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Chen Y, Chen Y, Wang C, Gao R, Zhang K. Different Thicknesses of Acellular Porcine Corneal Stroma on Prognosis of Fungal Corneal Ulcers Treated by Lamellar Keratoplasty: A Five-Year Retrospective Study. Cornea 2024:00003226-990000000-00608. [PMID: 38967525 DOI: 10.1097/ico.0000000000003616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/28/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE To compare the prognosis and efficacy of acellular porcine corneal stroma (APCS) with different thicknesses for the treatment of fungal corneal ulcers by lamellar keratoplasty (LKP). METHODS A total of 52 patients who underwent LKP with APCS for the treatment of fungal corneal ulcers were included in this retrospective study. Patients were divided into 2 groups according to the different thicknesses of APCS (0.30 ± 0.05 mm, L2 group, n = 20; 0.40 ± 0.05 mm, L3 group, n = 32). Observation indicators included best corrected visual acuity, graft transparency, corneal neovascularization, ocular irritation symptoms, corneal epithelial healing time, graft survival, central corneal thickness at 1 year after surgery, and postoperative complications. RESULTS Compared with the L3 group, the L2 group had better postoperative best corrected visual acuity and graft transparency (P < 0.001), less corneal neovascularization (P < 0.001), and lower incidence of complications (P < 0.05). There were significant differences in ocular irritation symptoms between the 2 groups (P < 0.05) at 3 and 6 months postoperatively, which might be related to the higher recurrence rate and graft rejection rate in the L3 group. The comparison of postoperative epithelial healing time also showed significant differences in 2 groups (P < 0.01). The 1-year survival rate was up to 63.5% in both groups, with no significant difference (P < 0.05). However, the risk of transplantation was less in the L2 group. Both APCS thicknesses could provide adequate central corneal thickness at 1 year after surgery (P > 0.05). CONCLUSIONS APCS was safe and effective in the treatment of fungal corneal ulcers by LKP. Thinner grafts should be preferred for LKP for fungal corneal ulcers to reduce the risk of grafting.
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Affiliation(s)
- Yingxin Chen
- Department of Ophthalmology, General Hospital of the Northern Theater Command of the Chinese People's Liberation Army, Shenyang, Liaoning Province, China
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Du YL, Wang JS, Geng W, Duan CY, Wang XH, Xie HT, Zhang MC. Amniotic membrane transplantation combined with conjunctival flap covering surgery for the treatment of corneal perforations in fungal keratitis. Heliyon 2023; 9:e22693. [PMID: 38107269 PMCID: PMC10724658 DOI: 10.1016/j.heliyon.2023.e22693] [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: 05/10/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To investigate the efficiency of amniotic membrane transplantation (AMT) combined with conjunctival flap covering surgery (CFCS) for patients with corneal perforations in fungal keratitis (FK). Methods In this non-comparative, retrospective case series, 16 participants of corneal perforation in FK were successfully treated by a combination of multilayer AMT and bipedicle conjunctival flap with partial tenon's capsule. Corneal healing, recurrence of FK, visual acuity, and relevant complications were reported as outcome measures. Results Sixteen patients (13 male, 3 female) had a mean age of 58.8 ± 10.3 (range 29-72) years. The mean diameter of corneal perforation was 1.9 ± 0.7 (range 0.5-2.8) mm. Corneal perforations healed and all the patients preserved their eyeballs. During the 11.0 ± 4.4 (range 6-18) months of follow-up, there was no recurrence of FK in any of these cases. Visual acuity improved in 15 eyes (93.8 %) and remained unchanged in 1 patient (6.3 %) who had no light perception when first admitted. All 6 patients who accepted secondary keratoplasty showed improved best corrected visual acuity of more than 4 lines. The most frequently found fungi were Aspergillus species (6 of 16, 37.5 %) and Fusarium species (4 of 16, 25.0 %), followed by 1 Scedosporium apiospermum (1 of 16, 6.3 %). Conclusions Combination AMT with CFCS is a safe and effective surgery for patients with corneal perforations in FK, particularly where eye banks and fresh corneas are not available. This surgery could preserve the integrity of the eyeball and avoid the recurrence of FK. Besides, it provides a greater opportunity for further optical keratoplasty.
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Affiliation(s)
- Ya-Li Du
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jia-Song Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wen Geng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chao-Ye Duan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xing-Hua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Sitnova A, Svetozarskiy S. Modern Technologies in Diagnosis of Fungal Keratitis (Review). Sovrem Tekhnologii Med 2023; 15:73-84. [PMID: 37389020 PMCID: PMC10306968 DOI: 10.17691/stm2023.15.2.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Indexed: 07/01/2023] Open
Abstract
Traumas and infectious diseases of the eye play a leading role in the development of corneal blindness responsible for 1.5-2 million cases of vision loss per year. To date, the issue of reducing the incidence of fungal keratitis is acute and needs to be solved worldwide. Trauma as a risk factor for corneal fungal disease is thought to be prevalent in developing countries due to agricultural involvement, while in developed countries the onset of the disease is predisposed by medical advances such as contact vision correction and modern ophthalmic surgery. Thorough analysis of the pathogenesis gives the possibility to describe the action of fungal enzymes, biofilm formation, and the resistance mechanism, which on the one hand explains the aggressive course of the disease and difficulties in its diagnosis, and on the other hand, it encourages searching for new methods of diagnosis and treatment. The non-specific clinical picture of fungal keratitis, the variety and availability of antibiotics nowadays become an obstacle for rapid detection of this pathology. Low public awareness and late visit to an ophthalmologist are also a barrier to successful combating the increasing incidence of fungal keratitis. Belated diagnosis, increasing resistance of fungi to antibiotics, and lack of registered antifungal ophthalmic drugs justify poor treatment efficacy resulting in decreased visual acuity or vision loss. Existing diagnostic methods need systematization and detailed comparison, identifying the advantages and disadvantages of each. This review considers causative agents and their influence on pathogenesis of the disease, describes difficulties of fungal keratitis diagnosis and possible ways of overcoming these problems using new developments, and also outlines further prospects of research in this direction.
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Affiliation(s)
- A.V. Sitnova
- 6-year Student, Medical Faculty; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - S.N. Svetozarskiy
- Ophthalmologist; Privolzhsky District Medical Center of the Federal Medico-Biological Agency (FMBA), 14 Ilyinskaya St., Nizhny Novgorod, 603000, Russia Tutor, Department of Eye Diseases; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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Wang JS, Du YL, Deng N, Peng X, Wong H, Xie HT, Zhang MC. Characteristics of In Vitro Culture and In Vivo Confocal Microscopy in Patients with Fungal Keratitis in a Tertiary Referral Hospital in Central China. Microorganisms 2023; 11:microorganisms11020406. [PMID: 36838371 PMCID: PMC9961814 DOI: 10.3390/microorganisms11020406] [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: 12/23/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate the characteristics of in vitro culture and in vivo confocal microscopy (IVCM) in patients with fungal keratitis (FK) presented in a tertiary referral hospital in central China. METHODS In this noncomparative retrospective study, patients with the diagnosis of FK between October 2021 and November 2022 were reviewed. An IVCM and fungal culture (corneal scraping specimens) were performed, and the characteristics were analyzed. RESULTS During October 2021 and November 2022, 85 patients were diagnosed with FK. From 63 culture-positive cases, 8 species of fungus were identified. The proportions of isolated fungal species were Fusarium and Aspergillus equally accounting for 33.3% (21 of 63), Alternaria 9.5% (6 of 63), Curvularia 6.3% (4 of 63), Scedosporium apiospermum 6.3% (4 of 63), Paecilomyces lilacinus 3.2% (2 of 63), Exserohilum 3.2% (2 of 63), and Candida 4.8% (3 of 63), respectively. In positive culture cases, IVCM was found to be positive for hyphae or spores in 61 of 63 patients (96.8%). Different fungal species had a variety of cultural characteristics and IVCM manifestations. CONCLUSIONS In a tertiary referral hospital in central China, Fusarium species, Aspergillus species, and Alternaria species were the 3 most common isolated fungal pathogens, and the proportion of Aspergillus species was significantly higher than that in other regions of China. Careful lesion depth examination by IVCM and OCT should be taken before lamellar keratoplasty to avoid postoperative recurrence. Identifying the IVCM image and culture characteristics will facilitate rapid diagnosis and proper treatment, but IVCM cannot yet replace fungal cultures to distinguish between different fungal species.
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Affiliation(s)
- Jia-Song Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ya-Li Du
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Nan Deng
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xi Peng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hang Wong
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (H.-T.X.); (M.-C.Z.); Tel.: +86-27-8572-6662 (M.-C.Z.)
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (H.-T.X.); (M.-C.Z.); Tel.: +86-27-8572-6662 (M.-C.Z.)
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Wei Z, Wang S, Wang Z, Zhang Y, Chen K, Gong L, Li G, Zheng Q, Zhang Q, He Y, Zhang Q, Chen D, Cao K, Pang J, Zhang Z, Wang L, Ou Z, Liang Q. Development and multi-center validation of machine learning model for early detection of fungal keratitis. EBioMedicine 2023; 88:104438. [PMID: 36681000 PMCID: PMC9869416 DOI: 10.1016/j.ebiom.2023.104438] [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: 08/17/2022] [Revised: 12/08/2022] [Accepted: 12/25/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Fungal keratitis (FK) is a leading cause of corneal blindness in developing countries due to poor clinical recognition and laboratory identification. Here, we aimed to identify the distinct clinical signature of FK and develop a diagnostic model to differentiate FK from other types of infectious keratitis. METHODS We reviewed the electronic health records (EHRs) of all patients with suspected infectious keratitis in Beijing Tongren Hospital from January 2011 to December 2021. Twelve clinical signs of slit-lamp images were assessed by Lasso regression analysis and collinear variables were excluded. Three models based on binary logistic regression, random forest classification, and decision tree classification were trained for FK diagnosis and employed for internal validation. Independent external validation of the models was performed in a cohort of 420 patients from seven different ophthalmic centers to evaluate the accuracy, specificity, and sensitivity in real world. FINDINGS Three diagnostic models of FK based on binary logistic regression, random forest classification, and decision tree classification were established and internal validation were achieved with the mean AUC of 0.916, 0.920, and 0.859, respectively. The models were well-calibrated by external validation using a prospective cohort including 210 FK and 210 non-FK patients from seven eye centers across China. The diagnostic model with the binary logistic regression algorithm classified the external validation dataset with a sensitivity of 0.907 (0.774, 1.000), specificity 0.899 (0.750, 1.000), accuracy 0.905 (0.805, 1.000), and AUC 0.903 (0.808, 0.998). INTERPRETATION Our model enables rapid identification of FK, which will help ophthalmologists to establish a preliminary diagnosis and to improve the diagnostic accuracy in clinic. FUNDING The Open Research Fund from the National Key Research and Development Program of China (2021YFC2301000) and the Open Research Fund from Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Tongren Hospital, Beihang University &Capital Medical University (BHTR-KFJJ-202001) supported this study.
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Affiliation(s)
- Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Shigeng Wang
- Beijing University of Posts and Telecommunications, Beijing, 100876, China
| | - Zhiqun Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Yang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Kexin Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Lan Gong
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Guigang Li
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qinxiang Zheng
- Eye Hospital, Wenzhou Medical College, Wenzhou, 325027, China
| | - Qin Zhang
- Department of Ophthalmology, Key Laboratory of Vision Loss and Restoration, Ministry of Education, People's Hospital, Peking University, Beijing, 100044, China
| | - Yan He
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Qi Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Jinding Pang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Leying Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Zhonghong Ou
- Beijing University of Posts and Telecommunications, Beijing, 100876, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China.
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Liu Q, Wan L, Zhou J, Huang Y. Ten-Year Analysis of Pathogenic Factors and Etiological Characteristics of Endophthalmitis from a Tertiary Eye Center in North China. Infect Drug Resist 2022; 15:3005-3012. [PMID: 35711516 PMCID: PMC9196666 DOI: 10.2147/idr.s367222] [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: 03/24/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the etiology and spectrum of isolated pathogens in endophthalmitis over 10 years from an ophthalmic hospital in North China and report their antimicrobial susceptibilities. Patients and Methods The data covered the patients with endophthalmitis treated at Qingdao Eye Hospital from January 2011 to December 2020. Patients’ medical history, pathogenic factors, bacterial and fungal culture results of intraocular specimens, and in vitro drug sensitivity test results were assessed. Results A total of 524 cases were counted in this study. Exogenous endophthalmitis was the main component, accounting for 94.66%, of which 49.62% of eyes had a history of ophthalmic trauma, intraocular surgery in 26.72% and suppurative keratitis in 17.37%. By comparison, endogenous endophthalmitis was found in only 5.34% of eyes. Among the 292 strains of pathogenic organisms obtained by co-culture, gram-positive bacteria accounted for 64.04%, with Staphylococcus epidermidis as the predominant pathogen (29.45%). Gram-positive cocci were identified in 76.77% of eyes with traumatic endophthalmitis, while 53.70% of keratitis-associated endophthalmitis was caused by fungi. The high susceptibility of bacteria to vancomycin (77.78%~98.33%) supported its continued use as empirical treatment. Among the fluoroquinolones, gram-positive cocci showed a higher susceptibility to gatifloxacin (94.83%), while there was a significant decrease to levofloxacin (51.67%). Gram-negative bacteria were less sensitive to cephalosporins (45.95%~66.67%) than fluoroquinolones (68.42%~78.05%) and aminoglycosides (75.00%~78.05%). Fungal susceptibilities to voriconazole and amphotericin B were 90.16% and 70.31% respectively. More than half of the 11 antibiotics were observed to exhibit a trend of reduced susceptibility. Conclusion Ophthalmic trauma was the primary pathogenic factor of endophthalmitis. Gram-positive cocci were the most common pathogens of traumatic and postoperative endophthalmitis, while suppurative keratitis-associated endophthalmitis often resulted from fungal pathogens. Levofloxacin as the preferred antibiotic in the perioperative period and cephalosporin as the first-line drug for the treatment of empiric endophthalmitis need to be vigilant.
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Affiliation(s)
- Qing Liu
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, People's Republic of China
| | - Lei Wan
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, People's Republic of China
| | - Jinyan Zhou
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, People's Republic of China
| | - Yusen Huang
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, People's Republic of China
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Recurrence of Infection in Corneal Grafts After Therapeutic Penetrating Keratoplasty for Microbial Keratitis. Cornea 2020; 39:39-44. [PMID: 31259861 DOI: 10.1097/ico.0000000000002044] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the factors responsible for the recurrence of infection after therapeutic penetrating keratoplasty (TPK) in severe microbial keratitis. METHODS This is a retrospective interventional case series that reviewed the medical records of 229 consecutive patients (2005-2017) who underwent TPK for microbial keratitis at a tertiary eye care center in Central India. The primary outcome was recurrence of the primary infection. The factors responsible for recurrence were identified by univariate and multivariate regression analysis. RESULTS The overall outcomes were clear graft in 50 (21.8%) eyes, failed graft in 139 (60.7%) eyes, evisceration in 19 (8.3%) eyes, phthisis bulbi in 14 (6.1%) eyes, repeat TPK in 2 (0.9%) eyes, and anterior staphyloma in 1 (0.4%) eye. Recurrence occurred in 63 (27.5%) eyes within 16.2 ± 13.8 (range: 2-66) days. Univariate analysis identified fungal etiology (P = 0.001), ulcer size > 60 mm (P = 0.001), limbal involvement (P = 0.001), endothelial exudates (P = 0.024), retro-iris exudates (P = 0.001), corneal perforation (P = 0.005), coexisting endophthalmitis (P < 0.001), and graft size ≥ 10 mm (P < 0.001) as significant risk factors. Multiple logistic regression identified fungal etiology (P = 0.013), retro-iris exudates (P = 0.011), coexisting endophthalmitis (P = 0.004), and graft size ≥ 10 mm (P = 0.058) as independent risk factors for recurrence. Presenting visual acuity of 20/200 or better was seen in 49 (21.4%) and 39 (17%) eyes, and no light perception in 11 (4.8%) and 26 (11.4%) eyes at postoperative months 1 and 3, respectively. CONCLUSIONS Fungal etiology, retro-iris exudates, coexisting endophthalmitis, and larger grafts were susceptible to recurrence. Early surgery may mitigate most of these factors. Despite the risk of recurrence, TPK remains an effective treatment in severe nonresponsive keratitis.
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Endothelial Plaques as Sign of Hyphae Infiltration of Descemet's Membrane in Fungal Keratitis. J Ophthalmol 2020; 2020:6083854. [PMID: 32566264 PMCID: PMC7271230 DOI: 10.1155/2020/6083854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 02/04/2023] Open
Abstract
Background To evaluate the relationship between corneal endothelial plaques and fungal hyphae infiltration in fungal keratitis. Methods Retrospective cross-sectional study of 60 fungal keratitis patients who underwent keratoplasty between January 2013 and March 2017. The endothelial plaques were graded as follows: grade 1, 1–3 endothelial plaques; grade 2, 4–8 endothelial plaques; and grade 3, more than 8 endothelial plaques or dense, merging endothelial plaques. The fungal pathogen culture and histopathology of diseased Descemet's membrane were evaluated. Results According to endothelial plaque grading, 3 patients were grade 1, 29 patients were grade 2, and 28 patients were grade 3. The PK surgery was performed in 57 patients with endothelial plaques of grade 2 and grade 3 and DALK surgery in 3 patients of grade 1. The predominating fungal pathogens were Aspergillus species (63.2%). All 57 patients with grade 2 and grade 3 had fungal hyphae in Descemet's membrane based on calcofluor white staining or PAS staining. In patients with grade 3, more hyphae and inflammatory cells were found in Descemet's membrane. The immunohistochemical staining of endothelial plaques revealed that CD15 and CD68 were positive in most cells. During the follow-up, 2 out of 3 patients who underwent DALK had recurrent fungal keratitis. Conclusions Endothelial plaques are considered as a sign of hyphae infiltrating Descemet's membrane. PK should be performed once plaques are detected in endothelium during the surgery.
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Sun XT, Zhai HL, Cheng J, Kong QQ, Cong L, Li L, Hao WP. Indications for penetrating keratoplasty and anterior lamellar keratoplasty during 2010-2017. Int J Ophthalmol 2019; 12:1878-1884. [PMID: 31850172 DOI: 10.18240/ijo.2019.12.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To review the indications of penetrating keratoplasty (PK) and anterior lamellar keratoplasty (ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS A total of 1869 eyes were included, among which 1405 eyes (75.2%) had PK and 464 eyes (24.8%) had ALK. The leading indications were suppurative keratitis (36.8%), keratoconus (15.5%), herpes keratitis (13.1%), and regraft (10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis (38.7%), herpes keratitis (15.3%), keratoconus (12.6%), and regraft (12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis (30.8%), keratoconus (24.1%), corneal dystrophies and degenerations (10.6%), and corneal dermoid tumor (9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.
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Affiliation(s)
- Xiao-Tong Sun
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Hua-Lei Zhai
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Jun Cheng
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Qian-Qian Kong
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Lin Cong
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Lin Li
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Wen-Pei Hao
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
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Cho CH, Lee SB. Clinical analysis of microbiologically proven fungal keratitis according to prior topical steroid use: a retrospective study in South Korea. BMC Ophthalmol 2019; 19:207. [PMID: 31619199 PMCID: PMC6796396 DOI: 10.1186/s12886-019-1212-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022] Open
Abstract
Background To compare the clinical characteristics and treatment outcomes of microbiologically proven fungal keratitis between users and non-users of prior topical steroids (PS and NPS, respectively). Methods Eighty-three cases with microbiologically proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors, clinical characteristics, microbiological profiles, and treatment outcomes were evaluated and compared between the PS and NPS groups. Treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated using multivariate logistic regression in the overall cohort. Results A total of 30 cases with PS group and 53 cases with NPS group were included. Of these, sixteen fungal isolates were identified in the PS group and 14 isolates in the NPS group. Candida was the most common organism in both groups (6 cases, respectively), while Aspergillus (4 cases) was found only in the PS group (p = 0.103). No significant differences were observed in the mean age, sex, occupational distribution, epithelial defect size, hypopyon, and presenting best-corrected visual acuity (BCVA) between the two groups. Differences were observed between the PS and NPS groups in terms of previous ocular surface disease (OSD) (43.3% vs. 22.6%, p = 0.048) and deep infiltration (53.3% vs. 32.1%, p = 0.057). Regarding treatment outcomes, final BCVA < 0.1 (60% vs. 44.2%, p = 0.133), the use of voriconazole (topical 10% vs. 0%, p = 0.044; systemic 23.3% vs. 1.9%, p = 0.003), surgical intervention (43.3% vs. 20.8%, p = 0.029), and treatment failure (46.7% vs. 22.6%, p = 0.023) were more common in the PS group than in the NPS group. The significant risk factors for treatment failure were hypopyon (odds ratio [OR] 6.01, p = 0.005) and deep infiltration (OR 4.38, p = 0.013). Conclusions Previous OSD and deep infiltration were more common in the PS group compared to the NPS group. The PS group also experienced worse disease progression and treatment outcomes. These results highlight the need for paying attention to the use of steroids in clinical practice.
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Affiliation(s)
- Chan-Ho Cho
- Department of Ophthalmology, Yeungnam University College of Medicine, 170, Hyunchung-ro, Nam-gu, Daegu, 705-717 (42415), South Korea
| | - Sang-Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, 170, Hyunchung-ro, Nam-gu, Daegu, 705-717 (42415), South Korea.
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Vasantha Ruban V, Anbukkarasi M, Anand T, Thomas PA, Geraldine P. Oxidative stress in corneal tissue in experimental keratitis due to Aspergillus flavus: Effect of topical voriconazole therapy. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2019. [DOI: 10.1016/j.bcab.2019.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wang Z, Tan XJ, Zhai HL, Cheng J, Gao Y, Xie LX. Etiology and failure analysis of anterior lamellar keratoplasty. Int J Ophthalmol 2018; 11:786-790. [PMID: 29862176 DOI: 10.18240/ijo.2018.05.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 03/01/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To analyze indications and reasons for failure of anterior lamellar keratoplasty (ALK). METHODS The clinical records were retrospectively reviewed. Main outcome measures included indications for ALK and reasons for failure of ALK. RESULTS A total of 434 patients (462 eyes) were treated with ALK at Qingdao Eye Hospital, Shandong Eye Institute from June 1, 2009 to May 31, 2016. The main indications were infectious keratitis (33.3%), keratoconus (23.6%), corneal dystrophy and degeneration (9.8%), Mooren's ulcer (8.4%), corneal neoplasm (7.8%), viral keratitis (6.5%) and regrafting (3.7%). Fungal keratitis accounted for 73.4% in the infectious keratitis cases. ALKs were failed in 36 patients, with the major causes being recurrence of primary diseases (63.9%). The leading causes of graft failure was Mooren's ulcer (36.1%), followed by infectious keratitis (30.6%). Recurrence of fungal keratitis accounted for 81.8% in the failed cases after ALK for infectious keratitis cases. CONCLUSION Infectious keratitis and keratoconus are the main indications for ALK, of which fungal keratitis was the major cause of corneal infections. Recurrence of primary disease is the main reason of graft failure after ALK, in which the main primary diseases associated with graft failure are Mooren's ulcer and fungal keratitis.
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Affiliation(s)
- Zhen Wang
- Qingdao University Medical College, Qingdao 266071, Shandong Province, China.,Affiliated Yidu Central Hospital of Weifang Medical College, Weifang 262500, Shandong Province, China
| | - Xiao-Jun Tan
- Affiliated Yidu Central Hospital of Weifang Medical College, Weifang 262500, Shandong Province, China
| | - Hua-Lei Zhai
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Jun Cheng
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Yan Gao
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Li-Xin Xie
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
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Ledbetter EC, Irby NL, Teixeira LB. In vivo confocal microscopy characteristics of equine epithelial and subepithelial nonulcerative keratomycosis. Vet Ophthalmol 2018; 22:168-176. [DOI: 10.1111/vop.12576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Eric C. Ledbetter
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Nita L. Irby
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Leandro B.C. Teixeira
- Comparative Ocular Pathology Laboratory of Wisconsin; Department of Pathobiological Sciences; School of Veterinary Medicine; University of Wisconsin-Madison; Madison WI USA
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Dan J, Zhou Q, Zhai H, Cheng J, Wan L, Ge C, Xie L. Clinical analysis of fungal keratitis in patients with and without diabetes. PLoS One 2018; 13:e0196741. [PMID: 29715322 PMCID: PMC5929555 DOI: 10.1371/journal.pone.0196741] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/18/2018] [Indexed: 11/19/2022] Open
Abstract
We compared the clinical characteristics, treatments, and prognoses of fungal keratitis in patients with and without diabetes. Patients diagnosed with fungal keratitis at Shandong Eye Institute between January 2010 and December 2016 were retrospectively reviewed and classified as diabetic and nondiabetic groups. One-hundred-and-eleven patients (111 eyes) with diabetes and 740 patients (740 eyes) without diabetes were included. The diabetic patients showed significantly older (p< 0.05) and lower male:female ratio (p<0.05). Plants trauma was the primary risk factor in both groups, and there was no significant difference of pathogen type (the most common was Fusarium genus, followed by Alternaria and Aspergillus genera). Multivariate logistic regression analyses revealed that diabetes and topical glucocorticoid use were the independent risk factors for the severity of fungal keratitis. The recurrent infection rate between the diabetic and nondiabetic patients during the follow-up (6 to 24 months) after penetrating keratoplasty (PKP) was not significantly different. Although the recurrent epithelial defect, rejection, and best-corrected visual acuity were similar between the patients with matched bed/graft size (7.75/8.0 mm) in the two groups 1 year after PKP, the incidence of delayed re-epithelialization (>7 days) was significantly higher in diabetic patients (3/10 versus 2/43 in nondiabetic patients, p<0.05). More specially, the diabetic patients with the duration ≥10 years showed more significantly delayed re-epithelialization than those with the diabetic duration less than 10 years (3/5 versus 1/26, p<0.05). In conclusion, the diabetes mellitus is an independent risk factor that affect the severity of fungal keratitis. Corneal re-epithelialization was significantly delayed after PKP in the diabetic patients, especially with the duration ≥10 years.
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Affiliation(s)
- Jing Dan
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China
| | - Qingjun Zhou
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China
| | - Hualei Zhai
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China
| | - Jun Cheng
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China
| | - Lei Wan
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China
| | - Cheng Ge
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China
| | - Lixin Xie
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China
- * E-mail:
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Ahmed SA, Hofmüller W, Seibold M, de Hoog GS, Harak H, Tammer I, van Diepeningen AD, Behrens-Baumann W. Tintelnotia,a new genus inPhaeosphaeriaceaeharbouring agents of cornea and nail infections in humans. Mycoses 2016; 60:244-253. [DOI: 10.1111/myc.12588] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- S. A. Ahmed
- Faculty of Medical Laboratory Sciences; University of Khartoum; Khartoum Sudan
| | - W. Hofmüller
- Department of Ophthalmology; Otto von Guericke University; Magdeburg Germany
| | | | - G. S. de Hoog
- CBS-KNAW Fungal Biodiversity Centre; Utrecht The Netherlands
- Institute of Biodiversity and Ecosystem Dynamics; University of Amsterdam; Amsterdam The Netherlands
| | - H. Harak
- Sesto San Giovanni Hospital; Milan Italy
| | - I. Tammer
- Department of Medical Microbiology; Otto von Guericke University; Magdeburg Germany
| | | | - W. Behrens-Baumann
- Department of Ophthalmology; Otto von Guericke University; Magdeburg Germany
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Periodic acid-Schiff staining demonstrates fungi in chronic anterior blepharitis. Eye (Lond) 2015; 29:1522-7. [PMID: 26293142 DOI: 10.1038/eye.2015.144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 05/13/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To evaluate the presence of fungi in patients with chronic anterior blepharitis with periodic acid-Schiff (PAS) staining of the eyelashes in addition to the conventional methods of fungal cultures and direct microscopy. METHODS Nineteen patients with chronic anterior blepharitis of seborrheic or mixed seborrheic/staphylococcal type and 11 healthy age- and sex-matched controls were included in this prospective, nonrandomized, cross-sectional study. Blepharitis was diagnosed based on clinical evidence of greasy scales between the cilia, lid margin erythema, conjunctival hyperemia, telangiectasia, thickening, or irregularity of the eyelid margins by slit-lamp biomicroscopy. Eyelash samples were obtained by epilation with a sterile forceps and evaluated with PAS staining, fungal cultures, and direct microscopy. RESULTS We demonstrated fungal elements with PAS staining in 79% of the blepharitis group (hyphae and/or spores) and 18% of the control group. The difference was statistically significant (P=0.002). Four patients in the blepharitis group (21%) had positive cultures for fungi. The isolated fungi were Penicillium species (2 cases), Candida species (1 case), and Trichophyton verrucosum (1 case). Direct microscopic examination revealed Demodex mites in 42.1% of the blepharitis group. No culture growth or Demodex mites were observed in the control group. CONCLUSIONS We have shown fungi with PAS staining in the majority of patients with chronic anterior blepharitis. Further controlled studies are necessary to clarify the role of fungi in the etiopathogenesis of blepharitis.
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Effects of Lamellar Keratectomy and Intrastromal Injection of 0.2% Fluconazole on Fungal Keratitis. J Ophthalmol 2015; 2015:656027. [PMID: 26064673 PMCID: PMC4439489 DOI: 10.1155/2015/656027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose. To evaluate effects of lamellar keratectomy and intrastromal injection of 0.2% fluconazole (LKIIF) on fungal keratitis. Methods. Data for 54 eyes of consecutive patients with fungal keratitis treated with LKIIF were retrospectively analyzed. The lesions in these eyes did not heal or were aggravated after antifungal chemotherapy for 7 days. The maximum lesion diameters were ≤5 mm and maximum depth was not more than half of full corneal thickness. Cases were followed up for at least 90 days. Results. Forty-six eyes were cured (85.2%). The wound healing times were 3–16 days and were less than 7 days in 28 cases (51.9%). In cured eyes, uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were both 20/250–20/20. The UCVA improved in 38 eyes and was unchanged in seven eyes. BCVA improved in 44 eyes and was unchanged in two eyes. When followed up for more than 90 days, 89% (41 of 46 eyes) showed improvement in UCVA and 11% were unchanged. Regarding BCVA, 98% improved and one eye was unchanged. No other complications were observed except neovascularization in one eye and thinner corneas. Conclusions. LKIIF was quick and effective for small fungal keratitis confined to half of the corneal thickness.
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Robaei D, Carnt N, Minassian DC, Dart JK. Therapeutic and Optical Keratoplasty in the Management of Acanthamoeba Keratitis. Ophthalmology 2015; 122:17-24. [DOI: 10.1016/j.ophtha.2014.07.052] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/20/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022] Open
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Erdem E, Kandemir H, Arıkan-Akdağlı S, Esen E, Açıkalın A, Yağmur M, İlkit M. Aspergillus terreus infection in a sutureless self-sealing incision made during cataract surgery. Mycopathologia 2014; 179:129-34. [PMID: 25362536 DOI: 10.1007/s11046-014-9829-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/26/2014] [Indexed: 11/26/2022]
Abstract
Here, we describe a case of keratitis caused by Aspergillus terreus in an 80-year-old immunocompetent woman 1 month after uneventful cataract surgery. The patient presented with decreased visual acuity (20/50) and severe pain in her right eye. Examination revealed a 3.5 × 4.5 mm white-colored deep stromal infiltration located on the temporal corneal tunnel incision. Corneal scraping samples were obtained for cytological and culture examinations. The cinnamon-brown colonies consisting of a dense felt of conidiophores were identified as A. terreus using molecular data. Using CLSI M38-A2 microdilution method, minimum inhibitory concentration values of amphotericin B, itraconazole, voriconazole, and posaconazole were determined to be 2, 1, 0.25, and 1 μg/ml, respectively, and minimum effective concentration values of caspofungin and anidulafungin were ≤0.03 and ≤0.03, respectively, at 48 h for the A. terreus strain. Antifungal therapy was started as topical 1 % voriconazole drops hourly and 5 % natamycin ointment five times a day; however, corneal infection and melting progressed despite the ongoing intensive treatment and visual acuity dropped to the 20/200 level at the end of the first week. Amniotic membrane transplantation was performed to promote corneal healing. Topical medication was tapered and discontinued within 2 months based on the clinical features. The ulcer healed with scarring and vascularization, and visual acuity improved to 20/50. In conclusion, A. terreus is a very uncommon cause of mycotic keratitis and is especially rare after cataract surgery. We suggest that early and accurate diagnosis and appropriate treatment of A. terreus keratitis may have a major impact on preventing severe disease complications.
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Affiliation(s)
- Elif Erdem
- Department of Ophthalmology, Faculty of Medicine, University of Çukurova, Adana, Turkey
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Big bubble deep anterior lamellar keratoplasty for management of deep fungal keratitis. J Ophthalmol 2014; 2014:209759. [PMID: 25105019 PMCID: PMC4106058 DOI: 10.1155/2014/209759] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/17/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. To evaluate the therapeutic effect of big bubble deep anterior lamellar keratoplasty (DALK) in patients with deep fungal keratitis. Methods.Consecutive patients who had DALK for deep fungal keratitis at Shandong Eye Hospital between July 2011 and December 2012 were included. In all patients, the infiltration depth was more than 4/5ths of the corneal thickness. DALK surgery was performed with bare Descemet membrane (DM) using the big bubble technique. Corrected distance visual acuity (CDVA), graft status, and intraoperative and postoperative complications were monitored. Results. Big bubble DALK was performed in 23 patients (23 eyes). Intraoperative perforation of the DM occurred in two eyes (8.7%) during stromal dissection. The patients received lamellar keratoplasty with an air bubble injected into the anterior chamber. Double anterior chamber formed in 3 eyes (13.0%). Mean CDVA of the patients without cataract, amblyopia, and fungal recurrence was improved from preoperative HM/20 cm−1.0 (LogMAR) to 0.23 ± 0.13 (LogMAR) at the last followup (P < 0.01). Fungal recurrence was found in two patients (8.7%). Corneal stromal graft rejection was noted in one patient (4.3%). Conclusions. DALK using the big bubble technique seems to be effective and safe in the treatment of deep fungal keratitis unresponsive to medication.
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Excimer laser phototherapeutic keratectomy for the treatment of clinically presumed fungal keratitis. J Ophthalmol 2014; 2014:963287. [PMID: 24891945 PMCID: PMC4033497 DOI: 10.1155/2014/963287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 04/12/2014] [Indexed: 11/24/2022] Open
Abstract
This retrospective study was to evaluate treatment outcomes of excimer laser phototherapeutic keratectomy (PTK) for clinically presumed fungal keratitis. Forty-seven eyes of 47 consecutive patients underwent manual superficial debridement and PTK. All corneal lesions were located in the anterior stroma and were resistant to medication therapy for at least one week. Data were collected by a retrospective chart review with at least six months of follow-up data available. After PTK, infected corneal lesions were completely removed and the clinical symptoms resolved in 41 cases (87.2%). The mean ablation depth was 114.39 ± 45.51 μm and diameter of ablation was 4.06 ± 1.07 mm. The mean time for healing of the epithelial defect was 8.8 ± 5.6 days. Thirty-four eyes (82.9%) showed an improvement in best spectacle-corrected visual acuity of two or more lines. PTK complications included mild to moderate corneal haze, hyperopic shift, irregular astigmatism, and thinning cornea. Six eyes (12.8%) still showed progressed infection, and conjunctival flap covering, amniotic membrane transplantation, or penetrating keratoplasty were given. PTK is a valuable therapeutic alternative for superficial infectious keratitis. It can effectively eradicate lesions, hasten reepithelialization, and restore and preserve useful visual function. However, the selection of surgery candidates should be conducted carefully.
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Abstract
Although relatively uncommon, fungi, atypical Mycobacteria, and Nocardia have been isolated from a variety of infections of eye including keratitis, scleritis, canaliculitis, dacryocystitis, endophthalmitis and orbital cellulites. The organisms typically cause a slowly progressive disease. The diseases caused by the organisms can pose both diagnostic and therapeutic challenges. In this manuscript we will describe updates on important aspects of the ocular infections caused by these organisms.
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Leal SM, Cowden S, Hsia YC, Ghannoum MA, Momany M, Pearlman E. Distinct roles for Dectin-1 and TLR4 in the pathogenesis of Aspergillus fumigatus keratitis. PLoS Pathog 2010; 6:e1000976. [PMID: 20617171 PMCID: PMC2895653 DOI: 10.1371/journal.ppat.1000976] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 05/28/2010] [Indexed: 02/06/2023] Open
Abstract
Aspergillus species are a major worldwide cause of corneal ulcers, resulting in visual impairment and blindness in immunocompetent individuals. To enhance our understanding of the pathogenesis of Aspergillus keratitis, we developed a murine model in which red fluorescent protein (RFP)-expressing A. fumigatus (Af293.1RFP) conidia are injected into the corneal stroma, and disease progression and fungal survival are tracked over time. Using Mafia mice in which c-fms expressing macrophages and dendritic cells can be induced to undergo apoptosis, we demonstrated that the presence of resident corneal macrophages is essential for production of IL-1beta and CXCL1/KC, and for recruitment of neutrophils and mononuclear cells into the corneal stroma. We found that beta-glucan was highly expressed on germinating conidia and hyphae in the cornea stroma, and that both Dectin-1 and phospho-Syk were up-regulated in infected corneas. Additionally, we show that infected Dectin-1(-/-) corneas have impaired IL-1beta and CXCL1/KC production, resulting in diminished cellular infiltration and fungal clearance compared with control mice, especially during infection with clinical isolates expressing high beta-glucan. In contrast to Dectin 1(-/-) mice, cellular infiltration into infected TLR2(-/-), TLR4(-/-), and MD-2(-/-) mice corneas was unimpaired, indicating no role for these receptors in cell recruitment; however, fungal killing was significantly reduced in TLR4(-/-) mice, but not TLR2(-/-) or MD-2(-/-) mice. We also found that TRIF(-/-) and TIRAP(-/-) mice exhibited no fungal-killing defects, but that MyD88(-/-) and IL-1R1(-/-) mice were unable to regulate fungal growth. In conclusion, these data are consistent with a model in which beta-glucan on A.fumigatus germinating conidia activates Dectin-1 on corneal macrophages to produce IL-1beta, and CXCL1, which together with IL-1R1/MyD88-dependent activation, results in recruitment of neutrophils to the corneal stroma and TLR4-dependent fungal killing.
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Affiliation(s)
- Sixto M. Leal
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Susan Cowden
- Department of Plant Biology, University of Georgia, Athens, Georgia, United States of America
| | - Yen-Cheng Hsia
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Mahmoud A. Ghannoum
- Center for Medical Mycology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Michelle Momany
- Department of Plant Biology, University of Georgia, Athens, Georgia, United States of America
| | - Eric Pearlman
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio, United States of America
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Risk Factors, Clinical Features, and Outcomes of Recurrent Fungal Keratitis after Corneal Transplantation. Ophthalmology 2010; 117:890-6. [DOI: 10.1016/j.ophtha.2009.10.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 09/01/2009] [Accepted: 10/01/2009] [Indexed: 11/18/2022] Open
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Boost M, Lai S, Ma C, Cho P. Do multipurpose contact lens disinfecting solutions work effectively against non-FDA/ISO recommended strains of bacteria and fungi? Ophthalmic Physiol Opt 2010; 30:12-9. [DOI: 10.1111/j.1475-1313.2009.00689.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hua X, Yuan X, Wilhelmus KR. A fungal pH-responsive signaling pathway regulating Aspergillus adaptation and invasion into the cornea. Invest Ophthalmol Vis Sci 2009; 51:1517-23. [PMID: 19850840 DOI: 10.1167/iovs.09-4348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To investigate the role of PalB and PacC, two components of a pH-responsive signal-transduction pathway of Aspergillus nidulans, during the pathogenesis of fungal infection of the cornea. METHODS Fungal strains included an A. nidulans wild-type isolate (A83), loss-of-function A. nidulans mutants of the palB (B7) or pacC (C6309) genes, and reconstituted genotypic strains (B7R and C6309R). Doubling times and radial growth rates were examined under neutral and acidic conditions. Corneal virulence was assessed ex vivo by topical inoculation of scarified porcine or human corneas with A. nidulans strains maintained in buffered medium until histologic examination after days 1, 3, and 5. RESULTS In vitro growth kinetics were similar for A. nidulans strains in liquid medium at pH 6.0 (P = 0.24) and 7.3 (P = 0.75). The pacC mutant C6309 grew more slowly (P < 0.001) on solid medium, whereas palB and pacC rescuants had growth kinetics comparable to those of the wild-type. Wild-type A. nidulans germinated on porcine corneas and produced hyphae that progressively invaded the stroma, reaching an average maximum penetration of 56% +/- 9% at 5 days after exposure. In contrast, hyphal invasion was significantly less by mutant strains B7 (P = 0.005) and C6309 (P = 0.003). Fungal penetration by C6309 was also significantly less than the wild-type (P = 0.0005) on explanted human corneas. Both fungal rescuants showed stromal invasion similar to the wild-type. CONCLUSIONS Corneal invasion by filamentous hyphae is attenuated by palB and pacC mutant strains of A. nidulans. The PacC pathway is involved in regulating fungal filamentation during ex vivo Aspergillus infection of the cornea.
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Affiliation(s)
- Xia Hua
- Sid W Richardson Ocular Microbiology Laboratory, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA
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Outcomes of Therapeutic Deep Lamellar Keratoplasty and Penetrating Keratoplasty for Advanced Infectious Keratitis. Ophthalmology 2009; 116:615-23. [PMID: 19243833 DOI: 10.1016/j.ophtha.2008.12.043] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 12/16/2008] [Accepted: 12/17/2008] [Indexed: 11/23/2022] Open
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Garg P. Lamellar keratoplasty. Ophthalmology 2009; 116:362-3; author reply 363. [PMID: 19187827 DOI: 10.1016/j.ophtha.2008.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022] Open
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Xie L, Zhai H. Author reply. Ophthalmology 2009. [DOI: 10.1016/j.ophtha.2008.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Alternaria Keratitis: Clinical Presentation and Resolution With Topical Fluconazole or Intrastromal Voriconazole and Topical Caspofungin. Cornea 2009; 28:116-9. [DOI: 10.1097/ico.0b013e31818225f8] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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