PURPOSE To evaluate the safety and efficacy of adjunctive intrastromal vancomycin and meropenem for the treatment of recalcitrant bacterial keratitis. METHODS We conducted a single-center, retrospective, non-comparative cohort study of consecutive patients with recalcitrant bacterial keratitis treated at a major tertiary center between January 2022 and April 2026. We included adults with suspected or culture‑proven bacterial keratitis failing topical therapy and meeting inclusion criteria. All underwent corneal scraping and adjunctive intrastromal vancomycin (5 mg/mL) and meropenem (20 mg/mL) using a circumferential barrage technique. Repeat injection at 48 hours was determined by a senior corneal specialist according to clinical response. The primary outcome was clinical resolution. Secondary outcomes included epithelial healing, reinjection, and complications. RESULTS Twenty eyes of 20 patients were included. At 28 days, 19/20 eyes (95%) achieved clinical resolution of stromal infiltrate and infection. Epithelial defects were present in 18/20 (90%) at baseline, with size reduction in 15/18 (75%) at early follow-up (median 2 days). Median time to complete epithelial healing was 12 weeks (range 10-16 weeks). Six eyes (30%) required reinjection. One eye progressed to perforation requiring penetrating keratoplasty. No direct injection-related adverse events were observed. Gram-positive organisms predominated (13/20, 65%), with polymicrobial infection in 3/20 (15%) and no growth in 3/20 (15%) cases. CONCLUSIONS Adjunctive intrastromal antibiotic therapy achieved a high rate of infection resolution in this cohort of recalcitrant bacterial keratitis, with a low complication rate. This approach may be considered in refractory cases or when unable to utilize conventional topical therapy. However, further evaluation of its role is needed in larger comparative studies.
PURPOSE To characterize national trends, mechanisms, and demographic patterns of cellphone-associated ocular injuries over 20 years using a nationally representative database. METHODS Retrospective cross-sectional study using the National Electronic Injury Surveillance System (NEISS) database, encompassing emergency department (ED) visits from approximately 100 nationally representative U.S. hospitals. Cellphone-associated eye injuries, which encompass cases of globe injury where cellphones or their accessories were involved, were identified and analyzed for patient demographics, clinical information, context of injury, and weighted national estimates. Temporal trends in ED visit rates were analyzed using joinpoint regression, and annual percent changes (APCs) quantified changes in ED visit rates. RESULTS Between 2004 and 2023, an estimated 16,107 ED visits from cellphone-associated eye injuries (95% CI, 13,280-18,933) were recorded in NEISS. By joinpoint analysis, ED visit rates increased significantly from 2008-2015 (APC, 22.4%; 95% CI, 9.7%-36.5%), and no statistically significant trend was observed from 2004-2008 (APC, 1.0%; 95% CI,15.9%-21.2%) or from 2015-2023 (APC, -3.9%; 95% CI, 12.1%-5.1%). Open globe injuries occurred in seven reported cases, representing 252 weighted-estimated ED visits (95% CI, 33-471) or 1.6% of all estimated ED visits. Direct mechanical (DM) injuries accounted for 83.2% (weighted n = 13,401, 95% CI, 11,002-15,800) of ED visits, predominantly from the phone body (46.2%) and screen glass (32.6%). Use-associated (UA) injuries comprised 16.8% weighted (n = 2,705, 95% CI, 1,641-3,770), with distraction-mediated activities (62.7%) being most common. CONCLUSIONS Cellphone-associated ocular ED visits increased substantially from 2008 to 2015, while no statistically significant change was detected between 2015 and 2023. Direct mechanical trauma, broken screen glass, and distraction represent commonly identified mechanisms. Eye care professionals should counsel patients on responsible handling of phones and accessories, limiting phone use while walking or driving, replacement of broken screens, and the importance of prompt assessment after penetrating or significant ocular trauma.
