China
Africa
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Small-Molecule Targeted Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Finally, it is worth noting that skin rashes are the most common adverse reactions associated with EGFR inhibitors, and many clinicians believe that this may be a useful biomarker of drug activity. However, sometimes this effect can be very harmful to patients, and cases of keratitis and ulcerative keratitis have been reported following treatment with EGFR inhibitors including erlotinib, gefitinib cetuximab, and panitumumab. In rare cases, this has resulted in corneal perforation and blindness.
Epidemiology of Mycotic Keratitis
Published in Mahendra Rai, Marcelo Luís Occhiutto, Mycotic Keratitis, 2019
Ana Luiza Mylla Boso, Rosane Silvestre Castro, Denise Oliveira Fornazari, Monica Alves
According to the World Health Organization, corneal pathologies are the second most important causes of unilateral loss of vision worldwide and are especially important in developing countries (Whitcher et al. 2001). As the number of cases of some infectious diseases such as trachoma and onchocerciasis is seeing a gradual decline due to successful public health initiatives, corneal ulcerations relatively growing as part of the causes of corneal blindness and it is estimated that it may affect more than two million people annually around the world (Whitcher et al. 2001). Although it is likely that the estimates are under reported, Gupta et al. estimated an annual incidence of corneal ulceration of 1.5–2 million people in India (Gupta et al. 2013), while in the United States the rates reported by Jeng (2010) were of 27.6 per 100.000 people per year. Corneal ulceration has a highly diverse epidemiology in different geographical areas, but undoubtedly it is a challenging condition that can lead in many cases to permanent visual dysfunction, monocular blindness, corneal perforation or even loss of the eye.
Pefloxacin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Overall, fluoroquinolones are relatively safe in terms of ocular toxicity, although when this kind of toxicity occurs it appears to be dose-dependent and results from drug class effects and specific fluoroquinolone structures. Toxic effects of fluoroquinolones on ocular collagen may in some cases be associated with Achilles tendinopathy. Corneal precipitation may provide an advantageous drug depot but delay healing and result in corneal perforation in approximately 10% of cases. The current recommended safe dose for intravitreal injections of pefloxacin is 200 μg/0.1 ml (Thompson, 2007).
Therapeutic non-ectasia applications of cornea cross-linking
Published in Clinical and Experimental Optometry, 2023
Haitham Al-Mahrouqi, Isabella Mei Yan Cheung, Lize Angelo, Tzu-Ying Yu, Akilesh Gokul, Mohammed Ziaei
Infectious keratitis is most commonly caused by bacteria, and to a lesser extent by fungal, amoebic, or viral organisms.6 Contact lens wear, ocular trauma and ocular surface disease are among the leading predisposing factors.7 Infectious keratitis frequently leads to the development of corneal opacification and scarring and is one of the most common causes of blindness worldwide.8 At present, infectious keratitis is predominately managed by intensive topical antimicrobial regimens.7 However, in severe disease, complications including endophthalmitis, corneal perforation, and visual loss can still develop, despite prompt and definitive therapy.9,10 Furthermore, resistance of causative organisms to readily available antimicrobials could increase the potential of treatment failure.11 In an effort to address the above issues, alternative therapeutic approaches have been evaluated in recent years. One such treatment modality is Photoactivated Chromophore for Infectious Keratitis (PACK)-CXL.12 PACK-CXL denotes the application of CXL in infectious keratitis. As well as biomechanical stabilisation of the damaged cornea, UVA irradiation and photoactivated riboflavin also confer antimicrobial properties, hypothesised to occur via microbial DNA and RNA damage.13–17
Peripheral Ulcerative Keratitis Secondary to the Inactive COVID-19 Vaccine-CoronaVac
Published in Ocular Immunology and Inflammation, 2023
Management of PUK often requires systemic therapy targeting the underlying immunological process including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, systemic immunosuppressive chemotherapy and biological therapy.26 Surgical treatment is necessary when corneal perforation occurs, procedures that employ cyanoacrylate glue, lamellar patch flap, or penetrating keratoplasty.4 Conjunctival resection of the inflamed area, conjunctival flap, and amniotic membrane transferring can accelerate the healing process with anti-inflammatory effectivity.28 Topical therapy with corticosteroids and immunosuppressive agents like cyclosporine are needed for regressing the stromal infiltrations and inflammation. But they could inhibit new collagen production and thereby increase the risk of perforation, so they must be used carefully.29 Despite all the systemic and topical medications and conservative surgical procedures the penetrant keratoplasty could be necessary for visual rehabilitation or tectonic reasons.
Tenon's Patch Graft: A Review of Indications, Surgical Technique, Outcomes and Complications
Published in Seminars in Ophthalmology, 2022
Anahita Kate, Sonal Vyas, Rahul Kumar Bafna, Namrata Sharma, Sayan Basu
As mentioned earlier, a number of factors need to be taken into consideration when planning surgical intervention in a case of corneal perforation. The choice of intervention may be obvious in some cases such as perforations smaller than 1 mm requiring only tissue adhesives or very large perforations >6 mm with collagenolysis in the adjacent cornea necessitating therapeutic keratoplasties for restoring the integrity of the globe. Cases that lie between the two ends of this spectrum often pose a dilemma to the treating surgeon, as they may be amenable to more than one surgical procedure. Unless there is no access to tissue adhesive and an eye bank backup is not available, TPG is not recommended in a corneal perforation due to acute suppuration. The inflammatory cells will cause rapid degradation of the tenon's layer via secretion of proteases and other inflammatory mediators.22