Cornea Society International Organization Advancing the treatment of corneal disease
Issue link: http://digital.corneanews.org/i/703146
Spring 2016 A Cornea Society publication Vol. 12, No. 2 News continued on page 3 Cornea Day highlights controversies and challenging cases preliminary reports show efficacy with crosslinking, but more clinical experi- ence is needed. In terms of antifungal therapy, natamycin may be a better and more accessible therapeutic, she said. Kristin Hammersmith, MD, Phil- adelphia, presented on corneal neovas- cularization and HSV. Physicians know that corneal transparency is essential to optimal vision and function, she said. Corneal neovascularization can block and disrupt light, can deposit lipids and proteins into the stroma, can damage the structural integrity of the cornea, and can worsen the prognosis of PK. The prevalence of corneal neovascu- larization is 4% of the general ophthal- mic eye service in the U.S. There is an estimated incidence of 1.4 million Americans per year, Dr. Hammersmith said, and HSV is the major cause of blindness in the developed world. Crosslinked corneas may have increased resistance to degradative enzymes. Stud- ies have shown that crosslinking appears to be a reasonable adjunctive therapy for corneal ulcers, Dr. Suh added. With still negative cultures, the pa- tient did admit to having uncontrolled diabetes mellitus. When a confocal mi- croscopy was performed, many branch- ing organisms were found throughout numerous scans, which was consistent with filamentous fungal organisms. Cultures showed Fusarium spp., and eventually a penetrating keratoplasty was performed for this patient. In conclusion, Dr. Suh highlighted the answers to 3 important questions: Is there a role for topical steroids in bacte- rial keratitis? Is there a role for collagen crosslinking in infectious keratitis? And what is the first line of antifungal thera- py in fungal ulcers? She said there may be a role for topical steroids for certain culture positive bacterial ulcers, and T he 2016 Cornea Day at the ASCRS•ASOA Symposium & Congress featured sessions on refractive surgery, challenging cornea cases, corneal and conjunctival surgery, and corneal cataract issues. Challenging cases The first session of the day focused on challenging cornea cases. Leejee Suh, MD, New York, spoke about infectious keratitis. She presented a case of a 49-year-old female with progressive vi- sion loss, redness, and pain in the right eye. The patient also had myopia, for which she used soft contact lenses. The patient was initially seen else- where, and the cornea was cultured, Dr. Suh said. The cultures were negative to date, and tobramycin and dexametha- sone had been used. However, when the patient presented, she was complaining of worsening eye pain. Is there a role for topical steroids in bacterial kerati- tis? Dr. Suh said the pros are that they can reduce the severity of stromal melt and scarring. Topical steroids could also inhibit neutrophil chemotaxis and collagenases. However, there could be a delay in epithelial healing, and steroids could prolong infections and may allow for fungal infections. The next step for this type of pa- tient, Dr. Suh said, would be to recul- ture, and do a confocal microscopy and biopsy. This particular patient was recultured from the cornea and contact lens case. Fortified vancomycin and to- bramycin was used, but the patient still complained of severe pain. Dr. Suh said that she and colleagues asked themselves if there is a role for collagen crosslinking in infectious kera- titis. In order to talk about crosslinking, you have to talk about the antimicrobial effect of riboflavin and UVA demonstrat- ed in vitro in animal studies, she said. Dr. Rhee discusses large-diameter cosmetic contact lenses.