Adjunctive Green Thermal Laser Photocoagulation for Treatment of Resistant Infectious Keratitis

Figures & data

Table 1 Epidemiology of Microorganisms Found in Infectious Keratitis Cases

Bacteria	Pure	Mixed	Total
Gram-positive	22	42	64 (42.7%)
Staphylococcus aureus	15	26	41 (27.3%)
Staphylococcus epidermidis	5	11	16 (10.7%)
Streptococcus pneumoniae	2	4	6 (4%)
Streptococcus viridans	0	1	1 (0.7%)
Gram-negative	13	29	42 (28%)
Pseudomonas aeruginosa	10	13	23 (15.3%)
Klebsiella pneumoniae	2	8	10 (6.7%)
Enterobacter species	1	3	4 (2.7%)
Proteus species	0	2	2 (1.3%)
Moraxella species	0	3	3 (2%)
Total	35 (23.3%)	71 (47.3%)	106 (70.7%)
Fungus	Pure	Mixed	Total
Fusarium species	17	13	30 (20%)
Aspergillus species	19	28	47 (31.3%)
Candida species	8	15	23 (15.3%)
Alternaria species	0	9	9 (6%)
Penicillium species	0	6	6 (4%)
Total	44 (29.3%)	71 (47.3%)	115 (76.7%)

Figure 1 3 examples of green thermal laser application for resistant infectious keratitis (IK). Case 1 (A–C) had a bacterial IK, with a 1 mm height hypopyon level. Pre-treatment (A), post-laser (B), and after complete healing (C). Case 2 (D–F) had a fungal IK, with a 3 mm hypopyon level. Pre-treatment (D), immediately post-laser with stained cornea (E), and after complete healing (F), with residual corneal opacity. Case 3 (G–I) had mixed bacterial and fungal dense central infiltration with a flat anterior chamber (G), Post-laser (H), and after amniotic membrane transplantation (I).

Figure 2 Duration till complete healing and full resolution of inflammatory signs after laser application, ranging between 2–6 weeks. The majority of cases had complete healing within the first 2 weeks (77 cases, 51.3%).

Figure 3 Presenting and final corrected distance visual acuity (CDVA) after adjunctive laser therapy. Before starting the treatment, 127 (84.6%) cases had a CDVA of hand movement (HM), or light perception (LP). After complete healing 78 (52%) of cases had a CDVA better than HM.