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Sutureless wound infection by unusual acid-fast organisms
Vandana Jain1, Prashant Garg, Savitri Sharma
1Cornea and Anterior Segment Service, Aditya Jyot Eye Hospital Pvt Ltd, Mumbai, India. docvandanajain@rediffmail.com
Purpose:
To report infection of self-sealing wounds in cataract surgery by unusual acid-fast organisms.
Methods:
Two patients who underwent phacoemulsification and developed corneal tunnel infection by acid-fast organisms were included. Both were managed with appropriate medical and surgical treatment modalities.
Results:
Diagnosis was facilitated in the first case by diagnostic and therapeutic lamellar keratoplasty and in the second case by the analysis of scrapings obtained from the inner lip of the tunnel. Ziehl-Neilsen staining helped diagnosis of acid-fast bacteria and implementation of adequate therapy. Nonresponse to appropriate susceptibility-guided medical therapy in the second case was controlled by timely surgical keratectomy as a peripheral patch graft.
Conclusions:
Tunnel infection after phacoemulsification is a serious complication and can be caused by relatively uncommon acid-fast bacteria. Appropriate diagnostic work-up will help in the identification and institution of appropriate therapy.
Insights
Cataract surgery patients developed rare acid-fast organism infections in self-sealing wounds. Early diagnosis and tailored treatment, including surgery, are crucial for managing this serious complication.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Phacoemulsification is a common cataract surgery technique utilizing self-sealing corneal incisions.
- Corneal tunnel infections are a rare but serious complication following cataract surgery.
Observation:
- Two cases of corneal tunnel infection after phacoemulsification are presented.
- The infections were caused by unusual acid-fast organisms, identified via Ziehl-Neelsen staining.
- Diagnosis was aided by lamellar keratoplasty and analysis of tunnel scrapings.
Findings:
- Acid-fast bacteria can cause post-phacoemulsification tunnel infections.
- Diagnosis requires specific staining techniques (Ziehl-Neelsen) and sample analysis.
- Medical therapy guided by susceptibility testing may be insufficient; surgical intervention (keratectomy, graft) might be necessary.
Implications:
- Highlights the potential for uncommon pathogens in post-surgical eye infections.
- Emphasizes the importance of a thorough diagnostic approach for unusual infections.
- Underscores the need for prompt and potentially combined medical-surgical management to preserve vision.
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