PURPOSE: Neurotrophic keratitis is corneal epithelial defects and stromal thinning associated with loss of sensory function in the ophthalmic branch of the trigeminal nerve. The purpose of this study was to determine the ultrastructural changes of corneal epithelium and basement membrane in neurotrophic keratitis. METHODS: The corneal tissues were obtained from the elevated margin of corneal ulcer in 5 patients with neurotrophic keratitis. Electron microscopic studies were performed. RESULTS: Degenerated epithelial cells, widened intercellular spaces and infiltrated inflammatory cells were observed. In addition, discontinuous basement membrane and loss of adhesion complex including hemidesmosome, anchoring fibril and anchoring plaque were found. CONCLUSIONS: These results suggest that ultrastructural pathology of persistent epithelial defect and inadequate healing of neurotrophic keratitis are loss of adheson complex, discontinuous basement membrane, degenerated epithelial cells, and infiltrating inflammatory cells.
Basement Membrane* ; Corneal Ulcer* ; Epithelial Cells ; Epithelium, Corneal* ; Extracellular Space ; Hemidesmosomes ; Humans ; Keratitis ; Pathology ; Sensation ; Trigeminal Nerve

The aim of this study was to assess the involvement of multipotential progenitor cells in the pathogenesis of Mooren's ulcer using immunohistochemical staining techniques. Tissue specimens were collected from 3 Mooren's ulcer patients who underwent lamellar keratectomy. Immunohistochemical staining patterns were analyzed using antibodies: CD34, c-kit, STRO-1, CD45RO, VEGF and alpha-SMA. Strong positive CD34, c-kit and STRO-1 cells were revealed in Mooren's ulcer specimens, especially in the superficial stroma. A few weakly expressed CD34 stroma cells were seen in normal limbal cornea but no immunoreactivity for c-kit and STRO-1 could be found. CD45RO positive T cells were found to have infiltrated in Mooren's ulcer. The immunostaining pattern of VEGF and yen a- SMA was closely correlated with the degree of expression and the number of CD34 positive cells. Bone marrow-derived multipotential progenitor cells may be involved in the pathogenesis of Mooren's ulcer by synergizing with other factors to amplify autoimmune destructive reactions and to contribute to the regeneration process. Specific therapeutic strategies that target the role of these cells in the disease are warranted.
Cornea/*pathology ; Corneal Ulcer/*pathology ; Hematopoietic Stem Cells/*pathology ; Humans ; Multipotent Stem Cells/*pathology ; Research Support, Non-U.S. Gov't

PURPOSE: To report a case of epidemic keratoconjunctivitis complicated by Alcaligenes xylosoxidans. METHODS: A 37-year-old man suffered epidemic keratoconjunctivitis in both eyes. Eleven days later, he developed a corneal ulcer in his left eye. Bacterial staining, culture, and antibiotics sensitivity test were performed from a corneal scrape. RESULTS: The cultures revealed a growth of Alcaligenes xylosoxidans, and the patient was treated with ceftazidime and levofloxacin, based on the sensitivity test results. After 21 days of treatment, the infection was resolved with mild scaring and final vision in the left eye of 20/20. CONCLUSIONS: Alcaligenes xylosoxidans should be considered a rare but potential pathogen able to produce corneal ulcer complication in epidemic keratoconjunctivitis.
Male ; Keratoconjunctivitis/*complications/pathology ; Humans ; Gram-Negative Bacterial Infections/*complications/pathology ; Corneal Ulcer/*microbiology/pathology ; Adult ; *Achromobacter denitrificans

A 60-year-old man with bilateral corneal opacity underwent cataract extraction surgery involving the use of a limbal relaxing incision in his left eye. He had lower lid ectropion and lagophthalmos in both eyes. Eleven days after the surgery, a slit-lamp examination revealed a neurotrophic corneal ulcer with a punch-out epithelial defect and rolled edges at the center of the pre-existing corneal opacity. The patient was treated with sodium hyaluronate, autologous serum, and oral doxycycline. Six weeks after the surgery an improvement in corneal sensation was observed and the neurotrophic corneal ulcer subsequently healed over the course of one year. In this report, we present a case of neurotrophic keratitis that occurred after performing cataract surgery concurrent with a limbal relaxing incision. As such, we suggest that limbal relaxing incisions should be performed cautiously in patients with causative risk factors for corneal hypesthesia.
Cataract Extraction/*adverse effects/*methods ; Corneal Diseases/etiology ; Corneal Ulcer/*etiology/*pathology/physiopathology ; Humans ; Hypesthesia/etiology ; Limbus Corneae/*surgery ; Male ; Middle Aged ; Ophthalmologic Surgical Procedures/*adverse effects ; Phacoemulsification ; Wound Healing

Considering the popular use of antibiotic-containing eyedrops in Korea, it is important to know the emerging antibiotic-resistant strains of bacteria before treating infectious eye diseases. This is especially important in high-risk groups because of the high incidence of resistant infections and the subsequent treatment requirements. We report two cases of methicillin-resistant Staphylococcus aureus (MRSA) corneal ulcers in high-risk groups. The first case involved a patient who had keratitis after using antibiotic- and steroid-containing eyedrops to treat a corneal opacity that developed after repeated penetrating keratoplasty. The second case involved a patient who used antibiotic-containing eyedrops and a topical lubricant on a regular basis for >1 month to treat exposure keratitis due to lagophthalmos. The second patient's problems, which included a persistent superficial infiltration, developed after brain tumor surgery. Both cases showed MRSA on corneal culture, and the corneal ulcers improved in both patients after the application of vancomycin-containing eyedrops. In conclusion, MRSA infection should be considered in corneal ulcers that have a round shape, mild superficial infiltration, and slow progression, especially in high-risk groups. This report includes descriptions of the characteristic features, antibiotic sensitivities, prevention, and successful treatment with vancomycin-containing eyedrops for MRSA corneal ulcers.
Cornea/*microbiology/pathology ; Corneal Ulcer/diagnosis/*microbiology ; Diagnosis, Differential ; Eye Infections, Bacterial/diagnosis/*microbiology ; Female ; Follow-Up Studies ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus/*isolation & purification ; Middle Aged ; Staphylococcal Infections/diagnosis/*microbiology