Successful treatment of Chrysosporium keratitis with voriconazole

Onsiri Thanathanee, Chavakij Bhoomibunchoo, Orapin Anutarapongpan, Olan Suwan-apichon, Yosanan Yospaiboon KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Objective: To report a patient with severe Chrysosporium keratitis successfully treated by voriconazole.Method: Case report.Results: A 37-year-old healthy male presented with irritation, pain and reduced vision in his left eye after mud contamination. Examination demonstrated corneal stromal infiltration, endothelial plaque and hypopyon. Corneal scrapings demonstrated numerous septate hyphae, and specimen cultures were positive for Chrysosporium sp. The lesion did not respond to aggressive topical 5% natamycin, 0.15% topical amphotericin B and oral itraconazole. The patient was then treated by topical 1% voriconazole every hour. Intracameral and intrastromal voriconazole injections (50  μg/0.1  mL) were also undertaken. The keratitis was significantly improved after voriconazole.Conclusion: To the best of the authors’ knowledge, this is the first report on the use of voriconazole for Chrysosporium keratitis. Voriconazole may be an effective alternative to conventional antifungal agents in some cases of fungal keratitis. It should be considered before shifting to therapeutic keratoplasty. Keywords: Chrysosporium, keratitis, keratoplasty, voriconazol

Randomised controlled study of conjunctival autograft versus amniotic membrane graft in pterygium excision

AIM: To determine whether amniotic membrane can be used as an alternative to conjunctival autograft after pterygium excision. METHODS: 287 eyes with either primary or recurrent pterygium were included in this study. All eyes were randomised to undergo conjunctival autograft or amniotic membrane transplantation after pterygium excision by a single surgeon. 106 eyes in primary pterygium and 14 eyes in the recurrent group were treated with conjunctival autograft, and 148 eyes in primary pterygium and 19 eyes in the recurrent group were treated with amniotic membrane transplantation. Patients were followed up at 6 weeks and 6 months after operation. The main outcome measurement was recurrence rate after surgery. RESULTS: In the conjunctival group, the recurrence rate was 12.3%, 21.4% and 13.1% for primary, recurrent and all pterygia, respectively. In the amniotic membrane group, the recurrence rate was 25.0%, 52.6% and 28.1% for primary, recurrent and all pterygia, respectively. The recurrence rate for all pterygia in the amniotic membrane group was significantly higher than that in the conjunctival group (p = 0.003). CONCLUSIONS: Amniotic membrane graft had a higher recurrence rate than conjunctival autograft. However, it is an alternative choice, especially for advanced cases with bilateral heads or patients who might need glaucoma surgery later

Botulinum Toxin B-Induced Mouse Model of Keratoconjunctivitis Sicca

PURPOSE. To develop a mouse model of human chronic dry eye (keratoconjunctivitis sicca [KCS]). METHODS. Under direct visualization with an operating microscope, CBA/J mice received a transconjunctival injection of saline or 1.25, 5, or 20 milliunits (mU) of botulinum toxin B (BTX-B) into the lacrimal gland. The mice were either left unstressed or were subjected to an air blower for 5 h/d, 5 d/wk in fixed temperature and humidity conditions. Tear production and corneal fluorescein staining were evaluated in all groups before injection and at several time points after. Tear production was measured with phenol red-impregnated cotton threads. Corneal fluorescein staining was photographed under cobalt blue light with a digital camera fitted with a macro lens. RESULTS. BTX-B-injected mice displayed significantly decreased tear production until the 4-week time point. Throughout all time points, the addition of environmental blower stress did not appear to alter tear production significantly. Linear regression models, used to evaluate the effects of various doses of BTX-B on tear production, showed that doses higher than 1.25 mU did not provide significantly different outcomes. After 3 days, saline-injected mice showed no corneal staining, whereas BTX-B-injected mice displayed various amounts of staining. At the early time point (day 3), there did not appear to be an additional effect of the blower on corneal fluorescein staining. However, at 1, 2, and 4 weeks, the blower stress appeared to increase the amount of corneal fluorescein staining at each BTX-B dose, although not significantly. Furthermore, at 8 to 10 weeks, in the BTX B-injected groups, corneas had persistent staining, even though tear production had already returned to normal levels. Histopathologic analyses revealed no inflammatory cell infiltration of the stroma or acini of the lacrimal glands and conjunctivae of both saline-injected and BTX-B-injected animals. CONCLUSIONS. Intralacrimal gland injection of BTX-B resulted in persistent corneal fluorescein staining within 3 days, and a significant decrease in aqueous tear production that persisted for 1 month. Intralacrimal gland injection of BTX-B suppressed lacrimation, thereby establishing a dry eye state. This animal model could be a useful tool for investigating the pathogenesis of the chronic condition KCS in humans. (Invest Ophthalmol Vis Sci. 2006;47:133-139

A new donor cornea harvesting technique for posterior lamellar keratoplasty

Aims: To describe a technique for posterior lamellar keratoplasty donor preparation. Methods: In an experimental study eight human donor research corneas were mounted onto an artificial anterior chamber and deep stromal pockets dissected. Four corneas were mounted in the standard endothelial side down orientation and dissected using standard instruments (group 1). Another four corneas were mounted endothelial side up and dissected using a flat spatula (group 2). Trephined lamellar graft thickness was assessed by ultrasound pachymetry. The grafts were also analysed using vital staining of the endothelium and standard histological preparation. Results: Achieved posterior graft thickness was 118 (SD 32) μm (group 1) and 92 (23) μm (group 2) (p = 0.324). Percentage of devitalised endothelial cells was 0.86% (1.48%) (group 1) and 3.9% (2.9%) (group 2) (p = 0.185). The dissections using both harvesting techniques remained in plane and were smooth. Conclusions: A blunt spatula and endothelium side up orientation on an artificial anterior chamber can be used to create posterior lamellar dissections without compromising endothelial cell number or planarity when compared to standard endothelium side down harvest