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Purpose: to conduct a clinical and morphological study of the role of corticosteroids in the healing of the ulcerative defect on an experimental model of the bacterial corneal ulcer. Material and methods . The developed model of the bacterial corneal ulcer was used. Rabbits with bacterial corneal ulcer were divided into 4 groups of 10 animals (10 eyes) each. Group 1 received local antibacterial treatment. Groups 2 and 3 additionally received injections of 0.2–0.3 ml of Dexamethasone 0.1 % solution once per day (parabulbarly or under the skin of the back, respectively). Group 4 received no treatment but was checked clinically after ulcer modeling. Structural changes in eye tissues were assessed by histopathological examination using an examination on a Leica microscope system with a magnification of 100 to 600. Results. Addition of corticosteroids in the early period of bacteria ulcer treatment contributes to an inhibition of the inflammatory process, reduces the action of collagenolysis processes and the size of the ulcer defect, and suppresses angiogenesis, which leads to an improvement in scar tissue quality. Conclusion. Topical parabulbar injections of corticosteroids adding to the treatment topically in the form of parabulbar injections of corticosteroids contributes to changes in the emerging fibrous tissue which fills the ulcerous defect: a thin scar is formed, which is optically useful.

Purpose: to study the role of human herpesviruses (HHV) in the pathogenesis of prolonged bacterial corneal ulcers. Patients and methods. 117 patients with bacterial corneal ulcer were examined. Two groups were identified: a favorable course-with duration of bacterial corneal ulcer epithelialization for 17 days (62 people) and a prolonged course with a persistent ulcer more than 17 days (55 people). Blood samples (n = 117) and scrapes from corneal ulcer (n = 117) were investigated in polymerase chain reaction (PCR) for the presence of deoxyribonucleic acid (DNA) of Herpes simplex virus (HSV1, 2), Epstein-Barr virus (EBV), Human herpesvirus type 6, 7 (HHV-6, HSV-7). Results. The HSV1, 2 and EBV genomes were detected in the cornea significantly more often in BCU of prolonged course compared with a favorable course (HSV1, 2 p = 0.012; EBV p = 0.012), and HHV-6 was detected not only in the cornea (p = 0.000), but also and in blood (p = 0.007). In patients with HHV DNA in corneal scarps and/or blood, after resorption of purulent infiltrate, corneal epithelialization was absent, and the use of antiherpetic drugs allowed to reduce the completion time of BCU epithelialization. Conclusion. The role of HHV-6, EBV, HSV 1, 2 in the pathogenesis of bacterial corneal ulcer of protracted course was revealed. The expediency of examination of patients with bacterial corneal ulcer on HHV is shown, a method of treatment is proposed, including antiherpetic therapy, which makes it possible to prevent the development of a protracted course.

Purpose: to describe the characteristic clinical signs and to study the causes of the development of an unfavorable prolonged course of bacterial corneal ulcers of central localization, and to improve treatment effectiveness. Material and methods. A total of 289 patients with central bacterial corneal ulcers were examined. Two types courses of bacterial corneal ulcer were distinguished: favorable (acute and subacute) and unfavorable (prolonged subacute and prolonged chronic forms). Blood (122 samples) and scrapings from corneal ulcers (110 samples) were examined in a nested polymerase chain reaction (PCR) to detect deoxyribonucleic acid (DNA) of simple herpes virus (HSV) 1 and 2 types, virus Epstein–Barr (VEB), human herpes virus (HHV)-6, and HHV-7. To detect autoimmune sensitization to the corneal antigens, migration inhibition reaction of leukocytes (MIRL, 215 samples) was used. Results. In patients with unfavorable course of the disease, blood and corneal HHV DNA was detected in 88.7 % of cases, while with a favorable course only 10 % of cases showed the presence of HHV DNA (р < 0.002). In all patients, HHV type 6 was predominating. Autosensitivity to corneal antigens was detected in 8 (10.4 %) out of 77 patients at the end of the first week of the disease, and as the disease progressed, the number of patients with an autoimmune component increased to reach 63.2 % (48 of 76). The inclusion of antiviral and immunosuppressive drugs into the routine treatment plan led to complete epithelialization of the cornea within 5–10 days. Сonclusion. The protracted course of bacterial corneal ulcers was found to be caused by a mixed herpes-bacterial infection, which is corroborated by the effectiveness of the modified treatment tactics.

Диабетическая кератопатия диагностируется у 50–70% пациентов c сахарным диабетом (СД) и влияет на течение воспалительных заболеваний роговицы у этой группы пациентов.Цель работы – повысить эффективность лечения бактериального кератита у пациентов с СД 1-го типа с помощью дополнительного применения глазных капель с аутологической сывороткой крови после эрадикации возбудителя заболевания при различных стадиях тяжести диабетической полинейропатии (ДПН).Материалы и методы. В исследование были включены 19 пациентов (19 глаз) c бактериальными язвами роговицы и СД 1-го типа, у которых отмечалось замедленное заживление язвенного дефекта роговицы и при повторном бактериологическом исследовании мазков и соскобов роговицы, взятых через 1 неделю после назначения лечения, подтверждено отсутствие микроорганизмов. Пациенты были разделены на 2 группы. Основную группу составили 10 пациентов, которым после подтверждения отсутствия возбудителя при повторном исследовании, полученного через 2 недели после начала лечения, на фоне продолжения местного лечения антисептиками, мидриатиками и системной противовоспалительной терапии дополнительно назначали глазные капли с аутологической сывороткой крови. Контрольную группусоставили 9 пациентов, которые продолжили местное лечение антисептиками, трофическими препаратами, репарантами, слезозаменителями, мидриатиками и системную противовоспалительную терапию. Пациентов основной и контрольной группы также разделили на 2 подгруппы, согласно стадии тяжести ДПН. Кроме стандартных методы офтальмологического исследования включали бактериологическое исследование, флюоресцеиновый тест, оптическую когерентную томографию переднего отрезка глаза, бесконтактное исследование чувствительности роговицы.Результаты. Дополнительное местное использование аутологической сыворотки крови после эрадикации возбудителя заболевания у пациентов с бактериальным кератитом и СД, у которых отмечалось замедленное заживление язвенного дефекта роговицы, привело к выздоровлению всех пациентов, как с симптоматической, так и со стадией тяжелых осложнений ДПН. В противовес в контрольной группе заживление язвенного дефекта роговицы произошло у всех пациентов с симптоматической стадией ДПН и только у 25% пациентов со стадией тяжелых осложнений ДПН. У 3 пациентов (75%) контрольной группы со стадией тяжелых осложнений ДПН на 24-й день лечения остались язвенные дефекты роговицы. Дополнительное местное использование аутологической сыворотки крови при симптоматической ДПН привело к повышению чувствительности роговицы на 37,3% и ускорению нормализации цвета конъюнктивы и эпителизации роговицы на 3 дня, а при стадии тяжелых осложнений ДПН – к повышению чувствительности роговицы на 30% и уменьшению продолжительности инфильтрации роговицы на 3 дня по сравнению с соответствующими подгруппами контрольной группы (p, Diabetic keratopathy is diagnosed in 50–70% of patients with diabetes mellitus (DM) and influence on the course of corneal inflammatory diseases.The purpose was to increase the effectiveness of the treatment of bacterial keratitis in T1DM patients using additional application of eye drops with autologous blood serum after eradication of the cause of the disease at various stages of severity of diabetic polyneuropathy (DPN).Materials and methods. The study included 19 patients (19 eyes) with bacterial corneal ulcers and T1DM, in whom delayed healing of the corneal defect was noted, and repeated bacteriological examination of smears and scrapings of the cornea taken 1 week after treatment was confirmed absence of microorganisms. Patients were divided into 2 groups. The main group consisted of 10 patients who, after confirming the eradication of the causative agent during repeated examination obtained 2 weeks after the start of treatment, against the background of continued local treatment with antiseptics, mydriatics, and systemic anti-inflammatory therapy, were additionally prescribed eye drops with autologous blood serum. The control group was 9 people who continued local treatment with antiseptics, trophic drugs, reparents, artificial tears, mydriatics, and systemic anti- inflammatory therapy. Patients of the main and control groups were also divided into 2 subgroups, according to the stage of severity of DPN. In addition to standard, ophthalmic examination methods included bacteriological examination, fluorescein test, OCT of the anterior eye segment, non- contact examination of corneal sensitivity.Results. Additional local use of autologous blood serum after eradication of the pathogen in patients with bacterial keratitis and DM, in which delayed healing of corneal ulcer defect wasnoted, led to the recovery of all patients, both with symptomatic and with severe complications of DPN. In contrast to the control group, in which the healing of a corneal ulcer occurred in all patients with the symptomatic stage of DPN, and only in 25% of patients with the stage of severe complications of DPN. In 3 patients (75%) of the control group with severe complications of DPN, corneal ulcer defects remained on the 24th day of treatment. Additional local use of autologous blood serum in patients with symptomatic DPN increased the corneal sensitivity by 37.3% and accelerated the normalization of conjunctival color and corneal epithelization by 3 days, in the stage of severe complications DPN increased corneal sensitivity by 30% and decreased the duration of corneal infiltration by 3 days compared with the corresponding subgroups of the control group (p, Офтальмология. Восточная Европа, Выпуск 4 2021, Pages 521-531

Purpose/Aim: This study aims to evaluate the predisposing risk factors and antibiotic resistance of bacterial corneal ulcer to commonly used antibiotics. In addition, assess the in vitro efficacy of plant-derived essential oils (EOs) as safe and effective antimicrobial agents.Demographic features and predisposing risk factors of corneal ulcer patients were recorded. Isolation and identification of bacteria was performed using conventional microbiological methods. Antibacterial activity was determined by disk diffusion and the micro-dilution broth methods. EOs were extracted by steam distillation and were analyzed by gas chromatography mass spectrometry technique.Out of the 200 patients with corneal ulcer evaluated in this study, the main predisposing factor of bacterial corneal ulcer was trauma (26.5%) and 96.7% isolates were multidrug resistant. Staphylococcus aureus was the predominant isolate 33 cases. Antibiotic susceptibility of bacterial isolates showed that the fourth-generation fluoroquinolones, gatifloxacin was the most effective antibiotic with sensitivity rate 81.3%. Seven selected EOs showed significant activity against most of the tested bacteria. Syzygium aromaticum oil showed high activity against all tested bacterial species with highest sensitivity rate (97.5%) and low minimal inhibitory concentration values against S. aureus (0.10 µl/ml). The chemical composition of the EOs showed that the monoterpenes were predominant. The main constituent of S. aromaticum oil was eugenol (76%).The current study showed that S. aromaticum oil had high antibacterial activity that could be helpful in the treatment of ocular bacterial infections to minimizing the possible side effects of commonly used antibiotic.

Background: Corneal ulcer is one of the most common causes of visual acuity impairment and blindness all over the world. The aim of the study was to evaluate various factors affecting the bacterial corneal ulcers healing, including the predisposing factors, causative organisms, antibiotic sensitivity, as well as the treatment outcomes.Methods: All data were taken retrospectively from medical records of patients who underwent corneal scraping for Gram examination and/or culture over a-4-year period (2008-2011) at the Cipto Mangunkusumo Hospital Jakarta. Treatment outcome were analyzed using Chi-square test, one-way ANOVA, and post-hoc analysis. Mean time required for complete epithelial healing was also investigated.Results: 220 cases of bacterial corneal ulcers in 216 patients were included. The most common risk factors were ocular trauma (45.8%). Gram-positive coccus were found in 65.7% cases other than other microbes. Pseudomonas sp. (25,0%) and Staphylococcus epidermidis (18.4%) were the most common isolates, sensitive to almost all kinds of antibiotics. About 83.0% (106 cases) were improved with antibiotics only, the rest were not improved and worsened. Mean time for complete epithelial healing was 17.5 ± 8.9 days with mild ulcer had the most rapid recovery. Eyes treated with fluoroquinolone eyedrops were healed in 14 days, faster than other regiments.Conclusion: Ocular trauma was the most common risk factor for corneal ulcer, and the most commonly isolated organism was Pseudomonas sp. Most cases were improved with antibiotics, and fluoroquinolone showed faster healing. Complete epithelial healing occurred in about 17.5 days.

Background : Corneal ulcer is an emergency condition in ophthalmology, causing visual impairment, mostly by bacterial infection with rapid pathogenesis. The aim of this study was to discover the characteristics of bacterial corneal ulcer patients in the National Eye Center, Cicendo Eye Hospital, Bandung. Methods : A total of 99 medical records consisted of patients diagnosed with bacterial corneal ulcer were selected in this descriptive study. The clinical patterns and predisposing factors of the patients were analyzed. The study also identified the pathogenic bacteria of the cases. This study was carried out in the National Eye Center, Cicendo Eye Hospital, Bandung from January to December 2011 Clinical patterns. The collected data were analyzed and presented in frequency tabulation. Results : The male to female ratio was 2:1, with the average age of 44.4 years. The most common presenting symptom was eye pain (70.7%). Most patients came with decreased visual acuity that was categorized as (near-) blindness (78.8%) and the location of the ulcer was in central area of the cornea (56.5%). The most common predisposing factor was ocular trauma (74.7%) that was caused by exposed to plants. Single-bacterial infection (67.7%) was predominant, with 56 cases (56.6%) of Gram-positive cocci infection. Conclusions : Bacterial corneal ulcer contributes to 48.8% of all microbial corneal ulcers. Most patients came with mild condition, centralized location, and poor visual function. The common predisposing factor was trauma associated with exposed to plants. DOI : 10.15850/amj.v2n3.505

During the study 50 eyes with NHBCU referred from various hospitals & from periphery to our OPD during academic session 2005-06 were taken to find out various factors responsible for non healing bacterial corneal ulcer. Various factors which were responsible for non healing were uncorrected lid abnormalities, chronic dacryocystitis, ocular surface disorder, uncontrolled glaucoma, and systemic factors like DM, Hypovitaminosis A & immunocompromised state, incorrect diagnosis and incorrect treatment. All these patients were managed accordingly and meticulously. This paper will discuss above finding in details.

In the article the current ideas of a role of free radical processes in physiology of a cornea and microorganisms are surveyed. The role of an oxidative stress in the pathogenesis of the bacterial corneal ulcer is discussed. The review of researches on the application of antioxidants for treatment of a bacterial ulcer is done.

Corneal scraping material was taken from 58 eyes of 58 patients with bacterial corneal ulcer. Ulcer size and epithelial healing were determined using biomicroscopy. A combination of cefazolin 33 mg/mL and gentamycin 14 mg/mL was administered before cultures results were returned. Mean ulcer size and epithelial healing in culture negative patients were significantly lower than in culture positive patients.

Medical Journal of Indonesia In this issue, Asroruddin, et al1 reported their study on various factors affecting bacterial corneal ulcer healing, and concluded that the most common risk factor for corneal ulcer was trauma, and Pseudomonas sp. was the most common bacteria found in corneal ulcer. Most cases were healed by antibiotics and epithelial healing was complete after more or less 17.5 days.1 However, a corneal ulcer might be difficult to diagnose and the cause might be elusive, which causes delayed treatment, impaired healing and development of a large corneal scar that lead to visual acuity impairment or even blindness.2

This article provides an overview of the role of the nurse in the assessment and management of five ocular conditions that give rise to an acute red eye in older people. The conditions discussed are acute closed angle glaucoma, acute iritis, acute conjunctivitis, herpes zoster ophthalmicus and bacterial corneal ulcer.

Objective : To assess the efficacy of Gatifloxacin 0.3% ophthalmic solution in infective corneal ulcer. Methods : This observational (non comparative) clinical analysis was done at the Department of ophthalmology unit-II, Liaquat University Eye hospital Hyderabad of Liaquat University of Medical and Health Sciences Jamshoro / Sindh, Pakistan from April 2010 to March 2012. All the subjects who fulfilled the inclusion criteria were registered. Anterior segment examination was performed. Corneal staining and sensitivity test was done to exclude viral and paralytic element. Corneal samples were collected for gram’s staining and culture sensitivity tests. After getting the preliminary laboratory results, Gatifloxacin 0.3% ophthalmic solution was used in bacterial corneal ulcer every 30 minutes for first twenty four hours, and every one hour till three days. On obtaining better response the drops were used every two hours up to 7 days. The treatment was continued with tapering of dosage for three weeks. After total recovery (re-epithelialization of corneal epithelium) the drops were used two times a day for one more week. Results : The total of 170 patients (male=68.8%; female=31.2%) were recruited. Culture sensitivity examination revealed staphylococcus (36.5%), followed by fungi (24.1%). Pseudomonas thus detected were 10%. Gatifloxacin showed highest sensitivity and lowest resistance i.e. 87.65% and 12.35% respectively against gram positive and gram negative isolates. Conclusion: Gatifloxacin 0.3% ophthalmic solution due to its strong activity against various gram-positive and gram-negative microbes is strongly effective in the treatment of acute bacterial keratitis.

La úlcera de córnea bacteriana o queratitis es una condición seria que puede llevar a la pérdida de la visión. La selección del tratamiento se basa en estudios microbiológicos y en el patrón de sensibilidad en un área geográfica determinada. El objetivo de este estudio fue conocer la sensibilidad y la mejor terapia empírica para el tratamiento de pacientes con queratitis bacteriana; de la Cátedra de Oftalmología del Hospital de Clínicas, y cuyas muestras fueron tomadas en el laboratorio de Microbiología del Instituto de Investigaciones en Ciencias de la Salud. Se revisaron las fichas de todos los pacientes con queratitis en cuyos cultivos se aislaron bacterias, desde julio de 2003 a diciembre de 2006. De 175 pacientes con queratitis, se encontró que 73 eran de origen bacteriano, encontrándose más de una bacteria en algunas muestras. De las 87 bacterias,; estafilococos coagulasa negativo (Scn: 27,6%) fueron predominantes, seguido de Staphylococcus aureus (Sau: 11,2%), Streptococcus pneumoniae (Spn: 10,3%), Pseudomonas aeruginosa (Pae: 12,6%) y Acinetobacter sp Ac - 8%). El 100% de los aislados de Scn y Sau, fue sensible a ciprofloxacina y a oxacilina, 89% y 100% a gentamicina, 80% y 88% a tobramicina, respectivamente. Todos los aislados de Spn fueron sensibles a eritromicina, de igual manera todos los aislados de Pae y Ac- a ciprofloxacina y tobramicina; 73% y 100% a gentamicina, respectivamente. El 93% de los pacientes recibió tratamiento empírico de colirio antibiótico reforzado (CAR) de cefazolina 50 mg/ml y gentamicina 16mg/ml; y 7% ciprofloxacina al 0,3%. En esta serie, para las úlceras de córnea debidas a estafilococos y a bacilos gramnegativos no fermentadores, la droga de elección es la ciprofloxacina, y debida a S. pneumoniae, eritromicina. En base a los datos obtenidos se concluye que la combinación de cefazolina y ciprofloxacina es un esquema terapéutico empírico que puede ser recomendado para las queratitis bacterianas. Bacterial corneal ulcer or keratitis is a serious condition that can lead to visual loss. Treatment selection is based on microbiologic studies and in susceptibility pattern of the especific geographical area. The objective of this study was to determine the susceptibility and best empirical treatment of patients with bacterial keratitis of the Chair of Ophthalmology of the Hospital de Clinicas whose samples were collected in the Microbiology Laboratory of the Instituto de Investigaciones en Ciencias de la Salud. A retrospective review of the medical records of all culture-positive bacterial keratitis seen from July 2003 to December 2006 was performed. Out of 175 patients with keratitis 73 were found to be of bacterial ethiology. Of the 87 bacteria, coagulase-negative staphylococci (Scn: 27.6%) was predominant followed by Staphylococcus aureus (Sau: 11.2%), Streptococcus pneumoniae (Spn: 10.3%), Pseudomonas aeruginosa (Pae: 12.6%) and Acinetobacter sp (Ac- 8%). All Scn and Sau isolates showed susceptibility to ciprofloxacin and oxacillin, 89% and 100% to gentamicin and 80% and 88% to tobramycin, respectively. All Spn isolates were susceptible to eritromicin; all Pae and Ac- isolates were susceptible to ciprofloxacin and tobramycin, 73% and 100% to gentamicin, respectively. Ninety three percent of the patients received an empirical treatment with a reinforced antibiotic eyedrops of cefazolin 50 mg/ml and gentamicine 16mg/ml; and 7% with ciprofloxacine 0.3%. In this series, for the corneal ulcer due to Staphylococcus species and non-fermenting Gram-negative rods, the drug of choice is ciprofloxacin and for S. pneumoniae is eritromicin. Based in the results of this study, it can said that cefazolin and ciprofloxacin combination is an empirical therapeutic scheme that could be recommended for bacterial keratitis.

A retrospective clinicomicrobiological review of 314 patients with bacterial corneal ulcers from January 1982 to December 1992 was performed. Multivariate statistical analysis was done with multiple logistic regression using PROC LOGIST of SAS statistical software. Positive cultures were grown from 134 (42.7%) of the patients. Pseudomonas aeruginosa, staphylococci, and Acinetobacter spp. were the most frequent pathogens. Significant associations between contact lens use and P. aeruginosa (odds ratio, OR 8.16), between previous herpes simplex keratitis and Streptococcus spp. (OR 18.2) were found. Acinetobacter spp. occurred more frequently in eyes with burn and/or lagophthalmos (OR 13.1/26.2). Staphylococcus aureus was associated with trauma (OR 6.27) and age under 50 (OR 5.08–13.6). Nonpseudomonal gram-negative bacilli were associated with age over 50 (OR 3.24). Drug sensitivity tests for these isolated microorganisms showed that vancomycin and ceftazidime were the most effective agents.

We present a case of corneal melting in a patient with severe rheumatoid arthritis and Sjögren's syndrome. The melting appeared in the area of a bacterial corneal ulcer that healed after treatment with antibiotics. No signs of scleritis were present. Repeated melting of two corneal grafts was seen after surgery.

RESUMO Fez-se um estudo retrospectivo de 10 pacientes portadores de úlceras bacterianas que não responderam ao tratamento clínico e, conseqüentemente, foram submetidos a transplante de córnea penetrante terapêutico, no sentido de avaliar os resultados visuais, as principais complicações, os agentes etiológicos mais freqüentes e a sua validade terapêutica. A indicação do transplante fez-se nos casos de descemetocele com risco ou presença de perfuração. O agente etiológico mais isolado foi a Pseudomonas sp representando 3 dos 10 casos. Todos os pacientes apresentavam, no pré-operatório, acuidade visual (AV) menor que conta dedos (CD), sendo que a maioria dos pacientes não alcançou AV superior a CD no pós-operatório, com exceção de um que chegou a 20/25. As principais complicações foram a rejeição endotelial (50%) e as sinéquias posteriores (50%). Um paciente evoluiu para atrofia ocular. SUMMARY A retrospective study was done in 10 patients with bacterial ulcers that underwent therapeutic penetrating keratoplasty. They were considered as failures of medical treatment. Visual improvement, complications, etiologic agent and its therapeutic value were discussed. The keratoplasty was indicated in all cases of descemetocele with impending or present perforation. Pseudomonas sp was the most frequent isolated agent that represented 3 of the 10 cases. The visual acuity before surgery was worse than finger counting (FC) in all patients and it did not improve after the keratoplasty in most of the cases, except for one who reached the visual acuity of 20/25. The most frequent complications were the endothelial rejection (50%) and the posterior synechea (50%). One patient progressed to ocular atrophy.

The authors report on eight patients with perforated corneal ulcers (six unilateral, two bilateral) and Sjogren's syndrome associated with rheumatoid arthritis. Five patients were evaluated serologically at the time of perforation. Circulating immune complex-like material, positive latex and Waaler-Rose tests, C-reactive protein and pathologic complements C3 and C4 were found in all patients. One patient with features clinically similar to those seen in the patients with Sjogren's syndrome had an iridocyclitis associated with HLA-B 27, with circulating immune complexes but negative latex and Waaler-Rose tests. Penetrating keratoplasty was performed in three eyes, eccentric keratoplasty in one, a penetrating mini-keratoplasty in four, and a tectonic sclerokeratoplasty in three. The keratoplasties had to be repeated in one case after ten years because of endothelial decompensation, in another case three months postoperatively because of a bacterial corneal ulcer, and in a third for optical reasons. After follow-up periods of between 12 and 1 1/4 years it was established that even though the interventions were sometimes extensive, the prognosis was good provided rheumatologic check-ups were thorough.

Infection with diplobacilli of the Moraxella group was the most common cause of bacterial corneal ulcer in a population of derelict alcoholics living in the Bowery district in New York City from 1965 through 1968. No distinction could be made between Moraxella subspecies on the basis of severity of ulcer or antibiotic sensitivities. Of 100 Bowery inhabitants examined, 35 harbored Moraxella in their noses. After 1968 and coinciding with an improvement in nutrition and sanitation, but with no apparent change in the incidence of alcoholism in this population, we noted a marked decline in the incidence of corneal ulcers caused by Moraxella species.

A retrospective clinicomicrobiological study of 228 patients with bacterial corneal ulcers was performed. Positive cultures of corneal ulcer samples were obtained from 68% of all patients. A high incidence of Staphylococcus epidermidis was isolated from patients' ulcers, Staphylococcus aureus, Pseudomonas, Streptococcus pneumoniae, and Streptococcus were the next most frequent pathogens. Of some help in identifying the causative organism were the locations of the ulcer, the presence or absence of hypopyon and the frequency of perforation of the ulcer. Cephaloridine, gentamicin and polymyxin were found to be the most effective therapy. Gram strains of ulcer samples were positive for organisms in only 13% of patients and accordingly were not considered useful in determining initial therapy of ulcers. Since corneal and conjunctival cultures in the majority of the control group were negative, one can presume that most of the S. epidermidis isolated from patients' ulcers was exogenous in nature.

In two hospitals, one in Central America and one in North America,Pseudomonas aeruginosawas the most common cause of acute bacterial corneal ulcer. Although specific chemotherapy was used more frequently and initiated earlier in California, final outcome was equally bad in both countries. El Salvador strains were more pathogenic for the rabbit cornea than the California strains. Typing with pyocine showed a higher prevalence of type 6 in Central America and of type 0 in North America. The poor outcome in California may have been due to the higher frequency of underlying eye disease. The equally poor outcome in El Salvador may have been due to the greater pathogenicity of El Salvador strains and to delayed therapy. The pyocine type of the infectingPseudomonasshould be considered in any future evaluation of therapy.

We report a bacterial corneal ulcer that occurred in a patient who had worn extended-wear rigid gas-permeable contact lenses on a 1-week cycle for 9 months. Pseudomonas aeruginosa was cultured not only from the corneal ulcer but also from the contact lens solutions, suggesting that the patient had been noncompliant with care procedures. To our knowledge, this is the first report of a bacterial corneal ulcer associated with use of a rigid gas-permeable contact lens on an extended-wear basis.