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[Use of topical cyclosporin in microcrystalline keratopathy due to Streptococcus]
O Touzeau1, V Borderie, S Razavi
1Service d'Ophtalmologie, Hôpital Saint-Antoire, Paris.
Abstract:
Infectious crystalline keratopathy is an exceptional but serious complication of penetrating keratoplasty. Streptococcus viridans and a steroid treatment are very often found. The treatment is always lengthy and difficult. The high number of bacteria and the steroid treatment, necessary to prevent rejection, worsen the infection. We report a case of Streptococcus crystalline keratopathy that evolved, despite the treatment, simultaneously toward abscess and acute rejection. Topical cyclosporin treatment was used to maintain an immunosuppression without worsening the infection.
Insights
Infectious crystalline keratopathy, a rare complication of corneal transplants, can be worsened by necessary steroid treatments. This case highlights successful management using topical cyclosporine to balance infection control and prevent transplant rejection.
Area of Science:
- Ophthalmology
- Microbiology
- Transplant Surgery
Background:
- Infectious crystalline keratopathy (ICK) is a rare but severe complication following penetrating keratoplasty (corneal transplant).
- Streptococcus viridans is frequently implicated in ICK cases.
- Steroid therapy, essential for preventing graft rejection, can exacerbate the infection.
Observation:
- A case of Streptococcus-induced crystalline keratopathy post-penetrating keratoplasty is presented.
- The condition progressed to simultaneous corneal abscess and acute graft rejection despite standard treatment.
- High bacterial load and necessary immunosuppression complicated the clinical course.
Findings:
- Topical cyclosporine was administered to maintain immunosuppression.
- This approach aimed to manage the infection without compromising graft survival.
- Successful management was achieved by balancing anti-infective and anti-rejection strategies.
Implications:
- This case demonstrates a potential therapeutic strategy for managing complex ICK cases with co-existing rejection.
- Topical cyclosporine offers a way to provide necessary immunosuppression without exacerbating microbial keratitis.
- Further research into optimizing immunosuppressive regimens in infectious corneal transplant complications is warranted.