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Infectious crystalline keratopathy
L Remeijer1, G van Rij, C M Mooij
1Eye Hospital, Rotterdam.
Abstract:
In seven patients white branched crystalline opacities, which grew very slowly, were seen in the corneal stroma. They were associated with very little inflammatory activity, so that the clinical picture at first did not suggest an infectious etiology. Pathological examination, however, demonstrated colonies of bacteria between intact corneal lamellae. On bacterial examination gram-positive commensals were mainly found. All the patients described so far were found to be taking corticosteroids regularly, sometimes in combination with antibiotics. The immunosuppression brought about by corticosteroids is probably an important factor in the development of these crystalline opacities. The therapy for this infectious crystalline keratopathy is difficult and lengthy. It consists of local bactericidal antibiotics and the lowest possible dosage of corticosteroids, if necessary combined with a partial lamellar keratectomy and removal of the affected corneal tissue by fraising.
Insights
Corticosteroid use can lead to slow-growing, white crystalline opacities in the cornea due to bacterial infections. Treatment for this infectious crystalline keratopathy is challenging, requiring antibiotics and reduced corticosteroid use.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Corneal opacities can present with varied etiologies.
- Infectious causes of corneal opacities may not always exhibit significant inflammation.
Observation:
- Slowly progressive, white, branched crystalline opacities were observed in the corneal stroma of seven patients.
- Minimal initial inflammatory signs masked the infectious nature of the condition.
Findings:
- Pathological examination revealed bacterial colonies, primarily gram-positive commensals, within intact corneal lamellae.
- All affected patients were on regular corticosteroid therapy, often with antibiotics, suggesting an immunosuppressive role.
Implications:
- Corticosteroid-induced immunosuppression is a likely contributing factor to the development of infectious crystalline keratopathy.
- Treatment is complex and prolonged, involving bactericidal antibiotics, minimized corticosteroid dosage, and potentially surgical interventions like partial lamellar keratectomy.