Neonatal Pseudomonas Keratitis Managed With Amniotic Membrane Transplantation And Pupilloplasty: Long-Term Visual Outcome

Pseudomonas aeruginosa keratitis in neonates is a rare but aggressive infection that may lead to corneal destruction and permanent visual impairment. Early diagnosis and timely intervention are essential to preserve ocular integrity and visual function. We present the long-term clinical course and visual outcome of a neonate with culture-proven Pseudomonas keratitis managed with intensive medical and surgical treatment.

Department of Ophthalmology, Bezmialem Vakif University Hospital, a tertiary academic referral center in Istanbul, Türkiye.

A neonate born on June 17, 2019, was referred at 6 days of age with purulent discharge and corneal opacity in the left eye while in the neonatal intensive care unit. Examination revealed conjunctival hyperemia, central corneal ulcer, and stromal infiltration. Corneal and conjunctival cultures grew Pseudomonas aeruginosa. Intensive topical fortified tobramycin and ceftazidime, along with systemic antibiotics, autologous serum, and breast milk drops, were initiated. Due to progression despite medical treatment, amniotic membrane transplantation was performed to preserve corneal integrity. Infection was controlled; however, vascularized corneal leukoma developed. At 3 years of age, pupilloplasty was performed to enlarge the visual axis. The patient was followed for 6 years. Best-corrected visual acuity improved from 0.1 to 0.3 and remained stable without further complications.

Neonatal Pseudomonas keratitis may result in severe corneal damage and visual impairment. Early diagnosis, aggressive antimicrobial therapy, and timely surgical intervention may help preserve ocular integrity and improve functional visual outcomes. Long-term follow-up and individualized management are critical in optimizing visual prognosis in these high-risk patients.