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Dong G, Hao Z, Zhang C, Deng A. Unveiling challenging corneal infections: a comprehensive etiological diagnosis through metagenomic next-generation sequencing (mNGS) of corneal tissue samples. Int Ophthalmol 2024; 44:246. [PMID: 38907102 DOI: 10.1007/s10792-024-03201-x] [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: 03/24/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE The objective of this study was to assess the clinical diagnostic value of metagenomic next-generation sequencing (mNGS) in cases of challenging corneal infections using corneal tissue samples. METHODS This retrospective study involved 42 patients with corneal infections, where conventional diagnostic techniques failed to identify the causative pathogen. Corneal tissue specimens underwent mNGS, followed by microbial culture for validation. Sensitivity-guided antimicrobial therapy was administered upon identification of the pathogen. The diagnostic and therapeutic efficacy of mNGS was analyzed to evaluate its clinical utility. RESULTS A total of 42 patients were included in this study, with mNGS detection results obtained for 38 cases (90.48%). Among them, 30 cases (71.43%) were clinically significant, eight cases (19.05%) had low clinical relevance, and four cases (9.52%) showed no detection. Following corresponding antimicrobial treatment, 30 patients exhibited significant improvement, resulting in a treatment effectiveness of 71.43%. The prognosis of mNGS-positive patients was superior to that of mNGS-negative patients, with statistically significant differences observed (P < 0.001). CONCLUSIONS Corneal tissue mNGS facilitated the rapid identification of causative agents in challenging corneal infections with unclear clinical diagnoses. It could be seamlessly integrated with traditional diagnostic methods to guide the diagnosis and treatment of corneal diseases.
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Affiliation(s)
- Guangguo Dong
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan, 250200, China
| | - Zhongkai Hao
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan, 250200, China
- Department of Ophthalmology, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, China
| | - Chenming Zhang
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan, 250200, China.
- Department of Ophthalmology, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, China.
| | - Aijun Deng
- Department of Ophthalmology, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, China.
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2
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Wang H, Song F, Qi X, Zhang X, Ma L, Shi D, Bai X, Dou S, Zhou Q, Wei C, Zhang BN, Wang T, Shi W. Penetrative Ionic Organic Molecular Cage Nanozyme for the Targeted Treatment of Keratomycosis. Adv Healthc Mater 2024:e2401179. [PMID: 38895924 DOI: 10.1002/adhm.202401179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/13/2024] [Indexed: 06/21/2024]
Abstract
Keratomycosis, caused by pathogenic fungi, is an intractable blinding eye disease. Corneal penetration is an essential requirement for conventional antifungal medications to address keratomycosis. Due to the distinctive anatomical and physiological structure of the cornea, the therapeutic efficacy is hampered by the inadequate penetration capacity. Despite the emergence of diverse antifungal drug delivery systems and advanced antifungal nanomaterials, it has remained challenging to achieve corneal penetration over the past decade. This study fabricates a penetrative ionic organic molecular cage-based nanozyme (OMCzyme) for treating keratomycosis. The synthesis of OMCzyme involved two steps. Initially, the ionic OMC is synthesized by a [2+3] cycloimination reaction of triformylphloroglucinol and 2,3-diaminopropionic acid. Subsequently, OMCzyme is fabricated by coordination of Fe2⁺ with carboxyl anions and phenolic hydroxyls in the organic cage, and further deposition of silver nanoparticles on the surface of OMC-Fe complex. The as-prepared OMCzyme demonstrates excellent water dispersion, peroxidase-like activity, in vitro and in vivo biocompatibility, and corneal penetration. Notably, the nanozyme displays targeted antifungal activity, effectively combating Fusarium solani with negligible cytotoxicity toward human corneal epithelial cells. The hybrid mimic is further demonstrated to be effective in treating keratomycosis in mice, indicating the potential of OMCzyme for curing fungal infectious diseases.
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Affiliation(s)
- Hongwei Wang
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Fangying Song
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Xia Qi
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Xiaoyu Zhang
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Li Ma
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Depeng Shi
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Xiaofei Bai
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Shengqian Dou
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Qingjun Zhou
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Chao Wei
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Bi Ning Zhang
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Ting Wang
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
| | - Weiyun Shi
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
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3
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Zhang J, Li Y, Xie S, Lou H, Chen H, Zhang G. Baicalein glycymicelle ophthalmic solution: Preparation, in vitro antimicrobial activities, and antimicrobial mechanism evaluations. Int J Pharm 2024; 654:123964. [PMID: 38430948 DOI: 10.1016/j.ijpharm.2024.123964] [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: 01/21/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
The purpose of this study was to develop a novel baicalein (BAI) loaded glycymicelle ophthalmic solution with small molecule phytochemical glycyrrhizin as nanocarriers and to explore this solution's potential as an antimicrobial agent against ocular infections. The optimized BAI glycymicelles had a high encapsulation efficiency (98.76 ± 1.25 %), a small particle size (54.38 ± 2.41 nm), a uniform size distribution (polydispersity index = 0.293 ± 0.083), and a zeta potential of -28.3 ± 1.17 mV. The BAI glycymicelle ophthalmic solution exhibited an excellent short-term storage stability. BAI glycymicelles significantly increased the apparent solubility and in vitro release capability of BAI. The BAI glycymicelle ophthalmic solution exhibited no hen's egg-chorioallantoic membrane' irritation and strong in vivo ocular tolerance in rabbits. The BAI glycymicelles noticeably enhanced the in vivo corneal permeation. The BAI glycymicelles also precipitated increased in vitro antioxidant activity and significantly improved in vitro antipathogen activities. Various antimicrobial mechanisms, including the destruction of the bacterial cell wall, damage to the bacterial cell membranes, interruptions to the biofilm structure, and the apoptosis of bacteria, were inflicted on BAI glycymicelles. These findings provided useful knowledge regarding the development of a novel ophthalmic solution and formulation of BAI.
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Affiliation(s)
- Jing Zhang
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China
| | - Yuhang Li
- The Eighth People's Hospital of Qingdao, Qingdao, China
| | - Sibin Xie
- Qingdao Central Medical Group, Qingdao, China
| | - Huadong Lou
- The Eighth People's Hospital of Qingdao, Qingdao, China
| | - Hao Chen
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China.
| | - Guowen Zhang
- The Eighth People's Hospital of Qingdao, Qingdao, China.
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4
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Petrillo F, Tortori A, Vallino V, Galdiero M, Fea AM, De Sanctis U, Reibaldi M. Understanding Acanthamoeba Keratitis: An In-Depth Review of a Sight-Threatening Eye Infection. Microorganisms 2024; 12:758. [PMID: 38674702 PMCID: PMC11052265 DOI: 10.3390/microorganisms12040758] [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: 03/13/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Acanthamoeba keratitis (AK) is a rare but potentially sight-threatening corneal infection caused by the Acanthamoeba parasite. This microorganism is found ubiquitously in the environment, often in freshwater, soil, and other sources of moisture. Despite its low incidence, AK presents significant challenges due to delayed diagnosis and the complex nature of therapeutic management. Early recognition is crucial to prevent severe ocular complications, including corneal ulceration and vision loss. Diagnostic modalities and treatment strategies may vary greatly depending on the clinical manifestation and the available tools. With the growing reported cases of Acanthamoeba keratitis, it is essential for the ophthalmic community to thoroughly understand this condition for its effective management and improved outcomes. This review provides a comprehensive overview of AK, encompassing its epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment.
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Affiliation(s)
- Francesco Petrillo
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Antonia Tortori
- Ophthalmology Unit, Surgery Department, Piacenza Hospital, 29121 Piacenza, Italy;
| | - Veronica Vallino
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy;
| | - Antonio M. Fea
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Ugo De Sanctis
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
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5
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Raghavan A, Rammohan R. Acanthamoeba keratitis - A review. Indian J Ophthalmol 2024; 72:473-482. [PMID: 38454853 PMCID: PMC11149514 DOI: 10.4103/ijo.ijo_2627_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/23/2023] [Indexed: 03/09/2024] Open
Abstract
This is a comprehensive review after a thorough literature search in PubMed-indexed journals, incorporating current information on the pathophysiology, clinical features, diagnosis, medical and surgical therapy, as well as outcomes of Acanthamoeba keratitis (AK). AK is a significant cause of ocular morbidity, and early diagnosis with timely institution of appropriate therapy is the key to obtaining good outcomes. The varied presentations result in frequent misdiagnosis, and co-infections can increase the morbidity of the disease. The first line of therapy continues to be biguanides and diamidines, with surgery as a last resort.
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Affiliation(s)
- Anita Raghavan
- Cornea & Refractive Surgery, Department of Microbiology, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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6
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Clare G, Kempen JH, Pavésio C. Infectious eye disease in the 21st century-an overview. Eye (Lond) 2024:10.1038/s41433-024-02966-w. [PMID: 38355671 DOI: 10.1038/s41433-024-02966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
Infectious diseases affecting the eye often cause unilateral or asymmetric visual loss in children and people of working age. This group of conditions includes viral, bacterial, fungal and parasitic diseases, both common and rare presentations which, in aggregate, may account for a significant portion of the global visual burden. Diagnosis is frequently challenging even in specialist centres, and many disease presentations are highly regional. In an age of globalisation, an understanding of the various modes of transmission and the geographic distribution of infections can be instructive to clinicians. The impact of eye infections on global disability is currently not sufficiently captured in global prevalence studies on visual impairment and blindness, which focus on bilateral disease in the over-50s. Moreover, in many cases it is hard to differentiate between infectious and immune-mediated diseases. Since infectious eye diseases can be preventable and frequently affect younger people, we argue that in future prevalence studies they should be considered as a separate category, including estimates of disability-adjusted life years (DALY) as a measure of overall disease burden. Numbers of ocular infections are uniquely affected by outbreaks as well as endemic transmission, and their control frequently relies on collaborative partnerships that go well beyond the remit of ophthalmology, encompassing domains as various as vaccination, antibiotic development, individual healthcare, vector control, mass drug administration, food supplementation, environmental and food hygiene, epidemiological mapping, and many more. Moreover, the anticipated impacts of global warming, conflict, food poverty, urbanisation and environmental degradation are likely to magnify their importance. While remote telemedicine can be a useful aide in the diagnosis of these conditions in resource-poor areas, enhanced global reporting networks and artificial intelligence systems may ultimately be required for disease surveillance and monitoring.
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Affiliation(s)
| | - John H Kempen
- Department of Ophthalmology and Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary; and Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Sight for Souls, Bellevue, WA, USA
- MCM Eye Unit; MyungSung Christian Medical Center (MCM) Comprehensive Specialized Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
- Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
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7
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Scotto R, Forte P, Macrì A, Bonzano C, Traverso CE. In Vivo Confocal Microscopy Characterization of Candida parapsilosis Keratitis. Eye Contact Lens 2024; 50:112-115. [PMID: 38284908 PMCID: PMC10871614 DOI: 10.1097/icl.0000000000001059] [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] [Accepted: 09/26/2023] [Indexed: 01/30/2024]
Abstract
ABSTRACT The present clinical case concerns two patients with mycotic keratitis because of Candida parapsilosis in which corneal confocal microscopy presented a characteristic feature of this pathogen. Both described patients used a therapeutic contact lens and administered a therapy with steroid eye drops which are well known predisposing factors for the onset of corneal mycoses. This report can be useful for correctly identifying the pathologic condition and quickly directing the therapy.
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Affiliation(s)
- R. Scotto
- Clinica Oculistica (R.S., P.F., C.B., C.E.T.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genova, Italy; and IRCCS Ospedale Policlinico San Martino (P.F., A.M., C.B., C.E.T.), Genova, Italy
| | - P. Forte
- Clinica Oculistica (R.S., P.F., C.B., C.E.T.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genova, Italy; and IRCCS Ospedale Policlinico San Martino (P.F., A.M., C.B., C.E.T.), Genova, Italy
| | - A. Macrì
- Clinica Oculistica (R.S., P.F., C.B., C.E.T.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genova, Italy; and IRCCS Ospedale Policlinico San Martino (P.F., A.M., C.B., C.E.T.), Genova, Italy
| | - C. Bonzano
- Clinica Oculistica (R.S., P.F., C.B., C.E.T.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genova, Italy; and IRCCS Ospedale Policlinico San Martino (P.F., A.M., C.B., C.E.T.), Genova, Italy
| | - C. E. Traverso
- Clinica Oculistica (R.S., P.F., C.B., C.E.T.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genova, Italy; and IRCCS Ospedale Policlinico San Martino (P.F., A.M., C.B., C.E.T.), Genova, Italy
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Chong YJ, Azzopardi M, Hussain G, Recchioni A, Gandhewar J, Loizou C, Giachos I, Barua A, Ting DSJ. Clinical Applications of Anterior Segment Optical Coherence Tomography: An Updated Review. Diagnostics (Basel) 2024; 14:122. [PMID: 38248000 PMCID: PMC10814678 DOI: 10.3390/diagnostics14020122] [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: 11/20/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Since its introduction, optical coherence tomography (OCT) has revolutionized the field of ophthalmology and has now become an indispensable, noninvasive tool in daily practice. Most ophthalmologists are familiar with its use in the assessment and monitoring of retinal and optic nerve diseases. However, it also has important applications in the assessment of anterior segment structures, including the cornea, conjunctiva, sclera, anterior chamber, and iris, and has the potential to transform the clinical examination of these structures. In this review, we aim to provide a comprehensive overview of the potential clinical utility of anterior segment OCT (AS-OCT) for a wide range of anterior segment pathologies, such as conjunctival neoplasia, pterygium, scleritis, keratoconus, corneal dystrophies, and infectious/noninfectious keratitis. In addition, the clinical applications of AS-OCT (including epithelial mapping) in preoperative planning and postoperative monitoring for corneal and refractive surgeries are discussed.
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Affiliation(s)
- Yu Jeat Chong
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
- Modality Ophthalmology, Modality Partnership, Birmingham B19 1BP, UK;
| | - Matthew Azzopardi
- Department of Ophthalmology, Royal Free Hospital, London NW3 2QG, UK;
| | - Gulmeena Hussain
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK;
| | - Alberto Recchioni
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Jaishree Gandhewar
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK;
| | | | - Ioannis Giachos
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
| | - Ankur Barua
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
| | - Darren S. J. Ting
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Lotfy NM, Aldhefeery N, Alenezi MN, Alherz Y, Taleb Ali Y. Frequency and visual outcomes of herpes simplex keratitis in a Kuwaiti tertiary referral center. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2023; 12:98-105. [PMID: 38357609 PMCID: PMC10862024 DOI: 10.51329/mehdiophthal1475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/22/2023] [Indexed: 02/16/2024]
Abstract
Background Herpes simplex virus (HSV), a cause of many ocular pathologies, may affect the corneal epithelium, stroma, or endothelium, with the epithelium as the most frequently affected location. We aimed to determine the frequency and visual outcomes of HSV keratitis over a 1-year period at Farwaniya Hospital, Kuwait. Methods This prospective observational case series included patients diagnosed with HSV keratitis who presented to the outpatient or eye casualty department between September 2022 and September 2023. Full history, demographic profile, detailed ocular and slit-lamp examinations, and visual acuity assessments were recorded prior to and after treatment. Baseline corneal sensation was assessed in the four corneal quadrants using the cotton wisp test. Results Of the 227 patients who presented with infectious keratitis, 72 (31.7%) were diagnosed with HSV keratitis. The mean (SD) age was 45.86 (16.06) years, and 48 (66.7%) patients were male. The subtypes of HSV keratitis were endotheliitis in 27 (37.5%) patients, dendritic ulcer in 22 (30.6%), stromal keratitis with ulceration in 9 (12.5%) and without ulceration in 8 (11.1%), and geographic ulcer in 6 (8.3%). The mean baseline best-corrected distance visual acuity (BCDVA) differed significantly between the HSV keratitis subtypes (P < 0.001). Most patients (n = 70, 97.2%) had unilateral eye involvement, were treated within 1 - 2 weeks, and demonstrated improved BCDVA. Despite the improvement in BCDVA in all HSV keratitis subtypes, a significant difference in the median BCDVA remained after treatment (P < 0.001). Pairwise comparisons revealed a significantly better BCDVA after treatment in eyes with dendritic epithelial ulcers than in eyes with HSV stromal keratitis with ulceration (P = 0.003) or geographic epithelial ulcers (P = 0.005). After treatment, corneal haze and neovascularization were detected in 54 (75.0%) and 24 (33.3%) patients, respectively. Conclusions We detected a substantial frequency of HSV keratitis in one of the governorates of Kuwait, with endotheliitis as the most common manifestation. Timely standard treatment interventions based on valid guidelines resulted in BCDVA improvement in all subtypes of HSV keratitis in our series, indicating the importance of early treatment. However, the BCDVA in eyes with dendritic epithelial ulcers remained substantially better than that in eyes with geographic epithelial ulcers or HSV stromal keratitis with ulceration, signifying the effect of the initial HSV keratitis subtype on visual outcomes. To our knowledge, this is the first study to highlight the frequency of HSV keratitis in a Kuwaiti hospital, and larger-scale research in this region is needed to further understand and manage the condition.
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Affiliation(s)
- Nancy M. Lotfy
- Department of Ophthalmology, Kasr Alainy Faculty of Medicin, Cairo University, Cairo, Egypt
| | | | | | - Yousuf Alherz
- Department of Ophthalmology, Farwaniya Hospital, Kuwait
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10
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Wong TL, Ong ZZ, Marelli L, Pennacchi A, Lister M, Said DG, Dua HS, Ting DSJ. False positive microbiological results in Acanthamoeba keratitis: the importance of clinico-microbiological correlation. Eye (Lond) 2023; 37:3699-3701. [PMID: 37179412 PMCID: PMC10686398 DOI: 10.1038/s41433-023-02573-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Thai Ling Wong
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Zun Zheng Ong
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Luca Marelli
- Eye Clinic San Giuseppe Hospital, IRCCS Multimedica Scientific Institute, Milan, Italy
| | | | - Michelle Lister
- Department of Microbiology, Queen's Medical Centre, Nottingham, UK
| | - 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
| | - Harminder S Dua
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren S J Ting
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK.
- Birmingham and Midland Eye Centre, Birmingham, UK.
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
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11
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Xu S, Lu S, Gu Y, Sun H, Ma M, Leng Y, Liu W. Metagenomic next-generation sequencing to investigate infectious keratitis by Corynespora cassiicola: a case report. Front Med (Lausanne) 2023; 10:1285753. [PMID: 38046412 PMCID: PMC10690767 DOI: 10.3389/fmed.2023.1285753] [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: 08/30/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
In this report, the case of a 65-year-old immunosuppressed female who presented with recurring redness and irritation in her right eye for 2 months is described. Ocular examination revealed conjunctival congestion, feather-like greyish-white corneal deep stromal infiltrate, white, floccular material sprawling from the anterior chamber angle and hypopyon. The in vivo confocal microscopy (IVCM) instantly confirmed fungal keratitis, and empirical antifungal therapy was thus administered. The patient exhibited therapeutic penetrating keratoplasty, however, due to the progression of infection and the lack of identified pathogens. The fungal isolate was identified as Corynespora cassiicola by metagenomic next-generation sequencing (mNGS) of the host cornea. The patient responded well to intensive conservative therapy and subsequent surgical therapy. To our knowledge, this case represents the first case of C. cassiicola infection from China, highlighting the emergence of a rare fungus that causes keratitis. Furthermore, mNGS has the capability to facilitate prompt identification and timely management of challenging ocular infections that are difficult to diagnose.
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Affiliation(s)
- Shuo Xu
- Department of Ophthalmology, Jiangnan University Medical Center, Wuxi, China
| | - Shui Lu
- Department of Ophthalmology, Jiangnan University Medical Center, Wuxi, China
| | - Yan Gu
- Department of Ophthalmology, Jiangnan University Medical Center, Wuxi, China
| | - Hongjuan Sun
- Department of Ophthalmology, Jiangnan University Medical Center, Wuxi, China
| | - Minghui Ma
- Department of Drug Clinical Trial Institution, Jiangnan University Medical Center, Wuxi, China
| | - Yue Leng
- Department of Human Resources Division, The Affiliated Wuxi People’s Nanjing Medical University, Wuxi, China
| | - Wenhui Liu
- Department of Ophthalmology, Jiangnan University Medical Center, Wuxi, China
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12
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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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13
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Cabrera-Aguas M, Watson SL. Updates in Diagnostic Imaging for Infectious Keratitis: A Review. Diagnostics (Basel) 2023; 13:3358. [PMID: 37958254 PMCID: PMC10647798 DOI: 10.3390/diagnostics13213358] [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: 08/16/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Infectious keratitis (IK) is among the top five leading causes of blindness globally. Early diagnosis is needed to guide appropriate therapy to avoid complications such as vision impairment and blindness. Slit lamp microscopy and culture of corneal scrapes are key to diagnosing IK. Slit lamp photography was transformed when digital cameras and smartphones were invented. The digital camera or smartphone camera sensor's resolution, the resolution of the slit lamp and the focal length of the smartphone camera system are key to a high-quality slit lamp image. Alternative diagnostic tools include imaging, such as optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM). OCT's advantage is its ability to accurately determine the depth and extent of the corneal ulceration, infiltrates and haze, therefore characterizing the severity and progression of the infection. However, OCT is not a preferred choice in the diagnostic tool package for infectious keratitis. Rather, IVCM is a great aid in the diagnosis of fungal and Acanthamoeba keratitis with overall sensitivities of 66-74% and 80-100% and specificity of 78-100% and 84-100%, respectively. Recently, deep learning (DL) models have been shown to be promising aids for the diagnosis of IK via image recognition. Most of the studies that have developed DL models to diagnose the different types of IK have utilised slit lamp photographs. Some studies have used extremely efficient single convolutional neural network algorithms to train their models, and others used ensemble approaches with variable results. Limitations of DL models include the need for large image datasets to train the models, the difficulty in finding special features of the different types of IK, the imbalance of training models, the lack of image protocols and misclassification bias, which need to be overcome to apply these models into real-world settings. Newer artificial intelligence technology that generates synthetic data, such as generative adversarial networks, may assist in overcoming some of these limitations of CNN models.
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Affiliation(s)
- Maria Cabrera-Aguas
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia;
- Sydney Eye Hospital, Sydney, NSW 2000, Australia
| | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia;
- Sydney Eye Hospital, Sydney, NSW 2000, Australia
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14
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Olshaker H, Achiron A, Chorny A, Hafezi F, Yahalomi T, Kratz A, Tsumi E, Lu NJ, Knyazer B. Accelerated high fluence photoactivated chromophore for infectious keratitis-corneal cross-linking (PACK-CXL) at the slit lamp: a pilot study. Front Pharmacol 2023; 14:1229095. [PMID: 37745064 PMCID: PMC10512457 DOI: 10.3389/fphar.2023.1229095] [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: 05/25/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction: Photoactivated Chromophore for Infectious Keratitis-Corneal Cross-Linking (PACK-CXL) has garnered substantial interest among researchers and ophthalmologists due to its high promise as a potential treatment for infectious keratitis. The aim of this study is to evaluate the efficacy and safety of high fluence PACK-CXL, using 10.0 J/cm2 (30 mW/cm2, 5 min, and 33 s) at the slit lamp. Methods: This prospective interventional, nonrandomized cohort study included 20 eyes of 20 patients with bacterial, fungal, or mixed origin keratitis who underwent high fluence PACK-CXL treatment as an adjunct therapy to conventional antimicrobial therapy per American Academy of Ophthalmology treatment guidelines. The re-epithelization time was recorded, and corneal endothelial cell density was counted before and after treatment. Results: The average re-epithelization time was 8.2 ± 2.8 days (range 3-14 days). After PACK-CXL treatment, eight patients (40%) were directly discharged, while the remained patients stayed in the hospital for an average of 5.6 ± 3.5 days. No eyes required keratoplasty. Endothelial cell density counts before and after the PACK-CXL procedure were 2,562.1 ± 397.3, and 2,564.8 ± 404.5 cells/mm2, respectively (p = 0.96). Conclusion: although it was not a randomized control trial, we conclude that high fluence PACK-CXL as an adjuvant therapy is safe with no complications observed, and efficient as time to re-epithelization was less than 14 days for all patients and no patients underwent tectonic keratoplasties. Further research is needed to compare it to the current standard of care.
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Affiliation(s)
- Hagar Olshaker
- Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Achiron
- Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Chorny
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Farhad Hafezi
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
- ELZA Institute, Dietikon, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Ophthalmology, University of Southern California Roski Eye Institute, University of Southern California, Los Angeles, Los Angeles, CA, United States
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Assaf Kratz
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Erez Tsumi
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Nan-Ji Lu
- ELZA Institute, Dietikon, Switzerland
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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Ong ZZ, Wong TL, Suresh L, Hammoudeh Y, Lister M, Said DG, Dua HS, Ting DSJ. A 7-year review of clinical characteristics, predisposing factors and outcomes of post-keratoplasty infectious keratitis: the Nottingham infectious keratitis study. Front Cell Infect Microbiol 2023; 13:1250599. [PMID: 37712055 PMCID: PMC10499169 DOI: 10.3389/fcimb.2023.1250599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background/objectives Post-keratoplasty infectious keratitis (PKIK) is a unique sight-threatening clinical entity which often poses significant therapeutic challenges. This study aimed to examine the clinical presentation, risk factors, management, and clinical outcomes of PKIK. Methods This was a retrospective study of all patients who presented to the Queen's Medical Centre, Nottingham, with PKIK between September 2015 and August 2022 (a 7-year period). Relevant data on types of keratoplasty, clinical presentations, causative microorganisms, management, and outcome were analyzed. Results Forty-nine PKIK cases, including four cases of interface infectious keratitis, were identified during the study period. The most common graft indications for PKP, DALK and EK were failed grafts (9, 37.5%), keratoconus (6, 54.5%) and Fuchs endothelial corneal dystrophy (FECD; 8, 57.1%), respectively. Staphylococcus spp. were the most commonly identified organisms (15, 50.0%). Bullous keratopathy (18, 36.7%), ocular surface disease (18, 36.7%), and broken/loose sutures (15, 30.6%) were the most common risk factors. Concurrent use of topical steroids was identified in 25 (51.0%) cases. Of 31 functioning grafts at presentation, 12 (38.7%) grafts failed at final follow-up with 15 (48.4%) patients retaining a CDVA of ≥1.0 logMAR. The overall estimated 5-year survival rate post-PKIK was 55.9% (95% CI, 35.9%-75.9%), with DALK having the highest survival rate [63.6% (95% CI, 28.9%-98.3%)], followed by EK [57.1% (95% CI, 20.4%-93.8%)] and PKP [52.7% (95% CI, 25.1%-80.3%)], though no statistical difference was observed (p=0.48). Conclusions PKIK represents an important cause of IK and graft failure. Bullous keratopathy, OSD and suture-related complications are the commonest risk factors, highlighting the potential benefit of prophylactic topical antibiotics (for unhealthy ocular surface) and early suture removal (where possible) in reducing the risk of PKIK. Graft survival may be higher in lamellar keratoplasty following PKIK but larger studies are required to elucidate this observation.
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Affiliation(s)
- Zun Zheng Ong
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Thai Ling Wong
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Lakshmi Suresh
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Yasmeen Hammoudeh
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Michelle Lister
- Department of Microbiology, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Dalia G. Said
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Harminder S. Dua
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Darren S. J. Ting
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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16
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Azzopardi M, Chong YJ, Ng B, Recchioni A, Logeswaran A, Ting DSJ. Diagnosis of Acanthamoeba Keratitis: Past, Present and Future. Diagnostics (Basel) 2023; 13:2655. [PMID: 37627913 PMCID: PMC10453105 DOI: 10.3390/diagnostics13162655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis is primarily achieved through a combination of clinical suspicion, microbiological investigations and corneal imaging. Historically, corneal scraping for microbiological culture has been considered to be the gold standard. Despite its technical ease, accessibility and cost-effectiveness, the long diagnostic turnaround time and variably low sensitivity of microbiological culture limit its use as a sole diagnostic test for AK in clinical practice. In this review, we aim to provide a comprehensive overview of the diagnostic modalities that are currently used to diagnose AK, including microscopy with staining, culture, corneal biopsy, in vivo confocal microscopy, polymerase chain reaction and anterior segment optical coherence tomography. We also highlight emerging techniques, such as next-generation sequencing and artificial intelligence-assisted models, which have the potential to transform the diagnostic landscape of AK.
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Affiliation(s)
- Matthew Azzopardi
- Department of Ophthalmology, Royal London Hospital, London E1 1BB, UK;
| | - Yu Jeat Chong
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Benjamin Ng
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Alberto Recchioni
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | | | - Darren S. J. Ting
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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17
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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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18
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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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19
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Matsumura T, Yamaguchi T, Suzuki T, Ogiwara Y, Takamura Y, Inatani M, Shimazaki J. Changes in corneal higher-order aberrations during treatment for infectious keratitis. Sci Rep 2023; 13:848. [PMID: 36646747 PMCID: PMC9842715 DOI: 10.1038/s41598-023-28145-7] [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: 10/26/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
This study aimed to quantify the changes in corneal higher-order aberrations (HOAs) before and after treatment for infectious keratitis and verify the correlation between corneal HOAs and visual acuity. Corneal HOAs were analysed using swept-source anterior segment optical coherence tomography (AS-OCT). Ninety-eight eyes of 96 consecutive patients with infectious keratitis treated with topical eye drops were retrospectively evaluated. Corneal HOAs increased with the infection but decreased with infection resolution following antimicrobial treatment. Corneal HOAs became larger as the degree of corneal findings became more severe. The increase in HOAs of the total cornea was correlated with the decrease in visual acuity both before and after treatment (4 mm, ρ = 0.530 and 0.590; 6 mm, ρ = 0.479 and 0.567, respectively; all P < 0.0001). Furthermore, pretreatment HOA (anterior, 6 mm), pretreatment logMAR best spectacle-corrected visual acuity, and age were prognostic factors significantly associated with posttreatment visual acuity (β = 0.31, P = 0.013; β = 0.36, P < 0.0001; and β = 0.35, P = 0.0007, respectively) (adjusted R2 = 0.474). These results indicate that corneal HOAs quantified using AS-OCT can be used as an objective index to evaluate corneal optical function during the treatment of infectious keratitis.
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Affiliation(s)
- Takehiro Matsumura
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan. .,Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Takanori Suzuki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Yurina Ogiwara
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan.,Cornea Center Eye Bank, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
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20
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Nie L, Li Y, Liu Y, Shi L, Chen H. Recent Applications of Contact Lenses for Bacterial Corneal Keratitis Therapeutics: A Review. Pharmaceutics 2022; 14:pharmaceutics14122635. [PMID: 36559128 PMCID: PMC9786638 DOI: 10.3390/pharmaceutics14122635] [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: 10/09/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022] Open
Abstract
Corneal keratitis is a common but severe infectious disease; without immediate and efficient treatment, it can lead to vision loss within a few days. With the development of antibiotic resistance, novel approaches have been developed to combat corneal keratitis. Contact lenses were initially developed to correct vision. Although silicon hydrogel-based contact lenses protect the cornea from hypoxic stress from overnight wear, wearing contact lenses was reported as an essential cause of corneal keratitis. With the development of technology, contact lenses are integrated with advanced functions, and functionalized contact lenses are used for killing bacteria and preventing infectious corneal keratitis. In this review, we aim to examine the current applications of contact lenses for anti-corneal keratitis.
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Affiliation(s)
- Linyan Nie
- Department of Ophthalmology, The People’s Hospital of Yuhuan, Yuhuan 317600, China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325001, China
| | - Yuanfeng Li
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325001, China
| | - Yong Liu
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325001, China
| | - Linqi Shi
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325001, China
- Correspondence: (L.S.); (H.C.)
| | - Huiyun Chen
- Department of Ophthalmology, The People’s Hospital of Yuhuan, Yuhuan 317600, China
- Correspondence: (L.S.); (H.C.)
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Barac IR, Artamonov AR, Baltă G, Dinu V, Mehedințu C, Bobircă A, Baltă F, Barac DA. Photoactivated Chromophore Corneal Collagen Cross-Linking for Infectious Keratitis (PACK-CXL)-A Comprehensive Review of Diagnostic and Prognostic Factors Involved in Therapeutic Indications and Contraindications. J Pers Med 2022; 12:1907. [PMID: 36422083 PMCID: PMC9698237 DOI: 10.3390/jpm12111907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 09/07/2023] Open
Abstract
Infectious keratitis is a severe infection of the eye, which requires urgent care in order to prevent permanent complications. Typical cases are usually diagnosed clinically, whereas severe cases also require additional tools, such as direct microscopy, corneal cultures, molecular techniques, or ophthalmic imaging. The initial treatment is empirical, based on the suspected etiology, and is later adjusted as needed. It ranges from topical administration of active substances to oral drugs, or to complex surgeries in advanced situations. A novel alternative is represented by Photoactivated Chromophore Corneal Collagen Cross-Linking (PACK-CXL), which is widely known as a minimally invasive therapy for corneal degenerations. The purpose of this review is to identify the main diagnostic and prognostic factors which further outline the indications and contraindications of PACK-CXL in infectious keratitis. Given the predominantly positive outcomes in the medical literature, we ponder whether this is a promising treatment modality, which should be further evaluated in a systematic, evidence-based manner in order to develop a clear treatment protocol for successful future results, especially in carefully selected cases.
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Affiliation(s)
- Ileana Ramona Barac
- Department of Ophthalmology/ENT, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050747 Bucharest, Romania
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania
| | | | - George Baltă
- Department of Ophthalmology/ENT, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050747 Bucharest, Romania
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania
| | - Valentin Dinu
- Department of Ophthalmology/ENT, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050747 Bucharest, Romania
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania
| | - Claudia Mehedințu
- Department of Obstetrics and Gynecology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050747 Bucharest, Romania
| | - Anca Bobircă
- Department of Rheumatology and Internal Medicine, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050747 Bucharest, Romania
| | - Florian Baltă
- Department of Ophthalmology/ENT, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050747 Bucharest, Romania
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania
| | - Diana Andreea Barac
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050747 Bucharest, Romania
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22
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Chitosan/HPMC-based mucoadhesive film co-loaded with fluconazole and ofloxacin for management of polymicrobial keratitis. Int J Biol Macromol 2022; 222:2785-2795. [DOI: 10.1016/j.ijbiomac.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
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23
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A Review on Pathogens and Necessary Diagnostic Work for Bleb-Related Infections (BRIs). Diagnostics (Basel) 2022; 12:diagnostics12092075. [PMID: 36140477 PMCID: PMC9497804 DOI: 10.3390/diagnostics12092075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
At the present time, as newer techniques and minimally invasive procedures gain popularity among anterior segment surgeons for regulating intraocular pressure, trabeculectomy still has a leading role in glaucoma surgery. Trabeculectomy retains a highly successful and safe profile; however, one of the major complications includes bleb-related infections (BRIs). To date, the most common pathogens remain Gram-positive cocci, but the list of pathogens that have been identified in the literature includes more than 100 microorganisms. Because antibiotic use is more widespread than ever before and our ability to identify pathogens has improved, the pathogen spectrum will broaden in the future and more pathogens causing BRIs will be described as atypical presentations. The scope of this review was to identify all pathogens that have been described to cause bleb-related infections to date, as well as focus on the risk factors, clinical presentation, and various available diagnostic tools used for an appropriate diagnostic workup.
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24
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Alginate-Based Composites for Corneal Regeneration: The Optimization of a Biomaterial to Overcome Its Limits. Gels 2022; 8:gels8070431. [PMID: 35877516 PMCID: PMC9316786 DOI: 10.3390/gels8070431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 12/27/2022] Open
Abstract
For many years, corneal transplantation has been the first-choice treatment for irreversible damage affecting the anterior part of the eye. However, the low number of cornea donors and cases of graft rejection highlighted the need to replace donor corneas with new biomaterials. Tissue engineering plays a fundamental role in achieving this goal through challenging research into a construct that must reflect all the properties of the cornea that are essential to ensure correct vision. In this review, the anatomy and physiology of the cornea are described to point out the main roles of the corneal layers to be compensated and all the requirements expected from the material to be manufactured. Then, a deep investigation of alginate as a suitable alternative to donor tissue was conducted. Thanks to its adaptability, transparency and low immunogenicity, alginate has emerged as a promising candidate for the realization of bioengineered materials for corneal regeneration. Chemical modifications and the blending of alginate with other functional compounds allow the control of its mechanical, degradation and cell-proliferation features, enabling it to go beyond its limits, improving its functionality in the field of corneal tissue engineering and regenerative medicine.
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25
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Bakken IM, Jackson CJ, Utheim TP, Villani E, Hamrah P, Kheirkhah A, Nielsen E, Hau S, Lagali NS. The use of in vivo confocal microscopy in fungal keratitis - Progress and challenges. Ocul Surf 2022; 24:103-118. [PMID: 35278721 DOI: 10.1016/j.jtos.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 01/02/2023]
Abstract
Fungal keratitis (FK) is a serious and sight-threatening corneal infection with global reach. The need for prompt diagnosis is paramount, as a delay in initiation of treatment could lead to irreversible vision loss. Current "gold standard" diagnostic methods, namely corneal smear and culture, have limitations due to diagnostic insensitivity and their time-consuming nature. PCR is a newer, complementary method used in the diagnosis of fungal keratitis, whose results are also sample-dependent. In vivo confocal microscopy (IVCM) is a promising complementary diagnostic method of increasing importance as it allows non-invasive real-time direct visualization of potential fungal pathogens and manifesting infection directly in the patient's cornea. In numerous articles and case reports, FK diagnosis by IVCM has been evaluated, and different features, approaches, sensitivity/specificity, and limitations have been noted. Here, we provide an up-to-date, comprehensive review of the current literature and present the authors' combined recommendations for fungal identification in IVCM images, while also looking to the future of FK assessment by IVCM using artificial intelligence methods.
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Affiliation(s)
- Ingvild M Bakken
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Catherine J Jackson
- Ifocus Eye Clinic, Haugesund, Norway; Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor P Utheim
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Health and Nursing Science, The Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Edoardo Villani
- Department of Clinical Science and Community Health, University of Milan, Italy; Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Pedram Hamrah
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Esben Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Scott Hau
- Department of External Disease, NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Neil S Lagali
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Division of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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26
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Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011-2020: A 10-Year Study. J Fungi (Basel) 2021; 7:jof7110966. [PMID: 34829253 PMCID: PMC8624743 DOI: 10.3390/jof7110966] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022] Open
Abstract
Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen’s Medical Centre, Nottingham, and the Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. We included 117 patients (n = 117 eyes) with FK in this study. The mean age was 59.0 ± 19.6 years (range, 4–92 years) and 51.3% of patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with Candida spp. (33, 62.3%), Fusarium spp. (9, 17.0%), and Aspergillus spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9 ± 16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67 ± 1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3 mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all p < 0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcomes, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.
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