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Whitney Smith, Joshua Duncan, Joseph M Miller, Mingwu Wang; Continuous Topical Antibiotics Infusion through a Morgan Lens in Sight-threatening Pseudomonas Keratitis. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
Despite standard treatment, Pseudomonas keratitis can continue to progress, resulting in loss of vision or eye. This study is to demonstrate that a Morgan lens can be highly effective in delivering topical antibiotics in cases of refractory keratitis.
Two patients (three eyes) were treated in this report. Patient 1 was an 11-year-old female with a diagnosis of contact lens-related Pseudomonas keratitis in the right eye. Despite a 2-week treatment including topical 15 mg/ml tobramycin q1h and ciprofloxacin QID, corneal perforation appeared imminent (Figure 1A). Patient 2 was an 11-month-old female inpatient with Apert syndrome on ventilator support for complicated pneumonia. Lagophthalmos led to exposure keratitis and bilateral Pseudomonas keratitis. Fortified antibiotics q1h over two days did not contain the infection (Figure 1B). In all eyes, a Morgan lens (MorTan, Inc., Missoula, MT) was inserted under the eyelids and connected to standard IV tubing (Figure 2A). In patient 2, the Morgan lens was further secured by bilateral temporary tarsorraphy (Figure 2B). Ceftazidime 50 mg/ml was the key topical antibiotic infused at 20 ml/hour over the ocular surface.
Three days after initiation of the infusion, corneal culture became negative in all eyes. The infusion was continued for at least a week to ensure eradication of the infection before switching to standard topical antibiotic regimens. Amniotic membrane graft and/or topical steroid were used as necessary in the acute recovery phase to control inflammation. A combined cataract and corneal transplant 9 months later in patient 1 resulted in a best spectacle corrected vision of 20/60. In patient 2, the corneas remain epithelialized with stable scars and await future transplant.
This application of a Morgan lens is non-invasive, requires minimal training and monitoring by caregivers. It can deliver high concentrations of antibiotics to the entire ocular surface and possibly the intraocular tissues as well. Continuous lavage is performed in standard concentrations at a rate sufficient to keep pathogens from accumulating. IV connectors allow for an easy switch between medications or simultaneous administration of multiple medications, and titration of dosing. Additionally, monitoring of therapeutic effects is not hindered.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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