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Clinical profile of pythium keratitis: perioperative measures to reduce risk of recurrence
  1. Shweta Agarwal1,
  2. Geetha Iyer1,
  3. Bhaskar Srinivasan1,
  4. Mamta Agarwal1,
  5. Shobha Panchalam Sampath Kumar2,
  6. Lily K Therese3
  1. 1CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
  2. 2Elite School of Optometry, Birla Institute of Technology and Science, Chennai, Tamil Nadu, India
  3. 3L&T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Geetha Iyer, CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai 600006, India; drgeethaiyer{at}gmail.com

Abstract

Purpose To report the clinical profile and role of perioperative adjunctive measures to reduce the risk of recurrence in Pythium insidiosum keratitis.

Methods Retrospective analysis of 10 eyes of 10 patients with P. insidiosum keratitis. Diagnosis was confirmed by PCR DNA sequencing.

Results 7out of 10 patients were from urban locales, and none had any obvious history of injury with vegetative matter and were being treated for fungal keratitis. 6 eyes presented with central full thickness infiltrates with subepithelial and superficial stromal infiltrates radiating in a reticular pattern. Corneal scraping in all eyes revealed sparsely septate fungal-like filaments on potassium hydroxide/Calcofluor. All eyes underwent the first therapeutic penetrating keratoplasty (TPK) based on worsening or non-responsiveness of clinical features to the antifungal regimen. Recurrence was noted in 7 out of 10 eyes of which 2 eyes underwent evisceration. Of the six eyes that underwent cryotherapy following confirmation of microbiological diagnosis of Pythium (along with primary TPK-1, with re-TPK-5), only one eye had a recurrence and had to be eviscerated. Of the two eyes that did not undergo cryotherapy during re-TPK, following microbiological diagnosis, one eye had a recurrence and had to be eviscerated. In two eyes with adjoining scleritis, the host bed was swabbed using absolute alcohol of which one eye was salvaged.

Conclusion This series highlights the need to be aware of this entity in the management of refractory fungal keratitis. It also brings to fore the adjunctive measures that could have a beneficial role in the management of pythium keratitis.

  • Cryotherapy
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Footnotes

  • Contributors SA, GI and BS designed the study, provided the material, analysed and interpreted the data, and wrote, proofed and revised the article. MA and SPS provided the material and proofed the article. LKT provided the material, analysed and interpreted the data and proofed the article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. The figures have been replaced as the colours were showing in negative. The content of the figures has not changed.

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