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Published on: May 12, 2020
Medical and surgical management of Pasteurella canis infectious keratitis
Ankit Shah1, Mansi Talati1, Thomas Mauger1
1Ohio State University Havener Eye Institute Department of Ophthalmology and Visual Science, USA.
Introduction:
We describe a case of refractory Pasteurella Canis keratitis that initially failed antimicrobial treatment but was successfully treated with a conjunctival flap followed by a penetrating keratoplasty.
Case Discussion:
A 70-year-old male had persistent corneal edema related to previous herpes zoster keratouveitis with visual acuity of 20/400. An endothelial keratoplasty was performed with improvement in vision to 20/25. Several months after this surgery the patient developed a corneal infiltrate and cultures grew Pasturella canis. The infection persisted despite topical treatment with broad spectrum fortified vancomycin, tobramycin and fluoroquinolones. A conjunctival flap combined with corneal cryotherapy was performed to help mitigate symptoms and to allow the ulcer to heal. A penetrating keratoplasty was done several months later.
Discussion:
The patient achieved pain relief immediately after the flap was placed. Medications were tapered off in the following few months after the procedure. A penetrating keratoplasty was performed 4 months later. The patient has remained almost entirely symptom free, and the graft remained clear one year after surgery.
Conclusions:
A keratitis caused by Pasteurella canis that is resistant to medical therapy can be treated successfully with a conjunctival flap and cryotherapy followed by a penetrating keratoplasty.
Insights
Refractory Pasteurella Canis keratitis, a challenging eye infection, can be successfully treated with a conjunctival flap and cryotherapy, followed by penetrating keratoplasty when antimicrobial therapy fails.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Corneal infections can lead to significant vision loss.
- Refractory Pasteurella Canis keratitis poses a treatment challenge.
Purpose of the Study:
- To describe a successful treatment protocol for refractory Pasteurella Canis keratitis.
Main Methods:
- A case of Pasteurella Canis keratitis unresponsive to antimicrobials was treated.
- Surgical intervention included a conjunctival flap with corneal cryotherapy.
- A subsequent penetrating keratoplasty was performed.
Main Results:
- The conjunctival flap provided immediate pain relief and facilitated ulcer healing.
- The patient experienced sustained symptom relief and graft clarity one year post-penetrating keratoplasty.
Conclusions:
- A combination of conjunctival flap, cryotherapy, and penetrating keratoplasty is an effective treatment for antimicrobial-resistant Pasteurella Canis keratitis.
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