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    Managing infections in artificial cornea

    Contemporary prevention, management may allay cases of keratitis, endophthalmitis

     

    Infectious keratitis

    Dr. Colby advised that ophthalmologists maintain a high index of suspicion for possible infectious keratitis.

    “Don’t ignore subtle infiltrates, and be wary of deposits on bandage lenses because these may indicate the presence of fungus,” she said.

    Related: Keratoconic eye experience with a long-arc intrastromal corneal ring

    “Performing cultures is the mainstay of therapy to establish the diagnosis but cultures can be challenging,” said Dr. Colby, recommending imaging, corneal biopsies, or passing a suture through the area of a deep infiltrate to make the diagnosis.

    The first step in management is removing the bandage contact lens, which can either be replaced or left off. Steroids can be tapered or stopped and topical antibiotics that cover gram-negative and gram-positive organisms should be prescribed.

    Related: Using femtosecond lasers in eyes with previous surgery

    Administration of a topical antifungal drug, usually amphotericin B, is a consideration. Most fungal infections that develop after device implantation are identified as Candida, Dr. Colby said.

    Other considerations are the role of systemic therapy, removal of the KPro, and replacement with tectonic penetrating keratoplasty. In all scenarios, the patients should be followed closely.

    Related: Photoactivation holds promise for keratitis treatment

    Possible complications after infectious keratitis include corneal melting that exposes the back plate of the device. A retroprosthetic membrane is another possibility after infectious keratitis.

    Infectious endophthalmitis

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