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Antibiotic resistance of crystalline bacterial ingrowth in a corneal graft
Abstract:
Four recent reports have described the clinical appearance of fine needle-like opacities in the corneal stroma of six patients. In five of these patients these developed in a corneal graft. Histologically, all the corneal buttons had bacterial ingrowth between the stromal lamellae, with a striking lack of inflammatory response. We report a patient in whom this process occurred following penetrating keratoplasty. Intensive topical antibiotic treatment failed, and she underwent a second, successful, penetrating keratoplasty. Postoperatively, this patient has maintained good vision with no recurrence for over three years. Histologic and ultrastructural study of the corneal button revealed viable and nonviable gram-positive cocci with a marked paucity of inflammatory infiltrate.
Insights
Fine needle-like opacities in corneal grafts, caused by bacterial ingrowth, were observed in patients. Successful treatment involved a second corneal transplant, preventing recurrence and preserving vision.
Area of Science:
- Ophthalmology
- Microbiology
- Histopathology
Background:
- Reports describe fine needle-like opacities in the corneal stroma, often in corneal grafts.
- This clinical presentation is associated with bacterial ingrowth within the corneal stroma.
Observation:
- A patient developed these opacities following penetrating keratoplasty.
- Initial intensive topical antibiotic treatment was unsuccessful in resolving the condition.
Findings:
- Histological examination revealed bacterial (gram-positive cocci) ingrowth between stromal lamellae.
- A significant lack of inflammatory response was noted despite the bacterial presence.
Implications:
- A second penetrating keratoplasty was successful, leading to good vision and no recurrence for over three years.
- This suggests that surgical intervention may be a viable option for managing this specific type of corneal bacterial infection.
- The paucity of inflammation highlights a unique host-pathogen interaction in these cases.