noted. The excised corneal button was also subjected to microbiological and histopathological examination. Results: A rare case of keratitis caused by co-infection of Candida albicans with Pseudomonas aeruginosa was identified. Results confirmed the inter-specific interaction of the two microorganisms. Conclusion: Cases of co-infection by Candida and Pseudomonas are not abundantly reported and difficult to treat. In this case, treatment involved Amphotercin-B and ciprofloxacin, effectively eradicated the infection. This therapy may be successfully implied for such cases of co-infection in future.

A peculiar case of corneal autograft in a patient with bilateral advanced glaucoma

The technique of autograft employs the use of a clear corneal graft from an otherwise blind eye that is transplanted to the fellow eye, which has a visual potential in the same patient. A patient with advanced glaucoma in both eyes presented to us with pseudophakic bullous keratopathy with Ahmed glaucoma valve in the right eye, and cataract and patent peripheral iridotomy with no perception of light in the left eye. The autograft and allograft corneas for bilateral penetrating keratoplasty (PK) were obtained from the contralateral eye and a cadaver eye, respectively. Central corneal button was used for PK. One year after the surgery, the graft host junction was well apposed with no vascularization, corneal surface was clear, sutures were intact, and best corrected visual acuity improved in right eye to 1 logMAR. Bilateral simultaneous PK with autograft in one eye and allograft in the other was done to decrease the chances of rejection.

An innovative model to quantify corneal transparency in donor corneal buttons

Assessment of corneal transparency in donor corneal buttons has only been performed qualitatively. The quantification of corneal transparency has implications with respect to clinical suitability of the donor cornea and research involving corneal transparency as an outcome measure. In this study an artificial anterior chamber was modified to create a central transparent passage. This was made possible by replacing the base of the chamber with Perspex and a water tight seal. An inlet and outlet tube was a ached to the sides of chamber. This was done to maintain a standardized pressure within the chamber when connected to an IV bo le. A corneal button rejected for corneal transplant was placed on the artificial anterior chamber and the chamber was filled with normal saline. A digital camera and a laser source were placed on either side of the chamber at predetermined intervals. Alignment was achieved so that the laser light passed through the center of the cornea. The image of the laser spot was acquired and subjected to image analysis. To test this proof of concept, a human cornea rejected for human transplant was injected with intrastromal saline to create corneal haze. Pre and Post injection images were analyzed. The average pixel intensity that was calculated was found to be 111 pre-saline injury and 17.2 post-saline injection. Pre and Post-saline measurement showed a marked difference in average pixel intensity. This simple inexpensive setup and ease of analysis are advantages of this method of quantification.

Patch Grafting Using a Cryopreserved Descemet Stripping Automated Endothelial Keratoplasty Flap for Treating Corneal Perforation

A 73-year-old woman with a corneal perforation of undetermined etiology was treated with corneal patch grafting. A residual partial-thickness corneal button obtained during a previous Descemet stripping automated endothelial keratoplasty (DSAEK) surgery and stored at –80°C in Optisol GS for 3 months was used as a patch graft. Five days postoperatively, the anterior chamber was reformed and the perforation was masked by the donor cornea. During the next several weeks, gradual displacement of the anterior edge of the donor cornea in the limbal direction occurred. Seven weeks postoperatively, further displacement of the donor cornea resulted in unmasking of the perforated area. At this time, the corneal defect was closed by stromal scar tissue and corneal epithelium. Five months postoperatively, best corrected visual acuity was 1.0 without marked astigmatism and intraocular pressure was 9 mm Hg in the left eye. From this case, we learned that cryopreserved DSAEK flaps stored longer than reported previously can be used as patch grafts to treat emergency conditions. Scar tissue can fill a corneal stromal defect 1 mm in diameter during temporary patch grafting for less than 2 months.