March 25, 2014
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Speaker highlights controversies, evolving management strategies for infectious keratitis

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LISBON, Portugal — Culture-directed therapy should be preferred to empirical methods in cases of severe and non-severe infectious keratitis, according to one specialist.

“Many clinicians treat non-severe disease empirically, without obtaining a specimen,” Terrence P. O’Brien, MD, said at the Controversies in Ophthalmology meeting. “My suggestion is to always obtain a scraping of the cornea for culture, apply a broad-spectrum antibiotic therapy, follow the patient, and then modify the treatment based on patient response and on laboratory findings about susceptibility of the organisms that have been identified.”

For severe disease, scraping for smears and culture followed by a combination of fortified antibiotics covering the most likely pathogens was recommended.

“Given the emergence and spread of MRSA and MRSE, topical vancomycin is now recommended as first line, combined with fortified aminoglycoside or fluoroquinolone. If scleral extension or impending perforation is imminent, adjunctive systemic therapy is suggested,” O’Brien said.

Use of topical corticosteroids remains controversial, he said, and should be initiated only after adequate antibacterial therapy with sufficient concentrations and duration to bring organism replication under control.

Compliance with frequent dosing schedules is imperative for treatment success.

“Newer methods of drug delivery may allow for effective infection control with less frequent dosing and improved compliance,” O’Brien said.

Disclosure: O’Brien is a consultant to Alcon, Allergan, Abbott Medical Optics/Visx, Bausch + Lomb, Inspire and Ista-Vistakon.