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C Kirkness

Publications and source records attributed to C Kirkness.

6 recordsLinked to original sources
PubMed1996

Successful medical therapy of Acanthamoeba keratitis with topical chlorhexidine and propamidine.

INTRODUCTION: Following laboratory studies on new potential chemotherapy for Acanthamoeba keratitis, when chlorhexidine and propamidine provided an additive in vitro effect, a series of 12 patients with culture-proven Acanthamoeba keratitis from three UK centres was monitored during and after therapy. METHODS: In all cases the clinical diagnosis was confirmed by amoebal culture. In some instances identification of the protozoa by direct microscopy of corneal tissue was possible. The medication was provided topically in drop form until the keratitis had resolved. In vitro sensitivity to chlorhexidine and propamidine was performed on all isolates and compared with sensitivity to a range of other drugs used for treatment of the infection. RESULTS: In vitro drug testing confirmed that trophozoites and cysts of all 12 Acanthamoeba isolates were fully sensitive to chlorhexidine and propamidine. Therapy was satisfactory for controlling and eradicating the acanthamoebal infection in all patients. Three patients developed discrete stromal infiltration at the site of infection that resolved 1 week after commencing therapy, with or without use of steroids. Two patients developed a late inflammatory effect in the stromal scar at 6 months, which resolved with steroids. No clinical evidence of chlorhexidine toxicity was found in any patients. CONCLUSIONS: The combination of topical chlorhexidine and propamidine was very effective for treating Acanthamoeba keratitis provided the drugs were continued for a sufficient period. No drug toxicity or resistance of Acanthamoeba isolates was observed in the 12 treated patients.

Acanthamoeba↗
PubMed1993

Prognosis for keratoplasty in Acanthamoeba keratitis.

STUDY: Penetrating keratoplasty (PK) was undertaken between 1985-1991 at Moorfields Eye Hospital in 13 eyes (19 PKs) of 11 patients who developed Acanthamoeba keratitis. Infection was ultimately controlled in all cases. Retrospective analysis was undertaken to establish risk factors for PK. Six eyes were quiet and 7 had uncontrolled infection at the time of keratoplasty. The outcome for these was compared. COMPLICATIONS: Complications included cataract in 50% of quiet eyes and 100% of inflamed eyes. Intumescent cataract resulted in glaucoma requiring drainage surgery in 4 eyes. Graft rejection episodes occurred in 50% of quiet eyes, but were treated aggressively and did not cause graft failure. RESULTS: Graft survival was excellent for quiet eyes, but was compromised by recurrent infection in inflamed eyes and 6 patients were regrafted. Survival compared poorly with grafting for active herpetic or bacterial keratitis, indicating that early diagnosis and treatment are essential for adequate control of this disease.

Acanthamoeba Keratitis↗
PubMed1993

Refractive results after corneal triple procedures (PK+ECCE+IOL)

We have analysed the refractive results of corneal triple procedures (penetrating keratoplasty with extracapsular cataract extraction and posterior chamber intraocular lens implantation) in 52 eyes of 47 patients with a mean follow-up of 39 months. The patients were predominantly old and female and most received unilateral surgery. The contralateral acuity was 6/24 or worse in more than 50% of cases at the time of surgery. Many of these patients were significantly ametropic pre-operatively. Biometry does not seem to have improved the refractive results in those patients in whom it was attempted. The majority of patients were hypermetropic when their refraction stabilised, with resulting poor uncorrected visual performance. Possible improvements are discussed.

Aged↗
PubMed1991

Microbial keratitis--the false negative.

The investigation of presumed microbial keratitis includes microscopy and culture of corneal specimens obtained by scraping the infiltrated cornea. Routine microscopy fails to identify the infecting organism in about 15% of cases. We discuss the problems presented by 20 such eyes which required further investigation. We present a diagnostic algorithm aimed at reducing the delay in identifying the pathogen and increasing the rate of positive culture. This is important since unusual pathogens may require treatment with drugs other than the 'first line' broad spectrum combination of an aminoglycoside and a cephalosporin. The algorithm allows sequential restaining and reculturing of specimens for more thorough investigation. In addition to the use of special stains and culture conditions, it presents indications for further corneal scrapes and biopsies. Uncontrolled infection resulted in five perforations and penetrating keratoplasty was indicated in 11 cases. The visual outcome for these patients was poor with fewer than 30% achieving 6/12 acuity. The delay in diagnosis increases morbidity and this should be significantly reduced by adopting the algorithm we propose.

Adult↗