[Treatment refractory multidrug-resistant bacterial keratitis]

This article reports a case of severe, treatment refractory infectious keratitis. Multiple samples of the cornea and the anterior chamber were taken without detection of any pathogens. Ultimately a multidrug-resistant Pseudomonas aeruginosa was isolated and successfully treated with tobramycin and amikacin, according to its antibiotic sensitivity. If there is a clinical suspicion multiple samples should be taken and multidrug-resistant pathogens considered as a differential diagnosis.

Topical tacrolimus nanocapsules eye drops for therapeutic effect enhancement in both anterior and posterior ocular inflammation models

Tacrolimus has shown efficacy in eye inflammatory diseases. However, due to the drug lability, its formulation into a stable ophthalmic product remains a challenge. Tacrolimus-loaded nanocapsules (NCs) were designed for ocular instillation. Further, the stability and effects of the formulation were analyzed under different experimental conditions. Physicochemical characterization of the NCs revealed suitable homogeneous size and high encapsulation efficiency. Moreover, the lyophilized formulation was stable at ICH long term and accelerated storage conditions, for at least 18 and 3 months, respectively. The tacrolimus NCs did not elicit any eye irritation in rabbits after single- and multiple-dose applications. Additionally, ex vivo penetration assays on isolated porcine cornea and pharmacokinetics analyses in various rabbit eye compartments demonstrated the superiority of the NCs in retention and permeation into the anterior chamber of the eye compared to the free drug dissolved in oil. Moreover, multiple dose ocular instillation of the NCs in rats allowed high tacrolimus levels in the eye with very low plasma concentrations. Finally, the developed delivery system achieved a significant decrease in four typical inflammatory markers in a murine model of keratitis, an anterior chamber inflammation. Furthermore, these NCs, applied as eye drops, displayed clinical and histological efficacy in the mainly posterior chamber inflammation model of murine, experimental auto-immune uveitis.

Galectin-3 plays an important pro-inflammatory role in A. fumigatus keratitis by recruiting neutrophils and activating p38 in neutrophils

PURPOSE

To determine the role of galectin-3 (Gal-3) in cornea infected by Aspergillus fumigatus (A. fumigatus).

METHODS

Gal-3 was tested in normal and infected corneas of C57BL/6 mice. Mice corneas were pretreated with or without rmGal-3 or Gal-3 siRNA and infected with A. fumigatus. Recombinant mouse (rm) Gal-3 stimulated polymorphonuclear neutrophilic leukocytes (PMNs). PMNs were stimulated with 75% ethanol-killed A. fumigatus with or without pretreatment of Gal-3 siRNA. Disease severity was documented by clinical score and photographs with a slit lamp. PCR, Western blot, and ELISA tested expression of Gal-3, interleukin (IL)-1β, IL-6, macrophage inflammatory protein 2 (MIP-2) and p-p38. PMNs infiltration was assessed by flow cytometry and myeloperoxidase (MPO) assay.

RESULTS

Gal-3 expression was significantly elevated by A. fumigatus in mice corneas. rmGal-3 treatment increased clinical scores, PMNs infiltration, and cytokines expression, which were decreased by Gal-3 siRNA treatment. In PMNs, Gal-3 expression was also significantly increased by A. fumigatus. The rmGal-3 treatment upregulated proinflammatory cytokines secretion and p-p38 expression, which was significantly inhibited by Gal-3 siRNA.

CONCLUSION

These data proved that A. fumigatus increased Gal-3 expression and elevated disease clinical scores, PMNs infiltration and cytokines expression through Gal-3. In PMNs, A. fumigatus upregulated IL-1β and IL-6 secretion through the Gal-3 / p38 pathway.

First report of human infection caused by Colletotrichum chlorophyti occurring in a post-corneal transplant patient with endophthalmitis

Keratomycosis or mycotic keratitis is recognized as one of the major causes of ophthalmic morbidity worldwide. The most common organisms linked to keratomycosis include Candida spp., Fusarium spp., and Aspergillus spp. However, varieties of saprobic fungi have been reported as causative agents of keratomycosis. Amongst these are members of the genus Colletotrichum. Herein we present the first reported case of C. chlorophyti infection in a post-corneal transplant patient, suggesting an increasing role for Colletotrichum species as emerging human pathogens, particularly in the transplant population.

Descemet stripping endothelial keratoplasty after cytomegalovirus corneal endotheliitis and immunosuppression for Mooren's ulcer

Purpose

The aim of this report was to describe a case of cataract surgery and Descemet stripping automated endothelial keratoplasty (DSAEK) after cytomegalovirus (CMV) corneal endotheliitis and bullous keratopathy (BK) following immunosuppressive treatment for Mooren's ulcer.

Observations

A 64-year-old man was referred to our hospital because of peripheral ulcerative keratitis in his left eye. He had a history of trabeculectomy for open angle glaucoma in his left eye. He was diagnosed with Mooren's ulcer and treated with topical betamethasone and tacrolimus with systemic cyclosporine. The corneal ulcer improved, but the peripheral cornea thinned from 6 to 12 and 0-2 o'clock. Five months later, cells were observed in the left anterior chamber, and real-time polymerase chain reaction examination of the aqueous humor showed CMV-DNA-positive results. The patient was diagnosed with CMV corneal endotheliitis, and oral ganciclovir was administered. Fifteen months after the initial presentation, BK appeared with decreased vision to 20 cm/n. d. After confirmation of negative CMV-DNA in the aqueous humor, DSAEK was performed following cataract surgery. The postoperative visual acuity recovered to 0.3. Mooren's ulcer exacerbation and CMV corneal endotheliitis did not recur postoperatively.

Conclusions and Importance

This is the first report of a case in which a patient with Mooren's ulcer developed BK due to CMV corneal endotheliitis and required DSAEK. Cataract surgery and DSAEK could be performed without issue by creating the main wound and side ports in a manner that avoids the thinned parts of the cornea.

Combined Bacterial and Herpes Simplex Virus Keratitis following Small-Incision Lenticule Extraction for the Correction of Myopia

A 28-year-old male presented unilateral visual loss, intense ocular pain, redness and intraocular hypertension in his right eye 2 days after undergoing small-incision lenticule extraction (SMILE) in both eyes. Initial examination of the affected eye revealed the presence of white infiltrates within the corneal interface, as well as a central epithelial defect. The patient was diagnosed with infectious keratitis, posteriorly the eye was irrigated with balanced saline solution and treatment was initiated with hourly moxifloxacin 0.5%. Since this approach failed to resolve symptoms, a sample from the interface was obtained for PCR assay, which revealed the presence of herpes simplex virus DNA, confirming the cause of the infection. The patient was prescribed a regimen of oral acyclovir, topical ganciclovir and prednisolone. Clinical improvement following resolution of the epithelial defect was observed. Although rare, herpetic keratitis following SMILE is best managed via early diagnosis and initiation of appropriate anti-herpetic treatment.

Tracing Ocular Conditions in 15,921 Interwar Refugees, Veria, Greece (1926-1940)

OBJECTIVE

This historical epidemiological study aims to investigate ocular conditions in Greek refugees during the Interwar period (1926-1940) in the region of Imathia, Greece.

MATERIALS AND METHODS

The archival material encompasses 15,921 patients who were admitted to the Refugee Hospital of Veria, Imathia, Greece. Descriptive statistics were estimated.

RESULTS

Twenty-two cases of ocular conditions were identified. Ten patients had anterior segment conditions, such as keratitis, blepharoconjunctivitis, conjunctivitis, epithelioma, leukoma and an operated cataract. Another patient was diagnosed with ocular trachoma. Four patients presented sympathetic ophthalmia; two additional patients suffered from ophthalmia due to syphilis. One patient was diagnosed with ocular malaria. Four cases of ocular traumas were recorded, among which an ocular burn due to gunpowder, a motorcycle accident leading to a retro-ocular hematoma, and a kick in the eye resulting in ocular trauma were notable.

CONCLUSION

The disease spectrum in Greek refugees reflects the adverse conditions during the Interwar era.

Development of anti-acanthamoebic approaches

Acanthamoeba keratitis is a sight-endangering eye infection, and causative organism Acanthamoeba presents a significant concern to public health, given escalation of contact lens wearers. Contemporary therapy is burdensome, necessitating prompt diagnosis and aggressive treatment. None of the contact lens disinfectants (local and international) can eradicate Acanthamoeba effectively. Using a range of compounds targeting cellulose, ion channels, and biochemical pathways, we employed bioassay-guided testing to determine their anti-amoebic effects. The results indicated that acarbose, indaziflam, terbuthylazine, glimepiride, inositol, vildagliptin and repaglinide showed anti-amoebic effects. Compounds showed minimal toxicity on human cells. Therefore, effects of the evaluated compounds after conjugation with nanoparticles should certainly be the subject of future studies and will likely lead to promising leads for potential applications.

Quantitative real-time polymerase chain reaction analysis in herpes simplex virus keratitis with and without epithelial involvement

PURPOSE

To evaluate the quantitative real-time polymerase chain reaction (qRT-PCR) analysis in herpes simplex virus (HSV) keratitis with and without epithelial involvement.

METHODS

This cross-sectional study was performed on 70 patients with different HSV types and an active ocular lesion in Farabi Eye Hospital, Tehran, Iran. From these 70 patients, 171 samples were collected, including seventy tear samples and 33 scraping samples from involved eyes; and 68 samples from uninvolved fellow eyes. Samples were frozen at - 70 °C until DNA extraction was performed. Quantity of HSV was measured using qRT-PCR in all three samples.

RESULTS

The mean age of HSV patients was 52.19 ± 20.42 years (range, 4-85 years). Forty-one (58.6%) HSV patients had epithelial involvement, and 29 (41.4%) patients did not have epithelial involvement. In PCR-positive cases, the mean number of viruses in affected eyes' tears (8,831,234 ± 4,051,979) was significantly higher than uninvolved eyes' tears (182,603 ± 69,141) (P = 0.02). The mean of PCR in HSV patients with and without epithelial involvement was 10,320,269 ± 5,329,800 and 1,469,419 ± 1,070,396, respectively (P = 0.04). The qRT-PCR of involved tears in both groups (with and without epithelial involvement) was significantly higher than unaffected eyes' tears (P < 0.0001 and P = 0.01, respectively). In cases with and without epithelial involvement, the cutoff points of viral load in involved eyes' tears were 281,000 and 126,000 copies, respectively.

CONCLUSION

The results indicated that qRT-PCR is an excellent method for the detection of herpes simplex keratitis.

Ocular surface disease associated with immune checkpoint inhibitor therapy

Immune-related adverse events (irAEs) is a term used to describe the various toxicities associated with immune checkpoint inhibitor (ICI) use. As this class of cancer immunotherapy grows, the diversity of documented irAEs also continues to expand. Ocular toxicities secondary to ICI use are relatively rare, with dry eye and uveitis as the most frequently reported ocular side effects. This article specifically investigates the relationship between ocular surface disease and ICI therapy through a review of the existing literature. Dry eye disease (DED), conjunctivitis, and keratitis were the most commonly reported irAEs affecting the ocular surface across the 29 studies reviewed. Keratoplasty graft rejection was also described in two case reports. Our review of eight clinical trials found the incidence of DED, the most common ocular surface irAE, to range from 1 to 4%. Nearly all cases of ocular surface irAEs were graded as mild or moderate in severity and were often self-limited or controlled with conservative treatment. Duration of checkpoint inhibitor use prior to onset of ocular surface side effects varied widely, ranging from days to months. Ocular surface toxicities associated with checkpoint immunotherapy appear to be under-reported and under-investigated. Further work remains to be done to investigate the full breadth of ocular surface pathologies and the molecular mechanisms by which these toxicities occur.

Effect of therapeutic UVC on corneal DNA: Safety assessment for potential keratitis treatment

PURPOSE

Antimicrobial ultraviolet C (UVC) has proven efficacy in vitro against keratitis isolates and has potential to treat corneal infection if safety can be confirmed.

METHOD

Safety of 265 nm, 1.93 mW/cm² intensity UVC (15-300 s exposures) was investigated in vitro via cyclobutane pyrimidine dimer (CPD) formation in DNA of human cultured corneal epithelial cells; ex vivo, by evaluating UVC transmissibility as a function of porcine corneal thickness; and in vivo, by evaluating CPD induction in the mouse cornea following UVC exposure.

RESULTS

A single exposure of 15 s UVC did not induce significant CPD formation (0.92 ± 1.45%) in vitro relative to untreated control (p = 0.93) whereas 300 s exposure caused extensive CPD formation (86.8 ± 13.73%; p < 0.0001). Cumulative exposure to 15 s UVC daily for 3 days induced more CPD (14.6 ± 8.2%) than a single equivalent 45 s exposure (8.3 ± 4.0%) (p < 0.001) but levels returned to baseline within 72 h (p = 0.29), indicating highly efficient DNA repair. Ex vivo, UVC transmission decreased sharply with increasing corneal thickness, confirming UVC effects are limited to the superficial corneal layers. In vivo evaluations demonstrated no detectable CPD after three consecutive daily 15 s UVC exposures, whereas a single 300 s exposure induced extensive CPD formation in superficial corneal epithelium.

CONCLUSION

Up to three daily doses of 15 s UVC, in vivo, appear safe with respect to CPD formation. Ongoing research exploring UVC as a possible treatment for microbial keratitis is warranted.

Nocardia keratitis mimicking superior limbic keratoconjunctivitis and herpes simplex virus

Purpose

Nocardia keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how Nocardia often escapes accurate diagnosis due to its insidious onset, variable clinical manifestations, and unusual characteristics on cultures.

Observation

The patient presented with an epithelial defect and superior pannus and scarring, which was misdiagnosed as superior limbic keratoconjunctivitis (SLK) and herpes simplex virus (HSV) keratitis. Repeat corneal scraping cultures, smears, and conjunctival biopsy were necessary to elucidate the diagnosis. It can be effectively treated with the intravenous preparation of trimethoprim-sulfamethoxazole 80 mg/mL (brand name SEPTRA) used topically as eye drops.

Conclusion

The diagnosis of Nocardia keratitis relies on a high clinical suspicion and a prompt corneal scraping with culture. Due to its potential for rapid resolution with early therapy, it is important to isolate Nocardia early in its disease course.

Importance

Topical amikacin had been the standard of care for Nocardia keratitis for many years. However, recently there is increasing resistance of Nocardia to amikacin. SEPTRA offers an alternative therapy. Nocardia keratitis mimics other infectious and inflammatory etiologies so rapid diagnosis and treatment is critical in the prevention of long-term complications.

Incidence of Fungal Infection in Positive Donor Rim Cultures after Corneal Transplantation

PURPOSE

To determine the clinical outcomes of corneal transplant patients that had positive rim cultures for fungi.

METHODS

Retrospective study.

RESULTS

Of 1276 rim cultures obtained between 2009 and 2019, 16 were positive for fungus (incidence of 1.25%). Clinical data were available for 12 patients. Candida and Cladosporium species were the most common organisms. Recipient ages ranged from 51 to 86 (median age 69 years; 9 males, 7 females). The most common surgery was Endothelial Keratoplasty (n = 8). There were no instances of fungal keratitis or endophthalmitis. Three patients were treated with prophylactic antimycotics. One patient developed bacterial keratitis. One patient had a varicella zoster virus reactivation without corneal involvement.

CONCLUSIONS

This study adds to the growing data on the low rate of fungal keratitis and endophthalmitis after a corneal transplant, even in the case of positive rim cultures. This study also suggests that positive rim cultures do not advance the risk of postoperative fungal infection in the recipient.

Quercetin amelioratesAspergillus fumigatuskeratitis by inhibiting fungal growth, toll-like receptors and inflammatory cytokines

PURPOSE

To investigate the antifungal and anti-inflammatory effects of quercetin on Aspergillus fumigatus (A. fumigatus) keratitis.

METHODS

Human corneal epithelial cells (HCECs) and C57BL/6 mice were stimulated by A. fumigatus and treated with quercetin or dimethyl sulfoxide (DMSO) after infection. In HCECs, minimum inhibitory concentration (MIC) and cytotoxicity tests (CCK-8) were used to detect the antifungal effect and cytotoxicity of quercetin. In mice with A. fumigatuskeratitis, clinical score, plate counting and hematoxylin-eosin (HE) staining were performed to evaluate the effects of quercetin in vivo. Myeloperoxidase (MPO) assay and immunofluorescence staining were applied to assess neutrophil recruitment and infiltration. Real time PCR (RT-PCR), enzyme-linked immunosorbent assay (ELISA) and western blot were used to detect the mRNA and protein expressions of inflammatory mediators.

RESULTS

Compared with DMSO control, quercetin (16-64 μM) significantly inhibited the growth of A. fumigatus in a concentration-dependent manner without affecting cell viability in HCECs. In corneas of mice with A. fumigatuskeratitis, quercetin decreased clinical score and fungal load, and reduced neutrophil recruitment and infiltration to the corneal stroma. Moreover, quercetin attenuated the expression of inflammatory mediators including toll-like receptor-4 (TLR-4), TLR-2, interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and high mobility group box 1 (HMGB1) in vitro and in vivo.

CONCLUSIONS

Our study demonstrated that quercetin treatment can ameliorate A. fumigatus keratitis by inhibiting the growth of A. fumigatus, decreasing neutrophil recruitment and infiltration, and downregulating the productions of TLR-4, TLR-2, TNF-α, IL-1β and HMGB1, indicating quercetin is likely to become a potential therapeutic agent in FK treatment.

Androgen deprivation therapy and the risk of subsequent keratitis

Objectives:

The objective of the study was to determine the risk of subsequent keratitis in prostate cancer (PCa) patients treated with androgen deprivation therapy (ADT).

Materials and Methods:

Three thousand three hundred and nine patients with PCa were identified using data from Taiwan’s National Health Insurance Research Database for 2001 through 2013. Among those patients, 856 treated with ADT comprised the study group, while 856 non-ADT-treated patients matched with 1:1 propensity-score-matched analysis comprised the control group. The demographic characteristics and comorbidities of all the patients were analyzed, and Cox proportional hazards regression was utilized to determine the hazard ratios (HRs) for subsequent keratitis.

Results:

A total of 157 (9.2%) patients had newly diagnosed keratitis. Compared to the non-ADT-treated patients, the ADT-treated patients had a reduced risk of subsequent keratitis, with an adjusted HR of 0.38 (95% confidence interval: 0.27–0.55; P < 0.001).

Conclusion:

ADT treatment apparently decreased the risk of subsequent keratitis in the investigated PCa patients, but the clinical significance of this finding should be further assessed in additional studies.

Comparison of the effect of teicoplanin and vancomycin on experimental methicillin-resistant staphylococcus aureus keratitis

PURPOSE

To evaluate the early efficacy and safety of intrastromal injection of teicoplanin as the alternative treatment for the methicillin-resistant Staphylococcus aureus (MRSA) keratitis by comparing it with vancomycin.

MATERIALS AND METHODS

Twenty-four eyes of 24 New Zealand white rabbits were included in the study. MRSA keratitis was induced in the right eye of each rabbit by injecting 0.1 mL MRSA suspension containing 1000 colony-forming units (CFU) intrastromally to the central cornea. The rabbits were divided into three treatment groups 24 h after the inoculation of MRSA. Eight rabbits received intrastromal teicoplanin therapy, eight received intrastromal vancomycin therapy, and eight received balanced salt solution and served as the control group. Nine hours after the treatment, all rabbits were sacrificed and corneal tissues were collected for microbiological analysis. We also examined and scored all the rabbits clinically before and after the treatment.

RESULTS

The control group scored higher with regard to conjunctival injection, iritis, fibrin, hypopyon, epithelial erosion, and corneal infiltrate than the vancomycin and teicoplanin groups (p = 0.031, 0.010, < 0.001, 0.029, 0.009, and < 0.001, respectively). Chemosis and corneal oedema were similar in all groups (p = 0.731 and 0.075, respectively). The severity of all clinical parameters was similar in both the vancomycin and teicoplanin groups after the treatment. The bacterial load was the highest (7.83 ± 0.71 log₁₀ CFU/g) in the control group. The eyes treated with vancomycin and teicoplanin had similar bacterial loads (6.40 ± 0.69 vs. 6.31 ± 0.75 log₁₀ CFU/g, p = 0.809).

CONCLUSION

The efficiency of teicoplanin seems to be comparable to that of vancomycin when administered intrastromally in the early treatment of MRSA keratitis. The former may be preferred in the treatment of selected cases with vancomycin hypersensitivity or resistance.

Acanthamoeba keratitis in a mouse model using a novel approach

CONTEXT

Acanthamoeba is increasingly implicated in causing keratitis in patients wearing contact lens or ocular trauma and has a poor prognosis. Establishment of an animal model is critical to study the disease pathology, pathogenesis and to evaluate anti-amoebic drugs. Some studies have used contact lenses to establish Acanthamoeba keratitis (AK) in a mouse model, which is expensive and not very successful as lenses get dislodged.

OBJECTIVE

To assess the feasibility of using parafilm (Bemis Company Inc., USA) as an alternative to contact lens for the establishment of AK in the mouse model.

METHODS

Thirty-six Balb/c mice in three groups of six mice each for two strains of Acanthamoeba were used to induce AK. Three experimental approaches used were; i) Acanthamoeba impregnated contact lens, ii) Acanthamoeba impregnated parafilm and iii) scratching followed by inoculation of Acanthamoeba suspension. In all three models, tarsorrhaphy was performed. Infection was evaluated by clinical examination and also through microscopic examination of corneal scrapings and corneal sections.

RESULTS

AK model was successfully established with parafilm whereas only one mouse developed AK with the use of contact lens and none with scratching and Acanthamoeba inoculation.

CONCLUSION

The use of parafilm is convenient, reliable and cheaper and can be considered an alternative to contact lenses to induce AK in a mouse model.

Intensive ocular sampling for the detection of subclinical canine herpesvirus-1 shedding in dogs with experimentally-induced latent infection

Latent canine herpesvirus-1 (CaHV-1) infections are common in domestic dogs, but viral shedding patterns in dogs are poorly understood. Previous research failed to detect spontaneous subclinical ocular CaHV-1 shedding in dogs following ocular infection, a situation that is fundamentally distinct from many of the alphaherpesviruses closely related to CaHV-1. One possible explanation for this finding is that the sampling interval in the prior studies evaluating ocular shedding patterns was too infrequent to detect rapidly cleared, brief ocular viral shedding episodes. To evaluate for this potential viral shedding scenario, 10 laboratory beagles recovered from experimental primary ocular CaHV-1 infection and with latent CaHV-1infection were intensively monitored for viral reactivation and shedding for 28 days. Clinical ophthalmic examinations were performed daily. Ocular swab samples were collected for CaHV-1 polymerase chain reaction 3 times daily and CaHV-1 virus neutralizing antibody assays were evaluated at 2-week intervals. No abnormalities suggestive of recurrent CaHV-1 ocular disease were observed during clinical ophthalmic examination in the dogs during the study. Ocular CaHV-1 shedding was not detected by polymerase chain reaction and CaHV-1 virus neutralizing antibody titers remained stable in all dogs for the study duration. In the present study utilizing frequent multiple daily sample collections, no evidence of subclinical ocular CaHV-1 shedding was detected in mature dogs with experimentally-induced latent CaHV-1 infection.

[Necrotizing scleritis after acanthamoeba keratitis]

Die noduläre Skleritis und die nekrotisierende Skleritis sind seltene Komplikationen der Akanthamöbenkeratitis. Wir präsentieren den Fall einer 61-jährigen Patientin, die seit mehr als 4 Monaten an einer persistierenden Keratitis am rechten Auge litt. Es wurde eine perforierende Limbokeratoplastik durchgeführt. Die Untersuchung des Hornhautexplantates zeigte Akanthamöbenzysten. In den folgenden 5 Monaten zeigte die Sklera rezidivierende Abszedierungen. Wir führten insgesamt 2 Thermokauterisationen und 3 Amnionmembrantransplantationen durch. Nach unserem Wissen ist dies der erste Fall einer Sklerokeratitis nach einer Akanthamöbenkeratitis, welcher mit einer Kombination aus Thermokauterisation und Amnionmembrantransplantation behandelt wurde. Weitere Studien sind notwendig, um dieses Verfahren als Alternative zur etablierten Kryotherapie zu untersuchen.

Evaluation of the Effects of Rumex obtusifolius Seed and Leaf Extracts Against Acanthamoeba: An in vitro Study

BACKGROUND

Acanthamoebiasis treatment is a major and challenging problem due to the presence of resistant cyst form. Many herbal extracts and their derivatives have been used against trophozoites and cysts of Acanthamoeba, but no effective therapeutic agent has yet been discovered. Therefore, the present study aimed to evaluate the effect of Rumex obtusifolius (R. obtusifolius) extracts against a clinical strain of Acanthamoeba genotype T4 in vitro.

METHODS

In this experimental study, after genotyping the clinical isolate, the hydroalcohlic extracts of R. obtusifolius seeds and leaves were prepared. Different concentrations (1.25, 2.5, 5 and 10 mg/ml) of extracts were tested in triplicate (24, 48 and 72h) on trophozoites and cysts of Acanthamoeba. The mortality of the parasite was assessed by trypan blue vital staining and flow cytometry analysis.

RESULTS

Results showed that the extract of R. obtusifolius leaves at the concentration of 10 mg/ml killed 100% of trophozoites and cysts after 72 h. However, the seed extract of R. obtusifolius had weak inhibitory effects on trophozoites and cysts of Acanthamoeba. In the presence of 10 mg/ml of hydroalcoholic seed extract of R.obtusifolius in culture medium after 72 h, 28.6% of trophozoites and 0% of cysts of Acanthamoeba were killed. After analysis by flow cytometry, seeds and leaves extract indicated apoptosis effect. Seed and leaf extracts caused 2.6% and 0.4% percent apoptosis.

CONCLUSION

These extracts are not promising candidates for further medicine development on acanthamoebiasis. Nonetheless, further research is necessary to clarify the effects of effective fractions of seed and leaf extracts of R. obtusifolius and their mechanisms of action.

Mycotic Keratitis in a Tertiary Hospital in Northeastern Malaysia

Objectives:

To identify the clinical profile, etiology, and outcome of culture-positive mycotic keratitis in a tertiary referral centre in the northeastern part of Malaysia.

Materials and Methods:

A retrospective review of all patients with culture-positive mycotic keratitis in Hospital Universiti Sains Malaysia over a 3-year period, from January 2015 to December 2017.

Results:

This study included 27 eyes of 27 patients treated for mycotic keratitis based on a positive fungal culture. The most common predisposing factor was ocular trauma, in 22 patients (81.5%). Eleven patients (40.7%) had a presenting visual acuity worse than 6/60, due to central ulcer involvement. Approximately half of these (6 patients) experienced visual improvement post-treatment. Fusarium spp. was the most common fungus isolated (37%), followed by non-sporulating fungi and Curvularia spp. Three patients (7.4%) had corneal microperforations, which healed after gluing and bandage contact lens application. One patient (3.7%) required tectonic penetrating keratoplasty and 1 patient (3.7%) underwent evisceration. The final visual acuity was 6/18 or better in approximately half (14 patients) of our cohort and worse than 3/60 in approximately 20% (5 patients).

Conclusion:

Mycotic keratitis occurred mainly in males and secondary to ocular trauma. The most common organism isolated was Fusarium spp. Although treatment may improve vision, the visual outcome is guarded.

Therapeutic potential of nanolipoidal α-terpineol in combating keratitis induced by Pseudomonas aeruginosa in the murine model

Developing non-antibiotic alternatives is one of the top priorities in healthcare and community settings, especially for combating biofilm-associated infections caused by multi-drug resistant pathogens. The therapeutic efficacy of nanolipoidal α-terpineol was explored against Pseudomonas aeruginosa induced keratitis using the mice model in the present study. Topical administration of nanostructured lipid carriers (NLCs) containing α-terpineol (αT) resulted in significant reduction in bacterial count in corneal tissue by 4 log₁₀ on 5th post infection day. The protective efficacy of αT-NLCs demonstrated improvement in corneal histopathology, decreased the levels of various inflammatory markers including myeloperoxidase (MPO) and reactive nitrogen intermediates (RNI). Further, αT-NLCs treatment showed immunomodulatory effects by manipulating the production of inflammatory cytokines, tumor necrotic factor (TNF-α), macrophage inhibitory protein-2 (MIP-2) and interleukin-2 (IL-2) in infected eyes. In addition, ex vivo studies exhibited enhanced susceptibility of P. aeruginosa towards serum and macrophages in presence of αT-NLCs. A potent antibiofilm effect was also observed by αT-NLCs against P. aeruginosa which was confirmed by fluorescent microscopic analysis. Hence, based on the results of the present study, a novel therapeutic is being proposed for the treatment of biofilm associated keratitis caused by P. aeruginosa.

Understanding clinical and immunological features associated with Pseudomonas and Staphylococcus keratitis

Pseudomonas aeruginosa and Staphylococcus aureus are the two dominant Gram-negative and -positive species, respectively, isolated from patients with contact lens-related bacterial keratitis. The clinical features of bacterial keratitis vary, such that timely differential diagnosis can be challenging, which may cause a delay in diagnosis resulting in poorer outcome. This review aims to explore the current understanding of clinical and immunological features associated with contact lens-related P. aeruginosa and S. aureus keratitis based on currently available evidence. Firstly, the review characterises contact lens-related P. aeruginosa and S. aureus keratitis, based on clinical features and prognostic factors. Secondly, the review describes the primary immune response associated with a bacterial infection in in-vivo non-scratch contact lens-wearing animal models, colonised by bacteria on contact lens and topical administration of bacteria on the cornea. Finally, the review discusses the role of macrophage inflammatory protein-2 (MIP-2) and intercellular adhesion molecule (ICAM-1) in neutrophil recruitment based on both in-vivo scratch models of bacterial keratitis and bacterial challenged in cell culture models.

Evaluation of in-situ gel-forming eye drop containing bacteriophage against Pseudomonas aeruginosa keratoconjunctivitis in vivo

Introduction: Eradication of Pseudomonas aeruginosa has become increasingly difficult due to its remarkable capacity to resist antibiotics. Bacteriophages have been suggested as an alternative treatment for bacterial infections. Methods: In-situ gel-forming eye drop containing phage against P. aeruginosa keratoconjunctivitis was prepared. The Cystoviridae phage was formulated as in-situ gel-forming formulation which is a solution formulation but turns into gel when it contacts the eye. Therapeutic effectiveness of the in-situ gel forming formulation was evaluated by histological examination on day 12 post-infection. Results: The viscosity of selected formulation increased when it was instilled into the eye. The histological results showed edema, abscesses, and destruction of the stromal structure of cornea in groups where no in-situ gel-forming formulation was used. In the group where in-situ gel forming formulation was used, re-epithelialization and normal corneal structure were observed. Conclusion: In-situ gel-forming ophthalmic formulation containing phage can be effective in the treatment of P. aeruginosa keratoconjunctivitis.

GSDMD, an executor of pyroptosis, is involved in IL-1β secretion in Aspergillus fumigatus keratitis

The protein GSDMD is an important performer of pyroptosis and a universal substrate for the inflammatory caspase. However, the role and regulatory mechanism of GSDMD in Aspergillus fumigatus keratitis is remains unknown. Here we detected GSDMD protein in the cornea of normal and fungal-infected C57BL/6 mice. Human corneal epithelial cell (HCECs) were preincubated with a hydrochloride solution (IFNR inhibitor), ruxolitinib (JAK/STAT inhibitor), belnacasan (caspase-1 inhibitor) before infection with A. fumigatus conidia. Mice corneas were infected with Aspergillus fumigatus after pretreatment of GSDMD siRNA via subconjunctival injection. After, samples were harvested at specific time points and the expression of GSDMD and IL-1β was assessed by PCR, Western blot and immunofluorescence staining. Compared with the control group, we observed that the expression of GSDMD in fungal-infected mice cornea was significantly increased. After pretreatment with IFNR, JAK/STAT and caspase-1 inhibitors before fungal infection, the expression of GSDMD was significantly inhibited compared to the DMSO control in HCECs. Moreover, the GSDMD siRNA treatment have significantly weaken corneal inflammatory response, decreasing the proinflammatory factor IL-1β secretion and reducing neutrophils and macrophages recruitment in mice infected corneas. In summary, the data here provided evidences that GSDMD, an executor of pyroptosis, is involved in the early immune response of A. fumigatus keratitis. Additionally, the inhibition of GSDMD expression can affect the secretion of IL-1β and the recruitment of neutrophil and macrophages by blocking IFNR, JAK/STAT and caspase-1 signaling pathway. The protein GSDMD may emerge as a potential therapeutic target for A. fumigatus keratitis.