Ocular Infection Update

Ocular infections continue to be a significant source of vision loss, and there have been many important advancements in our understanding of the mechanisms, prevention, and treatment of these conditions. In this issue of MEAJO, the reader finds a comprehensive update on several topics of interest.

Majumder et al.[1] provide an update on infectious uveitis. Ophthalmologists continue to be on the frontline of treating diseases such as tuberculosis, syphilis, and toxoplasmosis. Emerging infections, however, may also become paramount; eye care providers should be aware of the ophthalmic manifestations of diseases such as Chikungunya virus and West Nile virus, which are increasingly prevalent throughout the world.

Postcataract endophthalmitis is a rare but devastating complication of modern cataract surgery. There are only a few prospective, randomized, controlled trials to provide guidance; however, a high level of evidence supports the efficacy of intracameral cefuroxime as a prophylaxis. Not all surgeons have adopted intracameral antibiotics, and questions remain regarding the safety of this intervention; Al-Abduljabbar et al.[2] review the “risk” aspect of the risk: benefit equation for intracameral cefuroxime use.

Bacterial keratitis remains an important cause of visual impairment in the developing and industrialized world alike. Timely diagnosis and antimicrobial therapy remain the main-stay of therapy, but many adjunctive therapies have been proposed. Dakhil et al.[3] review the many interventions that have been proposed for infectious keratitis and summarize the level of evidence for such alternatives as cryotherapy, amniotic membrane, topical povidone-iodine, and matrix metalloproteinase inhibitors.

Corneal crosslinking is an exciting tool for treating ocular disease; this technology has gained wide acceptance for treating ectatic disorders of the cornea. Early reports of efficacy for treating infectious keratitis are encouraging, but many questions remain. Garg et al.[4] review the current literature addressing the use of photoactivated riboflavin crosslinking for infections of the cornea.

Antibiotic resistance is perhaps the most worrisome variable that clinicians should contend with when treating patients with ocular infections. The paucity of new antimicrobials seems to be vastly outpaced by the development of resistant organisms. Miller[5] reviews the current state of antibiotic resistance among ocular pathogens. Her study highlights the need to be aware of regional antibiotic susceptibility patterns, the importance of obtaining cultures and sensitivity testing in individual patients, and the increasing need for further research on the prevention and treatment of antibiotic-resistant ocular infections.

We are excited to offer this series of timely articles and hope that the information provided will not only benefit each of our patients with ocular infectious diseases but also stimulate greater discovery for the patients of the future.