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Zhang X, Qi X, Lu X, Gao H. Modified tectonic corneoscleral graft technique for treating devastating corneoscleral infections. BMC Ophthalmol 2024; 24:402. [PMID: 39261792 DOI: 10.1186/s12886-024-03669-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND This study aims to evaluate the clinical outcomes and efficacy of a modified tectonic corneoscleral graft (TCG) in patients suffering from devastating corneoscleral infections. METHODS Thirty-eight eyes from 38 patients who underwent the modified TCG were included in this study. The outcomes measured were recurrence rates, best-corrected visual acuity (BCVA), ocular surface stability, postoperative complications, and graft survival. RESULTS Among the 38 patients, 23 had fungal infections, 9 had bacterial infections and 6 had Pythium insidiosum infections. At the final follow-up, with an average duration of 25.1 ± 8.6 months, the rate of monocular blindness decreased from 100 to 58%. Significant improvements in LogMAR BCVA were observed from preoperative to postoperative measurements (P < 0.001). Thirty-two eyes (84.2%) maintained a stable ocular surface. The survival rate of ocular surface stability was 84.2%±5.9% at one year and 57.7%±9.7% at three years post-surgery. Twenty eyes (52.6%) retained a clear graft, with a survival rate for graft clarity was 81.6%±6.3% at one year and 36.0%±10.8% at three years post-surgery. The incidence of immune rejection was 36.8%. Corneal epithelial defects were observed in ten patients, and choroidal detachment occurred in four patients. No cases of elevated intraocular pressure were detected. CONCLUSIONS The modified TCG is effective in eradicating infections, preserving the eyeball, and maintaining useful vision in cases of devastating corneoscleral infections. Regular use of tacrolimus, timely administration of glucocorticoids, and good patient compliance can help mitigate postoperative challenges.
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Affiliation(s)
- Xiaoyu Zhang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, 372 Jingsi Road, Jinan, 250021, China
- School of Ophthalmology, Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Xiaolin Qi
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, 372 Jingsi Road, Jinan, 250021, China
- School of Ophthalmology, Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Xiuhai Lu
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, 372 Jingsi Road, Jinan, 250021, China
- School of Ophthalmology, Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Hua Gao
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, 372 Jingsi Road, Jinan, 250021, China.
- School of Ophthalmology, Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.
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Deng Y, Li L, Xu J, Yao Y, Ding J, Wang L, Luo C, Yang W, Li L. A biomimetic human disease model of bacterial keratitis using a cornea-on-a-chip system. Biomater Sci 2024. [PMID: 39233608 DOI: 10.1039/d4bm00833b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Bacterial keratitis is a common form of inflammation caused by the bacterial invasion of the corneal stroma after trauma. In extreme cases, it can lead to severe visual impairment or even blindness; therefore, timely medical intervention is imperative. Unfortunately, widespread misuse of antibiotics has led to the development of drug resistance. In recent years, organ-on-chips that integrate multiple cell co-cultures have extensive applications in fundamental research and drug screening. In this study, immortalized human corneal epithelial cells and primary human corneal fibroblasts were co-cultured on a porous polydimethylsiloxane membrane to create a cornea-on-a-chip model. The developed multilayer epithelium closely mimicked clinical conditions, demonstrating high structural resemblance and repeatability. By introducing a consistently defective epithelium and bacterial infection using the space-occupying method, we successfully established an in vitro model of bacterial keratitis using S. aureus. We validate this model by evaluating the efficacy of antibiotics, such as levofloxacin, tobramycin, and chloramphenicol, through simultaneously observing the reactions of bacteria and the two cell types to these antibiotics. Our study has revealed the barrier function of epithelium of the model and differentiated efficacy of three drugs in terms of bactericidal activity, reducing cellular apoptosis, and mitigating scar formation. Altogether, the cornea on chip enables the assessment of ocular antibiotics, distinguishing the impact on corneal cells and structural integrity. This study introduced a biomimetic in vitro disease model to evaluate drug efficacy and provided significant insights into the extensive effects of antibiotics on diverse cell populations within the cornea.
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Affiliation(s)
- Yudan Deng
- School of Ophthalmology & Optometry, Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
| | - Lingjun Li
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
- Wenzhou Key Laboratory of Biomedical Imaging, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China
| | - Jian Xu
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
| | - Yili Yao
- School of Ophthalmology & Optometry, Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
| | - Jiangtao Ding
- School of Ophthalmology & Optometry, Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
| | - Lei Wang
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
| | - Chunxiong Luo
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
- Center for Quantitative Biology, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- The State Key Laboratory for Artificial Microstructures and Mesoscopic Physics, School of Physics, Peking University, Beijing, China
| | - Wei Yang
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
| | - Lingli Li
- School of Ophthalmology & Optometry, Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China
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Jindal A, Brandao-de-Resende C, Neo YN, Melo M, Day AC. Enhancing Ophthalmic Triage: identification of new clinical features to support healthcare professionals in triage. Eye (Lond) 2024; 38:2536-2544. [PMID: 38627545 PMCID: PMC11385555 DOI: 10.1038/s41433-024-03070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/07/2024] [Accepted: 04/05/2024] [Indexed: 09/11/2024] Open
Abstract
OBJECTIVE To investigate which features from a patient's history are either high or low risk that could support healthcare professionals in ophthalmic emergency triage. METHODS Prospective, 12,584 visits from 11,733 adult patients attending an Accident and Emergency department at a single tertiary centre were analysed. Data were collected by ophthalmic nurses working in triage, using an online form from August 2021 to April 2022. Multivariate analysis (MVA) was conducted to identify which features from the patients' history would be associated with emergency care. RESULTS This study found that 45.5% (5731 patient visits (PV)) required a same day eye emergency examination (SDEE), 11.3% (1416 PV) needed urgent care, and 43.2% (5437 PV) were appropriate for elective consultations with a GP or optometrist. The MVA top ten features that were statistically significant (p < 0.05) that would warrant SDEE with odds ratio (95% CI) were: bilateral eye injury 36.5 [15.6-85.5], unilateral eye injury 25.8 [20.9-31.7], vision loss 4.8 [2.9-7.8], post-operative ophthalmic ( < 4 weeks) 4.6 [3.8-5.7], contact lens wearer 3.9 [3.3-4.7], history of uveitis 3.9 [3.3-4.7], photophobia 2.9 [2.4-3.6], unilateral dark shadow/curtain in vision 2.4 [1.8-3.0], unilateral injected red eye 2.0 [1.8-2.2] and rapid change in visual acuity 1.8 [1.5-2.2]. CONCLUSION This study characterises presenting features covering almost 100 ophthalmic acute presentations that are commonly seen in emergency and elective care. This information could supplement current red flag indicators and support healthcare professionals in ophthalmic triage. Further research is required to evaluate the cost effectivity and safety of our findings for triaging acute presentations.
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Affiliation(s)
- Anish Jindal
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
- Department of Brain Sciences, Institute of Ophthalmology, University College London, London, UK.
| | - Camilo Brandao-de-Resende
- Department of Brain Sciences, Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, United Kingdom
| | - Yan Ning Neo
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Mariane Melo
- NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, United Kingdom
| | - Alexander C Day
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Department of Brain Sciences, Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, United Kingdom
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Khor WB, Lakshminarayanan R, Periayah MH, Prajna VN, Garg P, Sharma N, Mehta JS, Young A, Goseyarakwong P, Puangsricharern V, Tan AL, Beuerman RW, Tan DTH. The antibiotic resistance profiles of Pseudomonas aeruginosa in the Asia Cornea Society Infectious Keratitis Study. Int Ophthalmol 2024; 44:361. [PMID: 39215853 PMCID: PMC11365837 DOI: 10.1007/s10792-024-03270-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To describe the prevalence and antibiotic resistance profiles of Pseudomonas aeruginosa isolated from the Asia Cornea Society Infectious Keratitis Study (ACSIKS). METHODS All bacterial isolates from ACSIKS underwent repeat microbiological identification in a central repository in Singapore. Minimum inhibitory concentration (MIC) determination was conducted for isolates of P. aeruginosa against thirteen antibiotics from 6 different classes, and categorized based on Clinical Laboratory Standard Institutes' reference ranges. The percentage rates of resistance (non-susceptibility) to each antibiotic included isolates of both intermediate and complete resistance. Multi-drug resistance (MDR) was defined as non-susceptibility to at least one agent in three or more antimicrobial classes. RESULTS Of the 1493 unique bacterial specimens obtained from ACSIKS, 319 isolates were of P. aeruginosa. The majority of isolates were from centers in India (n = 118, 37%), Singapore (n = 90, 28.2%), Hong Kong (n = 31, 9.7%) and Thailand (n = 30, 9.4%). The cumulative antibiotic resistance rate was the greatest for polymyxin B (100%), ciprofloxacin (17.6%) and moxifloxacin (16.9%), and lowest for cefepime (11.6%) and amikacin (13.5%). Isolates from India demonstrated the highest antibiotic resistance rates of all the centers, and included moxifloxacin (47.5%) and ciprofloxacin (39.8%). Forty-eight of the 59 MDR isolates also originated from India. Antibiotic resistance rates were significantly lower in the other ACSIKS centers, and were typically less than 10%. CONCLUSIONS The antibiotic resistance profiles of P. aeruginosa varied between different countries. While it was low for most countries, substantial antibiotic resistance and a significant number of multi-drug resistant isolates were noted in the centers from India.
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Affiliation(s)
- Wei-Boon Khor
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Rajamani Lakshminarayanan
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | | | | | - Prashant Garg
- LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Alvin Young
- The Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Panida Goseyarakwong
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vilavun Puangsricharern
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ai Ling Tan
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Roger W Beuerman
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Donald Tiang-Hwee Tan
- Singapore National Eye Centre, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Camden Medical Centre, 1 Orchard Blvd, #13-03, Singapore, 248649, Singapore.
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Cai Y, Clancy N, Watson M, Hay G, Angunawela R. Retrospective analysis on the outcomes of contact lens-associated keratitis in a tertiary centre: an evidence-based management protocol to optimise resource allocation. Br J Ophthalmol 2024:bjo-2024-325637. [PMID: 39009420 DOI: 10.1136/bjo-2024-325637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND/AIMS Contact lens-associated keratitis (CLAK) is a common sight-threatening complication of contact lens use. Current management protocols in the UK are based on historical practice and necessitate a review for every patient within 48 hours regardless of severity, increasing the treatment burden on a resource-limited healthcare service. Our study aims to identify the different risk factors associated with CLAK, categorise CLAK using a novel grading system and recommend modifications to current management protocols based on the outcomes in the individual subgroups. METHODS The retrospective cohort study identified 161 eyes from 153 patients with CLAK from the electronic patient records of a tertiary eye centre between 1 July 2021 and 28 February 2022. Patients were categorised based on epithelial defect size (grade 1: <1.0 mm, grade 2: 1.0-2.0 mm, grade 3: >2.0 mm) and their risk factors, clinical features, treatments and outcomes were analysed. RESULTS The most significant risk factors for CLAK include extended-wear contact lens, poor hygiene and prolonged duration of wear. Grades 1 and 2 CLAKs have excellent outcomes following an empirical treatment regime with topical moxifloxacin with 96% discharged within 48 hours and 94.1% discharged in 2 weeks, respectively. Grade 3 CLAKs require prolonged average duration of treatment. CONCLUSION We recommend typical grade 1 and 2 CLAKs can be discharged with empirical fluoroquinolone treatment. Grade 3 and all CLAKs with atypical features require monitoring for resolution, further diagnostics or treatment. We provide an evidence-based approach to reduce unnecessary patient visits and optimise resource allocation in an urban setting.
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Affiliation(s)
- Yijun Cai
- Cornea and External Diseases, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Noah Clancy
- Cornea and External Diseases, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Martin Watson
- Cornea and External Diseases, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gordon Hay
- Accident and Emergency, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Romesh Angunawela
- Cornea and External Diseases, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Cheng KKW, Fingerhut L, Duncan S, Prajna NV, Rossi AG, Mills B. In vitro and ex vivo models of microbial keratitis: Present and future. Prog Retin Eye Res 2024; 102:101287. [PMID: 39004166 DOI: 10.1016/j.preteyeres.2024.101287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
Microbial keratitis (MK) is an infection of the cornea, caused by bacteria, fungi, parasites, or viruses. MK leads to significant morbidity, being the fifth leading cause of blindness worldwide. There is an urgent requirement to better understand pathogenesis in order to develop novel diagnostic and therapeutic approaches to improve patient outcomes. Many in vitro, ex vivo and in vivo MK models have been developed and implemented to meet this aim. Here, we present current in vitro and ex vivo MK model systems, examining their varied design, outputs, reporting standards, and strengths and limitations. Major limitations include their relative simplicity and the perceived inability to study the immune response in these MK models, an aspect widely accepted to play a significant role in MK pathogenesis. Consequently, there remains a dependence on in vivo models to study this aspect of MK. However, looking to the future, we draw from the broader field of corneal disease modelling, which utilises, for example, three-dimensional co-culture models and dynamic environments observed in bioreactors and organ-on-a-chip scenarios. These remain unexplored in MK research, but incorporation of these approaches will offer further advances in the field of MK corneal modelling, in particular with the focus of incorporation of immune components which we anticipate will better recapitulate pathogenesis and yield novel findings, therefore contributing to the enhancement of MK outcomes.
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Affiliation(s)
- Kelvin Kah Wai Cheng
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, United Kingdom
| | - Leonie Fingerhut
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, United Kingdom
| | - Sheelagh Duncan
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, United Kingdom
| | - N Venkatesh Prajna
- Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Adriano G Rossi
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, United Kingdom
| | - Bethany Mills
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, United Kingdom.
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Chen YC, Hsiao YT, Kuo SF, Yu HJ, Fang PC, Ho RW, Yang IH, Kuo MT. Monitoring the transition from corneal ulceration to healed scar using a Scheimpflug tomography-based densitometry. Graefes Arch Clin Exp Ophthalmol 2024; 262:2189-2198. [PMID: 38349421 DOI: 10.1007/s00417-024-06390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/29/2023] [Accepted: 01/22/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE To compare corneal haze between active ulcer and healed scarring using a Scheimpflug densitometry. MATERIALS AND METHODS A prospective longitudinal study enrolled 30 patients (30 eyes) with ulcerative keratitis (UK). Each subject's corneal optical density (COD) was measured with a Scheimpflug corneal densitometry, Pentacam® AXL (Oculus GmbH, Wetzlar, Germany), at the active ulcerative and complete scarring stage. The COD data were analyzed through distinct methods (inbuilt, sorted annular partitions, and ulcer-matching densitometric maps). We compared different CODs to select the better index for clinically monitoring the transition from corneal ulceration to healed scar. RESULTS The CODs of the periphery (P = 0.0024) and outside of the active ulcer (P = 0.0002) significantly decreased after scarring. Partitioning the cornea into different depths and annular zones, the anterior layer, center layer, and the 2-6 mm annular zone had a more remarkable COD decrease after scar formation. The 3rd-sorted COD in the anterior layer revealed the highest area under the receiver-operating characteristic curves (0.709), in which 90% of subjects had COD reduction during the ulcer-to-scar transition. CONCLUSIONS Aside from subjective judgment based on clinical signs, the Scheimpflug tomography-based densitometry could provide objective and efficient monitoring of the corneal opacity evolution in UK patients. Because the 3rd-sorted annular COD is a better index than the inbuilt or mapping CODs in differentiating active ulcers from healed scars, this COD could be a clinically promising parameter to monitor the progression of UK patients.
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Affiliation(s)
- Yen-Cheng Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - Yu-Ting Hsiao
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - Shu-Fang Kuo
- Department of Laboratory Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, 83301, Taiwan
- Department of Laboratory Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, 261363, Taiwan
- Department of Medical Biotechnology and Laboratory Sciences, College of Medicine, Chang Gung University, Taoyuan City, 333323, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Ren-Wen Ho
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - I-Hui Yang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan.
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Tsao YC, Huang YH. Impact of SARS-CoV-2 pandemic and lockdown measures on microbial keratitis in Taiwan. Int Ophthalmol 2024; 44:238. [PMID: 38904686 DOI: 10.1007/s10792-024-03200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE This study aimed to evaluate how the SARS-CoV-2 pandemic and associated lockdown measures influenced microbial keratitis in Taiwan by comparing demographic data, predisposing factors, pathogen profiles, and treatment outcomes in 2019 and 2020. METHODS Data from patients diagnosed with microbial keratitis at National Chung Kung University Hospital between January 2019 and December 2020 were examined, focusing on patient demographics, predisposing factors, isolated pathogens, antibiotic usage, and clinical progress. RESULTS No significant differences were found in patient sex, laterality, or average age between the two years. Predisposing factors, such as contact lens use and chronic ocular/systemic disorders, remained unchanged. While fungal isolates slightly increased during the lockdown, bacterial isolates remained consistent. Medical treatment effectiveness, treatment strategies, and antibiotic susceptibility for common bacteria showed no significant alterations. CONCLUSION Despite the challenges posed by the SARS-CoV-2 pandemic and lockdown measures, this study revealed minimal changes in microbial keratitis trends in Taiwan. This highlights the importance of maintaining access to medical care during crises and offers insights into potential treatment strategies for patients facing difficulties in receiving timely care. Further research should investigate the pandemic's impact on healthcare access and patient outcomes in various populations and regions.
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Affiliation(s)
- Yu-Chien Tsao
- College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Yi-Hsun Huang
- Department of Ophthalmology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, 70101, Taiwan.
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Ispizua Mendivil E, Durán de la Colina JA. Infectious keratitis associated with contact lens wear: REGINFECOR multicenter study. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:237-247. [PMID: 38588998 DOI: 10.1016/j.oftale.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/27/2024] [Indexed: 04/10/2024]
Abstract
This 32-centre multicentre study addresses the lack of knowledge about the prevalence and significance of microbial keratitis (MK) associated with contact lens (CL) wear in Spain. A total of 304 cases recruited from 32 hospitals were studied and showed that infectious keratitis associated with contact lens wear mainly affects young women during the summer months. In this study, soft lenses with monthly replacement and single solution cleaning were most commonly used, purchased and fitted in opticians' shops. Common risk factors were identified among users, such as topping off solutions, prolonging the life of lenses, and frequently sleeping, swimming and showering with lenses. Overnight lens wear was significantly associated with a higher incidence of corneal opacities, and the presence of Pseudomonas aeruginosa in bacterial cultures was associated with more severe sequelae and a greater need for corneal transplantation. Although most cases were benign, the time taken to heal was long, which poses a problem for working patients. This study provides valuable epidemiological, microbiological and risk factor information and estimates the incidence of CL related MK in Spain to be approximately 1 case per 30,000 inhabitants per year.
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Affiliation(s)
- E Ispizua Mendivil
- Departamento de Oftalmología, Hospital de Urduliz, Urduliz, Bizkaia, Spain.
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Kashima Y, Kato K, Takeuchi M, Yonekawa Y, Takashima Y, Hirano K, Kondo M. Development of acute hydrops in eye with infectious keratitis: A case report. Am J Ophthalmol Case Rep 2024; 34:102045. [PMID: 38559364 PMCID: PMC10979013 DOI: 10.1016/j.ajoc.2024.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/09/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To determine the characteristics of an eye that developed acute hydrops while being treated for infectious keratitis. Observation A 35-year-old man presented with pain and blurred vision in his left eye. He had undergone cataract surgery seven years earlier and was being treated for poorly controlled atopic dermatitis. The decimal best-corrected visual acuity (BCVA) of the left eye was 0.01. Slit-lamp microscopy showed conjunctival injection, corneal opacification, and a corneal ulcer. The patient was diagnosed with infectious keratitis and was treated with topical and systemic antibiotics. During the hospitalization, the patient was noted to rub his eyes frequently and vigorously. Five days after the first visit, the cornea protruded markedly, and the stroma surrounding the ulcerated area was edematous. These findings led to a diagnosis of acute hydrops.Penetrating keratoplasty was performed to prevent corneal perforation. Histopathological study of the excised cornea showed stromal edema, infiltration of leukocytes, and a tear in Descemet's membrane. Unfortunately, the patient developed endophthalmitis the day after the surgery. The anterior chamber was irrigated with antibiotics, and antibiotics were also injected into the vitreous. The endophthalmitis gradually subsided, and two years after the surgery, the patient's decimal BCVA had improved to 0.6. Conclusion and importance Vigorous eye rubbing in cases of infectious keratitis can induce acute hydrops, and timely surgical intervention is recommended.
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Affiliation(s)
- Yuzen Kashima
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kumiko Kato
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Maki Takeuchi
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuka Yonekawa
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuko Takashima
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Ophthalmology, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Koji Hirano
- Department of Ophthalmology, Toyota Memorial Hospital, Toyota, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
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11
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Erdem E, Köktaş Z, İnan Harbiyeli I, Atalay E, Kibar F, Durmaz G, Arslan YK, Seydaoğlu G, Yıldırım N, Yağmur M. The effect of climatic and seasonal factors on the microbial keratitis profile. J Fr Ophtalmol 2024; 47:104018. [PMID: 37932171 DOI: 10.1016/j.jfo.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/31/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE To compare retrospective data on microbial keratitis (MK) from two different climatic regions in Turkey over 11 years. STUDY DESIGN Retrospective cohort. METHODS This retrospective cohort study included patients diagnosed with presumed MK at two referral centers. Center A was located in the subtropical region of Turkey, whereas Center B was located in a continental temperate climate zone. Clinical and laboratory data were also recorded. The results were evaluated for seasonal variations. RESULTS This study included data from 665 patients with presumed MK (351 and 314 patients from centers A and B, respectively). The most common predisposing factors were ocular trauma in Center A, prior ocular surgery, and systemic disease in Center B. Severe keratitis was related to prior ocular surgery, presence of systemic disease, and fungal infection at presentation. The culture positivity rate was higher in spring and lower in summer at both centers. Gram-positive bacteria were the most commonly isolated bacteria in both centers in all seasons. The fungal and mixed keratitis ratios were higher in Center A than in Center B. In Center A, filamentous fungi were common pathogens that were found year-round, and peaks were observed in July and October. CONCLUSION The results of this study show that climatic and seasonal factors may affect the microbial profile of keratitis. Fungal keratitis appears to be a climatic disease. Understanding the regional profile of MK can aid clinicians in their disease management.
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Affiliation(s)
- E Erdem
- Ophthalmology Department, Faculty of Medicine, Cukurova University, Balcalı Hospital, 1380 Sarıcam, Adana, Turkey.
| | - Z Köktaş
- Ophthalmology Department, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - I İnan Harbiyeli
- Ophthalmology Department, Faculty of Medicine, Cukurova University, Balcalı Hospital, 1380 Sarıcam, Adana, Turkey
| | - E Atalay
- Ophthalmology Department, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - F Kibar
- Microbiology Department, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - G Durmaz
- Microbiology Department of Eskişehir Osmangazi, University Faculty of Medicine, Eskişehir, Turkey
| | - Y K Arslan
- Statistic Department of Cukurova University, Faculty of Medicine, Adana, Turkey
| | - G Seydaoğlu
- Statistic Department of Cukurova University, Faculty of Medicine, Adana, Turkey
| | - N Yıldırım
- Ophthalmology Department, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - M Yağmur
- Ophthalmology Department, Faculty of Medicine, Cukurova University, Balcalı Hospital, 1380 Sarıcam, Adana, Turkey
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12
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Rajagopal RN, Murthy SI, Rathi VM. Microbial keratitis and its management at a rural centre: achieving success with limited resources. Int Ophthalmol 2024; 44:205. [PMID: 38676784 DOI: 10.1007/s10792-024-03125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Microbial keratitis is a sight-threatening condition with a higher incidence in agrarian populations. In countries with a high indigent population, due to financial and other constraints, patients prefer to seek therapy locally rather than travel to advanced centres. The aim of this study is to describe the epidemiology, clinical characteristics, and outcomes of 60 consecutive patients with microbial keratitis managed at a rural centre. METHODS Descriptive case series. All patients clinically diagnosed with infectious keratitis were included. Corneal scrapings were obtained and microbiological identification was done by Gram stain. Anti-microbial therapy was commenced based on smear findings and the patients were followed up till disease resolution. RESULTS Sixty eyes of 60 patients were diagnosed with microbial keratitis in the study period. The mean age was 47.43 ± 18.69 years. Male:female ratio was 47:53. Risk factors included ocular trauma in the majority of patients (46/60; 76.7%). Microorganisms were identified on 75.6% of smears, with fungal filaments (65.4%) being the most common. Ulcers were central in over half (32/60; 53.3%), and > 3 mm in diameter in over three-fourths (81.6%) of patients. Forty-four patients (73.3%) achieved treatment success whereas 16/60 (26.6%) required referral to our tertiary-eye care facility for management. The median time to resolution was 14 days (IQR 10-26 days). CONCLUSION Our series demonstrates the feasibility of microbiology-guided therapy in microbial keratitis by ophthalmologists at the secondary rural eye-care level. Two-thirds of the patients could be successfully managed at the rural centre and only severe cases needed a referral to tertiary centres.
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Affiliation(s)
- Raksheeth Nathan Rajagopal
- Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, India
- The Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute (LVPEI), Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500034, India
| | - Somasheila I Murthy
- The Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute (LVPEI), Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500034, India.
| | - Varsha M Rathi
- The Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute (LVPEI), Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500034, India
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute (LVPEI), LV Prasad Marg, Hyderabad, India
- Indian Health Outcomes, Public Health Outcomes and Health Economics (IHOPE), L V Prasad Eye Institute, Hyderabad, India
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13
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Tey KY, Cheong EZK, Ang M. Potential applications of artificial intelligence in image analysis in cornea diseases: a review. EYE AND VISION (LONDON, ENGLAND) 2024; 11:10. [PMID: 38448961 PMCID: PMC10919022 DOI: 10.1186/s40662-024-00376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
Artificial intelligence (AI) is an emerging field which could make an intelligent healthcare model a reality and has been garnering traction in the field of medicine, with promising results. There have been recent developments in machine learning and/or deep learning algorithms for applications in ophthalmology-primarily for diabetic retinopathy, and age-related macular degeneration. However, AI research in the field of cornea diseases is relatively new. Algorithms have been described to assist clinicians in diagnosis or detection of cornea conditions such as keratoconus, infectious keratitis and dry eye disease. AI may also be used for segmentation and analysis of cornea imaging or tomography as an adjunctive tool. Despite the potential advantages that these new technologies offer, there are challenges that need to be addressed before they can be integrated into clinical practice. In this review, we aim to summarize current literature and provide an update regarding recent advances in AI technologies pertaining to corneal diseases, and its potential future application, in particular pertaining to image analysis.
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Affiliation(s)
- Kai Yuan Tey
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Marcus Ang
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Saade JS, Noureddine BN, Ibrahim HA. Corneal Deposits: A Presentation of Arthrobacter Keratitis. Case Rep Ophthalmol 2024; 15:353-357. [PMID: 38623408 PMCID: PMC11018329 DOI: 10.1159/000538474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction Infectious keratitis, an inflammatory condition of the cornea, poses a significant public health concern globally. Bacterial keratitis, the most common type, primarily involves Staphylococcus aureus and Pseudomonas aeruginosa. Timely diagnosis and treatment are crucial to prevent vision loss. Case Presentation This case report presents a 78-year-old male patient with a burning sensation persisting for 1 week. The patient was diagnosed with keratitis caused by Arthrobacter, a Gram-positive coccobacillus commonly found in the environment. While the literature reports a few cases of Arthrobacter species keratitis, limited data exist regarding its clinical course and outcomes. Treatment with ciprofloxacin eye drops resulted in complete resolution of symptoms and a clear cornea upon final follow-up. Conclusion Arthrobacter, a rare causative agent of keratitis, requires early suspicion for accurate diagnosis and treatment. Despite the limited literature on Arthrobacter keratitis, this case highlights the importance of considering uncommon pathogens in corneal infections. Further research is necessary to understand the prevalence and clinical course of Arthrobacter keratitis.
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Affiliation(s)
- Joanna S Saade
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Baha' N Noureddine
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hanadi A Ibrahim
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
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15
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Agarwal S, Srinivasan B, Iyer G, Pandey S, Agarwal M, Dhiman R, Surya J, Anand AR. Depth, size of infiltrate, and the microbe - The trio that prognosticates the outcome of infective keratitis. Indian J Ophthalmol 2024; 72:44-50. [PMID: 38131568 PMCID: PMC10841783 DOI: 10.4103/ijo.ijo_1022_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/02/2023] [Accepted: 08/23/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To analyze the influence of infiltrate size, depth, and organism on the outcome of microbial keratitis. DESIGN Retrospective comparative study. METHODS Medical records of patients with infective keratitis, who reported from January 2015 to December 2019 to a tertiary eye care center, were analyzed. Size and depth of ulcer at presentation were the factors used to group patients, and the influence on the outcome of the organism causing it was analyzed. Grouping was as follows: group A: ulcer size <6 mm/anterior to midstromal infiltrate, group B: ulcer < 6 mm/full-thickness infiltrate, group C: ulcer >6 mm/anterior to midstromal infiltrate, group D: ulcer > 6 mm/full-thickness infiltrate. Patients with viral keratitis or unidentified organism were excluded. Response to treatment and best-corrected visual acuity (BCVA) at the final follow-up were the outcome measures. RESULTS In the study, 1117/6276 patients were included, with 60.8% patients in group A. A significant improvement in visual acuity was noted in groups A/B compared to groups C/D. Group A had the best response to medical management, irrespective of the organism. Higher risk for surgery was noted in group C compared to group B, with group A as the reference. Overall resolution with medical treatment was noted in 70% miscellaneous keratitis, 64.8% bacterial keratitis, 64.3% mixed keratitis, 62.5% acanthamoeba keratitis, 52.6% fungal keratitis, and 12.1% Pythium keratitis. Bacteria and acanthamoeba responded better to medical management than fungal keratitis, whereas Pythium had the highest risk for surgery. CONCLUSION An interplay between virulence of the organism along with depth and size of the infiltrate determines the outcome of microbial keratitis.
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Affiliation(s)
- Shweta Agarwal
- CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Bhaskar Srinivasan
- CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Geetha Iyer
- CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Sunita Pandey
- CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Manokamna Agarwal
- CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Richa Dhiman
- CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Janani Surya
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Appakkudal R Anand
- L and T Microbiology Research Centre, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Wang Y, Chen H, Wang F, Dong Y. Six-year analysis of the pathogenic spectrum, risk factors, and prognosis of non-traumatic fungal keratitis in Northern China. Clin Exp Ophthalmol 2024; 52:111-113. [PMID: 37873694 DOI: 10.1111/ceo.14314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/09/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Yani Wang
- Department of Corneal Diseases, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Huabo Chen
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Fangyuan Wang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Yanling Dong
- Department of Corneal Diseases, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
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Byanju R, Kandel RP, Poudyal B, Bhandari S, Ligal A, Pradhan S, Gautam M, Shrestha P, Sah RK, Gonzales JA, Porco TC, Whitcher JP, Srinivasan M, Upadhyay MP, Lietman TM, Keenan JD, O'Brien KS. Risk factors for corneal ulcers: a population-based matched case-control study in Nepal. Br J Ophthalmol 2023; 107:1771-1775. [PMID: 36202599 PMCID: PMC10076439 DOI: 10.1136/bjo-2022-322141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS We aimed to examine risk factors for corneal ulcer in a rural and peri-urban setting in Nepal. METHODS This population-based matched case-control study was nested in a cluster randomised trial in 24 village development committees in Nepal. Incidence density sampling was used to match incident corneal opacity cases to controls, matching on time of opacity, age, sex and location. Cases and controls were invited to participate in a survey of risk factors for corneal ulcer. Risk factors were evaluated using conditional logistic regression to account for matching. RESULTS Of the 540 participants with incident opacities identified in the trial, 433 were willing to participate in this substudy and matched to a control. Compared with controls, cases had lower odds of having any education vs no education (adjusted OR, aOR 0.60, 95% CI 0.39 to 0.94), working in non-manual labour occupations vs manual labour occupations (aOR 0.64, 95% CI 0.42 to 0.95) and preferring medical shops for ocular trauma versus eye care system centres (aOR 0.58, 95% CI 0.37 to 0.92). Cases had higher odds of protective goggle use versus no protection (aOR 3.8, 95% CI 1.3 to 11.0) and having an ocular injury vs none (aOR 7.7, 95% CI 4.3 to 13.6) compared with controls. CONCLUSION We found ocular injury, manual labour and lower education to be strongly associated with the development of corneal ulcer. Given the persistent burden of corneal blindness in this area, prevention efforts could target efforts to increase access to care in areas where these factors are common.
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Affiliation(s)
| | - Ram Prasad Kandel
- Bharatpur Eye Hospital, Bharatpur, Nepal
- Seva Foundation, Berkeley, California, USA
| | | | | | - Anju Ligal
- Bharatpur Eye Hospital, Bharatpur, Nepal
| | | | | | | | | | - John A Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - John P Whitcher
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | | | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Jeremy David Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
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18
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Cheng Y, An N, Ishaq HM, Xu J. Ocular microbial dysbiosis and its linkage with infectious keratitis patients in Northwest China: A cross-sectional study. Microb Pathog 2023; 184:106371. [PMID: 37741304 DOI: 10.1016/j.micpath.2023.106371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVES To evaluate the alteration of ocular surface microbiome of patients with infectious keratitis in northwest of China. METHODS The corneal scrapings, eyelid margin and conjunctiva samples were collected from 57 participants, who were divided into bacterial keratitis, fungal keratitis, viral keratitis and control group. The V3-V4 region of bacterial 16S rDNA in each sample was amplified and sequenced on the Illumina HiSeq 2500 sequencing platform, and the differences among different groups were compared bioinformatically. RESULTS Significant alterations of the microbiome were observed in alpha-diversity and beta-diversity analysis between the keratitis groups and the control group (p < 0.05). There was no significant differences between eyelid margin and conjunctiva samples in Alpha-Diversity analysis, but a significant difference between eyelid margin and corneal scraping samples in the keratitis group (p < 0.05, independent t-test). The abundances of Bacillus, Megamonas, Acinetobacter, and Rhodococcu were significantly elevated, while the abundance of Staphylococcus was decreased in the keratitis group compared to the control group. CONCLUSIONS The abundance of the ocular microbiome in patients with bacterial keratitis, fungal keratitis, or viral keratitis was significantly higher than those in the control group. Keratitis patients may have ecological disorder on ocular surface microbiome compared with controls. We believe that the conjunctiva and eyelid margin microbiome combined analysis can more comprehensively reflect the composition and abundance of ocular surface microbiome.
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Affiliation(s)
- Yan Cheng
- Department of Microbiology and Immunology, Key Laboratory of Environment and Genes Related to Diseases of Chinese Ministry of Education, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Na An
- The Fist Affiliated Hospital of Northwestern University, Department of Ophthalmology, The Xi'an Fist Hospital, Shaanxi Institute of Ophthalmology, China
| | - Hafiz Muhammad Ishaq
- Faculty of Veterinary and Animal Sciences, Muhammad Nawaz Shareef University of Agriculture Multan, Pakistan
| | - Jiru Xu
- Department of Microbiology and Immunology, Key Laboratory of Environment and Genes Related to Diseases of Chinese Ministry of Education, School of Medicine, Xi'an Jiaotong University, Xi'an, China.
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Huang X, Li L, Chen Z, Yu H, You X, Kong N, Tao W, Zhou X, Huang J. Nanomedicine for the Detection and Treatment of Ocular Bacterial Infections. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2302431. [PMID: 37231939 DOI: 10.1002/adma.202302431] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/15/2023] [Indexed: 05/27/2023]
Abstract
Ocular bacterial infection is a prevalent cause of blindness worldwide, with substantial consequences for normal human life. Traditional treatments for ocular bacterial infections areless effective, necessitating the development of novel techniques to enable accurate diagnosis, precise drug delivery, and effective treatment alternatives. With the rapid advancement of nanoscience and biomedicine, increasing emphasis has been placed on multifunctional nanosystems to overcome the challenges posed by ocular bacterial infections. Given the advantages of nanotechnology in the biomedical industry, it can be utilized to diagnose ocular bacterial infections, administer medications, and treat them. In this review, the recent advancements in nanosystems for the detection and treatment of ocular bacterial infections are discussed; this includes the latest application scenarios of nanomaterials for ocular bacterial infections, in addition to the impact of their essential characteristics on bioavailability, tissue permeability, and inflammatory microenvironment. Through an in-depth investigation into the effect of sophisticated ocular barriers, antibacterial drug formulations, and ocular metabolism on drug delivery systems, this review highlights the challenges faced by ophthalmic medicine and encourages basic research and future clinical transformation based on ophthalmic antibacterial nanomedicine.
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Affiliation(s)
- Xiaomin Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200030, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, 200030, China
- Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Luoyuan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200030, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, 200030, China
- The Eighth Affiliated Hospital Sun Yat-sen University, Shenzhen, Guangdong, 518033, P. R. China
| | - Zhongxing Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200030, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, 200030, China
| | - Haoyu Yu
- The Eighth Affiliated Hospital Sun Yat-sen University, Shenzhen, Guangdong, 518033, P. R. China
| | - Xinru You
- Center for Nanomedicine and Department of Anesthesiology Brigham and Women's Hospital Harvard Medical School, Boston, MA, 02115, USA
| | - Na Kong
- Center for Nanomedicine and Department of Anesthesiology Brigham and Women's Hospital Harvard Medical School, Boston, MA, 02115, USA
| | - Wei Tao
- Center for Nanomedicine and Department of Anesthesiology Brigham and Women's Hospital Harvard Medical School, Boston, MA, 02115, USA
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200030, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, 200030, China
| | - Jinhai Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200030, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, 200030, China
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Kuo MT, Hsu BWY, Lin YS, Fang PC, Yu HJ, Hsiao YT, Tseng VS. Monitoring the Progression of Clinically Suspected Microbial Keratitis Using Convolutional Neural Networks. Transl Vis Sci Technol 2023; 12:1. [PMID: 37910082 PMCID: PMC10627292 DOI: 10.1167/tvst.12.11.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose For this study, we aimed to determine whether a convolutional neural network (CNN)-based method (based on a feature extractor and an identifier) can be applied to monitor the progression of keratitis while managing suspected microbial keratitis (MK). Methods This multicenter longitudinal cohort study included patients with suspected MK undergoing serial external eye photography at the 5 branches of Chang Gung Memorial Hospital from August 20, 2000, to August 19, 2020. Data were primarily analyzed from January 1 to March 25, 2022. The CNN-based model was evaluated via F1 score and accuracy. The area under the receiver operating characteristic curve (AUROC) was used to measure the precision-recall trade-off. Results The model was trained using 1456 image pairs from 468 patients. In comparing models via only training the identifier, statistically significant higher accuracy (P < 0.05) in models via training both the identifier and feature extractor (full training) was verified, with 408 image pairs from 117 patients. The full training EfficientNet b3-based model showed 90.2% (getting better) and 82.1% (becoming worse) F1 scores, 87.3% accuracy, and 94.2% AUROC for 505 getting better and 272 becoming worse test image pairs from 452 patients. Conclusions A CNN-based approach via deep learning applied in suspected MK can monitor the progress/regress during treatment by comparing external eye image pairs. Translational Relevance The study bridges the gap between the investigation of the state-of-the-art CNN-based deep learning algorithm applied in ocular image analysis and the clinical care of suspected patients with MK.
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Affiliation(s)
- Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Benny Wei-Yun Hsu
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yi Sheng Lin
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Yu-Ting Hsiao
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Vincent S. Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Kusumesh R, Ambastha A, Arya LK, Kumari A, Kumari N, Sinha BP, Mohan N, Kumari N. Epidemiological and microbiological profiles of microbial keratitis in a tertiary eye center in Eastern India (Bihar). Indian J Ophthalmol 2023; 71:3506-3512. [PMID: 37870015 PMCID: PMC10752331 DOI: 10.4103/ijo.ijo_1605_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/17/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To determine the demography, risk factors, and causative organisms of microbial keratitis (MK) in Bihar, an eastern state of India. Design Retrospective study. Methods We reviewed the demographic, clinical, and microbiological data of 2303 patients with MK (non-viral) presenting between January 2019 and December 2022. Results This study revealed a predominance of males (65.0%) compared to females (34.9%), with a mean age of 48.4 ± 16.5 years. The majority of patients (63.1%) presented after 2 weeks from the onset of symptoms. The most common risk factor observed was corneal injury (58.1%), followed by ocular surface diseases (13.6%) and diabetes mellitus (13.3%). The majority of patients (73.16%) were involved in agriculture. Prior to presentation, almost all patients (92%) had received topical antibiotics. Unsupervised use of topical corticosteroids was observed in 29.2% of the patients for the median duration of 3 days (odds ratio, 0.17). At presentation, the median size of corneal ulcers was 5 mm, the best-corrected visual acuity was less than 20/400 in 51.4% of patients, and corneal perforation was in 14% of patients. The smear and culture positivity rate were 75.4% and 47.9%, respectively. The common causative organism was fungus (48.8%), followed by bacteria (17.4%). Aspergillus spp. and Staphylococcus spp. were the most commonly identified organisms; a quarter of the patients (24.5%) remained unidentified. All bacteria showed good sensitivity to vancomycin. Conclusion MK is a significant cause of ocular morbidity in Bihar. The knowledge of epidemiology, risk factors, and microbiological profiles of MK can provide a valuable approach to disease prevention, diagnosis, and management.
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Affiliation(s)
- Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Ambastha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Lalan K Arya
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Kumari
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Neha Kumari
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Bibhuti P Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Nilesh Mohan
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Namrata Kumari
- Department of Microbiology Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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22
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Gunasekaran R, Chandrasekaran A, Rajarathinam K, Duncan S, Dhaliwal K, Lalitha P, Prajna NV, Mills B. Rapid Point-of-Care Identification of Aspergillus Species in Microbial Keratitis. JAMA Ophthalmol 2023; 141:966-973. [PMID: 37768674 PMCID: PMC10540059 DOI: 10.1001/jamaophthalmol.2023.4214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/30/2023] [Indexed: 09/29/2023]
Abstract
Importance Microbial keratitis (MK) is a common cause of unilateral visual impairment, blindness, and eye loss in low-income and middle-income countries. There is an urgent need to develop and implement rapid and simple point-of-care diagnostics for MK to increase the likelihood of good outcomes. Objective To evaluate the diagnostic performance of the Aspergillus-specific lateral-flow device (AspLFD) to identify Aspergillus species causing MK in corneal scrape and corneal swab samples of patients presenting with microbial keratitis. Design, Setting, and Participants This diagnostic study was conducted between May 2022 and January 2023 at the corneal clinic of Aravind Eye Hospital in Madurai, Tamil Nadu, India. All study participants were recruited during their first presentation to the clinic. Patients aged 15 years or older met the eligibility criteria if they were attending their first appointment, had a corneal ulcer that was suggestive of a bacterial or fungal infection, and were about to undergo diagnostic scrape and culture. Main Outcomes and Measures Sensitivity and specificity of the AspLFD with corneal samples collected from patients with MK. During routine diagnostic scraping, a minimally invasive corneal swab and an additional corneal scrape were collected and transferred to aliquots of sample buffer and analyzed by lateral-flow device (LFD) if the patient met the inclusion criteria. Photographs of devices were taken with a smartphone and analyzed using a ratiometric approach, which was developed for this study. The AspLFD results were compared with culture reports. Results The 198 participants who met the inclusion criteria had a mean (range) age of 51 (15-85) years and included 126 males (63.6%). Overall, 35 of 198 participants with corneal scrape (17.7%) and 17 of 40 participants with swab samples (42.5%) had positive culture results for Aspergillus species. Ratiometric analysis results for the scrape samples found that the AspLFD achieved high sensitivity (0.89; 95% CI, 0.74-0.95), high negative predictive value (0.97; 95% CI, 0.94-0.99), low negative likelihood ratio (0.12; 95% CI, 0.05-0.30), and an accuracy of 0.94 (95% CI, 0.90-0.97). Ratiometric analysis results for the swab samples showed that the AspLFD had high sensitivity (0.94; 95% CI, 0.73-1.00), high negative predictive value (0.95; 95% CI, 0.76-1.00), low negative likelihood ratio (0.07; 95% CI, 0.01-0.48), and an accuracy of 0.88 (95% CI, 0.73-0.96). Conclusions and Relevance Results of this diagnostic study suggest that AspLFD along with the ratiometric analysis of LFDs developed for this study has high diagnostic accuracy in identifying Aspergillus species from corneal scrapes and swabs. This technology is an important step toward the provision of point-of-care diagnostics for MK and could inform the clinical management strategy.
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Affiliation(s)
- Rameshkumar Gunasekaran
- Department of Ocular Microbiology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Abinaya Chandrasekaran
- Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Karpagam Rajarathinam
- Department of Ocular Microbiology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Sheelagh Duncan
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, United Kingdom
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, United Kingdom
| | - Prajna Lalitha
- Department of Ocular Microbiology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - N. Venkatesh Prajna
- Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Bethany Mills
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, United Kingdom
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23
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Arimoto S, Inagaki K, Todokoro D, Suzuki T, Makimura K, Ishino T. Antifungal Efficacy of Luliconazole in an Experimental Rabbit Model of Fungal Keratitis Caused by Fusarium solani. Mycopathologia 2023; 188:775-782. [PMID: 37603230 DOI: 10.1007/s11046-023-00783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
Fungal keratitis is a corneal fungal infection that potentially leads to blindness and is mainly caused by filamentous fungi, such as Fusarium, with limited drug options available, such as natamycin and voriconazole. Therefore, this study aimed to evaluate the therapeutic effects of the imidazole antifungal drug-luliconazole-using a rabbit experimental model of fungal keratitis caused by Fusarium solani, which is the dominant causative agent of fungal keratitis. F. solani was inoculated into rabbit corneas. luliconazole 1% suspension or natamycin 5% eye drops were administered four times a day (N = 6 for each group) 3 days after inoculation. Signs were scored up to 14 days after inoculation to evaluate the efficacy of the drugs. Compared with the peak mean sign scores of the placebo control group, there was a significant decrease in the mean sign scores of both the treatment groups (P < 0.05). Sign score trends were similar between the two treatment groups. In conclusion, luliconazole demonstrated therapeutic efficacy comparable to that of natamycin in treating experimental fungal keratitis. This suggests that luliconazole can be a novel therapeutic agent for human fungal keratitis.
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Affiliation(s)
- Sho Arimoto
- Department of Parasitology and Tropical Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
- Nihon Nohyaku Co., Ltd., Tokyo, Japan.
| | | | - Daisuke Todokoro
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Suzuki
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Koichi Makimura
- Institute of Medical Mycology, Teikyo University, Tokyo, Japan
| | - Tomoko Ishino
- Department of Parasitology and Tropical Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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24
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Chantra S, Chotcomwongse P, Jittreprasert S, Senarak W, Amornpetchsathaporn A, Kemchoknatee P, Ruamviboonsuk P. Assessment of Direct Costs of Admission Due to Presumed Microbial Keratitis in a Tertiary Referral Hospital in Thailand: A 7-Year Retrospective Study. Clin Ophthalmol 2023; 17:2845-2860. [PMID: 37794953 PMCID: PMC10547063 DOI: 10.2147/opth.s425058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
Objective To evaluate the direct healthcare cost of admission and examine the effects of cost drivers of treating presumed microbial keratitis (MK) at a tertiary referral hospital. Design Retrospective study. Methods A total of 741 patients who presented with MK were included. All information regarding costs was collected, and demographic data were employed for risk factor analysis. Results The total cost of treating MK over a 7-year period at Rajavithi Hospital was US$14,514,625.04, while the median cost was US$10,840.17 per patient (Q1-3, US$5866.56-24,172.28). The medical professional services were the highest cost category in terms of both total cost of treatment over 7 years and median cost per patient, accounting for US$6,474,718.43 and US$5235.20 (Q1-3, US$2582.79-10,474.24) respectively. In 2020, the total cost of treatment declined, corresponding with fewer hospitalized patients; however, the median cost per patient was the highest of all years, amounting to US$15,089.90 (Q1-3, US$8064.17-29102.50), while the median cost per patient from 2014 to 2019 was US$9969.96 (Q1-3, US$5177.98-21,942.68). Statistical significance was found in the median cost per patient in 2020 compared to the median cost per patient in 2014-2019 (p-value 0.019). Risk factors associated with the more expensive cost of treatment were longer length of stay (LOS); age more than 60 years old; readmission; diabetes mellitus (DM); hypertension; and heart disease. Conclusion There were several key factors impacting the direct healthcare costs of severe MK treatment. Medical professional services emerged as the most substantial cost category, while longer hospital stays, older age groups, readmission cases, and comorbidities such as diabetes mellitus, hypertension, and heart disease were all linked to elevated treatment expenses. There were no statistically significant differences in the direct medical expenses during hospitalization associated with treating severe MK, whether the culture results were positive or negative, or regardless of the type of cultured organism utilized.
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Affiliation(s)
- Somporn Chantra
- Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
| | | | | | - Wirapha Senarak
- Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
| | | | - Parinee Kemchoknatee
- Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
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25
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Christy JS, Mathews P, Ravisankar R, Akpek EK. Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India. Indian J Ophthalmol 2023; 71:3171-3177. [PMID: 37602604 PMCID: PMC10565919 DOI: 10.4103/ijo.ijo_1344_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose This study aimed to review the demographics, clinical characteristics, and long-term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital. Methods Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow-up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes. Results The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6-month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three-year follow-up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty. Conclusion Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome.
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Affiliation(s)
| | - Priya Mathews
- Cornea and External Diseases Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, United States
| | | | - Esen K Akpek
- Cornea and External Diseases Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, United States
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26
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Manns RPC, Achiron A, Knyazer B, Elhaddad O, Darcy K, Yahalomi T, Tole D, Avadhanam VS. Use of corneal cross-linking beyond keratoconus: a systemic literature review. Graefes Arch Clin Exp Ophthalmol 2023; 261:2435-2453. [PMID: 36881260 DOI: 10.1007/s00417-023-05994-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/13/2023] [Accepted: 02/04/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE The success of corneal collagen cross-linking in altering keratoconus' clinical course has driven a search for further uses of this procedure. This literature review aims to analyze the scientific evidence available for the benefit of cross-linking in the management of ophthalmic diseases other than progressive keratoconus or ectasia induced by corneal refractive procedures. METHODS A systemic literature review. RESULTS We reviewed 97 studies. We found that collagen cross-linking can limit the progression of several other corneal ectasias, thus reducing and limiting the need for keratoplasty. Collagen cross-linking also can reduce the refractive power of the cornea and can be considered for a moderate degree of bacterial keratitis or when the organism is unidentified, which is refractive to antibiotics alone. However, the comparative rarity of these procedures has limited the extent of evidence. In fungal, Acanthamoeba, and herpes virus keratitis, the evidence is inconclusive of the safety and efficacy of cross-linking. CONCLUSION Current clinical data is limited, and laboratory data has not fully correlated with published clinical data.
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Affiliation(s)
- Richard P C Manns
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
| | - Asaf Achiron
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Omar Elhaddad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kieran Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
| | - Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
| | - Venkata S Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK.
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27
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Mitoma K, Chikama TI, Toda R, Yuasa Y, Kiuchi Y. Usefulness of smear microscopy for therapeutic decision-making in patients with infectious keratitis. Jpn J Ophthalmol 2023; 67:570-577. [PMID: 37439922 DOI: 10.1007/s10384-023-01011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To determine the usefulness of smears in the diagnosis of infectious keratitis by comparing smears and 2 different culture methods. STUDY DESIGN Retrospective, observational study. METHODS The foci of 73 patients diagnosed with infectious keratitis at Hiroshima University Hospital between July 2011 and September 2015 were abraded, and smear microscopy and culturing were performed. The microorganism detection rates and other parameters were compared. RESULTS Microorganisms were detected in 47 of 73 specimens. Microorganisms were identified in 32 of 69 cases cultured on plain medium (detection rate, 46.4%) compared with 22 of 61 cases cultured on swab transport medium (detection rate, 36.1%). There was no significant difference in the microbial detection rate between the plain medium method and the swab transport medium method (P = 0.23). Smear microscopy and culture findings were concordant in 21 (28.8%) cases, and different microorganisms were detected in 9 cases. In 17 cases, the culture was negative, despite the presence of microorganisms on smear microscopy, and in 7 cases, the culture was positive, despite the absence of microorganisms on smear microscopy. The positivity rate of microbial detection was significantly higher when no antimicrobial agents had been administered previously (odds ratio 7.50, P = 0.017). CONCLUSION Smear microscopy of abrasions from lesions is useful for the initiation of treatment for infectious keratitis. However, culture studies should be conducted at the same time to confirm antimicrobial sensitivity. If possible, smear microscopy should be performed before the initiation of antimicrobial therapy.
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Affiliation(s)
- Kaori Mitoma
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan.
| | - Tai-Ichiro Chikama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Ryotaro Toda
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yuki Yuasa
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
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28
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Cesur S, Ilhan E, Tut TA, Kaya E, Dalbayrak B, Bosgelmez-Tinaz G, Arısan ED, Gunduz O, Kijeńska-Gawrońska E. Design of Cinnamaldehyde- and Gentamicin-Loaded Double-Layer Corneal Nanofiber Patches with Antibiofilm and Antimicrobial Effects. ACS OMEGA 2023; 8:28109-28121. [PMID: 37576652 PMCID: PMC10413367 DOI: 10.1021/acsomega.3c00914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023]
Abstract
In this study, two-layer poly(vinyl alcohol)/gelatin (PVA/GEL) nanofiber patches containing cinnamaldehyde (CA) in the first layer and gentamicin (GEN) in the second layer were produced by the electrospinning method. The morphology, chemical structures, and thermal temperatures of the produced pure (PVA/GEL), CA-loaded (PVA/GEL/CA), GEN-loaded (PVA/GEL/GEN), and combined drug-loaded (PVA/GEL/CA/GEN) nanofiber patches were determined by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy, and differential scanning calorimetry, respectively. Their mechanical properties, swelling and degradation behavior, and drug release kinetics were investigated. SEM images showed that both drug-free and drug-loaded nanofiber patches possess smooth and monodisperse structures, and nanofiber size increase occurred as the amount of drug increased. The tensile test results showed that the mechanical strength decreased as the drug was loaded. According to the drug release results, CA release ended at the 96th hour, while GEN release continued until the 264th hour. The antibacterial and antibiofilm activities of PVA/GEL, PVA/GEL/CA, PVA/GEL/GEN, and PVA/GEL/CA/GEN nanofiber patches against Pseudomonas aeruginosa and Staphylococcus aureus were evaluated. Results showed that PVA/GEL/GEN and PVA/GEL/CA/GEN nanofiber patches have excellent antibacterial and antibiofilm activities. Moreover, all materials were biocompatible, with no cytotoxic effects in the mammalian cell model for 8 days. PVA/GEL/GEN nanofiber patches were the most promising material for a high cell survival ratio, which was confirmed by SEM images. This research aims to develop an alternative method to stop and treat the rapid progression of bacterial keratitis.
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Affiliation(s)
- Sumeyye Cesur
- Center
for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, Istanbul 34722, Turkey
- Department
of Metallurgical and Materials Engineering, Faculty of Technology, Marmara University, Istanbul 34722, Turkey
| | - Elif Ilhan
- Center
for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, Istanbul 34722, Turkey
| | - Tufan Arslan Tut
- Center
for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, Istanbul 34722, Turkey
- Department
of Metallurgical and Materials Engineering, Faculty of Technology, Marmara University, Istanbul 34722, Turkey
| | - Elif Kaya
- Department
of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Marmara University, Istanbul 34668, Turkey
| | - Basak Dalbayrak
- Department
of Biotechnology, Institute of Biotechnology, Gebze Technical University, Gebze 41400, Kocaeli, Turkey
| | - Gulgun Bosgelmez-Tinaz
- Department
of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Marmara University, Istanbul 34668, Turkey
| | - Elif Damla Arısan
- Department
of Biotechnology, Institute of Biotechnology, Gebze Technical University, Gebze 41400, Kocaeli, Turkey
| | - Oguzhan Gunduz
- Center
for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, Istanbul 34722, Turkey
- Department
of Metallurgical and Materials Engineering, Faculty of Technology, Marmara University, Istanbul 34722, Turkey
| | - Ewa Kijeńska-Gawrońska
- Centre
for Advanced Materials and Technologies CEZAMAT, Warsaw University of Technology, 02-822 Warsaw, Poland
- Faculty of
Materials Science and Engineering, Warsaw
University of Technology, 02-507 Warsaw, Poland
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29
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Al-Mahrouqi H, Cheung IMY, Angelo L, Yu TY, Gokul A, Ziaei M. Therapeutic non-ectasia applications of cornea cross-linking. Clin Exp Optom 2023; 106:580-590. [PMID: 36690333 DOI: 10.1080/08164622.2022.2159790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/28/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023] Open
Abstract
Corneal cross-linking is a photopolymerization technique traditionally used to strengthen corneal tissue. Corneal cross-linking utilizes riboflavin (vitamin B2) as a photosensitizer and ultraviolet-A light (UVA) to create strong covalent bonds within the corneal stroma, increasing tissue stiffness. Multiple studies have demonstrated corneal cross-linking's effectiveness in treating corneal ectasia, a progressive, degenerative, and non-inflammatory thinning disorder, as quantified by key tomographic, refractive, and visual parameters. Since its introduction two decades ago, corneal cross-linking has surpassed its original application in halting corneal ectatic disease and its application has expanded into several other areas. Corneal cross-linking also possesses antibacterial, antienzymolytic and antioedematous properties, and has since become a tool in treating microbial keratitis, correcting refractive error, preventing iatrogenic ectasia, stabilising bullous keratopathy and controlling post keratoplasty ametropia. This review provides an overview of the current evidence base for the therapeutic non-ectasia applications of cornea cross-linking and looks at future developments in the field.
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Affiliation(s)
| | | | - Lize Angelo
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Tzu-Ying Yu
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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30
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Atta S, Singh RB, Samanthapudi K, Perera C, Omar M, Nayyar S, Kowalski RP, Jhanji V. Clinical Characterization and Outcomes of Culture- and Polymerase Chain Reaction-Negative Cases of Infectious Keratitis. Diagnostics (Basel) 2023; 13:2528. [PMID: 37568892 PMCID: PMC10417528 DOI: 10.3390/diagnostics13152528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/11/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE To examine the clinical presentation, management, and outcomes of culture and polymerase chain reaction (PCR) negative cases of infectious keratitis. METHODS In this retrospective case series, we evaluated the laboratory and medical records of culture- and PCR-negative cases (2016-2020) reported to a tertiary care center, which were presumed to be infectious keratitis on the basis of clinical history and presentation. RESULTS A total of 121 cases with culture-negative keratitis were included in this study. The mean age of the patients was 48.42 ± 1.89 years, and 53.72% were female. At presentation, the presumed etiology was viral in 38.01%, bacterial in 27.27%, fungal in 8.26%, Acanthamoeba in 6.61%, and unlisted in 28.92% of cases. The most common risk factors were a previous history of ocular surface diseases (96.69%) and contact lens use (37.19%). In total, 61.98% of the patients were already on antimicrobial medication at presentation. The initial management was altered in 79 cases (65.29%) during the treatment course. Average presenting and final (post-treatment) visual acuities (VA) were 0.98 ± 0.04 (LogMAR) and 0.42 ± 0.03 (LogMAR), respectively. A significantly higher frequency of patients with a final VA worse than 20/40 (Snellen) had worse VA at initial presentation (p < 0.0001). A history of ocular surface disease, cold sores, and recurrent infection (p < 0.05) were more commonly associated with a presumed diagnosis of viral keratitis. The patients with presumed bacterial etiology were younger and had a history of poor contact lens hygiene (p < 0.05). CONCLUSIONS We observed a distinct difference in clinical features among patients with culture-negative and PCR-negative keratitis managed for presumed viral and bacterial infections. Although there was significant variability in presentation and management duration in this cohort, the visual outcomes were generally favorable.
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Affiliation(s)
- Sarah Atta
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.A.); (K.S.); (M.O.); (S.N.); (R.P.K.)
| | - Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02115, USA;
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Keerthana Samanthapudi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.A.); (K.S.); (M.O.); (S.N.); (R.P.K.)
| | - Chandrashan Perera
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Mahmoud Omar
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.A.); (K.S.); (M.O.); (S.N.); (R.P.K.)
| | - Shannon Nayyar
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.A.); (K.S.); (M.O.); (S.N.); (R.P.K.)
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Regis P. Kowalski
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.A.); (K.S.); (M.O.); (S.N.); (R.P.K.)
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.A.); (K.S.); (M.O.); (S.N.); (R.P.K.)
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Chantra S, Jittreprasert S, Chotcomwongse P, Amornpetchsathaporn A. Estimated direct and indirect health care costs of severe infectious keratitis by cultured organisms in Thailand: An 8-year retrospective study. PLoS One 2023; 18:e0288442. [PMID: 37437049 DOI: 10.1371/journal.pone.0288442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE To evaluate the economic impact of treating severe infectious keratitis (IK) at one tertiary referral center in Thailand by analyzing the direct costs of treatment and estimating the indirect costs, and to determine whether cultured organisms had any effect on treatment expenditure. METHODS A retrospective study was conducted of patients with severe IK who had been hospitalized between January 2014 and December 2021 in Rajavithi Hospital. Data from medical records were collected from the time of the patients' admission until the point at which they were discharged and treated in the outpatient department and their IK was completely healed, or until evisceration/enucleation was performed. The direct costs of treatment included fees for services, medical professionals and investigation, as well as for operative and non-operative treatment. The indirect costs consisted of patients' loss of wages, and costs of travel and food. RESULTS A total of 335 patients were studied. The median direct, indirect and total costs were US$65.2, range US$ 6.5-1,119.1, US$314.5, range US$50.8-1,067.5, and US$426.1, range 57.5-1,971.5 respectively. There was no statistically significant difference between direct, indirect, or total treatment costs for culture-negative and culture-positive patients. Among those who were positive, fungal infections entailed the highest total cost of treatment, and this difference was statistically significant (p<0.001). In terms of direct and indirect costs, patients with fungal infections had the greatest direct costs, and this figure was statistically significant (p = 0.001); however, those with parasitic infections had the highest indirect treatment costs, and this was also statistically significant (p<0.001). CONCLUSION Severe IK can cause serious vision impairment or blindness. Indirect costs represented the majority of the expense at 73.8%. There was no difference between direct, indirect, and total treatment costs for patients who were culture-negative or positive. Among the latter, fungal infections resulted in the highest total cost of treatment.
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Affiliation(s)
- Somporn Chantra
- Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
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Shekhawat NS, Hall LN, Sulewski ME, Woreta F, Wang J, Smith K, Kuo IC. Corneal Culture and Antibiotic Susceptibility Results for Microbial Keratitis in the Mid-Atlantic Region of the United States, 2016 to 2020. Eye Contact Lens 2023; 49:267-274. [PMID: 37166232 PMCID: PMC10330016 DOI: 10.1097/icl.0000000000000993] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To examine the microbial distribution and antimicrobial susceptibility of culture-positive microbial keratitis at a large tertiary referral center in the mid-Atlantic region of the United States. METHODS Retrospective review of culture-positive microbial keratitis cases at the Wilmer Eye Institute from 2016 through 2020. RESULTS Of the 474 culture-positive microbial keratitis cases, most were bacterial (N=450, 94.9%), followed by fungal (N=48, 10.1%) and Acanthamoeba keratitis (N=15, 3.1%). Of the 450 bacterial isolates, 284 (69.5%) were gram-positive organisms, whereas 157 (28.4%) were gram-negative organisms. The most common bacterial species isolated was coagulase-negative Staphylococcus spp (N=154, 24.8%), and the most common gram-negative isolate was Pseudomonas aeruginosa (N=76, 12.3%). Among fungi, the most common isolates were Candida (N=25, 45.4%), whereas Fusarium (N=6, 10.9%) and Aspergillus (N=3, 5.5%) were less common. Of the 217 bacterial isolates tested for erythromycin susceptibility, 121 (55.7%; ∼60% of coagulase-negative staphylococci and corynebacteria tested) showed resistance to erythromycin. CONCLUSIONS Microbial keratitis in the Baltimore Mid-Atlantic region of the United States is most commonly caused by bacteria, with fungi and acanthamoeba being less common. Gram-positive bacterial infections predominate. Among fungal keratitis cases, Candida species are more commonly encountered than are filamentous species. Use of erythromycin as infection prophylaxis should be reexamined. Findings from our study may guide empiric treatment in this geographic region.
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Affiliation(s)
- Nakul S. Shekhawat
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leangelo N. Hall
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E. Sulewski
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika Woreta
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiangxia Wang
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA
| | - Kerry Smith
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irene C. Kuo
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
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Wu J, Yuan Z, Fang Z, Huang Z, Xu Y, Xie W, Wu F, Yao YF. A knowledge-enhanced transform-based multimodal classifier for microbial keratitis identification. Sci Rep 2023; 13:9003. [PMID: 37268729 DOI: 10.1038/s41598-023-36024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/27/2023] [Indexed: 06/04/2023] Open
Abstract
Microbial keratitis, a nonviral corneal infection caused by bacteria, fungi, and protozoa, is an urgent condition in ophthalmology requiring prompt treatment in order to prevent severe complications of corneal perforation and vision loss. It is difficult to distinguish between bacterial and fungal keratitis from image unimodal alone, as the characteristics of the sample images themselves are very close. Therefore, this study aims to develop a new deep learning model called knowledge-enhanced transform-based multimodal classifier that exploited the potential of slit-lamp images along with treatment texts to identify bacterial keratitis (BK) and fungal keratitis (FK). The model performance was evaluated in terms of the accuracy, specificity, sensitivity and the area under the curve (AUC). 704 images from 352 patients were divided into training, validation and testing set. In the testing set, our model reached the best accuracy was 93%, sensitivity was 0.97(95% CI [0.84,1]), specificity was 0.92(95% CI [0.76,0.98]) and AUC was 0.94(95% CI [0.92,0.96]), exceeding the benchmark accuracy of 0.86. The diagnostic average accuracies of BK ranged from 81 to 92%, respectively and those for FK were 89-97%. It is the first study to focus on the influence of disease changes and medication interventions on infectious keratitis and our model outperformed the benchmark models and reaching the state-of-the-art performance.
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Affiliation(s)
- Jianfeng Wu
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 31002, China
| | - Zhouhang Yuan
- College of Computer Science and Technology, Zhejiang University, Hangzhou, Zhejiang Province, 31002, China
| | - Zhengqing Fang
- College of Computer Science and Technology, Zhejiang University, Hangzhou, Zhejiang Province, 31002, China
| | - Zhengxing Huang
- College of Computer Science and Technology, Zhejiang University, Hangzhou, Zhejiang Province, 31002, China
| | - Yesheng Xu
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310016, China
- Key Laboratory for Corneal Diseases Research of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Wenjia Xie
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310016, China
- Key Laboratory for Corneal Diseases Research of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Fei Wu
- College of Computer Science and Technology, Zhejiang University, Hangzhou, Zhejiang Province, 31002, China.
| | - Yu-Feng Yao
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310016, China.
- Key Laboratory for Corneal Diseases Research of Zhejiang Province, Hangzhou, Zhejiang Province, China.
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Parmar GS, Meena AK, Borde P, Prasad S. Microbial keratitis and antibiotic sensitivity patterns: A retrospective analysis at a tertiary center in Central India. Indian J Ophthalmol 2023; 71:2455-2459. [PMID: 37322659 PMCID: PMC10417949 DOI: 10.4103/ijo.ijo_2070_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To report on the microbiological profile and antibiotic sensitivity patterns of infectious keratitis at a tertiary center in central India. Methods The suspected case of severe keratitis underwent microbiological culture and identification using the VITEK 2 technique. Antibiotic susceptibility for different sensitivity and resistance patterns was analyzed. Demographics, clinical profile, and socioeconomic history was also documented. Results Culture was positive in 233/455 (51.2%) patients. Pure bacterial growth was present in 83 (35.62%) patients and pure fungus was present in 146 (62.66%) patients. The most common bacterial cause of infectious keratitis was Pseudomonas followed by Staphylococcus and Bacillus. Pseudomonas showed 65%-75% resistance against levofloxacin, ceftazidime, imipenem, gentamycin, ciprofloxacin, and amikacin. Staphylococcus showed 65%-70% resistance against levofloxacin, erythromycin, and ciprofloxacin, with Streptococcus being 100% resistant to erythromycin. Conclusion This study highlights the current trend of microbiological profiles of infectious keratitis and their antibiotic susceptibility at a rural setup in central India. Fungal predominance and increased resistance against the commonly used antibiotics were noted.
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Affiliation(s)
- Gautam Singh Parmar
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Ashok Kumar Meena
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Prashant Borde
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Sonali Prasad
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
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Ong ZZ, Sadek Y, Liu X, Qureshi R, Liu SH, Li T, Sounderajah V, Ashrafian H, Ting DSW, Said DG, Mehta JS, Burton MJ, Dua HS, Ting DSJ. Diagnostic performance of deep learning in infectious keratitis: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e065537. [PMID: 37164459 PMCID: PMC10173987 DOI: 10.1136/bmjopen-2022-065537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Infectious keratitis (IK) represents the fifth-leading cause of blindness worldwide. A delay in diagnosis is often a major factor in progression to irreversible visual impairment and/or blindness from IK. The diagnostic challenge is further compounded by low microbiological culture yield, long turnaround time, poorly differentiated clinical features and polymicrobial infections. In recent years, deep learning (DL), a subfield of artificial intelligence, has rapidly emerged as a promising tool in assisting automated medical diagnosis, clinical triage and decision-making, and improving workflow efficiency in healthcare services. Recent studies have demonstrated the potential of using DL in assisting the diagnosis of IK, though the accuracy remains to be elucidated. This systematic review and meta-analysis aims to critically examine and compare the performance of various DL models with clinical experts and/or microbiological results (the current 'gold standard') in diagnosing IK, with an aim to inform practice on the clinical applicability and deployment of DL-assisted diagnostic models. METHODS AND ANALYSIS This review will consider studies that included application of any DL models to diagnose patients with suspected IK, encompassing bacterial, fungal, protozoal and/or viral origins. We will search various electronic databases, including EMBASE and MEDLINE, and trial registries. There will be no restriction to the language and publication date. Two independent reviewers will assess the titles, abstracts and full-text articles. Extracted data will include details of each primary studies, including title, year of publication, authors, types of DL models used, populations, sample size, decision threshold and diagnostic performance. We will perform meta-analyses for the included primary studies when there are sufficient similarities in outcome reporting. ETHICS AND DISSEMINATION No ethical approval is required for this systematic review. We plan to disseminate our findings via presentation/publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022348596.
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Affiliation(s)
- Zun Zheng Ong
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Youssef Sadek
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Xiaoxuan Liu
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Su-Hsun Liu
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Daniel Shu Wei Ting
- Duke-NUS Medical School, National University of Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Dalia G Said
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
- Research Institute of Ophthalmology, Cairo, Egypt
| | - Jodhbir S Mehta
- Duke-NUS Medical School, National University of Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Harminder Singh Dua
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren Shu Jeng Ting
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
- Birmingham and Midland Eye Centre, Birmingham, UK
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Todokoro D, Miyakubo T, Makimura K, Tamura T, Komori A, Akiyama H. Fungal Keratitis Caused by Talaromyces coalescens: A Case Report. Mycopathologia 2023:10.1007/s11046-023-00738-w. [PMID: 37160497 DOI: 10.1007/s11046-023-00738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/17/2023] [Indexed: 05/11/2023]
Abstract
Fungal keratitis is a severe corneal infection, and the causative fungi include various rare fungal species. Fungal keratitis caused by Talaromyces species has yet to be reported, and there is no information about this fungus as a cause of keratitis. A 77-year-old man developed fungal keratitis while waiting for a donor cornea due to bullous keratopathy in his left eye. Fungal culture of a corneal scraping grew filamentous fungi, which were morphologically identified as Paecilomyces species. The corneal infection did not improve after topical administration of 1% voriconazole, and ribosomal DNA sequencing definitively verified the fungus to be Talaromyces coalescens. The lesion gradually improved after switching to topical 5% natamycin. Antifungal susceptibility tests determined the high minimum inhibitory concentrations of voriconazole to be > 8 μg/mL. This is the first report of Talaromyces fungal keratitis. Clinicians, especially those in ophthalmology, need to be aware of this rare fungus.
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Affiliation(s)
- Daisuke Todokoro
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi-city, Gunma, 371-8511, Japan.
| | - Tomoko Miyakubo
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi-city, Gunma, 371-8511, Japan
| | - Koichi Makimura
- Teikyo University Institute of Medical Mycology, 2-11-1 Koga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Takashi Tamura
- Teikyo University Institute of Medical Mycology, 2-11-1 Koga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Aya Komori
- Teikyo University Institute of Medical Mycology, 2-11-1 Koga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi-city, Gunma, 371-8511, Japan
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Ashby NS, Johnson TJ, Castillo-Ronquillo Y, Payne CJ, Davenport C, Hoopes PC, Moshirfar M. Cutibacterium (Formerly Propionibacterium ) acnes Keratitis: A Review. Eye Contact Lens 2023; 49:212-218. [PMID: 36888541 DOI: 10.1097/icl.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ABSTRACT Infectious keratitis is a devastating cause of vision loss worldwide. Cutibacterium acnes ( C. acnes ), a commensal bacterium of the skin and ocular surface, is an underrecognized but important cause of bacterial keratitis. This review presents the most comprehensive and up-to-date information for clinicians regarding the risk factors, incidence, diagnosis, management, and prognosis of C. acnes keratitis (CAK). Risk factors are similar to those of general bacterial keratitis and include contact lens use, past ocular surgery, and trauma. The incidence of CAK may be approximately 10%, ranging from 5% to 25% in growth-positive cultures. Accurate diagnosis requires anaerobic blood agar and a long incubation period (≥7 days). Typical clinical presentation includes small (<2 mm) ulcerations with deep stromal infiltrate causing an anterior chamber cell reaction. Small, peripheral lesions are usually resolved, and patients recover a high visual acuity. Severe infections causing VA of 20/200 or worse are common and often do not significantly improve even after treatment. Vancomycin is considered the most potent antibiotic against CAK, although other antibiotics such as moxifloxacin and ceftazidime are more commonly used as first-line treatment.
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Affiliation(s)
- Nathaniel S Ashby
- Creighton University School of Medicine (N.S.A.), Omaha, NE; Spencer Fox Eccles School of Medicine at the University of Utah (T.J.J.), Salt Lake City, UT; Hoopes Vision Research Center (Y.C.-R., C.J.P., C.D., P.C.H., M.M.), Hoopes Vision, Draper, UT; Case Western Reserve University School of Medicine (C.J.P.), Cleveland, OH; John A. Moran Eye Center (M.M.), Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT; and Utah Lions Eye Bank (M.M.), Murray, UT
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Sakr SI, Nayel AA, Habeel CS, Elkhabiry HK, Ibrahim GM, Tolba MM, Ghaith AA. Epidemiological profile of microbial keratitis in Alexandria-Egypt a 5 years retrospective study. J Ophthalmic Inflamm Infect 2023; 13:18. [PMID: 37055636 PMCID: PMC10102273 DOI: 10.1186/s12348-023-00332-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/26/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE To evaluate the epidemiologic profile of microbial keratitis in Alexandria- Egypt, with special emphasis on risk factors, visual outcome and microbiological results. METHODS This retrospective study reviewed files of patients treated for microbial keratitis during a period of 5 years at Alexandria Ophthalmology Hospital Cornea Clinic, Alexandria- Egypt, between February 2017 and June 2022. The patients were evaluated for the risk factors e.g., trauma, eyelid disorders, co-morbidities, and contact lens use. They were also evaluated for their clinical picture, the identified microorganisms, visual outcomes, and complications. Non-microbial keratitis and incomplete files were excluded from the study. RESULTS A total of 284 patients were diagnosed as microbial keratitis in our study. Viral keratitis was the most common cause of microbial keratitis (n = 118 (41.55%)), followed by bacterial keratitis (n = 77 (27.11%)), mixed keratitis (n = 51 (17.96%)), acanthamoeba keratitis (n = 22 (7.75%)) and the least cause was fungal keratitis (n = 16 (5.63%)). Trauma was the most common risk factor for microbial keratitis (29.2%). Fungal keratitis had a statistically significant association with trauma (p < 0.001), while the use of contact lenses had a statistically significant association with Acanthamoeba keratitis (p < 0.001). The percentage of culture-positive results in our study was 76.8%. Gram-positive bacteria were the most frequently isolated bacterial isolate (n = 25 (36.2%)), while filamentous fungi were the most frequently isolated fungi (n = 13(18.8%)). After treatment, there was a significant increase in the mean visual acuity among all groups; it was significantly higher in Acanthamoeba keratitis group with a mean difference of 0.262 ± 0.161 (p = 0.003). CONCLUSION Viral keratitis followed by bacterial keratitis were the most frequent etiologic agents causing microbial keratitis found in our study. Although trauma was the most frequent risk factor for microbial keratitis, contact lens wear was found an important preventable risk factor for microbial keratitis in young patients. Performing culture properly whenever indicated before starting antimicrobial treatment increased the cultures' positive results.
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Affiliation(s)
- Suzan Ibrahim Sakr
- Cornea Clinic, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt.
| | - Amira Ahmed Nayel
- Clinical Pharmacy Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Christeena Saeed Habeel
- Cornea Clinic, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Hala Kamal Elkhabiry
- Microbiology Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Ghada Mahmoud Ibrahim
- Microbiology Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | | | - Alaa Atef Ghaith
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Huertas-Bello M, Cuéllar-Sáenz JA, Rodriguez CN, Cortés-Vecino JA, Navarrete ML, Avila MY, Koudouna E. A Pilot Study to Evaluate Genipin in Staphylococcus aureus and Pseudomonas aeruginosa Keratitis Models: Modulation of Pro-Inflammatory Cytokines and Matrix Metalloproteinases. Int J Mol Sci 2023; 24:ijms24086904. [PMID: 37108070 PMCID: PMC10138382 DOI: 10.3390/ijms24086904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023] Open
Abstract
Infectious keratitis is a vision-threatening microbial infection. The increasing antimicrobial resistance and the fact that severe cases often evolve into corneal perforation necessitate the development of alternative therapeutics for effective medical management. Genipin, a natural crosslinker, was recently shown to exert antimicrobial effects in an ex vivo model of microbial keratitis, highlighting its potential to serve as a novel treatment for infectious keratitis. This study aimed to evaluate the antimicrobial and anti-inflammatory effects of genipin in an in vivo model of Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa) keratitis. Clinical scores, confocal microscopy, plate count, and histology were carried out to evaluate the severity of keratitis. To assess the effect of genipin on inflammation, the gene expression of pro- and anti-inflammatory factors, including matrix metalloproteinases (MMPs), were evaluated. Genipin treatment alleviated the severity of bacterial keratitis by reducing bacterial load and repressing neutrophil infiltration. The expression of interleukin 1B (IL1B), interleukin 6 (IL6), interleukin 8 (IL8), interleukin 15 (IL15), tumor necrosis factor-α (TNF-α), and interferon γ (IFNγ), as well as MMP2 and MMP9, were significantly reduced in genipin-treated corneas. Genipin promoted corneal proteolysis and host resistance to S. aureus and P. aeruginosa infection by suppressing inflammatory cell infiltration, regulating inflammatory mediators, and downregulating the expression of MMP2 and MMP9.
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Affiliation(s)
- Marcela Huertas-Bello
- Department of Ophthalmology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Jerson Andrés Cuéllar-Sáenz
- Grupo de Investigación Parasitología Veterinaria, Department of Animal Health, Faculty of Veterinary Medicine and Zootechnics, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Cristian Nicolas Rodriguez
- Department of Microbiology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Jesús Alfredo Cortés-Vecino
- Grupo de Investigación Parasitología Veterinaria, Department of Animal Health, Faculty of Veterinary Medicine and Zootechnics, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Myriam Lucia Navarrete
- Department of Microbiology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Marcel Yecid Avila
- Department of Ophthalmology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Elena Koudouna
- Department of Ophthalmology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
- Structural Biophysics Group, School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4HQ, UK
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Ung L, Chodosh J. Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis. Ocul Surf 2023; 28:378-400. [PMID: 34461290 PMCID: PMC10721114 DOI: 10.1016/j.jtos.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Abstract
Infectious keratitis is a rare but potentially severe sight-threatening disease, associated with considerable societal burden, cost and morbidity. This review summarises the most recent evidence for the incidence, risk factors and impact of disease, all of which vary widely according to region, access to health care, socioeconomic and environmental factors, predisposing conditions and causative organisms. The frequency and societal impact of infectious keratitis are significantly higher in low-income countries. In non-viral infectious keratitis, bacterial causes predominate in most regions. Fungi, particularly linked with agricultural trauma, are more frequently associated with infectious keratitis in low-income regions, particularly in India and certain African countries. The disease impact is compounded by poverty and limited access to services and treatment. Early diagnosis, access to appropriate treatment, prophylaxis in ocular trauma, availability of eye protection, awareness of risk factors may be associated with reduced disease severity and vision loss. Evidence for the incidence and burden of disease is lacking in certain regions and well-designed epidemiological studies to identify independent risk factors for the disease and those associated with more severe outcomes may better identify causation and guide resource allocation and preventative strategies.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Level 3, North Wing, RMB, Gate 14, Barker St, Sydney, NSW, 2052, Australia.
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42
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Raj N, Gupta N, Kumar D, Vashist P, Tandon R. Population-based study on the prevalence, clinical characteristics and vision-related quality of life in patients with corneal opacity resulting from infectious keratitis: results from the Corneal Opacity Rural Epidemiological study. Br J Ophthalmol 2023; 107:476-482. [PMID: 34772664 DOI: 10.1136/bjophthalmol-2021-320077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/31/2021] [Indexed: 11/03/2022]
Abstract
AIM To estimate prevalence and characterise clinical features and vision-related quality of life (VR-QoL) of corneal opacities (COs) resulting from infectious keratitis in a rural North Indian population. METHODS The Corneal Opacity Rural Epidemiological study was a cross-sectional study conducted in 25 randomly selected clusters of rural Gurgaon, Haryana, India to determine prevalence of corneal disease across all age groups. During house-to-house visits, sociodemographic details, presence, type and clinical characteristics of corneal disease, laterality and resultant visual impairment (VI) was noted. Subgroup analysis of data was performed to understand the prevalence, clinical characteristics, VR-QoL in patients with CO due to infectious keratitis. VR-QoL scores were compared with healthy controls. RESULTS Overall, 65 of 12 113 participants had evidence of infectious keratitis-related CO with a mean age of 63.3 (±14.7 SD) years. Prevalence of infectious keratitis-related CO, including both bilateral (12/65) and unilateral (53/65) cases was 0.54% (95% CI 0.41 to 0.66) seen in a total of 77 eyes of 65 participants. Mean visual acuity was 1.18±0.80 with 30/77 (38.9%) eyes having a presenting visual acuity <3/60. Most of the CO due to infectious keratitis was <3 mm in size (61.03%; 47/77), nebular (42.85%; 33/77) and central (49.35%; 38/77) in location. These participants had significantly higher VR-QoL scores and hence poorer VR-QoL across all three domains of vision function (scores of 28 vs 22, 7.5 vs 5 and 15.5 vs 9, respectively; p<0.0001) when compared with healthy controls. CONCLUSION The data from this study give an insight into the burden and clinical characteristics of COs resulting from infectious keratitis. VR-QoL is significantly impaired in patients with CO resulting from infectious keratitis, both in bilateral and unilateral cases.
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Affiliation(s)
- Nimmy Raj
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Kumar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Vashist
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Incidence, Clinical Profile, and Management of Keratitis Caused by Uncommon Species of Pseudomonas at a Tertiary Eye Care Center. Cornea 2023; 42:359-364. [PMID: 36729653 DOI: 10.1097/ico.0000000000003194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/30/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to study the incidence, demographic features, clinical course, profiling, and management of uncommon species of Pseudomonas keratitis (other than Pseudomonas aeruginosa ) at a tertiary eye care center. METHODS Thirty cases of culture-proven uncommon species of Pseudomonas keratitis between January 2017 and December 2021 were retrospectively studied. The incidence, demographic and clinical profile, predisposing factors, microbial results, treatment, and visual outcomes were analyzed. We evaluated the risk factors for poor treatment outcomes. RESULTS Among bacterial keratitis cases, uncommon species of Pseudomonas keratitis occurred at a rate of 2.2%. The mean age at presentation was 51.37 years, and the most common predisposing factor was corneal trauma (36.7%). The mean best corrected visual acuity (BCVA) [in log of minimum angle of resolution (logMAR)] at presentation was 1.99, and the mean ulcer size was 5.75 mm. On culture, 56.7% of the cases were identified as Pseudomonas putida , 26.7% as Pseudomonas stutzeri , 10% as Pseudomonas mendocina, and 3.3% each of Pseudomonas oryzihabitans and Pseudomonas alcaligenes . We recorded good treatment responses in 66.7% of cases with the medical therapy of a combination of broad-spectrum antibiotics, whereas 33.3% of cases required surgical intervention. The risk factors for poor clinical outcome were older age, ocular trauma, previous ocular surgeries, poor BCVA at presentation, large ulcer size, delayed treatment, hypopyon, and early complications such as perforation, limbal involvement, and total ulcer. CONCLUSIONS Uncommon species of pseudomonas keratitis was more closely related to predisposing factors such as corneal trauma and other factors such as previous ocular surgeries, older age, large ulcers, longer duration of treatment, early surgical intervention in complicated cases, and poor visual outcome.
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Nanayakkara U, Khan MA, Hargun DK, Sivagnanam S, Samarawickrama C. Ocular streptococcal infections: A clinical and microbiological review. Surv Ophthalmol 2023:S0039-6257(23)00036-X. [PMID: 36764397 DOI: 10.1016/j.survophthal.2023.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
Streptococcus is a diverse bacterial genus that is part of the ocular surface microbiome implicated in conjunctivitis, keratitis, endophthalmitis, dacryocystitis, and orbital cellulitis which can lead to decreased visual acuity and require surgical intervention. The pathophysiology of S. pneumoniae is well established and the role of the polysaccharide capsule, pneumolysin, neuraminidases, and zinc metalloproteinases in ocular infections described. Additionally, key virulence factors of the viridans group streptococci such as cytolysins and proteases have been outlined, but there is a paucity of research on the remaining streptococcus species. These virulence factors tend to result in aggressive disease. Clinically, S. pneumoniae is implicated in 2.7-41.2% of bacterial conjunctivitis cases, more predominant in the pediatric population, and is implicated in 1.8-10.7% of bacterial keratitis isolates. Streptococcus bacteria are significantly implicated in acute postoperative, post-intravitreal, and bleb-associated endophthalmitis, responsible for 10.3-37.5, 29.4, and 57.1% of cases, respectively. Group A and B streptococcus endogenous endophthalmitis is rare, but has a very poor prognosis. Inappropriate prescription of antibiotics in cases of non-bacterial aetiology has contributed to increasing resistance, and a clinical index is needed to more accurately monitor this. Furthermore, there is an increasing need for prospective, surveillance studies of antimicrobial resistance in ocular pathogens, as well as point-of-care testing using molecular techniques.
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Affiliation(s)
| | | | | | - Shobini Sivagnanam
- Blacktown Hospital, Sydney, Australia; Australian Clinical Labs, Bella Vista, Sydney, Australia
| | - Chameen Samarawickrama
- University of Sydney, Australia; Translational Ocular Research and Immunology Consortium (TORIC), Westmead Institute for Medical Research, Australia.
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Yang Z, Yu S, Zhang C, Agrawal R, Feng Y. Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series. Ophthalmol Ther 2023; 12:599-611. [PMID: 36269489 PMCID: PMC9834490 DOI: 10.1007/s40123-022-00592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/05/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Severe viral keratitis with hypopyon and retrocorneal plaques is easily misdiagnosed as it mimics fungal or bacterial keratitis and is more likely to undergo emergency therapeutic penetrating keratoplasty (TPK) in the presence of active infection, resulting in poor outcomes. This case series offers some important insights for the management strategy of severe viral keratitis. METHODS This retrospective case series involved five patients with unilateral severe infectious keratitis with hypopyon over 3 mm and retrocorneal endothelial plaques. Testing for corneal sensation, microscopy, culture, and anterior segment optical coherence tomography (ASOCT) were performed. RESULTS At presentation, all five cases had visual acuity of counting fingers (CF) or worse, large centrally located ulcer with clean ulcer surface, hypopyon, and retrocorneal plaques with reduced corneal sensation. ASOCT demonstrated the presence of retrocorneal plaques with clear space between corneal endothelium and plaques. All cases received systemic and topical ganciclovir and topical steroids. Two patients received intravenous immunoglobulin (IVIG) weekly for 2 weeks. Complete resolution was achieved in all cases except one patient who underwent TPK because of diffuse anterior synechiae of the iris, with recurrence of infection after 10 days. The patients who received IVIG showed resolution earlier compared to the other patients. CONCLUSIONS Evaluation of characteristics of retrocorneal plaques by ASOCT and reduced corneal sensation are valuable aids in diagnosis of complicated viral keratitis. Conservative medical management may be a viable option even in severe cases. IVIG may have a role in speedy resolution of severe cases, but more research is needed to confirm this.
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Affiliation(s)
- Zhen Yang
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Shuo Yu
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Chun Zhang
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Rupesh Agrawal
- grid.240988.f0000 0001 0298 8161National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore ,grid.272555.20000 0001 0706 4670Singapore Eye Research Institute, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke NUS Medical School, Singapore, Singapore
| | - Yun Feng
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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Woodward MA, Niziol LM, Ballouz D, Lu MC, Kang L, Thibodeau A, Singh K. Prediction of Visual Acuity in Patients With Microbial Keratitis. Cornea 2023; 42:217-223. [PMID: 36256452 PMCID: PMC9805475 DOI: 10.1097/ico.0000000000003129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/16/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to predict visual acuity (VA) 90 days after presentation for patients with microbial keratitis (MK) from data at the initial clinical ophthalmic encounter. METHODS Patients with MK were identified in the electronic health record between August 2012 and February 2021. Random forest (RF) models were used to predict 90-day VA < 20/40 [visual impairment (VI)]. Predictors evaluated included age, sex, initial VA, and information documented in notes at presentation. Model diagnostics are reported with 95% confidence intervals (CIs) for area under the curve (AUC), misclassification rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS One thousand seven hundred ninety-one patients were identified. The presenting logMAR VA was on average 0.86 (Snellen equivalent and standard deviation = 20/144 ± 12.6 lines) in the affected or worse eye, and 43.6% with VI. VI at 90-day follow-up was present in the affected eye or worse eye for 26.9% of patients. The RF model for predicting 90-day VI had an AUC of 95% (CI: 93%-97%) and a misclassification rate of 9% (7%-12%). The percent sensitivity, specificity, PPV, and NPV were 86% (80%-91%), 92% (89%-95%), 81% (74%-86%), and 95% (92%-97%), respectively. Older age, worse presenting VA, and more mentions of "penetrating keratoplasty" and "bandage contact lens" were associated with increased probability of 90-day VI, whereas more mentions of "quiet" were associated with decreased probability of 90-day VI. CONCLUSIONS RF modeling yielded good sensitivity and specificity to predict VI at 90 days which could guide clinicians about the risk of poor vision outcomes for patients with MK.
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Affiliation(s)
- Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Dena Ballouz
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Linda Kang
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Alexa Thibodeau
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Karandeep Singh
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Ting DSJ, Deshmukh R, Ting DSW, Ang M. Big data in corneal diseases and cataract: Current applications and future directions. Front Big Data 2023; 6:1017420. [PMID: 36818823 PMCID: PMC9929069 DOI: 10.3389/fdata.2023.1017420] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
The accelerated growth in electronic health records (EHR), Internet-of-Things, mHealth, telemedicine, and artificial intelligence (AI) in the recent years have significantly fuelled the interest and development in big data research. Big data refer to complex datasets that are characterized by the attributes of "5 Vs"-variety, volume, velocity, veracity, and value. Big data analytics research has so far benefitted many fields of medicine, including ophthalmology. The availability of these big data not only allow for comprehensive and timely examinations of the epidemiology, trends, characteristics, outcomes, and prognostic factors of many diseases, but also enable the development of highly accurate AI algorithms in diagnosing a wide range of medical diseases as well as discovering new patterns or associations of diseases that are previously unknown to clinicians and researchers. Within the field of ophthalmology, there is a rapidly expanding pool of large clinical registries, epidemiological studies, omics studies, and biobanks through which big data can be accessed. National corneal transplant registries, genome-wide association studies, national cataract databases, and large ophthalmology-related EHR-based registries (e.g., AAO IRIS Registry) are some of the key resources. In this review, we aim to provide a succinct overview of the availability and clinical applicability of big data in ophthalmology, particularly from the perspective of corneal diseases and cataract, the synergistic potential of big data, AI technologies, internet of things, mHealth, and wearable smart devices, and the potential barriers for realizing the clinical and research potential of big data in this field.
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Affiliation(s)
- Darren S. J. Ting
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom,Birmingham and Midland Eye Centre, Birmingham, United Kingdom,Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom,*Correspondence: Darren S. J. Ting ✉
| | - Rashmi Deshmukh
- Department of Cornea and Refractive Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Daniel S. W. Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore,Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore,Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
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Kam KW, Rao SK, Young AL. The diagnostic dilemma of fungal keratitis. Eye (Lond) 2023; 37:386-387. [PMID: 35963942 PMCID: PMC9905469 DOI: 10.1038/s41433-022-02202-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China.
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Yi W, Gu L, Wang Y, Lin J, Zhang L, Wang Q, Diao W, Qi Y, Chi M, Yin M, Li C, Zhao G. Benzyl isothiocyanate improves the prognosis of Aspergillus fumigatus keratitis by reducing fungal load and inhibiting Mincle signal pathway. Front Microbiol 2023; 14:1119568. [PMID: 36876115 PMCID: PMC9978348 DOI: 10.3389/fmicb.2023.1119568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Aspergillus fumigatus keratitis is a potential blinding disease associated with A. fumigatus invasion and excessive inflammatory response. Benzyl isothiocyanate (BITC) is a secondary metabolite with broad antibacterial and anti-inflammatory activity extracted from cruciferous species. However, the role of BITC in A. fumigatus keratitis has not been discovered yet. This study aims to explore the antifungal and anti-inflammatory effects and mechanisms of BITC in A. fumigatus keratitis. Our results provided evidences that BITC exerted antifungal effects against A. fumigatus by damaging cell membranes, mitochondria, adhesion, and biofilms in a concentration-dependent manner. In vivo, fungal load and inflammatory response including inflammatory cell infiltration and pro-inflammatory cytokine expression were reduced in BITC-treated A. fumigatus keratitis. Additionally, BITC significantly decreased Mincle, IL-1β, TNF-α, and IL-6 expression in RAW264.7 cells that stimulated by A. fumigatus or Mincle ligand trehalose-6,6-dibehenate. In summary, BITC possessed fungicidal activities and could improve the prognosis of A. fumigatus keratitis by reducing fungal load and inhibiting the inflammatory response mediated by Mincle.
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Affiliation(s)
- Wendan Yi
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lingwen Gu
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuwei Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Lin
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lina Zhang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weilin Diao
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yinghe Qi
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Menghui Chi
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Min Yin
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cui Li
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guiqiu Zhao
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
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50
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Li M, Xin D, Gao J, Yi Q, Yuan J, Bao Y, Gong Y. The protective effect of URP20 on ocular Staphylococcus aureus and Escherichia coli infection in rats. BMC Ophthalmol 2022; 22:517. [PMID: 36585631 PMCID: PMC9801630 DOI: 10.1186/s12886-022-02752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Infectious keratitis, a medical emergency with acute and rapid disease progression may lead to severe visual impairment and even blindness. Herein, an antimicrobial polypeptide from Crassostrea hongkongensis, named URP20, was evaluated for its therapeutic efficacy against keratitis caused by Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) infection in rats, respectively. METHODS A needle was used to scratch the surface of the eyeballs of rats and infect them with S. aureus and E.coli to construct a keratitis model. The two models were treated by giving 100 μL 100 μM URP20 drops. Positive drugs for S. aureus and E. coli infection were cefazolin eye drops and tobramycin eye drops, respectively. For the curative effect, the formation of blood vessels in the fundus was observed by a slit lamp (the third day). At the end of the experiment, the condition of the injured eye was photographed by cobalt blue light using 5 μL of 1% sodium fluorescein. The pathological damage to corneal tissues was assessed using hematoxylin-eosin staining, and the expression level of vascular endothelial growth factor (VEGF) was detected by immunohistochemistry. RESULTS URP20 alleviated the symptoms of corneal neovascularization as observed by slit lamp and cobalt blue lamp. The activity of S. aureus and E.coli is inhibited by URP20 to protect corneal epithelial cells and reduce corneal stromal bacterial invasion. It also prevented corneal thickening and inhibited neovascularization by reducing VEGF expression at the cornea. CONCLUSION URP20 can effectively inhibit keratitis caused by E.coli as well as S. aureus in rats, as reflected by the inhibition of corneal neovascularization and the reduction in bacterial damage to the cornea.
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Affiliation(s)
- Meng Li
- grid.203507.30000 0000 8950 5267School of Medicine, Ningbo University, Ningbo, 315042 China ,Department of Ophtalmology, Ningbo Eye Hospital, Ningbo, 315042 China
| | - Danli Xin
- Department of Ophtalmology, Ningbo Eye Hospital, Ningbo, 315042 China
| | - Jian Gao
- Department of Ophtalmology, Ningbo Eye Hospital, Ningbo, 315042 China
| | - Quanyong Yi
- Department of Ophtalmology, Ningbo Eye Hospital, Ningbo, 315042 China
| | - Jianshu Yuan
- Department of Ophtalmology, Ningbo Eye Hospital, Ningbo, 315042 China
| | - Yongbo Bao
- grid.413076.70000 0004 1760 3510College of Biological & Environmental Sciences, Zhejiang Wanli University, Ningbo, 315100 China
| | - Yan Gong
- Department of Ophtalmology, Ningbo Eye Hospital, Ningbo, 315042 China ,grid.203507.30000 0000 8950 5267Department of Ophtalmology, Medical College of Ningbo University, Ningbo Eye Hospital, No. 599, Beiming Cheng Road, Yinzhou District, Ningbo, 315042 China
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