Evidence map›Paper›PMID 23558213›Full record

ArticleEye (London, England)2013

New insight into non-healing corneal ulcers: iatrogenic crystals.

I Livingstone, F Stefanowicz, S Moggach, J Connolly, S Ramamurthi, S Mantry, K Ramaesh

Open access · bronzeAbstract readCase Reports
In one paragraph

Article in Eye (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.1field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 8 citations in OpenAlex.

  1. Article
  2. Article
  3. Corneal biopsy as a primary diagnostic tool in microbial keratitis patients on poly-antimicrobials.Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological Society
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 1 country.

I LivingstoneTennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK. iainatlivingstone@gmail.com
F Stefanowicz
S Moggach
J Connolly
S Ramamurthi
S Mantry
K Ramaesh
Gartnavel General Hospital · GBGlasgow Royal Infirmary · GBUniversity of Edinburgh · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo characterise and correlate crystalline precipitations implicated in non-healing corneal ulceration in two patients with a previous history of acanthamoeba keratitis. MATERIALS AND

methodsPersistence of acanthamoeba and secondary bacterial infection was excluded with negative corneal scrapes. Confocal microscopy identified crystal-like deposits within the corneal stroma. To investigate possible precipitating combinations, all concurrent treatments at the time of presentation were mixed in wells, with observation of precipitate formation. Precipitates were observed with phase-contrast microscopy, and subsequently characterised via crystallography techniques and electrospray ionisation mass spectrometry.

resultsCombinations of dexamethasone 0.1% minims and chlorhexidine gluconate 0.2% formed an amorphous material characterised by electrospray ionisation mass spectrometry as an insoluble chlorhexidine salt. Combinations of chloramphenicol drops and timolol 0.5% formed a crystal identified via X-ray crystallography as santite (K(B₅O₆(OH)₄).(H₂O)₂). This is a borate mineral identified in nature, arising from thermal springs, but never reported in biological tissues. Clinical improvement was observed following the cessation of the implicated precipitating combinations.

conclusionOur observations suggest iatrogenic precipitate formation, with a potential deleterious effect upon healing. The substrates for these precipitates include several frequently prescribed topical ophthalmic treatments. These findings shed new light on the aetiopathogenesis of non-healing corneal ulceration, and have broad implications on topical prescribing for this challenging condition.

Indexed as

Corneal UlcerIatrogenic DiseaseAcanthamoeba KeratitisAgedChlorhexidineCrystallizationCrystallography, X-RayDexamethasoneDrug CombinationsFemaleHumansMicroscopy, ConfocalTimololWound HealingYoung AdultChlorhexidineDexamethasoneDrug CombinationsTimolol

Identifiers

PMID23558213
PMCPMC3682351
OpenAlexW2070273461

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.