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Wu M, Zhang X, Karunaratne S, Lee JH, Lampugnani ER, Selva KJ, Chung AW, Mueller SN, Chinnery HR, Downie LE. Intravital Imaging of the Human Cornea Reveals the Differential Effects of Season on Innate and Adaptive Immune Cell Morphodynamics. Ophthalmology 2024:S0161-6420(24)00273-2. [PMID: 38703795 DOI: 10.1016/j.ophtha.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE Defining how the in vivo immune status of peripheral tissues is shaped by the external environment has remained a technical challenge. We recently developed Functional in vivo confocal microscopy (Fun-IVCM) for dynamic, longitudinal imaging of corneal immune cells in living humans. This study investigated the effect of seasonal-driven environmental factors on the morphodynamic features of human corneal immune cell subsets. DESIGN Longitudinal, observational clinical study. PARTICIPANTS Sixteen healthy participants (aged 18-40 years) attended 2 visits in distinct seasons in Melbourne, Australia (Visit 1, November-December 2021 [spring-summer]; Visit 2, April-June 2022 [autumn-winter]). METHODS Environmental data were collected over each period. Participants underwent ocular surface examinations and corneal Fun-IVCM (Heidelberg Engineering). Corneal scans were acquired at 5.5 ± 1.5-minute intervals for up to 5 time points. Time-lapse Fun-IVCM videos were created to analyze corneal immune cells, comprising epithelial T cells and dendritic cells (DCs), and stromal macrophages. Tear cytokines were analyzed using a multiplex bead-based immunoassay. MAIN OUTCOME MEASURES Difference in the density, morphology, and dynamic parameters of corneal immune cell subsets over the study periods. RESULTS Visit 1 was characterized by higher temperature, lower humidity, and higher air particulate and pollen levels compared with Visit 2. Clinical ocular surface parameters and the density of immune cell subsets were similar across visits. At Visit 1 , corneal epithelial DCs were larger, with a lower dendrite probing speed (0.38 ± 0.21 vs. 0.68 ± 0.33 μm/min; P < 0.001) relative to Visit 2; stromal macrophages were more circular and had less dynamic activity (Visit 1, 7.2 ± 1.9 vs. Visit 2, 10.3 ± 3.7 dancing index; P < 0.001). Corneal T cell morphodynamics were unchanged across periods. Basal tear levels of interleukin 2 and CXCL10 were relatively lower during spring-summer. CONCLUSIONS This study identifies that the in vivo morphodynamics of innate corneal immune cells (DCs, macrophages) are modified by environmental factors, but such effects are not evident for adaptive immune cells (T cells). The cornea is a potential in vivo window to investigate season-dependent environmental influences on the human immune system. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mengliang Wu
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, Victoria, Australia; Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Xinyuan Zhang
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, Victoria, Australia
| | - Senuri Karunaratne
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, Victoria, Australia
| | - Ji-Hyun Lee
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, Victoria, Australia
| | - Edwin R Lampugnani
- School of BioSciences, The University of Melbourne, Parkville, Victoria, Australia; Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Kevin J Selva
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Amy W Chung
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Scott N Mueller
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Holly R Chinnery
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, Victoria, Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, Victoria, Australia.
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Erdem E, Köktaş Z, İnan Harbiyeli I, Atalay E, Kibar F, Durmaz G, Arslan YK, Seydaoğlu G, Yıldırım N, Yağmur M. The effect of climatic and seasonal factors on the microbial keratitis profile. J Fr Ophtalmol 2024; 47:104018. [PMID: 37932171 DOI: 10.1016/j.jfo.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/31/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE To compare retrospective data on microbial keratitis (MK) from two different climatic regions in Turkey over 11 years. STUDY DESIGN Retrospective cohort. METHODS This retrospective cohort study included patients diagnosed with presumed MK at two referral centers. Center A was located in the subtropical region of Turkey, whereas Center B was located in a continental temperate climate zone. Clinical and laboratory data were also recorded. The results were evaluated for seasonal variations. RESULTS This study included data from 665 patients with presumed MK (351 and 314 patients from centers A and B, respectively). The most common predisposing factors were ocular trauma in Center A, prior ocular surgery, and systemic disease in Center B. Severe keratitis was related to prior ocular surgery, presence of systemic disease, and fungal infection at presentation. The culture positivity rate was higher in spring and lower in summer at both centers. Gram-positive bacteria were the most commonly isolated bacteria in both centers in all seasons. The fungal and mixed keratitis ratios were higher in Center A than in Center B. In Center A, filamentous fungi were common pathogens that were found year-round, and peaks were observed in July and October. CONCLUSION The results of this study show that climatic and seasonal factors may affect the microbial profile of keratitis. Fungal keratitis appears to be a climatic disease. Understanding the regional profile of MK can aid clinicians in their disease management.
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Affiliation(s)
- E Erdem
- Ophthalmology Department, Faculty of Medicine, Cukurova University, Balcalı Hospital, 1380 Sarıcam, Adana, Turkey.
| | - Z Köktaş
- Ophthalmology Department, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - I İnan Harbiyeli
- Ophthalmology Department, Faculty of Medicine, Cukurova University, Balcalı Hospital, 1380 Sarıcam, Adana, Turkey
| | - E Atalay
- Ophthalmology Department, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - F Kibar
- Microbiology Department, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - G Durmaz
- Microbiology Department of Eskişehir Osmangazi, University Faculty of Medicine, Eskişehir, Turkey
| | - Y K Arslan
- Statistic Department of Cukurova University, Faculty of Medicine, Adana, Turkey
| | - G Seydaoğlu
- Statistic Department of Cukurova University, Faculty of Medicine, Adana, Turkey
| | - N Yıldırım
- Ophthalmology Department, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - M Yağmur
- Ophthalmology Department, Faculty of Medicine, Cukurova University, Balcalı Hospital, 1380 Sarıcam, Adana, Turkey
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Ling JYM, Yeung SN, Chan CC, Trinh T, Antaki F, Harissi-Dagher M, Sivachandran N, Fava M, Légaré MÈ, Iovieno A. Trends and Clinical Outcomes of Fungal Keratitis in Canada: A 20-year Retrospective Multicentre Study. Am J Ophthalmol 2024; 265:147-155. [PMID: 38642698 DOI: 10.1016/j.ajo.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE An increase in fungal and particularly filamentous keratitis has been observed in many geographic areas, mostly in contact lens wearers. This study seeks to characterize long-term trends in fungal keratitis in a continental climate area to provide guidance for diagnosis and treatment. DESIGN Retrospective multicentric case series. METHODS Cases of microbiology-confirmed fungal keratitis from 2003 to 2022 presenting to tertiary care centers across Canada were included. Charts were reviewed for patient demographics, risk factors, visual acuity, and treatments undertaken. RESULTS A total of 138 patients were identified: 75 had yeast keratitis while 63 had filamentous keratitis. Patients with yeast keratitis had more ocular surface disease (79% vs 28%) while patients with filamentous keratitis wore more refractive contact lenses (78% vs 19%). Candida species accounted for 96% of all yeast identified, while Aspergillus (32%) and Fusarium (26%) were the most common filamentous fungi species. The mean duration of treatment was 81 ± 96 days. Patients with yeast keratitis did not have significantly improved visual acuity with medical treatment (1.8 ± 1 LogMAR to 1.9 ± 1.5 LogMAR, P = .9980), in contrast to patients with filamentous keratitis (1.4 ± 1.2 LogMAR to 1.1 ± 1.3 LogMAR, P = .0093). CONCLUSIONS Fungal keratitis is increasing in incidence, with contact lenses emerging as one of the leading risk factors. Significant differences in the risk factors and visual outcomes exist between yeast keratitis and filamentous keratitis which may guide diagnosis and treatment.
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Affiliation(s)
- Jennifer Y M Ling
- From the Department of Ophthalmology and Visual Sciences (J.Y.M.L., S.N.Y., A.I.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia N Yeung
- From the Department of Ophthalmology and Visual Sciences (J.Y.M.L., S.N.Y., A.I.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences (C.C., T.T.), University of Toronto, Toronto, Ontario, Canada
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences (C.C., T.T.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (T.T.), Sydney Eye Hospital, Sydney, Australia
| | - Fares Antaki
- Department of Ophthalmology (F.A., M.H.), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology (F.A., M.H.), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Nirojini Sivachandran
- Division of Ophthalmology (N.S., M.F.), McMaster University, Hamilton, Ontario, Canada
| | - Mark Fava
- Division of Ophthalmology (N.S., M.F.), McMaster University, Hamilton, Ontario, Canada
| | - Marie-Ève Légaré
- Centre Universitaire d'Ophtalmologie - CHU de Québec (M.L.), Université Laval, Québec City, Québec, Canada
| | - Alfonso Iovieno
- From the Department of Ophthalmology and Visual Sciences (J.Y.M.L., S.N.Y., A.I.), University of British Columbia, Vancouver, British Columbia, Canada.
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Tey KY, Cheong EZK, Ang M. Potential applications of artificial intelligence in image analysis in cornea diseases: a review. EYE AND VISION (LONDON, ENGLAND) 2024; 11:10. [PMID: 38448961 PMCID: PMC10919022 DOI: 10.1186/s40662-024-00376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
Artificial intelligence (AI) is an emerging field which could make an intelligent healthcare model a reality and has been garnering traction in the field of medicine, with promising results. There have been recent developments in machine learning and/or deep learning algorithms for applications in ophthalmology-primarily for diabetic retinopathy, and age-related macular degeneration. However, AI research in the field of cornea diseases is relatively new. Algorithms have been described to assist clinicians in diagnosis or detection of cornea conditions such as keratoconus, infectious keratitis and dry eye disease. AI may also be used for segmentation and analysis of cornea imaging or tomography as an adjunctive tool. Despite the potential advantages that these new technologies offer, there are challenges that need to be addressed before they can be integrated into clinical practice. In this review, we aim to summarize current literature and provide an update regarding recent advances in AI technologies pertaining to corneal diseases, and its potential future application, in particular pertaining to image analysis.
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Affiliation(s)
- Kai Yuan Tey
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Marcus Ang
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Moledina M, Roberts HW, Mukherjee A, Spokes D, Pimenides D, Stephenson C, Bassily R, Rajan MS, Myerscough J. Analysis of microbial keratitis incidence, isolates and in-vitro antimicrobial susceptibility in the East of England: a 6-year study. Eye (Lond) 2023; 37:2716-2722. [PMID: 36709219 PMCID: PMC9883814 DOI: 10.1038/s41433-023-02404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/30/2022] [Accepted: 01/16/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/OBJECTIVES To report the incidence, microbiological profile and in-vitro antimicrobial susceptibilities of microbial keratitis (MK) in the East of England (EoE) over a 6-year period. SUBJECTS/METHODS A retrospective study of patients diagnosed with MK who underwent corneal scraping at participating trusts, within the EoE, between 01/01/2015-01/07/2020. Analysis was performed on MK isolate profiles, in-vitro anti-microbial sensitivities and trends over time. RESULTS The mean incidence of IK, in the EoE, was estimated at 6.96 per 100 000 population/year. 1071 corneal scrapes were analysed, 460 were culture positive (42.95%) of which 87.2% were bacteria (50.3% gram-positive and 49.7% gram-negative), 2.4% polymicrobial, 9.3% fungi and 1.1% acanthamoeba. The most common organisms were pseudomonas spp (29.57%). There was a non-statistically significant trend (NST) in increasing incidence of pseudomonas spp, staph aureus and serratia (p = 0.719, p = 0.615, and p = 0.099 respectively) and a declining NST in Fungi (p = 0.058). Susceptibilities in-vitro to, penicillin classes, fluoroquinolone and aminoglycosides were 76.7% and 89.4%, 79.2% and 97.2% and 95.4 and 96.1% to gram-positive and gram-negative bacteria respectively. Gram-negative organisms were increasingly resistant to cephalosporins with a 19.2% reduction in sensitivity over time. (p = 0.011). Ceftriaxone showed the greatest decrease in sensitivity of 41.67% (p = 0.006). CONCLUSION In the EoE, MK is relatively prevalent though likely underestimated. Profiles are similar to other UK regions with the exception of a higher fungal and lower acanthamoeba incidence. Common first and second-line antimicrobial selection provides, on the whole, good coverage. Nevertheless, anti-microbial resistance, to cephalosporins, was observed so selection should be carefully considered when treating MK empirically.
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Affiliation(s)
- Malik Moledina
- Department of Ophthalmology, Southend University Hospital, Southend, UK
| | - Harry W Roberts
- West of England Eye Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Achyut Mukherjee
- Department of Ophthalmology, Colchester General Hospital, Colchester, UK
| | - David Spokes
- Department of Ophthalmology Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Ramy Bassily
- Department of Ophthalmology, Ipswich Hospital, Ipswich, UK
| | - Madhavan S Rajan
- Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - James Myerscough
- Department of Ophthalmology, Southend University Hospital, Southend, UK.
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
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Shekhawat NS, Hall LN, Sulewski ME, Woreta F, Wang J, Smith K, Kuo IC. Corneal Culture and Antibiotic Susceptibility Results for Microbial Keratitis in the Mid-Atlantic Region of the United States, 2016 to 2020. Eye Contact Lens 2023; 49:267-274. [PMID: 37166232 PMCID: PMC10330016 DOI: 10.1097/icl.0000000000000993] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To examine the microbial distribution and antimicrobial susceptibility of culture-positive microbial keratitis at a large tertiary referral center in the mid-Atlantic region of the United States. METHODS Retrospective review of culture-positive microbial keratitis cases at the Wilmer Eye Institute from 2016 through 2020. RESULTS Of the 474 culture-positive microbial keratitis cases, most were bacterial (N=450, 94.9%), followed by fungal (N=48, 10.1%) and Acanthamoeba keratitis (N=15, 3.1%). Of the 450 bacterial isolates, 284 (69.5%) were gram-positive organisms, whereas 157 (28.4%) were gram-negative organisms. The most common bacterial species isolated was coagulase-negative Staphylococcus spp (N=154, 24.8%), and the most common gram-negative isolate was Pseudomonas aeruginosa (N=76, 12.3%). Among fungi, the most common isolates were Candida (N=25, 45.4%), whereas Fusarium (N=6, 10.9%) and Aspergillus (N=3, 5.5%) were less common. Of the 217 bacterial isolates tested for erythromycin susceptibility, 121 (55.7%; ∼60% of coagulase-negative staphylococci and corynebacteria tested) showed resistance to erythromycin. CONCLUSIONS Microbial keratitis in the Baltimore Mid-Atlantic region of the United States is most commonly caused by bacteria, with fungi and acanthamoeba being less common. Gram-positive bacterial infections predominate. Among fungal keratitis cases, Candida species are more commonly encountered than are filamentous species. Use of erythromycin as infection prophylaxis should be reexamined. Findings from our study may guide empiric treatment in this geographic region.
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Affiliation(s)
- Nakul S. Shekhawat
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leangelo N. Hall
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E. Sulewski
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika Woreta
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiangxia Wang
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA
| | - Kerry Smith
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irene C. Kuo
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
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Fang Y, Zhuo L, Yuan H, Zhao H, Zhang L. Construction of Graphene Quantum Dot-based Dissolving Microneedle Patches for the Treatment of Bacterial Keratitis. Int J Pharm 2023; 639:122945. [PMID: 37044225 DOI: 10.1016/j.ijpharm.2023.122945] [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: 11/30/2022] [Revised: 03/06/2023] [Accepted: 04/08/2023] [Indexed: 04/14/2023]
Abstract
Bacterial keratitis (BK) is an ophthalmic infection caused by bacteria and poses a risk of blindness. Numerous drugs have been used to treat BK, the majority suffered from limited effect owing to their backward antimicrobial and delivery efficacy. Herein, we evaluated the antibacterial effect of a cationic carbon-based nanomaterial, i.e., imidazole-modified graphene quantum dots (IMZ-GQDs), which exhibits disinfection rates of >90% against three typical Gram-positive strains within 3 h owing to the loss of membrane integrity and decline in membrane potential. For ocular application, we further developed IMZ-GQDs-loaded dissolving microneedle patches (IMZ-GQDs MNs) via a typical two-step micromolding method. IMZ-GQDs MNs showed sufficient dissolution and penetration for intrastromal delivery in vitro and successfully overcome the rabbit corneal epithelial layer in vivo. The excellent biocompatibility of IMZ-GQDs MNs was demonstrated both in cell and animal models, and they exhibited low cytotoxicity, low invasiveness and low ocular irritation. The topical application of IMZ-GQDs MNs has the benefits of both high antibacterial activity and effective drug delivery, thereby leading to the resolution of Staphylococcus aureus-induced BK in rabbits in 7 days. Therefore, IMZ-GQDs MNs is a promising approach for BK treatment, which is safe and efficient.
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Affiliation(s)
- Yirong Fang
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China
| | - Lin Zhuo
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China
| | - Hang Yuan
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China
| | - Hao Zhao
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China
| | - Lishu Zhang
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China.
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8
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Rauchman SH, Locke B, Albert J, De Leon J, Peltier MR, Reiss AB. Toxic External Exposure Leading to Ocular Surface Injury. Vision (Basel) 2023; 7:vision7020032. [PMID: 37092465 PMCID: PMC10123707 DOI: 10.3390/vision7020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/07/2023] Open
Abstract
The surface of the eye is directly exposed to the external environment, protected only by a thin tear film, and may therefore be damaged by contact with ambient particulate matter, liquids, aerosols, or vapors. In the workplace or home, the eye is subject to accidental or incidental exposure to cleaning products and pesticides. Organic matter may enter the eye and cause infection. Ocular surface damage can trigger a range of symptoms such as itch, discharge, hyperemia, photophobia, blurred vision, and foreign body sensation. Toxin exposure can be assessed clinically in multiple ways, including via measurement of tear production, slit-lamp examination, corneal staining, and conjunctival staining. At the cellular level, environmental toxins can cause oxidative damage, apoptosis of corneal and conjunctival cells, cell senescence, and impaired motility. Outcomes range from transient and reversible with complete healing to severe and sight-compromising structural changes. Classically, evaluation of tolerance and safety was carried out using live animal testing; however, new in vitro and computer-based, in silico modes are superseding the gold standard Draize test. This review examines how environmental features such as pollutants, temperature, and seasonality affect the ocular surface. Chemical burns to the eye are considered, and approaches to protect the ocular surface are detailed.
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Affiliation(s)
| | - Brandon Locke
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA
| | - Jacqueline Albert
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA
| | - Joshua De Leon
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA
| | - Morgan R. Peltier
- Department of Psychiatry and Behavioral Health, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA
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9
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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Choi JH, Ong ES, Munir WM. Social Media Evaluation of Seasonal and Geographic Trends of Corneal Ulcers in the United States. Eye Contact Lens 2023; 49:25-29. [PMID: 36201642 DOI: 10.1097/icl.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study is to evaluate if social media and Google search data can identify seasonal and geographic trends in the incidence of corneal ulcers in the United States. METHODS This is a case series of all corneal ulcer-related data collected from two major social media platforms and Google trends from US users between 2017 and 2021. Instagram and Twitter were searched for posts and hashtags related to "corneal ulcer." Web and image search volume of "corneal ulcer" were collected from Google trends ( https://trends.google.com ). Data were compared between seasons, defined by 3-month intervals, and chi-square tests were used to determine the statistical significance. RESULTS One hundred and sixty-five individuals (79% female) and 164 individuals (79% female) posted personal new corneal ulcer diagnoses on Twitter and Instagram, respectively. Summer resulted in the highest number of both Twitter (34%, P =0.07) and Instagram (33%, P =0.68) posts. Summer was also the most popular season for Google web and image searches of "corneal ulcer" (search volume average of 58.4 and 41.2, P =0.74 and P =0.01, respectively, with 100 being peak popularity). Across all platforms, the South was the most represented (32% Twitter, 38% Instagram, 32% Google Web, and 33% Google Images). CONCLUSIONS Our results indicate that social media and Google trends may reflect seasonal and geographic patterns of corneal ulcer incidence in the United States. However, further study with increased power is needed.
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Affiliation(s)
- Jamie H Choi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD
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11
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Alasadi SZ, Ibraheim W, Almusawi LA. Microbial Contamination of Soft Contact Lenses Among Medical School Students in Southern Iraq. Clin Ophthalmol 2022; 16:3651-3660. [PMID: 36389641 PMCID: PMC9642796 DOI: 10.2147/opth.s383086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Contamination of CLs and accessories risks potentially devastating microbial keratitis. We aimed to explore the rate of microbial contamination and predisposing factors among a group of asymptomatic young medical students. Methodology The study included 115 healthy female medical students with a mean age of 21.64 ± 2.02 years between January and November 2021. Information about CL use, wear and care was gathered. Each participant’s CL and case were swabbed for microbiological identification. Univariable and multivariable analyses were conducted to look for associations with a range of factors. Results Overall, 91 participants (79.13%) had at least one contaminated sample (lens and/or case). The rates of contamination of CL and their cases were 66% and 76.5%, respectively. Higher contamination rates were caused by gram-negative bacteria (60% of the contaminated samples) with P. aeruginosa being the most common contaminant both for CL and cases, whereas S. epidermidis and S. aureus were the most common contaminants for the CL and cases, respectively, regarding gram-positive contamination. Multivariable analysis showed younger age as a significant predictor of pseudomonas contamination of the lenses and cases (OR: 12.302, 6.555 for CL & cases, respectively; P = 0.001 for both). Older age was a significant predictor of K. pneumoniae contamination (OR: 4.154, P = 0.007). Pseudomonas contamination of both lenses and cases was predicted by the type of solution used (OR: 10.8 and 13.5, P = 0.001 and 0.003 for bottled and distilled water vs commercially available solutions for CL; OR: 4.5 and 5.8, P = 0.045 and 0.004, respectively, for cases). Pseudomonas case contamination was associated with low frequency of solution change. Conclusion Microbial contamination rate of soft CL and their cases is high among young medical students in comparison to previously reported rates and was predisposed by several poor hygienic practices and wearing regimens.
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Affiliation(s)
| | - Wijdan Ibraheim
- Department of Microbiology, College of Medicine, University of Basrah, Basrah, Iraq
| | - Loay Abdulmutalib Almusawi
- Department of Surgery, College of Medicine, University of Basrah, Basrah, Iraq
- Correspondence: Loay Abdulmutalib Almusawi, Department of Surgery, College of Medicine, University of Basrah, Basrah, 61022, Iraq, Tel +964 7705559205, Email
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12
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Anderson CD, Rees N, Koetsie K, Rose A, Makgotloe A. Microbial keratitis: Causative organisms, susceptibilities and trends at a tertiary eye hospital in South Africa. AFRICAN VISION AND EYE HEALTH 2022. [DOI: 10.4102/aveh.v81i1.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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13
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Michaels L, Richardson J, Walkden A, Carley F. Impact of the COVID-19 Pandemic on the Incidence and Characteristics of Culture-Positive Microbial Keratitis at a Tertiary Eye Hospital in the UK. Clin Ophthalmol 2022; 16:2513-2519. [PMID: 35974905 PMCID: PMC9375992 DOI: 10.2147/opth.s373758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The COVID-19 pandemic has led to drastic changes to the daily lives of those living in the United Kingdom. We hypothesized that the effect of the imposed lockdown on both behaviour and social interaction has the potential to influence the characteristics of microbial keratitis presenting locally to Manchester Royal Eye Hospital — a major tertiary eye centre in the UK. Methods We conducted a retrospective case-note review of all positive corneal scrape cultures identified by our local microbiology laboratory during the year since the announcement of lockdown measures in the UK (23 March 2020 to 23 March 2021). Culture results were compared with previously collated, published “baseline” data from prior to the onset of the COVID-19 pandemic (2004–2019). Statistical analysis was undertaken, predominantly looking at the incidence of microbial keratitis and the variety of cultured pathogens. Results A total of 6243 corneal scrape results were reviewed. Comparison of data between the COVID-19 pandemic and subsequent lockdown did not show a significant change in the incidence of culture-positive microbial keratitis: mean annual positive samples during 2004–2019 were 128 (35%) vs 91 (29%) during lockdown (P=0.096). No statistically significant shifts in the incidence of organism subtypes — fungi, acanthamoeba, Gram-positive bacteria, or Gram negative bacteria — were identified (P=0.196, 1, 0.366, and 0.087, respectively). Conclusion Contrary to our hypothesis, our results suggest that the COVID-19 pandemic did not alter the incidence or characteristics of microbial keratitis presenting to Manchester Royal Eye Hospital in the year following the implementation of lockdown measures in the UK.
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Affiliation(s)
| | | | - Andrew Walkden
- Manchester Royal Eye Hospital, Manchester, UK
- Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Correspondence: Andrew Walkden, Manchester Royal Eye Hospital, Oxford Road, Manchester, Greater Manchester, M13 9WL, UK, Tel +44 161-276-1234, Email
| | - Fiona Carley
- Manchester Royal Eye Hospital, Manchester, UK
- Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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Lim J, Cho CH, Lee SB. Microbiological Profile and Clinical Characteristics of Bacterial Keratitis with Poor Visual Outcome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.7.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To compare clinical characteristics between the poor visual outcome (PVO) and good visual outcome (GVO) groups in culture-proven bacterial keratitis.Methods: A total of 230 cases (44 and 186 eyes in the PVO and GVO groups, respectively) of culture-proven bacterial keratitis, treated between January 2007 and December 2020, were reviewed retrospectively. The PVO group included cases with the final best-corrected visual acuity (BCVA) of less than 0.1 and no improvement compared to the initial BCVA. The remaining cases were included in the GVO group. The microbiological profiles, epidemiology, predisposing factors, and clinical characteristics were compared between the PVO and GVO groups, and the risk factors for PVO were analyzed.Results: Staphylococcus spp. and Pseudomonas spp. were common isolates in both the PVO and GVO groups, with no significant differences in the distribution of isolates. There were no significant differences between the groups in terms of sex, seasonal distribution, corneal trauma, and prior topical steroid use, but contact lens wear was significantly less in the PVO group. Significant risk factors for PVO were age ≥60 years (Z = 4.22, two-proportion Z-test), central corneal lesions (Z = 3.80), epithelial defect size ≥5 mm<sup>2</sup> (Z = 3.74), prior ocular surgery (Z = 3.63), hypopyon (Z = 3.42), previous ocular surface disease (Z = 3.32), and diabetes (Z = 3.12).Conclusions: In patients with bacterial keratitis, PVO was associated with older age, severe initial corneal findings, previous ocular disease history, and diabetes, but not with the causative pathogen itself.
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15
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Ghosh AK, Thammasudjarit R, Jongkhajornpong P, Attia J, Thakkinstian A. Deep Learning for Discrimination Between Fungal Keratitis and Bacterial Keratitis: DeepKeratitis. Cornea 2022; 41:616-622. [PMID: 34581296 PMCID: PMC8969839 DOI: 10.1097/ico.0000000000002830] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Microbial keratitis is an urgent condition in ophthalmology that requires prompt treatment. This study aimed to apply deep learning algorithms for rapidly discriminating between fungal keratitis (FK) and bacterial keratitis (BK). METHODS A total of 2167 anterior segment images retrospectively acquired from 194 patients with 128 patients with BK (1388 images, 64.1%) and 66 patients with FK (779 images, 35.9%) were used to develop the model. The images were split into training, validation, and test sets. Three convolutional neural networks consisting of VGG19, ResNet50, and DenseNet121 were trained to classify images. Performance of each model was evaluated using precision (positive predictive value), sensitivity (recall), F1 score (test's accuracy), and area under the precision-recall curve (AUPRC). Ensemble learning was then applied to improve classification performance. RESULTS The classification performance in F1 score (95% confident interval) of VGG19, DenseNet121, and RestNet50 was 0.78 (0.72-0.84), 0.71 (0.64-0.78), and 0.68 (0.61-0.75), respectively. VGG19 also demonstrated the highest AUPRC of 0.86 followed by RestNet50 (0.73) and DenseNet (0.60). The ensemble learning could improve performance with the sensitivity and F1 score of 0.77 (0.81-0.83) and 0.83 (0.77-0.89) with an AUPRC of 0.904. CONCLUSIONS Convolutional neural network with ensemble learning showed the best performance in discriminating FK from BK compared with single architecture models. Our model can potentially be considered as an adjunctive tool for providing rapid provisional diagnosis in patients with microbial keratitis.
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Affiliation(s)
| | | | - Passara Jongkhajornpong
- Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
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16
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Swift T, Pinnock A, Shivshetty N, Pownall D, MacNeil S, Douglas I, Garg P, Rimmer S. GENERATION AND USE OF FUNCTIONALISED HYDROGELS THAT CAN RAPIDLY SAMPLE INFECTED SURFACES. MethodsX 2022; 9:101684. [PMID: 35540105 PMCID: PMC9078998 DOI: 10.1016/j.mex.2022.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
This paper outlined our method for developing polymer-linked contact lens type materials for rapid detection and differentiation of Gram-positive, Gram-negative bacteria and fungi in infected corneas. It can be applied to both model synthetic or ex-vivo corneal models and has been successfully trialed in an initial efficacy tested animal study. First a hydrogel substrate for the swab material is selected, we have demonstrated selective swabs using a glycerol monomethacrylate hydrogel. Alternatively any commercial material with carboxylic acid functional groups is suitable but risks nonspecific adhesion. This is then functionalised via use of N-hydroxysuccinimide reaction with amine groups on the specified highly branched polymer ligand (either individually gram negative, gram positive or fungal binding polymers or a combination of all three can be employed for desired sensing application). The hydrogel is then cut into swabs suitable for sampling, used, and then the presence of gram positive, game negative and fungi are disclosed by the sequential addition of dyes (fluorescent vancomycin, fluorescein isothiocyanate and calcofluor white). In summary this method presents: Method to produce glycerol monomethacrylate hydrogels to minimize nonspecific binding Methods of attaching pathogen binding highly branched polymers to produce selective hydrogel swabs Method for disclosing bound pathogens to this swab using sequential dye addition
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Affiliation(s)
| | | | | | | | | | | | | | - Stephen Rimmer
- University of Bradford, Bradford UK
- Corresponding author.
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17
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An Evaluation of a Simplified Impression Membrane Sampling Method for the Diagnosis of Microbial Keratitis. J Clin Med 2021; 10:jcm10235671. [PMID: 34884373 PMCID: PMC8658700 DOI: 10.3390/jcm10235671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to compare bacterial isolation rate using a corneal impression membrane (CIM) and a sharp instrument for obtaining corneal samples from patients with suspected microbial keratitis (MK). Data was retrospectively collected for all patients that had corneal samples taken for presumed MK between May 2014 and May 2020. Prior to May 2017 samples were collected by scraping the edges of the ulcer with a blade. From May 2017, samples were collected by placing a CIM (Millicell cell culture insert) against the ulcer. All corneal samples were processed using the same conventional diagnostic culture method. A total of 3099 corneal samples were included, of which 1214 (39.2%) were corneal scrapes and 1885 (60.9%) CIMs. Microorganisms were isolated from 235 (19.4%) and 1229 (65.2%) cases using a corneal scrape and CIM, respectively (p < 0.001). Of routinely described pathogenic microorganisms, there were significant increases in the isolations of S. aureus (2.4% to 11.3%) and Serratia (0.5% to 1.7%) using the CIM and no significant changes in the isolations of S. pneumoniae and P. aeruginosa. No significant differences were seen between the isolation rates of fungi or Acanthamoeba species. There was a significant increase in the isolation rates of other Streptococcal species (0.7% to 6.9%) and CNS species, specifically, S. epidermidis (2.1% to 26.2%), S. capitis (0.4% to 2.6%) and S. warneri (0.3% to 1.6%) using the CIM. The simplified CIM sampling method is an effective method for collecting corneal samples from patients with presumed MK in clinical practice.
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Singh RB, Das S, Chodosh J, Sharma N, Zegans ME, Kowalski RP, Jhanji V. Paradox of complex diversity: Challenges in the diagnosis and management of bacterial keratitis. Prog Retin Eye Res 2021; 88:101028. [PMID: 34813978 DOI: 10.1016/j.preteyeres.2021.101028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the "anti-biotic era". Although, we are expeditiously developing our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins. In this review article, we have provided an overview of the established classical diagnostic techniques and therapeutics for keratitis caused by various bacteria. We have extensively reported our recent in-roads through novel tools for accurate diagnosis of mono- and poly-bacterial corneal infections. Furthermore, we outlined the recent progress by our group and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discussed in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Leiden University Medical Center, 2333, ZA Leiden, the Netherlands
| | - Sujata Das
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneshwar, India
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Michael E Zegans
- Department of Ophthalmology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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The role of Acanthamoeba spp. in biofilm communities: a systematic review. Parasitol Res 2021; 120:2717-2729. [PMID: 34292376 DOI: 10.1007/s00436-021-07240-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/01/2021] [Indexed: 12/16/2022]
Abstract
Acanthamoeba spp. have always caused disease in immunosuppressed patients, but since 1986, they have become a worldwide public health issue by causing infection in healthy contact lens wearers. Amoebae of the Acanthamoeba genus are broadly distributed in nature, living either freely or as parasites, and are frequently associated with biofilms throughout the environment. These biofilms provide the parasite with protection against external aggression, thus favoring its increased pathogeny. This review aims to assess observational studies on the association between Acanthamoeba spp. and biofilms, opening potential lines of research on this severe ocular infection. A systematic literature search was conducted in May 2020 in the following databases: PubMed Central®/Medline, LILACS, The Cochrane Library, and EMBASE®. The studies were selected following the inclusion and exclusion criteria specifically defined for this review. Electronic research recovered 353 publications in the literature. However, none of the studies met the inclusion criterion of biofilm-producing Acanthamoeba spp., inferring that the parasite does not produce biofilms. Nonetheless, 78 studies were classified as potentially included regarding any association of Acanthamoeba spp. and biofilms. These studies were allocated across six different locations (hospital, aquatic, ophthalmic and dental environments, biofilms produced by bacteria, and other places). Acanthamoeba species use biofilms produced by other microorganisms for their benefit, in addition to them providing protection to and facilitating the dissemination of pathogens residing in them.
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20
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Ting DSJ, Ho CS, Deshmukh R, Said DG, Dua HS. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond) 2021; 35:1084-1101. [PMID: 33414529 PMCID: PMC8102486 DOI: 10.1038/s41433-020-01339-3] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 01/30/2023] Open
Abstract
Corneal opacity is the 5th leading cause of blindness and visual impairment globally, affecting ~6 million of the world population. In addition, it is responsible for 1.5-2.0 million new cases of monocular blindness per year, highlighting an ongoing uncurbed burden on human health. Among all aetiologies such as infection, trauma, inflammation, degeneration and nutritional deficiency, infectious keratitis (IK) represents the leading cause of corneal blindness in both developed and developing countries, with an estimated incidence ranging from 2.5 to 799 per 100,000 population-year. IK can be caused by a wide range of microorganisms, including bacteria, fungi, virus, parasites and polymicrobial infection. Subject to the geographical and temporal variations, bacteria and fungi have been shown to be the most common causative microorganisms for corneal infection. Although viral and Acanthamoeba keratitis are less common, they represent important causes for corneal blindness in the developed countries. Contact lens wear, trauma, ocular surface diseases, lid diseases, and post-ocular surgery have been shown to be the major risk factors for IK. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though its effectiveness is being challenged by the emergence of antimicrobial resistance, including multidrug resistance, in some parts of the world. In this review, we aim to provide an updated review on IK, encompassing the epidemiology, causative microorganisms, major risk factors and the impact of antimicrobial resistance.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | | | - Rashmi Deshmukh
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
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21
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Wolkoff P, Azuma K, Carrer P. Health, work performance, and risk of infection in office-like environments: The role of indoor temperature, air humidity, and ventilation. Int J Hyg Environ Health 2021; 233:113709. [PMID: 33601136 DOI: 10.1016/j.ijheh.2021.113709] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
Epidemiological and experimental studies have revealed the effects of the room temperature, indoor air humidity, and ventilation on human health, work and cognitive performance, and risk of infection. In this overview, we integrate the influence of these important microclimatic parameters and assess their influence in offices based on literature searches. The dose-effect curves of the temperature describe a concave shape. Low temperature increases the risk of cardiovascular and respiratory diseases and elevated temperature increases the risk of acute non-specific symptoms, e.g., dry eyes, and respiratory symptoms. Cognitive and work performance is optimal between 22 °C and 24 °C for regions with temperate or cold climate, but both higher and lower temperatures may deteriorate the performances and learning efficiency. Low temperature may favor virus viability, however, depending on the status of the physiological tissue in the airways. Low indoor air humidity causes vulnerable eyes and airways from desiccation and less efficient mucociliary clearance. This causes elevation of the most common mucous membrane-related symptoms, like dry and tired eyes, which deteriorates the work performance. Epidemiological, experimental, and clinical studies support that intervention of dry indoor air conditions by humidification alleviates symptoms of dry eyes and airways, fatigue symptoms, less complaints about perceived dry air, and less compromised work performance. Intervention of dry air conditions by elevation of the indoor air humidity may be a non-pharmaceutical treatment of the risk of infection by reduced viability and transport of influenza virus. Relative humidity between 40 and 60% appears optimal for health, work performance, and lower risk of infection. Ventilation can reduce both acute and chronic health outcomes and improve work performance, because the exposure is reduced by the dilution of the indoor air pollutants (including pathogens, e.g., as virus droplets), and in addition to general emission source control strategies. Personal control of ventilation appears an important factor that influences the satisfaction of the thermal comfort due to its physical and positive psychological impact. However, natural ventilation or mechanical ventilation can become sources of air pollutants, allergens, and pathogens of outdoor or indoor origin and cause an increase in exposure. The "health-based ventilation rate" in a building should meet WHO's air quality guidelines and dilute human bio-effluent emissions to reach an acceptable perceived indoor air quality. Ventilation is a modifying factor that should be integrated with both the indoor air humidity and the room temperature in a strategic joint control to satisfy the perceived indoor air quality, health, working performance, and minimize the risk of infection.
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Affiliation(s)
- Peder Wolkoff
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen Ø, Denmark.
| | - Kenichi Azuma
- Dept Environmental Medicine and Behavioral Science, Kindai University, Faculty of Medicine, Osakasayama, Osaka, Japan.
| | - Paolo Carrer
- Dept Biomedical and Clinical Sciences "L. Sacco", University of Milan, 20157, Milan, Italy.
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Evaluation of Acanthamoeba keratitis cases in a tertiary medical care centre over 21 years. Sci Rep 2021; 11:1036. [PMID: 33441799 PMCID: PMC7806847 DOI: 10.1038/s41598-020-80222-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/17/2020] [Indexed: 01/29/2023] Open
Abstract
To report on Acanthamoeba keratitis cases in a tertiary university eye-hospital in Graz, Austria, over a 21-year period. Retrospective study. Parameters included demographics, diagnostics, clinical courses, medical therapies, surgical interventions, secondary complications, and best spectacle-corrected visual acuity (BSCVA). Patient records for 44 eyes of 42 patients were analysed; 2 bilateral infections. Mean age at presentation was 31 ± 13 (16-65) years; contact lenses were used in 41 of 44 eyes (93.2%). Symptoms at initial presentation were mainly pain (41/43, 95.3%) and photophobia (16/43, 37.2%). Most frequent morphological findings were stromal infiltrates (30/44, 68.2%). Diagnosis was mainly confirmed by smears (40/42, 95.2%) and polymerase chain reaction (8/42, 19%). Antiamoebic treatment comprised biguanides and diamidines. Penetrating keratoplasty was performed in 10/44 (22.7%) eyes. Median time from symptom onset to initial visit was 2 (0-26) weeks; median follow-up was 30 (2-1008) weeks. BSCVA improved in 23/36 (63.9%) eyes, remained unchanged in 6/36 (16.7%) eyes and deteriorated in 7/36 (19.4%) eyes. Acanthamoeba keratitis predominantly occurs in young contact lens wearers. Diagnosis should be considered in patients with pain and stromal infiltrates. In the majority of cases, BSCVA can be improved. Early diagnosis and adequate treatment should be implemented to prevent complications.
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Cunha AM, Loja JT, Torrão L, Moreira R, Pinheiro D, Falcão-Reis F, Pinheiro-Costa J. A 10-Year Retrospective Clinical Analysis of Fungal Keratitis in a Portuguese Tertiary Centre. Clin Ophthalmol 2020; 14:3833-3839. [PMID: 33209016 PMCID: PMC7670085 DOI: 10.2147/opth.s268327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the microbiological profile, risk factors, treatment and surgical intervention rates of fungal keratitis at a tertiary referral centre. Methods A retrospective review of microbiological and medical records from hospitalised patients treated for fungal keratitis at Centro Hospitalar Universitário de São João from 2009 to 2019 was conducted. Results Overall, 43 patients were included in our study. The mean age of patients was 63.7 years and 46.5% were men. In culture were isolated 22 (51.2%) filamentous fungi and 21 (48.8%) yeast. Candida species (n = 20, 46.5%), Fusarium species (n = 10, 23.4%) and Aspergillus species (n = 4, 9.3%) were the most common isolated species. Important risk factors were contact lens use (n = 24, 55.8%), long-term users of topical corticosteroids (n = 19, 44.2%) and previous keratitis (n = 19, 44.2%). Yeast isolates had a statistically significant higher prevalence in long-term users of topical corticosteroids compared to filamentous ones (p = 0.043). Twenty-four cases (55.8%) required surgical intervention, of which 23 cases underwent therapeutic penetrating keratoplasty. Ocular complications, such as evisceration was noted in 12 patients (27.9%) and endophthalmitis in 5 (11.6%). No statistically significant changes of best corrected visual acuity (BCVA) were found after treatment (p = 0.687). Conclusion Most patients with fungal keratitis have associated risk factors. Filamentous and yeast species have equally prevalent etiologies. In general, our results mirror how difficult and challenging the approach and treatment of fungal keratitis could be.
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Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Dolores Pinheiro
- Laboratory of Microbiology, Service of Clinical Pathology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Ting DSJ, Ho CS, Cairns J, Gopal BP, Elsahn A, Al-Aqaba M, Boswell T, Said DG, Dua HS. Seasonal patterns of incidence, demographic factors and microbiological profiles of infectious keratitis: the Nottingham Infectious Keratitis Study. Eye (Lond) 2020; 35:2543-2549. [PMID: 33184491 DOI: 10.1038/s41433-020-01272-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purpose of this study is to examine the seasonal patterns of incidence, demographic factors and microbiological profiles of infectious keratitis (IK) in Nottingham, UK. METHODS A retrospective study of all patients who were diagnosed with IK and underwent corneal scraping during 2008-2019 at a UK tertiary referral centre. Seasonal patterns of incidence (in per 100,000 population-year), demographic factors, culture positivity rate and microbiological profiles of IK were analysed. RESULTS A total of 1272 IK cases were included. The overall incidence of IK was highest during summer (37.7, 95% confidence interval (CI): 31.3-44.1), followed by autumn (36.7, 95% CI: 31.0-42.4), winter (36.4, 95% CI: 32.1-40.8) and spring (30.6, 95% CI: 26.8-34.3), though not statistically significant (p = 0.14). The incidence of IK during summer increased significantly over the 12 years of study (r = 0.58, p = 0.049), but the incidence of IK in other seasons remained relatively stable throughout the study period. Significant seasonal variations were observed in patients' age (younger age in summer) and causative organisms, including Pseudomonas aeruginosa (32.9% in summer vs. 14.8% in winter; p < 0.001) and gram-positive bacilli (16.1% in summer vs. 4.7% in winter; p = 0.014). CONCLUSION The incidence of IK in Nottingham was similar among four seasons. No temporal trend in the annual incidence of IK was observed, as reported previously, but there was a significant yearly increase in the incidence of IK during summer in Nottingham over the past decade. The association of younger age, P. aeruginosa and gram-positive bacilli infection with summer was likely attributed to contact lens wear, increased outdoor/water activity and warmer temperature conducive for microbial growth.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | | | - Jessica Cairns
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Bhavesh P Gopal
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Ahmad Elsahn
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Mouhamed Al-Aqaba
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Tim Boswell
- Department of Microbiology, Nottingham University Hospital, Nottingham, UK
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK. .,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
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25
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Griffin B, Walkden A, Okonkwo A, Au L, Brahma A, Carley F. Microbial Keratitis in Corneal Transplants: A 12-Year Analysis. Clin Ophthalmol 2020; 14:3591-3597. [PMID: 33154618 PMCID: PMC7605946 DOI: 10.2147/opth.s275067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To investigate the frequencies, trends, and in vitro drug susceptibilities of the causative pathogens in corneal transplant microbial infections in Manchester Royal Eye Hospital. Methods Corneal scrape results recorded by the microbiology service between 2004 and 2015 were extracted from an established database. This microbiological data was matched with a separate database of all corneal transplant procedures performed in our centre over this time period. Patient records were examined to collect specific patient data and to confirm the diagnosis of microbial keratitis. Results A total of 1508 grafts had been performed at our centre in this period. 72 episodes of graft microbial keratitis were identified from 66 eyes that had undergone keratoplasty procedures. Mean age was 56, and 51% of subjects were male. Ninety-three percent of microbial keratitis episodes occurred in penetrating keratoplasty procedures and 6% in deep anterior lamellar keratoplasty procedures. No endothelial grafts presented with infections throughout this time period. Of the 79 organisms identified, 73% were gram positive, 23% gram negative and 4% fungi. With regard to gram-positive organisms, vancomycin and gentamicin showed 100% and 91% susceptibility, respectively. Ofloxacin had a resistance rate of 13.7%. In terms of gram-negative organisms, gentamicin and chloramphenicol showed 100% sensitivity, with cefuroxime showing 69%. Resistance rates were less than 15% in all tested gram-negative antimicrobials. Conclusion This paper describes the largest collection of corneal transplant infections identified within the UK. This finding may aid clinicians in predicting possible causative organisms for microbial keratitis and aid antibiotic choice.
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Affiliation(s)
- Benjamin Griffin
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew Walkden
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - Arthur Okonkwo
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - Leon Au
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - Arun Brahma
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - Fiona Carley
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
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26
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Pandemics, climate change, and the eye. Graefes Arch Clin Exp Ophthalmol 2020; 258:2597-2601. [PMID: 32997287 PMCID: PMC7525080 DOI: 10.1007/s00417-020-04947-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 11/17/2022] Open
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27
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Moraxella keratitis: epidemiology and outcomes. Eur J Clin Microbiol Infect Dis 2020; 39:2317-2325. [DOI: 10.1007/s10096-020-03985-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/03/2020] [Indexed: 11/27/2022]
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Lin L, Duan F, Yang Y, Lou B, Liang L, Lin X. Nine-year analysis of isolated pathogens and antibiotic susceptibilities of microbial keratitis from a large referral eye center in southern China. Infect Drug Resist 2019; 12:1295-1302. [PMID: 31190918 PMCID: PMC6527795 DOI: 10.2147/idr.s206831] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/16/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose: To analyze the genus profile of isolated pathogens and antibiotic susceptibility trends of microbial keratitis over nine years at a large referral eye center in southern China. Methods: Data of corneal specimens from January 2010 to August 2018 of patients clinically diagnosed with infectious keratitis were obtained from the center’s microbiology database. Results with positive cultures along with antibiotic susceptibility were reviewed and analyzed. Results: We collected and reviewed 7,229 specimens, including 3,092 with positive cultures. Among them, 1,630 (52.72%) were bacterial, 1781 (57.60%) were fungal, and 319 (10.32%) were coinfected. A significant decreasing trend was observed in the isolates of Gram-positive cocci (r =−0.711, P=0.032), among which the proportion of coagulase-negative staphylococcus (CNS) was also reduced (r =−0.883, P=0.002). In contrast, an increasing trend in the proportion of Gram-negative bacilli was observed (r=0.661, P=0.053). The susceptibility rates of Gram-positive cocci to cephalosporins were near 90%, which was relatively high compared to fluoroquinolones. Fluoroquinolones represented the antibiotics to which Gram-negative bacilli were the most susceptible. Their susceptibility to moxifloxacin was 78.79%. The overall performance of aminoglycosides and vancomycin was both around 70%. The susceptibility of Gram-positive cocci to several antibiotics including levofloxacin (r=−0.717, P=0.03), tobramycin (r= −0.933, P<0.001), cefazolin (r= −0.964, P<0.001), ceftazidime (r=−0.929, P=0.003), chloramphenicol (r=−0.929, P=0.003), and cefuroxime (r=−0.829, P=0.042) decreased over time. The susceptibility of Gram-negative bacilli to ofloxacin increased over time (r=0.854, P=0.004), whereas that to cefazolin (r=−0.833, P=0.005) and chloramphenicol (r=−0.886, P=0.019) decreased over time. Conclusion: From 2010 to 2018 in Zhongshan Ophthalmic Center, most isolates from infectious keratitis were Gram-positive cocci (mainly CNS), which decreased over time, with an increase in Gram-positive bacilli. More than half of the antibiotics showed reducing trend of susceptibilities, and the antibiotic resistance situation in southern China was not encouraging.
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Affiliation(s)
- Lixia Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Fang Duan
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yao Yang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Bingsheng Lou
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lingyi Liang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaofeng Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
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