Cornea Society News

DEC 2016

Cornea Society International Organization Advancing the treatment of corneal disease

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News December 2016 Vol. 12, No. 4 A Cornea Society publication Cornea Subspecialty Day at AAO T he 2016 American Academy of Ophthalmology (AAO) annual meeting featured an entire day of cornea presentations at Cornea Subspecialty Day. The program directors were Shahzad Mian, MD, Bennie Jeng, MD, and Carol Karp, MD. Antibiotic resistance and bacterial keratitis Antibiotic resistance can be a problem when trying to treat infections. Eduardo Alfonso, MD, Miami, spoke about antibi- otic resistance in the setting of bacterial keratitis. There are 1 million visits for keratitis and other contact lens cornea disorders annually, he said, and approx- imately 60,000 of these are cared for in the emergency room. "To better understand the problem of bacterial keratitis that may be non-re- sponsive or antibiotic resistant, we need to look at the organism involved," he said. Dr. Alfonso discussed possible bac- terial keratitis pathogens, noting that Pseudomonas aeruginosa and Staphylococ- cus aureus are two common pathogens. Physicians have to consider that they will only actually identify the organism in about 50% of cases, he said. Possible treatment options were discussed in the presentation, and Dr. Alfonso noted that fluoroquinolones are a popular treatment in the U.S. There are other antibiotic options, as well as fortified antibiotics with a higher con- centration to enhance their effect. Dr. Alfonso also suggested the possibility of using multiple antibiotics in therapy to reduce the risk that there will be antibi- otic resistance. Current recommendations are based on accurate diagnosis, he said. Acanthamoeba keratitis diagnosis Ensuring an accurate diagnosis of Acan- thamoeba keratitis is very important, and Jeremy Keenan, MD, San Francisco, shared several tips for how not to miss a diagnosis of Acanthamoeba keratitis. First, you need to know the epi- demiology. The incidence depends on where you look, he said. Contact lens wear and fresh water exposure are two of the biggest causes. It's also important to be aware of seasonality, as there is a peak in incidence in the summer months. Dr. Keenan said to know the early signs of infection. "These are things that are subtle and easy to miss, and you have to look hard," he said. Some signs may include pseudodendrites, epithelial ridge, and stromal involvement early on. A late sign may be ring infiltrates. Remember Acanthamoeba when diagnosing, Dr. Keenan said, particularly in herpes simplex (HSV). He also sug- gested a confocal to help with diagnosis. This is a quick test that you can do in the office and is usually helpful, he said. Finally, Dr. Keenan said to get a good corneal scraping, meaning that you need to get a lot of tissue. This is good both for diagnosis and to debulk and get rid of cysts on the epithelium, he said. Donor tissue When it comes to corneal transplants, there are many factors to consider before doing the transplant, including the quality of donor tissue and risks of dis- ease transmission from the donor to the Dr. Jeng, one of the program directors, speaks at the 2016 Cornea Subspecialty Day. continued on page 3

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