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Sophia Louisraj,1 Thendral Ponnudurai,1 Dominic Rodriguez,2 Philip A Thomas,1 Christadoss Arul Nelson Jesudasan,1 1Department of Orbit and Oculoplasty, Joseph Eye Hospital, 2Department of Medicine, Kauvery Medical Centre, Tiruchirapalli, India Abstract: We report an unusual presentation of an orbital cavernous hemangioma in a 26-year-old female, who noted sudden redness and swelling of the left eye (LE) on waking up. At presentation, upper eyelid edema with periorbital ecchymosis and subconjunctival hemorrhage were noted in the LE. Although there was transient symptomatic relief with topical medications, blurring of vision developed in the LE. When seen 10 days later, the patient’s LE showed axial proptosis. Magnetic resonance imaging revealed an intraconal soft tissue mass in the superomedial quadrant of the left orbit. Superior orbitotomy with mass excision was done; histopathological examination of the excised mass revealed a cavernous hemangioma. The patient had complete visual recovery following surgery. To our knowledge, an acute presentation of an orbital cavernous hemangioma with subconjunctival hemorrhage and periorbital ecchymosis has not previously been reported. Keywords: subconjunctival hemorrhage, ecchymosis, cavernous hemangioma

BACKGROUND: Ultrasonography is an important tool for evaluating the posterior segment in eyes with opaque media. AIM: To study the incidence of posterior segment pathology in eyes with advanced cataract and to see whether certain features could be used as predictors for an abnormal posterior segment on ultrasound. SETTING: Tertiary care hospital in South India. METHODS AND MATERIALS: In this prospective study conducted over a 6-month period, all eyes with dense cataracts precluding visualization of fundus underwent assessment with ultrasound. Presence of certain patient and ocular 'risk' factors believed to be associated with a higher incidence of abnormal posterior segment on ultrasound were looked for and the odds ratio (OR) for posterior segment pathology in these eyes was calculated. RESULTS: Of the 418 eyes assessed, 36 eyes (8.6%) had evidence of posterior segment pathology on ultrasound. Retinal detachment (17 eyes; 4.1%) was the most frequent abnormality detected. Among patient features, diabetes mellitus (OR= 4.9, P= 0.003) and age below 50 years (OR= 15.4, P= 0.001) were associated with a high incidence of abnormal ultrasound scans. In ocular features, posterior synechiae (OR= 20.2, P= 0.000), iris coloboma (OR= 34.6, P= 0.000), inaccurate projection of rays (OR= 15.1, P= 0.002), elevated intraocular pressure (OR= 15.1, P= 0.004) and keratic precipitates (OR= 22.4, P= 0.004) were associated with high incidence of posterior segment pathology. Only four eyes (1.5%) without these features had abnormal posterior segment on ultrasonography. CONCLUSIONS: Certain patient and ocular features are indicative of a high risk for posterior segment pathology and such patients should be evaluated by ultrasonography prior to cataract surgery. In the absence of these risk factors, the likelihood of detecting abnormalities on preoperative ultrasonography in eyes with advanced cataracts is miniscule. [ABSTRACT FROM AUTHOR]

Purpose: To compare data on anatomical and biometric parameters, and their combination, obtained by using ultrasound biomicroscopy (UBM) and A-scan in eyes with phacomorphic glaucoma (PG) and eyes with mature cataract and to determine differences that may predispose to development of PG., Methods: Eighty patients (80 eyes) were enrolled in this cross-sectional study. Anterior chamber parameters, namely anterior chamber depth (ACD), angle-opening distance (AOD), iris-lens contact distance (ILCD), and trabecular-ciliary process distance (TCPD), among other parameters, were assessed by UBM (35 MHz), while axial length (AL) and lenticular thickness (LT) were determined by A-scan biometry. Absolute lenticular position (ALP) and relative lenticular position (RLP) were also compared., Results: The mean AL of eyes with PG was less (P = 0.64) than the mean AL of eyes with mature cataract. The mean ILCD value in eyes with PG (1.30 ± 0.78 mm) was significantly higher (P = 0.0015) than that in eyes with mature cataract (0.86 ± 0.32 mm). The mean AOD value in eyes with PG (0.15 ± 0.10 mm) was significantly lower (P < 0.0001) than that in eyes with mature cataract (0.23 ± 0.06 mm); similarly, the mean RLP value in eyes with PG (0.20 ± 0.02) was significantly lower (P < 0.0001) than that in eyes with mature cataract (0.17 ± 0.02). TCPD showed negative correlation with LT r = -0.514; P = 0.017, r 2  = 0.264, in eyes with phacomorphic glaucoma and mature cataracts showed significant negative correlation of ILCD with AL (r = -0.575; P = 0.025, r 2  = 0.330)., Conclusion: The results of UBM examination suggest that there are multiple mechanisms underlying the pathophysiology of PG, namely crowding of the anterior segment, increased iris-lens contact distance, and a more pronounced anterior shift of the lens. Simultaneous evaluation of anatomic and biometric parameters can improve diagnostic accuracy in predicting cases at risk for PG.

We report a case of keratitis due to Fusarium langsethiae in a 56-year-old man. The patient presented with pain and tearing of 10 days duration in the right eye, which had sustained a paddy stalk injury. On examination, a hypopyon corneal ulcer was noted in the right eye. Multiple scrapings were obtained from the affected part of the cornea. A lactophenol cotton blue wet mount and a Gram-stained smear of scrapings were made. Scrapings were also inoculated on various culture media, including Sabouraud dextrose agar (SDA). A fungal etiology was sought by conventional microbiological techniques and polymerase chain reaction. In vitro susceptibility testing was performed by an agar dilution method. Direct microscopy of corneal scrapings revealed septate hyphae, leading to initiation of intensive topical therapy with natamycin (5 %). However, the keratitis progressed, necessitating therapeutic penetrating keratoplasty. White, powdery-like colonies, with abundant aerial mycelium, were recovered on SDA from corneal scrape material. Based on macroscopic and microscopic morphological features, the isolated fungus was initially identified as a Fusarium species. Sequence analysis of the 28S rRNA region of the fungal genome led to a specific identification of F. langsethiae. Antifungal susceptibility testing results suggested that the strain isolated was susceptible to voriconazole, ketoconazole, and itraconazole. To our knowledge, this is the first reported case of keratitis due to F. langsethiae; attention is drawn to the unique characteristics of the fungal isolate, difficulties in identification and non-responsiveness to medical therapy.

Purpose: The purpose of this study is to describe a case series of keratoconjunctivitis caused by a retained bindi (dot) in six children who presented to a tertiary eye care facility in Southern India., Patients and Methods: Over a period of 11 years (January 2000 and January 2012), six children (all female, ranging in age from 6 months to 3 years) were diagnosed with ocular manifestations subsequent to a retained bindi., Results: All patients presented with redness, photophobia, extensive lacrimation, and blepharospasm. Two patients presented with mucopurulent conjunctivitis, three patients with suppurative keratitis and one patient presented with corneal epithelial defect. After removal of the foreign body the response to topical antibiotics was good in five of six cases, whereas one patient required therapeutic keratoplasty., Conclusions: Young children presenting with unilateral keratitis and conjunctivitis should alert the clinician to the possibility of a retained foreign body in the eye.

Purpose: To investigate the possible free radical-scavenging activity of an extract of Cineraria maritima on selenite-induced cataractous lenses in Wistar rat pups., Methods: In the present study, Wistar rat pups were divided into three experimental groups. On P10, Group I (control) rat pups received an intraperitoneal injection of 0.89% saline. Rats in groups II (selenite-challenged, untreated) and III (selenite-challenged, C. maritima treated) received a subcutaneous injection of sodium selenite (19 μmol/kg bodyweight); Group III rat pups also received an intraperitoneal injection of the extract of C. maritima (350 mg/kg bodyweight) once daily P9-14. Both eyes of each pup were examined from P16 until P30. Cytochemical localization of nitroblue tetrazolium salts and generation of superoxide, hydroxyl, and nitric oxide levels were measured. The expression of the inducible nitric oxide synthase gene was evaluated with reverse transcription-PCR. Immunoblot analysis was also performed to confirm the differential expression of the inducible nitric oxide synthase protein., Results: Subcutaneous injection of sodium selenite led to severe oxidative damage in the lenticular tissues, shown by increased formation of formazan crystals, elevated generation of superoxide, hydroxyl, and nitric oxide radicals, and elevated inducible nitric oxide synthase gene and protein expression that possibly contributed to the opacification of the lens and thus cataract formation. When rat pups were treated with intraperitoneal administration of the extract of C. maritima, the generation of free radicals as well as the messenger ribonucleic acid and protein expression of inducible nitric oxide synthase were maintained at near normal levels., Conclusions: The data generated by this study suggest that an ethanolic extract of C. maritima possibly prevents cataractogenesis in a rat model by minimizing free radical generation.

Keratitis due to Auerswaldia lignicola in a 32-year-old Indian male carpenter is described. At presentation, the patient reported persistent pain and tearing (left eye) in spite of topical antimicrobial therapy for more than 3 weeks. Clinically, mycotic keratitis was suspected, and direct microscopy of corneal scrapings stained by lactophenol cotton blue and Gram stains revealed broad septate hyphae. Intensive topical antifungal therapy was then given for 15 days. The keratitis continued to progress, necessitating therapeutic penetrating keratoplasty. Following the keratoplasty, there was rapid reduction in inflammation and gradual quietening of the eye. Brown-black fungal colonies resembling Lasiodiplodia theobromae were isolated from corneal scrape and corneal button (post-surgery) material on Sabouraud glucose-neopeptone agar; however, sporulation did not occur, so the morphological identification could not be confirmed. Sequence analysis of the 18S rRNA region of extracted fungal genomic DNA yielded an identification of A. lignicola Ariyawansa, J.K. Liu & K.D. Hyde; the sequence data have been deposited in GenBank (A. lignicola strain DK/V4, accession number KC866317.1). Medical management of keratitis due to such rarely reported fungal species may be difficult, necessitating surgical procedures.

Aim: To report the aetiological spectrum and susceptibility patterns of bacteria isolated from patients with corneal ulceration., Method: The microbiological data of all patients with suspected infectious corneal ulceration who presented to the ocular microbiology service at this centre between 2005 and 2012 were reviewed retrospectively., Result: Microorganisms were recovered from 1665 (77%) of the 2170 ulcers. Bacterial isolates accounted for 1205 of the organisms isolated. The most common bacterial pathogens isolated were various species of Staphylococcus, representing 777 (64.5%), followed by Staphylococcus spp. (148; 12.3%) and Pseudomonas aeruginosa (117; 9.7%). High percentages of Gram-positive bacteria were susceptible to gatifloxacin (>94%), followed by ofloxacin and moxifloxacin. Almost 90% of Pseudomonas aeruginosa isolates were susceptible to ciprofloxacin and moxifloxacin. Sixty-two (44%) of 140 isolates of Streptococcus pneumoniae, 79 (14.8%) of 534 isolates of Staphylococcus epidermidis, and 33 (14%) of 234 isolates of Staphylococcus aureus were resistant to three or more antibiotics., Conclusion: Staphylococcus spp. were the most common bacterial pathogens isolated from patients with keratitis in this setting. High percentages of Gram-positive and Gram-negative bacteria were susceptible to gatifloxacin and moxifloxacin, respectively. Interestingly, a high percentage of Streptococcus pneumoniae isolates were found to be resistant to three or more antibiotics.

Aim. To describe keratitis due to Chaetomium sp. occurring in a 65-year-old woman who presented with a corneal ulcer with hypopyon of the right eye with a history of trauma by vegetable matter. Method. Multiple scrapings were obtained from the ulcer. A lactophenol cotton blue wet mount and a Gram-stained smear of the scrapings were made. Scrapings were also inoculated onto various culture media. Results. Direct microscopy of corneal scrapings revealed moderate numbers of septate fungal hyphae. Greenish-yellow-coloured fungal colonies with aerial mycelium were observed in culture of the corneal scrapes. On the basis of colony characteristics and conidial structure, the fungal isolate was identified as Chaetomium sp. The patient was treated with topical natamycin (5%) hourly and cyclopentolate 1% drops 3 times a day. After 4 weeks of therapy, the hypopyon had disappeared, the epithelial defect had healed, and the stromal infiltration had almost completely resolved; the visual acuity of the eye improved from hand movements to (1/2)/60. Conclusion. Fungi of the genus Chaetomium, which are rare causes of human disease (systemic mycosis, endocarditis, subcutaneous lesions), may also cause ocular lesions.

Purpose: To document transcriptional activation (expression) of key aflatoxin biosynthetic pathway genes in corneal isolates of Aspergillus flavus., Methods: The expression of certain regulatory (aflatoxin regulatory [aflR] and aflatoxin J [aflJ]) and structural (polyketide synthase acetate [pksA] and norsolonic acid-1 [nor-1]) genes in four corneal A. flavus isolates was evaluated by reverse transcription PCR. The aflatoxin-producing potential of each strain was determined by thin-layer chromatography and quantified by spectrophotometry. Four environmental isolates were used for comparison. The mean expression levels of these genes were compared in the corneal and environmental A. flavus isolates. In addition, the mean expression levels were also correlated with the aflatoxin production levels., Results: All isolates expressed aflJ, nor-1, and pksA, while all but one expressed aflR. Overall, significantly higher mean expression levels occurred in aflatoxigenic than in non-aflatoxigenic corneal isolates. A significant positive correlation was noted between the mean expression level of aflR and the quantum of aflatoxin production by the corneal isolates. Essentially similar patterns of expression of these genes were noted in four environmental A. flavus isolates used for comparison., Conclusions: For the first time, isolates of A. flavus from human keratitis patients have been shown to express regulatory and structural aflatoxin biosynthetic pathway genes. Further studies are needed to clarify the precise influence of the corneal microenvironment on expression of these genes and aflatoxin production by A. flavus infecting the cornea.

Purpose: To study the clinical and visual outcome and corneal topography in eyes that underwent full-thickness or lamellar eccentric-"shaped" (biconvex/crescentic) corneal grafts., Setting: Tertiary care center in south India., Methods: In this retrospective, interventional, noncomparative case series, eccentric-shaped corneal grafts were performed in 10 eyes (10 patients). Biconvex grafts were performed in 7 eyes, and crescentic grafts were done in 3 eyes. The indications for biconvex grafts were peripheral infected corneal ulcer (3 eyes), limbal dermoid (1 eye), squamous cell carcinoma at limbus (1 eye), rheumatoid arthritis-associated peripheral corneal melt (1 eye), and peripheral corneal perforation of unknown etiology (1 eye). Crescentic graft was performed for perforated Mooren ulcer in 3 eyes., Results: All grafts were tectonically effective. Three grafts developed stromal haze with fine vascularization. Visual acuity was equal to or better than that before surgery in all eyes but one. This eye had deterioration in visual acuity because of progression of cataract. Corneal topography was performed in 5 eyes, which revealed corneal asymmetry but regular central corneal surface., Conclusion: Shaped corneal grafts for peripheral corneal diseases are tectonically viable and result in good visual outcomes.

Purpose: To determine whether chlorazol black E, a chitin-specific stain, can be used to detect fungal filaments in corneal scrapings and to compare its sensitivity as a diagnostic aid for fungal keratitis with that of gram and lactophenol cotton blue stains., Design: Prospective study, laboratory investigation., Methods: Between December 1, 2005 and July 31, 2006, corneal scrapes from 163 patients with ulcerative keratitis were used for culture and to prepare smears that were stained by lactophenol cotton blue, chlorazol black E, or gram stains. A diagnosis of fungal keratitis was established if fungal growth occurred on the inoculated areas of multiple culture plates., Results: Fungi were isolated from corneal scrapes of 82 patients. Taking fungal culture positivity as the gold standard for diagnosis of fungal keratitis, direct microscopic examination of chlorazol black E mounts had a sensitivity of 82% and specificity of 98%; culture results and chlorazol black E results were identical in 89.6% of patients. Lactophenol cotton blue mounts and gram-stained smears had a sensitivity of 85%, specificity of 90% to 91%, and 88% agreement with culture results., Conclusions: Chlorazol black E can be used for detection of fungal filaments in corneal scrapings; however, it is less sensitive than lactophenol cotton blue and gram stains as a diagnostic aid for fungal keratitis.

Purpose: To report the clinical presentation, management and outcome of eyes with traumatic intralenticular abscess., Methods: In this interventional case series, records of eight patients (eight eyes) with intralenticular abscess developing following trauma were reviewed. All patients underwent extracapsular cataract extraction with intracameral antibiotics with or without pars plana vitrectomy. Main outcome measures studied were resolution of infection and final visual outcome., Results: Lens abscess developed in six eyes following penetrating injury and in two eyes following intraocular penetration of caterpillar hair. Gram positive cocci were cultured from the lens aspirate in five eyes and Staphylococcus epidermidis was the most common organism isolated. Cataract extraction resulted in control of the infection in all eyes and seven eyes (87.5%) had a favourable visual outcome., Conclusion: Early lens extraction with intracameral antibiotics in eyes with intralenticular abscess allows control of infection with good visual outcome.

Bilateral keratitis usually occurs in predisposed individuals such as contact lens wearers, those suffering from malnutrition and immunodeficiency or patients undergoing bilateral refractive corneal surgery. We report a 30-year-old man without any obvious predisposing factors who presented with complaints of pain and decreased vision in both eyes. Examination revealed corneal ulcers in both eyes, which on microbiological culture grew Pseudomonas aeruginosa. The patient underwent a therapeutic keratoplasty in the right eye while the left eye was managed medically. Bilateral Pseudomonas keratitis can develop in the absence of any obvious predisposing factors.

Purpose: To report the optical coherence tomographic (OCT) features in eyes with tuberculous choroidal granuloma., Design: Interventional case series., Methods: Nine eyes of nine patients with tuberculous granuloma of the choroid were studied using OCT scans., Results: OCT scan through the lesions revealed a distinctive feature of attachment between the retinal pigment epithelial- choriocapillaris layer and the neurosensory retina over the granuloma ("contact" sign). This was associated with surrounding subretinal fluid and inflammatory infiltrate in the deeper retinal layers., Conclusions: OCT can be useful in the differentiating choroidal tuberculous granulomas from noninflammatory lesions with a similar clinical appearance.

Purpose: To compare the per-operative contamination of anterior chamber among eyes undergoing manual small-incision cataract surgery (MSICS) and phacoemulsification (PE)., Design: Prospective, randomized, interventional clinical trial., Methods: In this study conducted at a tertiary-care center in southern India, 150 eyes undergoing cataract surgery were randomly allocated to undergo MSICS (group A, 75 eyes) and PE (group B, 75 eyes). Aqueous samples were taken before and at the end of surgery. Collected material was subjected to standard microbiological analysis. No preoperative antibiotics were used, but povidone-iodine 5% drops were instilled before surgery. Main outcome measures studied were the incidence of positive cultures in aqueous samples obtained from eyes in both groups., Results: The incidence of anterior chamber contamination in the MSICS group (4%) did not significantly differ from the PE group (2.7%; P = .65)., Conclusions: Incidence of anterior chamber contamination is similar among eyes undergoing MSICS and PE.

Purpose: To study the risk factors, clinical presentation, response to treatment and outcome of microbial keratitis occurring in patients at extremes of age (ie, children and the elderly) and to compare them with microbial keratitis affecting the general adult population., Methods: In this prospective, nonrandomized, analytical clinical study, all patients presenting with microbial keratitis and undergoing microbiological workup over a 1-year period were evaluated using a dedicated corneal ulcer protocol. Patients were divided into 3 groups based on age: (1) pediatric group if the age was 16 years or younger, (2) elderly group if the age was 65 years or older, and (3) control group if the age was between 17 and 64 years. Features studied included microbiological profile, predisposing factors, clinical presentation, response to treatment, and final visual outcome., Results: A total of 269 eyes of 269 patients were studied (26 in the pediatric group, 55 in the elderly group, and 188 in the control group). Culture positivity rates were similar in all the groups. The elderly and control groups had a similar incidence of fungal and bacterial keratitis, but the pediatric group had a significantly lower incidence of fungal keratitis (P = 0.001). Trauma was the most common predisposing factor in all groups. Elderly patients tended to present with a higher incidence of central ulcers (P = 0.04), severe ulcers (P = 0.04), and poor visual acuity (P = 0.003) as compared with the control group. The percentage of ulcers healing with medical treatment alone was significantly more in the pediatric group (P = 0.004), while the incidence of poor visual outcome was greater in the elderly group (P = 0.006) as compared with the control group., Conclusions: Microbial keratitis in pediatric patients is more likely to be of bacterial etiology, and nonsevere ulcers in this age group have a better chance of resolution with medical therapy alone when compared with that in the general adult population. Conversely, elderly patients with microbial keratitis tend to present with severe, central ulcers with a significant risk of having a poor visual outcome.

Purpose: To compare the bacteriologic and clinical efficacy of gatifloxacin and ciprofloxacin for the treatment of bacterial keratitis., Design: Prospective, randomized clinical trial., Methods: A total of 104 eyes of 104 patients with bacterial keratitis seen at a tertiary eye-care center were randomized to treatment with gatifloxacin 0.3% eyedrops (GAT group, 50 eyes) or ciprofloxacin 0.3% eyedrops (CIP group, 54 eyes). Patients and the treating physician were masked to the antibiotic being used. Main outcome measure studied was healing of the ulcer. Patients lost to follow-up before complete healing were excluded from further analysis., Results: A significantly higher proportion of ulcers in the GAT group exhibited complete healing compared with those in the CIP group (39 eyes [95.1%] vs 38 [80.9%]; P=.042). Gatifloxacin demonstrated a significantly better action than ciprofloxacin against gram-positive cocci in vitro (P<.001), and the percentage of ulcers caused by these pathogens that healed in the GAT group was significantly better than in the CIP group (P=.009). Mean time taken for healing of ulcer and the efficacy against gram-negative bacteria did not significantly differ between the two groups., Conclusions: Gatifloxacin had a significantly better action against gram-positive cocci both in vitro and in vivo when compared with ciprofloxacin. In view of these organisms being the leading cause of keratitis worldwide, gatifloxacin may be a preferred alternative to ciprofloxacin as the first-line monotherapy in bacterial keratitis.

Purpose: To compare the in vitro activity of gatifloxacin with that of other topical antibiotics against fresh bacterial isolates from various types of human ocular infections., Methods: A total of 498 strains of ocular bacterial isolates were tested for their susceptibility to gatifloxacin, ofloxacin, ciprofloxacin, norfloxacin, gentamicin, tobramycin, neomycin, chloramphenicol, erythromycin, tetracycline and amikacin., Results: Ninety-nine percent of gram-positive and 92% of gram-negative bacterial strains were found to be susceptible in vitro to gatifloxacin, whereas lower percentages of gram-positive and gram-negative bacteria were found to be susceptible to other antibiotics., Conclusions: In vitro, gatifloxacin exhibits good activity against various bacterial species isolated from different ocular sites. This requires corroboration in the clinical setting., (Copyright (c) 2005 S. Karger AG, Basel.)

Purpose: To compare the clinical efficacy of itraconazole 1% eyedrops with a standard therapy regimen (natamycin 5% eyedrops) for topical monotherapy of fungal keratitis., Methods: Patients presenting with suspected uniocular microbial keratitis over a period of 12 months (January to December 2002) underwent detailed clinical examination and microbiological investigation. One hundred consecutive patients with direct smear- and/or culture-proven fungal keratitis were enrolled in the study after obtaining informed consent. The ulcers were categorized as severe or nonsevere. The first 50 consecutive patients received primary therapy with topical natamycin hourly, and the next 50 consecutive patients received topical itraconazole hourly. The primary efficacy criteria were the physician's judgment of clinical success, cure rate, and the rate of treatment failure., Results: The diagnosis of fungal keratitis was established by positive microscopy and culture findings in 88 patients and by positive microscopy alone in 12 patients. Species of Fusarium, Aspergillus, and Curvularia were the principal isolates. Thirty-six (72%) of 50 patients (28 of 37 with nonsevere keratitis and 8 of 13 with severe keratitis) showed a favorable response to primary natamycin therapy (mean duration, 20.5 days), while 30 (60%) of 150 patients (25 of 38 with nonsevere keratitis and 5 of 12 with severe keratitis) exhibited a favorable response to primary itraconazole therapy (mean duration, 23.1 days). In keratitis due to Fusarium spp, 19 (79%) of 24 patients showed a favorable response to natamycin, which was significantly greater than the 8 (44%) of 18 patients who showed a favorable response to itraconazole (P < 0.02). However, no such difference was evident in keratitis due to Aspergillus spp or Curvularia spp; in keratitis due to Aspergillus spp, favorable responses were noted in 6 (54.5%) of 11 patients receiving natamycin and 5 (50%) of 10 patients receiving itraconazole, while in keratitis due to Curvurlaria spp, such responses occurred in both patients receiving natamycin and in 8 (89%) of 9 patients receiving itraconazole. Both antifungal formulations were generally well tolerated with no obvious adverse effects., Conclusions: Topical natamycin should continue to be considered as the treatment of choice for filamentous fungal keratitis; when natamycin is unavailable, topical itraconazole therapy could be used, particularly if the infections are due to Aspergillus or Curvularia spp.

Purpose: To assess the results of cataract surgery, in terms of visual outcome and effect on graft survival, in eyes that have previously undergone therapeutic penetrating keratoplasty for infective keratitis., Methods: Case records of patients who had undergone cataract surgery alone (group A) or in combination with regrafting (group B) following initial therapeutic penetrating keratoplasty between January 2000 and December 2001 were reviewed retrospectively. Main outcome measures studied were visual acuity, astigmatism, and effect of the cataract surgery on graft survival. Results were compared with eyes undergoing cataract surgery after optical keratoplasty and between eyes in groups A and B., Results: Frequency of cataract surgery after therapeutic keratoplasty was significantly greater than that following optical keratoplasty [68 (52%) versus 47 (21%); P<0.001]. Fifty-eight eyes of 58 patients undergoing cataract surgery after therapeutic penetrating keratoplasty were analyzed in detail. Mean follow-up period was 8.9 months (+/-7.6 months). Thirty eyes underwent cataract surgery alone (group A), and 28 eyes underwent cataract surgery with regrafting (group B). Eyes that had undergone therapeutic keratoplasty were significantly more likely to have opaque grafts requiring regrafting at the time of cataract surgery than eyes that had undergone optical keratoplasty [28 (48.3%) versus 5 (10.6%); P<0.001]. Incidence of graft failure after cataract surgery did not differ significantly in eyes that had undergone therapeutic or optical keratoplasty. Final visual acuity at last follow-up was 6/12 or better in 25 eyes (43%). There were no significant differences between eyes in groups A and B in terms of final visual acuity, astigmatism, or graft failure rates., Conclusions: Visual results of cataract surgery following therapeutic keratoplasty are comparable to those following optical keratoplasty. Combining a repeat keratoplasty for a failed graft with the cataract surgery does not significantly affect the final outcome.

Purpose: To describe a series of 7 patients with ulcerative keratitis caused by species of Colletotrichum, which are coelomycetous fungal pathogens., Methods: The patients presented with keratitis of varying degrees of severity. Multiple scrapes from the corneal lesions of 6 of the 7 patients were used for microbiological investigations by a standard protocol. In the seventh patient, scraping was not performed due to the presence of deep infiltration and a descemetocele at presentation. All 7 patients were hospitalized and treatment was initiated with topical applications of natamycin (5%) and ciprofloxacin (0.3%) every hour and cyclopentolate (1%) drops 3 times daily. An emergency therapeutic penetrating keratoplasty was performed after 48 hours in the patient who had presented with a descemetocele and for another patient whose keratitis did not respond to 10 days of medical therapy., Results: The corneal samples of all 7 patients yielded significant growth of filamentous fungi in culture. On the basis of macroscopic and microscopic characteristics, the fungal isolates were identified as Colletotrichum spp. Corneal lesions completely resolved with medical therapy alone in 5 patients. In the 2 patients who had undergone therapeutic penetrating keratoplasty, the infection was eradicated and the corneal graft remained clear even after several months of follow-up., Conclusion: Colletotrichum spp may be more frequent causes of keratitis than previously thought. Keratitis due to Colletotrichum spp frequently responds to medical therapy alone, although surgery may be indicated in a small proportion of patients.

Background: A multicentre study was carried out in Ghana and southern India to determine the aetiology of suppurative keratitis in two regions located at similar tropical latitudes. Studies of fungal keratitis from the literature were reviewed., Methods: Patients presenting at rural and urban eye units with suspected microbial keratitis were recruited to the study. Corneal ulceration was defined as loss of corneal epithelium with clinical evidence of infection with or without hypopyon. Microscopy and culture were performed on all corneal specimens obtained., Results: 1090 patients were recruited with suspected microbial keratitis between June 1999 and May 2001. Overall the principal causative micro-organisms in both regions were filamentous fungi (42%): Fusarium species and Aspergillus species were the commonest fungal isolates. Pseudomonas species were most frequently isolated from cases of bacterial keratitis in Ghana but in India the commonest bacterial isolates were streptococci., Conclusion: Infections of the cornea due to filamentous fungi are a frequent cause of corneal damage in developing countries in the tropics and are difficult to treat. Microscopy is an essential tool in the diagnosis of these infections. A knowledge of the "local" aetiology within a region is of value in the management of suppurative keratitis in the event that microscopy cannot be performed.