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Unsuspected infectious keratitis in host corneal buttons
T D Lindquist1, J D Cameron, V R Havener
1Department of Ophthalmology, University of Washington School of Medicine, Seattle.
Abstract:
Infectious keratitis may be unsuspected preoperatively in patients undergoing penetrating keratoplasty. We have diagnosed five cases of previously unknown corneal infection discovered only after post-keratoplasty histopathologic examination using specific stains. These cases of preoperatively unsuspected infectious keratitis illustrate examples where histopathologic examination using specialized stains may alert the physician to the need for appropriate postoperative antimicrobial therapy. Furthermore, these cases illustrate the ability of soft contact lenses to mask symptoms of infectious keratitis. Additionally, the clinical appearance of advanced bullous keratopathy may mask signs of infectious keratitis.
Insights
Undiagnosed infectious keratitis can occur before corneal transplants. Post-transplant histopathology revealed hidden infections, highlighting the need for antimicrobial therapy and noting contact lenses can mask symptoms.
Area of Science:
- Ophthalmology
- Pathology
Background:
- Infectious keratitis is a potential complication in patients undergoing penetrating keratoplasty.
- Preoperative diagnosis of infectious keratitis can be challenging.
Observation:
- Five cases of previously unknown corneal infections were diagnosed post-penetrating keratoplasty via histopathologic examination.
- Soft contact lenses and advanced bullous keratopathy can mask clinical signs of infectious keratitis.
Findings:
- Histopathologic examination with specialized stains is crucial for identifying unsuspected infectious keratitis.
- Early detection through histopathology can guide necessary postoperative antimicrobial therapy.
Implications:
- Histopathology is vital for diagnosing masked infectious keratitis in corneal transplant patients.
- Physicians should consider infectious keratitis even when masked by contact lens wear or bullous keratopathy.
- Prompt antimicrobial treatment based on histopathologic findings can improve outcomes.