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Aftab N, Raj A, Chandra B, Pati BK, Singh P. Demographic and microbiological profile of corneal ulcer patients presenting at a tertiary healthcare center of Eastern India during the COVID era: A hospital-based cross-sectional study. Indian J Ophthalmol 2023; 71:3522-3527. [PMID: 37870018 PMCID: PMC10752327 DOI: 10.4103/ijo.ijo_2752_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To determine the demographic and microbiological profile involved in the causation of corneal ulcers in Eastern India during the COVID era. Method Patients presenting with corneal ulcers fulfilling the inclusion and exclusion criteria were taken as the case. The study duration was from January 2021 to December 2021. Socio-demographic details and information about risk factors were noted. A detailed corneal examination followed by corneal scraping was performed for microbiological evaluation. Results In 1 year, 99 infective corneal ulcer patients were evaluated. Farmers (24.2%) were found to be maximally affected by corneal ulcers. The peak in cases was recorded from October to December (38.4%). Ocular trauma was the commonest risk factor (42.4%). The majority (80.8%) of patients were already on some topical antimicrobials. 22.2% of samples showed fungal filaments on KOH mount; 54.5% of these cases turned out to be culture-positive. 17.56% of KOH-negative samples turned out to be culture-positive (fungal). Overall, the culture positivity rate was 28.28% out of which fungal isolates were 89.28% and bacterial isolates were 10.72%. Fusarium species were identified as the most common organism contributing 42.85%, followed by Aspergillus fumigatus (14.28%). 10.72% of cases were culture positive for Pseudomonas aeuroginosa. Conclusion Trauma with the organic matter was the predominant cause of fungal keratitis. In this study, fungal keratitis was found to be more common. Fusarium was the most common isolate.
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Affiliation(s)
- Naila Aftab
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Bhawesh Chandra
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Binod Kumar Pati
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Prabhakar Singh
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, India
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Christy JS, Mathews P, Ravisankar R, Akpek EK. Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India. Indian J Ophthalmol 2023; 71:3171-3177. [PMID: 37602604 PMCID: PMC10565919 DOI: 10.4103/ijo.ijo_1344_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose This study aimed to review the demographics, clinical characteristics, and long-term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital. Methods Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow-up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes. Results The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6-month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three-year follow-up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty. Conclusion Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome.
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Affiliation(s)
| | - Priya Mathews
- Cornea and External Diseases Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, United States
| | | | - Esen K Akpek
- Cornea and External Diseases Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, United States
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Sheba E, Sharma S, Kumar Mishra D, Vivek Dave T, Ganguly Kapoor A, Joseph J. Microbiology Profile of COVID-19-Associated Rhino-Orbital Mucormycosis Pathogens in South India. Am J Trop Med Hyg 2023; 108:377-383. [PMID: 36572009 PMCID: PMC9896339 DOI: 10.4269/ajtmh.22-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/21/2022] [Indexed: 12/27/2022] Open
Abstract
This study describes the microbiological and histopathological features of patients with COVID-19-associated rhino-orbital mucormycosis (ROM) seen at the L V Prasad Eye Institute between May and August 2021. Diagnosed clinically and radiologically, 24 patients with ROM were included in the study. Deep nasal swabs or endoscopically collected nasal swabs or orbital tissues were submitted for microbiological evaluation and in vitro susceptibility testing by microbroth dilution for natamycin, amphotericin B, caspofungin, posaconazole, ketoconazole, and voriconazole. Cultures were processed by 28S ribosomal DNA polymerase chain reaction and molecular sequencing. A portion of orbital tissues was also sent for histopathological evaluation. The age of the patients ranged from 27 to 75 (mean 48.58 ± 14.09) years and the majority (79%) were male. Nineteen patients were known to be diabetic prior to developing ROM and 18 patients had recovered from active COVID-19 infection. Thirteen patients had a history of hospitalization during COVID-19 infection and eight received steroids. Of the 24 samples, microbiological evaluation identified Rhizopus arrhizus in 12, Rhizopus microsporus in 9, Lichtheimia ramosa in 2, and Rhizopus delemar in 1. Twelve isolates were tested for antifungal susceptibility and all were susceptible to natamycin and amphotericin B. The susceptibility to posaconazole was high, with minimum inhibitory concentration (MIC) < 2 µg/mL for 10/12 (84%) isolates, whereas the MIC of other drugs varied. Histopathological examination of tissues showed acute fulminant disease, granuloma formation, and vascular invasion by the fungal pathogens in these specimens. Rhizopus arrhizus was predominantly associated with ROM and most isolates were susceptible to amphotericin B and posaconazole. Further studies are needed to corroborate the findings and explain possible underlying links.
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Affiliation(s)
- Esther Sheba
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India;,The Ramoji Foundation for Ocular Infections, L V Prasad Eye Institute, Hyderabad, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India;,The Ramoji Foundation for Ocular Infections, L V Prasad Eye Institute, Hyderabad, India
| | | | - Tarjani Vivek Dave
- The Ramoji Foundation for Ocular Infections, L V Prasad Eye Institute, Hyderabad, India;,Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, India
| | - Anasua Ganguly Kapoor
- Ophthalmic Plastic and Facial Aesthetic, Orbit and Ocular Oncology, L V Prasad Eye Institute, Vijayawada, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India;,The Ramoji Foundation for Ocular Infections, L V Prasad Eye Institute, Hyderabad, India;,Address correspondence to Joveeta Joseph, Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India. E-mail:
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Roy A, Kanhere M, Rajarajan M, Dureja R, Bagga B, Das S, Sharma S, Mohammed A, Fernandes M. Challenges in management of microbial keratitis during COVID-19 pandemic related lockdown: a comparative analysis with pre pandemic data. Int Ophthalmol 2022; 43:1639-1645. [PMID: 36272014 PMCID: PMC9589810 DOI: 10.1007/s10792-022-02562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 10/06/2022] [Indexed: 11/27/2022]
Abstract
Purpose To study the challenges of managing microbial keratitis(MK) during the
COVID19 pandemic related lockdown and assess the outcomes of treatment at a
tertiary cornea service. Methods Retrospective, non comparative study of electronic medical records of MK presenting to a network of four tertiary care cornea services. The medical history, presenting clinical features, microbiology work up and treatment outcomes were analyzed. The primary outcome measure was final outcome at last follow up. Secondary outcomes measures were non-compliance to treatment due to travel restrictions, therapeutic PKP not done due non availability of corneal tissues. Results- MK was noted in 330 eyes of 330 patients between April and May 2020. Of these 237(71.8%) were males. Median age was 45 years(IQR, 33-56). Low socioeconomic status noted in 102(30.9%). Patients travelling beyond the district from where the hospital was located comprised of 64.9%(n=214). At a median follow up of 32 days(IQR, 9-54), 118(35.8%) patients had resolved, with medical management, 73(22.1%) patients were under active treatment, 139(42.1%) were lost to follow up. Sixty-six patients(20%) were non-compliant to treatment of which 59 could not follow appointment schedule due to travel restrictions. Therapeutic PKP (TPK) was planned in 48/128 (37.5%) patients, but was performed in only 34/48 (70.8%) due to non-availability of donor corneas. Conclusions Abnormal social circumstances due to the COVID pandemic and the ensuing impediments to travel for access to health care affected compliance to treatment of ocular emergencies such as microbial keratitis.
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Affiliation(s)
- Aravind Roy
- The Cornea Institute, KVC Campus, Vijayawada, India
| | - Minal Kanhere
- The Cornea Institute, GMRV Campus, Vishakhapatnam, India
| | | | - Rohit Dureja
- The Cornea Institute, GMRV Campus, Vishakhapatnam, India
| | | | - Sujata Das
- The Cornea Institute, MTC Campus, Bhubaneswar, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Cornea and Anterior Segment, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Ashik Mohammed
- Department of Biophysics, LV Prasad Eye Institute, KAR Campus, Hyderabad, India
| | - Merle Fernandes
- The Cornea Institute, GMRV Campus, Vishakhapatnam, India. .,The Cornea Institute, KAR Campus, Hyderabad, India.
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Kowsalya A, Chaudhary S, Sen S, Shanmugam M, Narayanamoorthy JK, Jain S, Sundar B. Neuro-ophthalmological manifestations of diabetes mellitus during COVID-19-related lockdown in India. Indian J Ophthalmol 2022; 70:3398-3402. [PMID: 36018129 DOI: 10.4103/ijo.ijo_558_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The coronavirus disease 19 (COVID-19) pandemic has resulted in a huge impact on the health care system. Diversion of health care workforce toward management of a high number of COVID-19 cases and lockdown restrictions have affected the follow-up of patients. The objective of this study was to analyze the impact of this situation on the control of diabetes, eventually resulting in related neuro-ophthalmological complications. Methods This retrospective case series included diabetic patients visiting the neuro-ophthalmology clinic at a tertiary care eye center in India from 25 March 2020 to 25 September 2020 during the lockdown. The incidence of diabetes-related neuro-ophthalmological complications, including third, fourth, sixth nerve palsies and non-arteritic anterior ischemic optic neuropathy (NAION) was evaluated and compared with that of the same period during 2019. Results Overall disease incidence rate was significantly higher in the year 2020 (60.2%) compared to the previous year of 2019 (29.8%). The proportion of third nerve palsy (4.8% vs 16.3%, P < 0.001) and NAION (0.3% vs 14.3%, P < 0.001) had increased. Even though the percentage of sixth nerve palsy was 25% in 2020, this was not significantly different from 2019. There was a reduction in the percentage of fourth nerve palsy cases from the year 2019 to 2020. Conclusion There was a significant increase in diabetes-related neuro-ophthalmic complications during the COVID-19 lockdown. This can possibly be attributed to worsening of glycemic control in diabetic patients.
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Affiliation(s)
- Akkayasamy Kowsalya
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sameer Chaudhary
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sagnik Sen
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | | | - Shreya Jain
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Balagiri Sundar
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Leung EH, Fan J, Flynn HW, Albini TA. Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare. Clin Ophthalmol 2022; 16:1-13. [PMID: 35018092 PMCID: PMC8742614 DOI: 10.2147/opth.s336963] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022] Open
Abstract
There is increasing information available about the effects of the SARS-CoV-2 virus on the systemic and ocular health of patients, as well as the effects of delayed health care. This mini-review summarizes the potential complications and treatments of COVID-19. Systemic findings include respiratory illness, risk of thromboembolic events, and neurologic findings. Some patients may develop persistent symptoms even after the infection resolves. Effective treatment options include glucocorticoids, antivirals, interleukin-6 antagonists, monoclonal antibodies, Janus kinase inhibitors and vaccines. Potential ocular findings of COVID-19 include conjunctivitis, cranial nerve palsies, and microvascular changes in the retina; most symptoms resolved over time. During the lockdown periods, teleophthalmology was utilized to triage non-urgent issues; patients who did present to emergency departments tended to have more severe disease with worse visual prognoses. While transient delays in outpatient ophthalmic care may be tolerated in some patients, others experienced significant vision loss with interruptions in treatments. Resumption of ophthalmic care as soon as possible may help mitigate the effects of delayed care due to the pandemic.
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Affiliation(s)
| | - Jason Fan
- Bascom Palmer Eye Institute/University of Miami, Miami, FL, USA
| | - Harry W Flynn
- Bascom Palmer Eye Institute/University of Miami, Miami, FL, USA
| | - Thomas A Albini
- Bascom Palmer Eye Institute/University of Miami, Miami, FL, USA
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Anitha V, Ravindran M. A novel eyeball simulator for training postgraduate students during pandemic times. Indian J Ophthalmol 2021; 69:2879-2880. [PMID: 34571661 PMCID: PMC8597525 DOI: 10.4103/ijo.ijo_2013_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Venugopal Anitha
- Senior Consultant, Cornea and Refractive Surgery Services, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Chief Medical Officer, Paediatric and Strabismus Surgery Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
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