Approach to Infectious Keratitis: Clinical Pearls While on Call

Authors

  • Sonia N. Yeung, MD, PhD, FRCSC, FACS Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, B.C.
  • Alfonso Iovieno, MD, PhD, FRCSC, FACS Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, B.C.
  • Barbara Burgos-Blasco, MD, PhD epartment of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, B.C.

Abstract

Microbial keratitis is a vision-threatening infection of the cornea and an important cause of ocular morbidity that can result in blindness. It is estimated that over 1.5 million people worldwide will develop blindness from infectious corneal ulceration each year. If left untreated or treated incorrectly, it can result in progressive tissue destruction with corneal perforation or extension of the infection to the adjacent tissue. Outcomes of these patients depend on timely diagnosis and treatment with close follow-up.

Author Biographies

Sonia N. Yeung, MD, PhD, FRCSC, FACS, Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, B.C.

Dr. Sonia N. Yeung is an Associate Professor and Head of the Cornea and External Diseases service in the Department of Ophthalmology and Visual Sciences at the University of British Columbia. She also serves as the Medical Director of the Eye Bank of British Columbia and the Chair of the Technical Subcommittee for Ocular Tissues for the Canadian Standards Association. She is a past recipient of the Royal College of Physicians and Surgeons of Canada Gold Medal Award and Claes Dohlman Fellow Award from the Cornea Society, and she has published over 100 papers in peer-reviewed journals. In 2022, Dr. Yeung was the recipient for the UBC Distinguished Achievement Award for overall excellence in research, service, and teaching. Dr Yeung is involved in teaching at the medical school, ophthalmology residency, cornea fellowship, and graduate programs at UBC and has been the recipient of both the Faculty Research Award and Resident Teaching Award.

Alfonso Iovieno, MD, PhD, FRCSC, FACS, Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, B.C.

Dr. Alfonso Iovieno is a Clinical Associate Professor at the University of British Columbia in Vancouver, Canada. Dr. Iovieno obtained his medical degree and completed his Ophthalmology residency at University Campus Bio-medico in Rome, Italy.  He then sub-specialized in cornea, external diseases, ocular surface and complex anterior segment surgery during his 3 years of fellowship training at the University of Toronto, Canada and Moorfields Eye Hospital in London, UK. Dr. Iovieno also completed a Ph.D. in ocular microbiology and immunology between University Campus Bio-medico and the Bascom Palmer Eye Institute in Miami, Florida. His research focus has spanned from ocular surface immunology to corneal infections, corneal transplantation and biomaterials. He has won numerous awards and recognitions and holds several patents for biomedical devices. Dr. Iovieno regularly presents and moderates at national and international meetings and has been extensively involved in training courses on the latest techniques for corneal transplantation. He is a member of the board of directors of the Italian Society of Corneal Transplantation (SITRAC), member with thesis of the Cornea Society and the Tearfilm and Ocular Surface Society (TFOS) Ambassador for Western Canada. He has authored over 100 papers in peer-reviewed journals and 15 book chapters.

Barbara Burgos-Blasco, MD, PhD, epartment of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, B.C.

Dr. Barbara Burgos-Blasco graduated from Medicine at the Universidad Complutense de Madrid in Spain. She completed her ophthalmology residency and her PhD at Hospital Clínico San Carlos (Madrid, Spain). She is currently doing a fellowship in Cornea and External Diseases at University of British Columbia.

References

Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: a global perspective. Bull World Health Organ. 2001;79:214–21.

Brown L, Leck AK, Gichangi M et al. The global incidence and diagnosis of fungal keratitis. Lancet Infect Dis 2021;21:e49–57.

Termote K, Joe AW, Butler AL et al. Epidemiology of bacterial corneal ulcers at tertiary centres in Vancouver, B.C. Can J Ophthalmol. 2018;53:330–6.

Trinh T, Emami S, Gould J et al. Clinical and microbiological analysis of fungal keratitis in Toronto, Canada: A 20-year study. Med Mycol. 2022;60.

Qiao GL, Ling J, Wong T et al. Candida keratitis: epidemiology, management, and clinical outcomes. ARVO Annual Meeting, Vancouver, Canada: n.d.

Noureddin GS, Sasaki S, Butler AL et al. Paediatric infectious keratitis at tertiary referral centres in Vancouver, Canada. Br J Ophthalmol. 2016;100:1714‑8.

Ling JY, Yeung SN, Chan C, et al. Trends and clinical outcomes of fungal keratitis in Canada: a 20-year retrospective multicentre study. Ocul. Microbiol. Immunol Abstract. 2023. General Meeting, Pittsburg, PA.

Allan BD, Dart JK. Strategies for the management of microbial keratitis. Br J Ophthalmol. 1995;79:777–86.

American Academy of Ophthalmology: Basic Clinical and Science Course, Section 8, External Disease and Cornea.

Lin A, Rhee MK, Akpek EK et al. Bacterial keratitis preferred practice pattern®. Ophthalmology. 2019;126:P1–55.

Pakzad-Vaezi K, Levasseur SD, Schendel S et al. The corneal ulcer one-touch study: a simplified microbiological specimen collection method. Am J Ophthalmol. 2015;159:37-43.e1.

Blondeau JM, Sanfilippo CM, Morris TW et al. In vitro antibiotic susceptibility profile of ocular pathogens—results from the first ARMOR Canada Surveillance Study. Assoc. Res. Vis. Ophthalmol. Annual Meeting. Orlando, FL: n.d., p. Poster 2840-B0073.

Loviano A. Unpublished data.

Hoffman JJ, Yadav R, Sanyam SD et al. Topical chlorhexidine 0.2% versus topical natamycin 5% for the treatment of fungal keratitis in Nepal: a randomized controlled noninferiority trial. Ophthalmology. 2022;129:530–41.

Hariprasad SM, Mieler WF, Holz ER et al. Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. Arch Ophthalmol. 2004;122:42–7.

Herretes S, Wang X, Reyes JMG. Topical corticosteroids as adjunctive therapy for bacterial keratitis. Cochrane Database Syst Rev. 2014 Oct 16;10(10): CD005430.

Srinivasan M, Mascarenhas J, Rajaraman R et al. Corticosteroids for bacterial keratitis: the steroids for corneal ulcers Trial (SCUT). Arch Ophthalmol. 2012;130:143–50.

Gokhale NS. Medical management approach to infectious keratitis. Indian J Ophthalmol. 2008;56:215‑20.

Austin A, Lietman T, Rose-Nussbaumer J. Update on the management of infectious keratitis. Ophthalmology. 2017;124:1678–89.

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Published

2024-02-28

How to Cite

1.
Yeung SN, Iovieno A, Burgos-Blasco B. Approach to Infectious Keratitis: Clinical Pearls While on Call. Can Eye Care Today [Internet]. 2024 Feb. 28 [cited 2024 May 2];3(1):32–37. Available from: https://canadianeyecaretoday.com/article/view/3-1-yeung_et_al

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Volume 3, Issue 1, February 2024

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