Lois and Molino (61) treated a case of Mycobacterium chelonae keratitis with topical fortified amikacin, with no response. They then debrided the epithelial and stromal lesions, and applied an amikacin-soaked corneal collagen shield, supplemented every 4 hours with topical fortified amikacin drops. After this treatment, clinical and laboratory examinations showed that no infectious organisms could be detected.
Kuster et al. (62) investigated the ability of collagen shields to deliver TFT to human cornea and aqueous humor. Collagen shields were soaked in commercially prepared TFT. Patients undergoing penetrating kerato-plasty wore a presoaked collagen shield for at least 30 minutes preopera-tively. Control patients received drops of TFT only. Cornea and aqueous samples were obtained during surgery. Collagen shields did not enhance delivery of TFT to the cornea with an intact epithelium. In corneas with poor epithelium, drug penetration was higher but variable. They concluded that the role of collagen shields as a drug delivery system for the treatment of herpes simplex keratitis remains to be determined.
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