Activity ID
7968Expires
August 26, 2024Format Type
Journal-basedCME Credit
1Fee
$30CME Provider: JAMA Ophthalmology
Description of CME Course
A woman in her 20s with a history of daily soft contact lens (CL) wear was referred by her local ophthalmologist for a recalcitrant central corneal ulcer in her left eye. She had no history of eye trauma, did not sleep in her CLs, and stopped using CLs at symptom onset. Of note, she had recently been swimming in a freshwater lake prior to the onset of the ulcer. She was initially treated with topical besifloxacin and followed up daily. She appeared to improve clinically with resolution of her epithelial defect after 3 days, and topical loteprednol was added. Results of initial corneal cultures were negative. One week later, she presented with worsening pain and vision, which prompted referral to our cornea clinic where, 2 weeks after her initial presentation, her best-corrected visual acuity was 20/20 OD and 20/150 OS. Left-eye examination demonstrated diffuse microcystic corneal edema and stromal thickening with no Descemet membrane folds (Figure 1A). A 2 × 2-mm stromal opacity was noted paracentrally with no epithelial defects. The anterior chamber demonstrated 1+ cell. Intraocular pressure was 17 mm Hg OS. Corneal cultures for bacteria, fungi, and acanthamoeba were repeated, and in vivo confocal microscopy (IVCM) was performed on the stromal infiltrate (Figure 1B). After reviewing the IVCM images, what empirical treatment would you recommend while awaiting the results of the repeated corneal cultures?
Disclaimers
1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.
ABMS Member Board Approvals by Type
ABMS Lifelong Learning CME Activity
Allergy and Immunology
Anesthesiology
Colon and Rectal Surgery
Family Medicine
Medical Genetics and Genomics
Nuclear Medicine
Ophthalmology
Orthopaedic Surgery
Pathology
Physical Medicine and Rehabilitation
Plastic Surgery
Preventive Medicine
Psychiatry and Neurology
Radiology
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Commercial Support?
NoNOTE: If a Member Board has not deemed this activity for MOC approval as an accredited CME activity, this activity may count toward an ABMS Member Board’s general CME requirement. Please refer directly to your Member Board’s MOC Part II Lifelong Learning and Self-Assessment Program Requirements.
Educational Objectives
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
Keywords
Clinical Challenge, Cornea, Infectious Diseases, Ophthalmology, Emergency Medicine
Competencies
Medical Knowledge
CME Credit Type
AMA PRA Category 1 Credit
DOI
10.1001/jamaophthalmol.2021.0948
