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Chronic recalcitrant bacterial infection in steroid modified interstitial (stromal) keratitis: presentation and

Suksri Chotikavanich1, Nattaporn Tesavibul, Mongkol Uiprasertkul

  • 1Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sisuksri@mahidol.ac.th

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|December 21, 2012
PubMed
Abstract

Insights

Bacterial interstitial keratitis (IK) can occur after prolonged topical steroid use. Corneal biopsy and 16S rDNA sequencing are crucial for diagnosis, with surgery or intrastromal antibiotics proving effective treatments.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Prolonged topical corticosteroid use can predispose corneas to atypical infections.
  • Multifocal interstitial keratitis (IK) may present with subtle inflammation, mimicking other conditions.
  • Standard bacterial keratitis treatments are often ineffective in these steroid-induced cases.

Purpose of the Study:

  • To report histopathologically confirmed bacterial infections presenting as multifocal interstitial keratitis.
  • To evaluate the diagnostic utility of corneal biopsy and 16S rDNA sequencing.
  • To assess treatment outcomes for bacterial IK in immunocompromised corneas.

Main Methods:

  • Retrospective analysis of 19 eyes from 15 patients with presumed viral keratitis treated with topical steroids.
  • Corneal biopsies for histopathology and 16S rDNA sequencing.
  • Analysis of treatment responses to conventional antibiotics, surgery, and intrastromal antibiotics.

Main Results:

  • All patients presented with multifocal stromal infiltration and mild inflammation, negative cultures, but positive biopsy findings for bacteria.
  • Bacteria identified included Stenotrophomonas maltophilia and coagulase-negative staphylococci.
  • Penetrating keratoplasty (57.9%) and intrastromal antibiotic injections (42.1%) were successful treatments.

Conclusions:

  • Bacterial infection, either primary or secondary, is a critical consideration in chronic IK, especially after prolonged steroid use.
  • Corneal biopsy and 16S rDNA sequencing are essential for diagnosing these challenging cases.
  • Aggressive management, including surgical intervention or targeted intrastromal antibiotics, is necessary for successful outcomes.

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