Recalcitrant Gram-Positive Bacterial Keratitis Treated with Intrastromal Levofloxacin 1.5% Ophthalmic Solution: A Case Report and Review of Literature
Bobbie Marie M. Santos, MD, PhD1, Josept Mari S. Poblete, MD, PhD1, George Michael N. Sosuan, MD1, Pablito F. Sandoval Jr., MD1, Billie Jean T. Cordero MD1, David Ammiel R. Tirol V, MD1, Ruben Lim Bon Siong, MD1,2
1Department of Ophthalmology and Visual Sciences, University of the Philippines – Philippine General Hospital, Manila, Philippines
2Eye Institute, St. Luke’s Medical Center, Quezon City, Philippines
Correspondence: Bobbie Marie M. Santos, MD, PhD
Office Address: Department of Ophthalmology and Visual Sciences, Sentro Oftalmologico Jose Rizal, Philippine General Hospital, Taft Avenue, Ermita, Manila
Office Phone Number: +63285548400
Email Address: bobbiemariesantos@gmail.com
Disclosures: Dr. Ruben Lim Bon Siong is in the advisory board and is a speaker for Santen. Dr. Tirol and Dr. Cordero were also speakers for Santen. The rest of the authors do not have conflicts of interest to disclose. This work received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
ABSTRACT
Objective: This paper demonstrated the effectiveness of intrastromal injection of levofloxacin 1.5% ophthalmic solution in the management of recalcitrant Gram-positive bacterial keratitis.
Methods: This is a report on two cases of recalcitrant bacterial keratitis encountered at the External Diseases and Cornea Clinic of the Department of Ophthalmology and Visual Sciences at the Philippine General Hospital.
Results: Two middle-aged females presented with bacterial keratitis unresponsive to previous antibiotic treatment with impending corneal perforation. The Gram stain of the corneal scraping in the first case revealed Gram-positive cocci, while the second case showed encapsulated Gram-positive bacilli and encapsulated Gram- positive cocci in chains. In both cases, repeated intrastromal injections of levofloxacin 1.5% in addition to increasing the frequency of topical levofloxacin 1.5% resulted in marked improvement in visual acuity and resolution of deep stromal infiltrates and hypopyon.
Conclusion: These cases highlighted the utility of intrastromal levofloxacin 1.5% ophthalmic solution in the management of recalcitrant Gram-positive bacterial keratitis.
Keywords: intrastromal injection, fluoroquinolone, levofloxacin, bacterial keratitis, recalcitrant keratitis