INFECTIOUS KERATITIS - AN AS-OCT PERSPECTIVE IN THE MANAGEMENT OF CORNEAL ULCERS

To present the evolution patterns monitored using AS-OCT in a case series of  infectious keratitis with different microbiologically confirmed pathogens: E.Coli, P. Aeruginosa, MDR S. Aureus.

Clinical Emergency Eye Hospital Bucharest

This is a retrospective case series. The patients were monitored from the first presentation to complete remission. Empirical treatment was initiated in all cases and adjusted according to the antibiogram. AS OCT was used to evaluate the extent of the corneal lesions and to observe the healing process in each case.

All the patients presented with an active corneal ulcer and with anterior chamber reaction, thus being admitted. The visual prognosis was variable, depending both on the response to the treatment, as well as the localisation of the ulcer. 

AS-OCT was the preferred imaging method for determining the extent and severity of the inflammation. We found that these parameters were good predictors for the amount of corneal thinning and scarring throughout the evolution of the infection.

 In Pseudomonas Keratitis cases, initially, the perilesional inflammation was more important,  with rapid involvement of adjacent tissue, in both sagittal and coronal planes. Pronounced anterior chamber flare (+++) and hypopyon were noted in both cases. Ciliary flush and perilesional edema maintained in spite of aggressive treatment. The re-epithelialization process was poor, due to a possible associated keratoneuritis. Patients needed additional mid-term treatment after resolution (lubricants, topical antibodies) for secondary prophylaxis.

In the MRSA keratitis case, the patient presented a moderate amount of anterior chamber flare (++) and the corneal defect remained localized in the anterior half of the stroma, with a less pronounced perilesional inflammatory response compared to the other patients in this series. Complete resolution occurred with a discrete amount of stromal thinning with superjacent scar tissue formation and complete re-epithelialization. Due to the paracentral localisation of the lesion, visual prognosis was good. 

In the E.Coli case, the inflammatory response was severe, with the following clinical findings: intralesional infiltrates, pseudohypopyon, important anterior chamber flare (++++), hypopyon. A more reserved prognosis was given, due to involvement of the functional optical zone. The resolution was better compared to Pseudomonas cases, with complete re-epithelialization. In this scenario, visual rehabilitation will most likely necessitate further surgical interventions (DALK).

This case series highlights the multiple patterns of corneal involvement in infectious keratitis with different pathogens. The morphological parameters obtained with AS-OCT provide insights into both the initial extension of the disease and dynamic data regarding treatment response, enabling us to adjust the curative methods and improve visual outcome.