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Al-Mahrouqi H, Lewis JS, Crawford AZ, McGhee CNJ. Indications and Outcomes of Emergency Keratoplasty in a Major New Zealand Eye Tertiary Referral Center, 2000 to 2021. Cornea 2024:00003226-990000000-00615. [PMID: 38984535 DOI: 10.1097/ico.0000000000003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/02/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE To report the indications and outcomes of emergency keratoplasty over a 21-year period in Greenlane Clinical Centre, the major tertiary eye referral center in Auckland, New Zealand (Aotearoa). METHODS A retrospective review of medical records of all emergency keratoplasties performed in Greenlane Clinical Centre from January 2000 to September 2021 was conducted. Demographic, preoperative, intraoperative, and 1-year postoperative data were collected. RESULTS Emergency keratoplasty was performed in 102 eyes of 97 patients (54 men), comprising 5.6% of transplants performed (N = 1830) in this period. The mean age was 53 years (range = 4-95 years, SD = 20). Patients of Māori ethnicity were overrepresented (31%). Corneal perforation was present in 90% of eyes, and microbial keratitis was the most common indication. Bacteria were the most commonly isolated organisms (38%). The mean preoperative and 12-month postoperative best potential corrected distance visual acuity was 1.6 and 1.2 (logMAR), respectively. All cases of therapeutic keratoplasty achieved initial therapeutic success, with no eyes lost or requiring repeat emergency keratoplasty. Complications included nonhealing epithelial defects (19%), cataract (19%), glaucoma (15%), allograft rejection (13%), and corneal melting (5%). Fifteen cases (15%) had documented graft failure at 12 months. Multivariate analysis revealed that younger age was the only statistically significant factor associated with failure at 12 months. CONCLUSIONS Emergency keratoplasty was the indication for 5.6% of keratoplasties performed. Our results compare favorably with those in the literature, possibly because of early intervention and lower incidence of fungal keratitis. The reported overrepresentation of Māori has important implications for health access and delivery in New Zealand.
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Affiliation(s)
- Haitham Al-Mahrouqi
- Department of Ophthalmology, Al-Nahdha Hospital, Ministry of Health, Muscat, Sultanate of Oman
| | - James S Lewis
- Department of Ophthalmology, Te Whatu Ora Te Pae Hauora o Ruahine o Tararua MidCentral (Palmerston North Hospital), Manawatū-Whanganui, New Zealand
| | - Alexandra Z Crawford
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand; and
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand; and
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
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2
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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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3
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Guo X, Zhang Z, Chen Q, Wang L, Xu X, Wei Z, Zhang Y, Chen K, Wang Z, Lu X, Liang Q. Whole Genome Sequencing Highlights the Pathogenic Profile in Nocardia Keratitis. Invest Ophthalmol Vis Sci 2024; 65:26. [PMID: 38502137 PMCID: PMC10959193 DOI: 10.1167/iovs.65.3.26] [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: 08/26/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose Nocardia keratitis is a serious and sight-threatening condition. This study aims to reveal the virulence and antimicrobial resistance gene profile of Nocardia strains using whole genome sequencing. Methods Whole-genome sequencing was performed on 23 cornea-derived Nocardia strains. Together with genomic data from the respiratory tract and the environment, 141 genomes were then utilized for phylogenetic and pan-genome analyses, followed by virulence and antibiotic resistance analysis. The correlations between virulence genes and pathogenicity were experimentally validated, including the characteristics of Nocardia colonies and clinical and histopathological evaluations of Nocardia keratitis mice models. Results Whole-genome sequencing of 141 Nocardia strains revealed a mean of 220 virulence genes contributed to bacterial pathogenesis. The mce gene family analysis led to the categorization of strains from the cornea into groups A, B, and C. The colonies of group C had the largest diameter, height, and fastest growth rate. The size of corneal ulcers and the clinical scores showed a significant increase in mouse models induced by group C. The relative expression levels of pro-inflammatory cytokines (CD4, IFN-γ, IL-6Rα, and TNF-α) in the lesion area exhibited an increasing trend from group A to group C. Antibiotic resistance genes (ARGs) spanned nine distinct drug classes, four resistance mechanisms, and seven primary antimicrobial resistance gene families. Conclusions Whole genome sequencing highlights the pathogenic role of mce gene family in Nocardia keratitis. Its distribution pattern may contribute to the distinct characteristics of the growth of Nocardia colonies and the clinical severity of the mice models.
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Affiliation(s)
- Xiaoyan Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiankun Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Leying Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kexin Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhiqun Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinxin Lu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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4
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Akosman S, Li R, Kwon B, West W, Asahi M, Wroblewski KJ. Sociodemographic and Clinical Predictors of Prolonged Length of Corneal Ulcer Hospitalizations. JAMA Ophthalmol 2024; 142:235-241. [PMID: 38329762 PMCID: PMC10853861 DOI: 10.1001/jamaophthalmol.2023.6512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
Importance The length of stay (LOS) of hospitalizations may be a useful indicator of the burden of disease of corneal ulcers. Identifying variables associated with longer LOS may help to enhance delivery of care for high-risk patients. Objective To investigate the sociodemographic, social, and clinical factors associated with LOS in hospitalizations for corneal ulcers in the US. Design, Setting, and Participants This was a retrospective cross-sectional study of adult patients (aged >18 years) admitted with a primary diagnosis of corneal ulcer between quarter 4 of 2015 through 2020 and conducted using data from the National Inpatient Sample (NIS). Patients were stratified into 2 even cohorts based on LOS: LOS of 4 days or less and LOS greater than 4 days. Individual-level sociodemographic, social risk factors, and medical comorbidities associated with longer LOS were examined by multivariable regression. Data were analyzed from October 2015 to December 2020. Exposure Potential sociodemographics or medical comorbidities at hospital admission. Main Outcome and Measure The primary outcome of interest was factors associated with extended length of stay. The hypothesis being tested was formulated during data collection. Results A total of 1187 patients (mean [SD] age, 53.5 [20.9] years; 602 female [50.7%]) were included for analysis. The cohort with LOS greater than 4 days had higher total charges than the cohort with LOS of 4 days or less (mean [SD] charges, $79 504 [$86 719] vs $26 474 [$20 743]; P < .001). Sociodemographic variables associated with LOS greater than 4 days were Black race (adjusted odds ratio [aOR], 1.41; 95% CI, 1.03-1.92; P = .03), Medicare insurance (aOR, 1.42; 95% CI, 1.09-1.85; P = .009), and housing insecurity (aOR, 1.99; 95% CI, 1.29-3.06; P = .002). Medical comorbidities associated with LOS greater than 4 days were alcohol use (aOR, 1.50; 95% CI, 1.00-2.26; P = .05), dementia (aOR, 2.35; 95% CI, 1.36-4.07; P = .002), complicated diabetes (aOR, 1.75; 95% CI, 1.21-2.53; P = .003), uncomplicated diabetes (aOR, 1.57; 95% CI, 1.02-2.42; P = .04), drug misuse (aOR, 1.66; 95% CI, 1.08-2.57; P = .02), and legal blindness (aOR, 3.42; 95% CI, 1.19-9.82; P = .02). Based on NIS national estimates, corneal ulcers were estimated to have a direct annual health care expenditure of $35 819 590 in the US. Conclusion and Relevance Corneal ulcer hospitalizations represent a significant burden of disease for patients and health care systems. This study highlights sociodemographic and clinical factors that may help clinicians identify high-risk patients vulnerable to complications and morbidity due to corneal ulcers.
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Affiliation(s)
- Sinan Akosman
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Renxi Li
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Bryan Kwon
- Department of Ophthalmology, George Washington University, Washington, DC
| | - William West
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Masumi Asahi
- Gavin Herbert Eye Institute, University of California Irvine, Irvine
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Cho CH, Choi NH, Lee SB. Clinical comparative analysis of culture-proven bacterial keratitis according to prior topical steroid use: a retrospective study in a tertiary referral center of South Korea. Sci Rep 2023; 13:14477. [PMID: 37660202 PMCID: PMC10475055 DOI: 10.1038/s41598-023-41588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023] Open
Abstract
This study analyzed the clinical characteristics of patients exposed to topical steroids before bacterial keratitis diagnosis (the prior topical steroid use, PS group), and compared these with those of the non-exposed group (the no prior topical steroid use, NPS group). We retrospectively analyzed 194 patients (PS, 34; NPS, 160) with culture-proven bacterial keratitis between 2007 and 2016. The microbiological profiles, epidemiology, predisposing factors, clinical characteristics, and treatment outcomes of PS and NPS were compared, and the risk factors for surgical intervention were evaluated. Pseudomonas spp. and Staphylococcus spp. were the most common isolates in PS and NPS, respectively, and no significant difference in the strain distribution between the two groups were observed. Significant differences were observed between PS and NPS for previous ocular surface disease (41.2%: 23.8%), initial BCVA < 0.1 (70.6%: 49.4%), epithelial defect size ≥ 5 mm2 (64.7%: 41.2%), epithelial healing time > 14 days (55.9%: 37.3%), and surgical intervention (23.5%: 8.8%). Prior topical steroid use, strong steroid use, and long-term steroid use groups were included in significant risk factors for surgical intervention. Previous exposure to topical steroids before the diagnosis of bacterial keratitis was associated with a worse initial clinical presentation and treatment outcomes. Additional multicenter studies should be conducted in the future.
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Affiliation(s)
- Chan-Ho Cho
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, 875, Haeun-daero, Haeundae-gu, Busan, 48108, South Korea
| | - Nam Hyeon Choi
- Nune Eye Hospital, 2179, Dalgubeol-daero, Jung-gu, Daegu, 41940, South Korea
| | - Sang-Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, 170, Hyunchung-ro, Nam-gu, Daegu, 42415, South Korea.
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Marasini S, Craig JP, Dean SJ, Leanse LG. Managing Corneal Infections: Out with the old, in with the new? Antibiotics (Basel) 2023; 12:1334. [PMID: 37627753 PMCID: PMC10451842 DOI: 10.3390/antibiotics12081334] [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: 06/16/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
There have been multiple reports of eye infections caused by antibiotic-resistant bacteria, with increasing evidence of ineffective treatment outcomes from existing therapies. With respect to corneal infections, the most commonly used antibiotics (fluoroquinolones, aminoglycosides, and cephalosporines) are demonstrating reduced efficacy against bacterial keratitis isolates. While traditional methods are losing efficacy, several novel technologies are under investigation, including light-based anti-infective technology with or without chemical substrates, phage therapy, and probiotics. Many of these methods show non-selective antimicrobial activity with potential development as broad-spectrum antimicrobial agents. Multiple preclinical studies and a limited number of clinical case studies have confirmed the efficacy of some of these novel methods. However, given the rapid evolution of corneal infections, their treatment requires rapid institution to limit the impact on vision and prevent complications such as scarring and corneal perforation. Given their rapid effects on microbial viability, light-based technologies seem particularly promising in this regard.
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Affiliation(s)
- Sanjay Marasini
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland 1142, New Zealand; (S.M.); (J.P.C.); (S.J.D.)
| | - Jennifer P. Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland 1142, New Zealand; (S.M.); (J.P.C.); (S.J.D.)
| | - Simon J. Dean
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland 1142, New Zealand; (S.M.); (J.P.C.); (S.J.D.)
| | - Leon G. Leanse
- Health and Sports Sciences Hub, Europa Point Campus, University of Gibraltar, Gibraltar GX11 1AA, Gibraltar
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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7
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Chantra S, Jittreprasert S, Chotcomwongse P, Amornpetchsathaporn A. Estimated direct and indirect health care costs of severe infectious keratitis by cultured organisms in Thailand: An 8-year retrospective study. PLoS One 2023; 18:e0288442. [PMID: 37437049 DOI: 10.1371/journal.pone.0288442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE To evaluate the economic impact of treating severe infectious keratitis (IK) at one tertiary referral center in Thailand by analyzing the direct costs of treatment and estimating the indirect costs, and to determine whether cultured organisms had any effect on treatment expenditure. METHODS A retrospective study was conducted of patients with severe IK who had been hospitalized between January 2014 and December 2021 in Rajavithi Hospital. Data from medical records were collected from the time of the patients' admission until the point at which they were discharged and treated in the outpatient department and their IK was completely healed, or until evisceration/enucleation was performed. The direct costs of treatment included fees for services, medical professionals and investigation, as well as for operative and non-operative treatment. The indirect costs consisted of patients' loss of wages, and costs of travel and food. RESULTS A total of 335 patients were studied. The median direct, indirect and total costs were US$65.2, range US$ 6.5-1,119.1, US$314.5, range US$50.8-1,067.5, and US$426.1, range 57.5-1,971.5 respectively. There was no statistically significant difference between direct, indirect, or total treatment costs for culture-negative and culture-positive patients. Among those who were positive, fungal infections entailed the highest total cost of treatment, and this difference was statistically significant (p<0.001). In terms of direct and indirect costs, patients with fungal infections had the greatest direct costs, and this figure was statistically significant (p = 0.001); however, those with parasitic infections had the highest indirect treatment costs, and this was also statistically significant (p<0.001). CONCLUSION Severe IK can cause serious vision impairment or blindness. Indirect costs represented the majority of the expense at 73.8%. There was no difference between direct, indirect, and total treatment costs for patients who were culture-negative or positive. Among the latter, fungal infections resulted in the highest total cost of treatment.
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Affiliation(s)
- Somporn Chantra
- Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
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Sakr SI, Nayel AA, Habeel CS, Elkhabiry HK, Ibrahim GM, Tolba MM, Ghaith AA. Epidemiological profile of microbial keratitis in Alexandria-Egypt a 5 years retrospective study. J Ophthalmic Inflamm Infect 2023; 13:18. [PMID: 37055636 PMCID: PMC10102273 DOI: 10.1186/s12348-023-00332-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/26/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE To evaluate the epidemiologic profile of microbial keratitis in Alexandria- Egypt, with special emphasis on risk factors, visual outcome and microbiological results. METHODS This retrospective study reviewed files of patients treated for microbial keratitis during a period of 5 years at Alexandria Ophthalmology Hospital Cornea Clinic, Alexandria- Egypt, between February 2017 and June 2022. The patients were evaluated for the risk factors e.g., trauma, eyelid disorders, co-morbidities, and contact lens use. They were also evaluated for their clinical picture, the identified microorganisms, visual outcomes, and complications. Non-microbial keratitis and incomplete files were excluded from the study. RESULTS A total of 284 patients were diagnosed as microbial keratitis in our study. Viral keratitis was the most common cause of microbial keratitis (n = 118 (41.55%)), followed by bacterial keratitis (n = 77 (27.11%)), mixed keratitis (n = 51 (17.96%)), acanthamoeba keratitis (n = 22 (7.75%)) and the least cause was fungal keratitis (n = 16 (5.63%)). Trauma was the most common risk factor for microbial keratitis (29.2%). Fungal keratitis had a statistically significant association with trauma (p < 0.001), while the use of contact lenses had a statistically significant association with Acanthamoeba keratitis (p < 0.001). The percentage of culture-positive results in our study was 76.8%. Gram-positive bacteria were the most frequently isolated bacterial isolate (n = 25 (36.2%)), while filamentous fungi were the most frequently isolated fungi (n = 13(18.8%)). After treatment, there was a significant increase in the mean visual acuity among all groups; it was significantly higher in Acanthamoeba keratitis group with a mean difference of 0.262 ± 0.161 (p = 0.003). CONCLUSION Viral keratitis followed by bacterial keratitis were the most frequent etiologic agents causing microbial keratitis found in our study. Although trauma was the most frequent risk factor for microbial keratitis, contact lens wear was found an important preventable risk factor for microbial keratitis in young patients. Performing culture properly whenever indicated before starting antimicrobial treatment increased the cultures' positive results.
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Affiliation(s)
- Suzan Ibrahim Sakr
- Cornea Clinic, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt.
| | - Amira Ahmed Nayel
- Clinical Pharmacy Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Christeena Saeed Habeel
- Cornea Clinic, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Hala Kamal Elkhabiry
- Microbiology Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Ghada Mahmoud Ibrahim
- Microbiology Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | | | - Alaa Atef Ghaith
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Abstract
Infectious keratitis is a rare but potentially severe sight-threatening disease, associated with considerable societal burden, cost and morbidity. This review summarises the most recent evidence for the incidence, risk factors and impact of disease, all of which vary widely according to region, access to health care, socioeconomic and environmental factors, predisposing conditions and causative organisms. The frequency and societal impact of infectious keratitis are significantly higher in low-income countries. In non-viral infectious keratitis, bacterial causes predominate in most regions. Fungi, particularly linked with agricultural trauma, are more frequently associated with infectious keratitis in low-income regions, particularly in India and certain African countries. The disease impact is compounded by poverty and limited access to services and treatment. Early diagnosis, access to appropriate treatment, prophylaxis in ocular trauma, availability of eye protection, awareness of risk factors may be associated with reduced disease severity and vision loss. Evidence for the incidence and burden of disease is lacking in certain regions and well-designed epidemiological studies to identify independent risk factors for the disease and those associated with more severe outcomes may better identify causation and guide resource allocation and preventative strategies.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Level 3, North Wing, RMB, Gate 14, Barker St, Sydney, NSW, 2052, Australia.
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10
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Lopez JB, Chan L, Saifee M, Seitzman GD, Yung M, Chan MF. Characterization of Infectious Keratitis in Opioid Users in a County Hospital Setting. CORNEA OPEN 2023; 2:e0010. [PMID: 37637189 PMCID: PMC10449330 DOI: 10.1097/coa.0000000000000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Purpose To determine risk factors and clinical course of corneal ulcers in the setting of opioid use. Methods A retrospective cohort study was performed of patients presenting with bacterial or fungal keratitis at a county hospital from 2010-2021. Subjects were separated into three groups: opioid drug users (heroin, methadone, fentanyl), non-opioid drug users, and non-drug users. 24 opioid users, 77 non-opioid drug users, and 38 non-drug users were included in the study. Chi-square and t-tests were used to compare hospitalization for corneal ulcer treatment; length of hospitalization; loss to follow-up; final best corrected visual acuity (BCVA); medication noncompliance; time to ulcer resolution; and visual disability (defined either by the legal limit for driving in California or the federal limit for blindness). Results Opioid users had higher rates of unemployment (p=0.002), homelessness (p=0.018), and psychiatric conditions (p=0.024) compared with non-opioid and non-drug users. They had more severe presentations, with worse initial BCVA of the affected eye (p=0.003), larger ulcer size (p=0.023), and higher rates of individuals below the legal vision thresholds for driving (p=0.009) and blindness (p=0.033) at initial presentation. Opioid use was associated with increased rate of hospitalization (p<0.001), higher fortified antibiotic use (p=0.009), worse final BCVA of the affected eye (p=0.020), and increased rates of BCVA worse than the legal vision thresholds for driving (p=0.043) and blindness (p<0.001) on final presentation. Conclusions Infectious keratitis associated with opioid use is associated with more severe presentations and poorer outcomes, including higher rates of visual disability.
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Affiliation(s)
- Jacqueline B. Lopez
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
| | - Lawrence Chan
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
| | - Murtaza Saifee
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
| | - Gerami D. Seitzman
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California,
San Francisco, San Francisco, CA, USA
| | - Madeline Yung
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma
Center, Department of Ophthalmology, San Francisco, CA, USA
| | - Matilda F. Chan
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California,
San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma
Center, Department of Ophthalmology, San Francisco, CA, USA
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11
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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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Marasini S, Dean SJ, Swift S, Perera J, Rupenthal ID, Wang T, Read H, Craig JP. Preclinical confirmation of UVC efficacy in treating infectious keratitis. Ocul Surf 2022; 25:76-86. [PMID: 35568373 DOI: 10.1016/j.jtos.2022.05.004] [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: 10/18/2021] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Preclinical evaluation of the therapeutic potential of antimicrobial 265 nm UVC for infectious keratitis. METHODS Four experiments explored UVC: 1) impact on bacterial and fungal lawns on agar, in individual or mixed culture, 2) bacterial inactivation dose in an in vitro deep corneal infection model, 3) dose validation in an ex vivo porcine keratitis model and 4) efficacy in a masked, randomised, controlled murine keratitis trial using bioluminescent Pseudomonas aeruginosa. RESULTS Minimum effective UVC exposures ranged between 2 s and 5 s for lawn bacteria and fungi in individual or mixed culture. Significant P. aeruginosa growth inhibition in the in vitro infection model was achieved with 15 s UVC, that resulted in a >3.5 log10 reduction of bacteria in a subsequent ex vivo keratitis model (p < 0.05). Bioluminescence fell below baseline levels in all treated animals, within 8 h of treatment (p < 0.05), in the in vivo study. Re-epithelialisation with corneal clarity occurred within 24 h in 75% of UVC-treated cases, with no relapse at 48 h. On plating, bacteria were recovered only from untreated controls. CONCLUSIONS UVC inhibited all tested bacteria and fungi, including mixed culture and strains linked to antibiotic resistance, in vitro, with exposures of ≤ 5 s. In vitro and ex vivo testing confirmed therapeutic potential of 15 s UVC. In vivo, 15 s UVC administered in two doses, 4 h apart, proved effective in treating murine bacterial keratitis.
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Affiliation(s)
- Sanjay Marasini
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Simon J Dean
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Simon Swift
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand
| | - Janesha Perera
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand
| | - Ilva D Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Tao Wang
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hannah Read
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
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Stapleton F, Shrestha GS, Vijay AK, Carnt N. Epidemiology, Microbiology, and Genetics of Contact Lens-Related and Non-Contact Lens-Related Infectious Keratitis. Eye Contact Lens 2022; 48:127-133. [PMID: 35192567 DOI: 10.1097/icl.0000000000000884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 01/14/2023]
Abstract
ABSTRACT Infectious keratitis is a rare but severe condition associated with a range of ocular and systemic predisposing conditions, including ocular trauma, prior surgery, surface disease, and contact lens (CL) wear. This review explores the epidemiology of infectious keratitis, specifically the differences in disease incidence and risk factors, causative organism profile and virulence characteristics and host microbiome, genetics, gene expression, proteomics, and metabolomic characteristics in CL-related and non-CL-related diseases. Differences exist in the epidemiology, demographics, causative organisms, and their virulence characteristics in CL-related and non-CL-related diseases, and there is less evidence to support differences between these groups of individuals in the ocular surface microbiome, genetics, and pathways of disease. Genetic variations, however, in the host immune profile are implicated in both the onset and severity of infectious keratitis in CL and non-CL wearers. As technologies in metabolomics, proteomics, and genomics improved to be better able to process small-volume samples from the ocular surface, there will be improved understanding of the interplay between the CL, ocular surface, host immune profile, and the microbial environment. This may result in a more personalized approach in the management of disease to reduce disease severity.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Repeated High-Fluence Accelerated Slitlamp-Based Photoactivated Chromophore for Keratitis Corneal Cross-Linking for Treatment-Resistant Fungal Keratitis. Cornea 2022; 41:1058-1061. [DOI: 10.1097/ico.0000000000002973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
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Hafezi F, Hosny M, Shetty R, Knyazer B, Chen S, Wang Q, Hashemi H, Torres-Netto EA. PACK-CXL vs. antimicrobial therapy for bacterial, fungal, and mixed infectious keratitis: a prospective randomized phase 3 trial. EYE AND VISION (LONDON, ENGLAND) 2022; 9:2. [PMID: 34996516 PMCID: PMC8742313 DOI: 10.1186/s40662-021-00272-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Infectious keratitis is a major cause of global blindness. We tested whether standalone photoactivated chromophore corneal cross-linking (PACK-CXL) may be an effective first-line treatment in early to moderate infectious keratitis, compared with standard antimicrobial treatment. METHODS This is a randomized, controlled, multinational phase 3 clinical trial. Participants in five centers in Egypt, India, Iran, Israel, and China, aged ≥ 18 years, with infectious keratitis of presumed bacterial, fungal, or mixed origin, were randomly assigned (1:1) to PACK-CXL, or antimicrobial therapy. Outcomes measures included healing, defined as time to re-epithelialization of the corneal epithelial defect in the absence of inflammatory activity in the anterior chamber and clearance of stromal infiltrates. Treatment success was defined as the complete resolution of signs of infection. RESULTS Between July 21, 2016, and March 4, 2020, participants were randomly assigned to receive PACK-CXL (n = 18) or antimicrobial therapy per American Academy of Ophthalmology (AAO) guidelines (n = 21). No participants were lost to follow-up. Four eyes were excluded from the epithelialization time analysis due to treatment failure: two in the antimicrobial therapy group, and two in the PACK-CXL group. Success rates were 88.9% (16/18 patients) in the PACK-CXL group and 90.5% (19/21 patients) in the medication group. There was no significant difference in time to complete corneal re-epithelialization (P = 0.828) between both treatment groups. CONCLUSIONS PACK-CXL may be an alternative to antimicrobial drugs for first-line and standalone treatment of early to moderate infectious keratitis of bacterial or fungal origin. Trial registration This trial is registered at ClinicalTrials.gov, trial registration number: NCT02717871.
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Affiliation(s)
- Farhad Hafezi
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland. .,ELZA Institute, Dietikon, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Department of Ophthalmology, Medical University of Wenzhou, Wenzhou, China. .,USC Roski Eye Institute, University of Southern California Los Angeles, Los Angeles, USA.
| | - Mohammed Hosny
- Department of Ophthalmology, University of Cairo, Cairo, Egypt
| | - Rohit Shetty
- Narayana Nethralaya Eye Hospital and the Postgraduate Institute of Ophthalmology, Bangalore, India
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Shihao Chen
- Department of Ophthalmology, Medical University of Wenzhou, Wenzhou, China
| | - Qinmei Wang
- Department of Ophthalmology, Medical University of Wenzhou, Wenzhou, China
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Emilio A Torres-Netto
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland.,ELZA Institute, Dietikon, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,University Hospital Zurich, Zurich, Switzerland
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Lim Wen Siang J, Wu Zhuan O, Yi Chen N, Sok Lin N. Profile of Microbial Keratitis. Cureus 2021; 13:e20663. [PMID: 35103213 PMCID: PMC8784021 DOI: 10.7759/cureus.20663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose: To study the demographic characteristics, predisposing factors, and latest trends of causative organisms and to analyze the prognostic factors of visual outcome in microbial keratitis. Methods: A retrospective study of patients diagnosed with microbial keratitis who required hospital admission in the period between January 2018 and December 2020 in Taiping Hospital, Perak, Malaysia. Results: A total of 75 eyes of 74 patients who were admitted to the hospital were studied. The male to female ratio was 13.8:1. Seventy percent of patients in this study were within the productive age group between 20 and 59 years old, with a mean age of 48 years old, and 51.4% of them were labourers. Cornea foreign bodies (42, 56%) were the most common predisposing factors and were associated with good visual outcomes (P<0.005). Other significant predictors for the final visual outcome were: presenting visual acuity, size of ulcer, duration of hospitalization, and duration of resolution. The mean duration of hospitalization was seven days. Corneal scrapings were done in all cases where 44 eyes (58.7%) were found to be positive for growth. Ten eyes (13.3%) that ended up with evisceration yielded a positive result. Gram-negative bacteria was the most prevalent causative organism of infective keratitis in the local/this region. Pseudomonas sp (20, 26.7%) being the most common bacterial isolate, was seen in all four contact lens-related cases and was associated with poor visual outcome and a high rate of evisceration. Patients who developed complications such as cornea melting (9, 12%), cornea perforation (11, 14.7%) and endophthalmitis (7, 9.3%) were associated with poor visual outcomes. Likewise, patients who required therapeutic interventions such as corneal gluing, tarsorrhaphy, and penetrating keratoplasty generally had poor visual outcomes (P<0.005; P=0.000008). Conclusion: Microbial keratitis is a major cause of ocular morbidity globally. Understanding the demographic and epidemiological characteristics of microbial keratitis of the region is important in the initial prompt treatment of the patients and may eventually improve the visual outcome.
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Blondeau JM, Proskin HM, Sanfilippo CM, DeCory HH. Characterization of Polybacterial versus Monobacterial Conjunctivitis Infections in Pediatric Subjects Across Multiple Studies and Microbiological Outcomes with Besifloxacin Ophthalmic Suspension 0.6. Clin Ophthalmol 2021; 15:4419-4430. [PMID: 34785887 PMCID: PMC8591116 DOI: 10.2147/opth.s335197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The choice of empiric therapy for bacterial conjunctivitis should be guided by an awareness of typical causative pathogen distributions. Bacterial conjunctivitis can be polybacterial, although pediatric-specific data are lacking. Methods This was a post-hoc analysis of data in pediatric subjects (1–17 years) from five bacterial conjunctivitis trials evaluating besifloxacin ophthalmic solution 0.6%. Results Of the 730 pediatric subjects with culture-confirmed conjunctivitis, nearly one-fourth (23.6%) had polybacterial infections and three-fourths (76.4%) had monobacterial infections at baseline. In both polybacterial and monobacterial infections, the most prevalent organisms were Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Streptococcus mitis/S. mitis group. In polybacterial versus monobacterial infections, S. mitis/S. mitis group (8.7% vs 4.3%; P=0.032) and Moraxella catarrhalis (4.7% vs 0.5%; P<0.001) were identified more frequently, whereas S. pneumoniae (14.0% vs 28.1%; P<0.001) was identified less frequently, as the dominant infecting species. MICs for individual species were similar for tested antibiotics regardless of polybacterial or monobacterial infection, except Staphylococcus epidermidis for which fluoroquinolone MICs were ≥3 dilutions higher for isolates of this species sourced from polybacterial compared to monobacterial infections. Treatment with besifloxacin resulted in microbial eradication in 79.1% of polybacterial and 92.3% of monobacterial infections (P≤0.005 vs vehicle). Discussion One in four pediatric bacterial conjunctivitis infections is polybacterial, highlighting the need for a broad-spectrum antibiotic when choosing empiric therapy.
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Affiliation(s)
- Joseph M Blondeau
- Clinical Microbiology, Royal University Hospital, Saskatoon, SK, Canada
| | | | | | - Heleen H DeCory
- Pharmaceutical Medical Affairs, Bausch + Lomb, Rochester, NY, USA
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Clinical aspects and prognosis of polymicrobial keratitis caused by different microbial combinations: a retrospective comparative case study. Int Ophthalmol 2021; 41:3849-3860. [PMID: 34275029 DOI: 10.1007/s10792-021-01955-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to compare the predisposing factors, clinical findings, treatment results, and prognosis for polymicrobial keratitis. METHODS In this retrospective comparative case study, we identified the cases of polymicrobial keratitis from the microbiological records (n = 649) at Balcalı Hospital, Çukurova University (Adana, Turkey; October 2010-2018). We included all the cases of infectious keratitis with two different types of microbial agents and grouped them as follows: group 1 (n = 25), bacterium-fungus coexistence; group 2 (n = 12), herpes simplex virus (HSV) or Acanthamoeba with bacterial infection; and group 3 (n = 7), HSV or Acanthamoeba with fungal infection. We compared the clinical and microbiological characteristics, and treatment outcomes among the groups. RESULTS In our study, we found that 44 infectious keratitis cases (6.7%) were of polymicrobial nature. The mean follow-up period was 11.4 ± 17.8 months. In total, 17 different bacteria along with 3 different fungi, HSV, and Acanthamoeba were isolated. The most common bacterium was Staphylococcus epidermidis (25%). Most of the fungal pathogens were filamentous. Patients with initial treatment failure and requiring surgical intervention had larger infiltrates (p = 0.023, p = 0.003, respectively) than other patients. Older age was associated with delayed recovery and poor visual prognosis. CONCLUSIONS Bacterial-fungus coexistence is the most common combination among patients, but other combinations should also be considered for suspected polymicrobial etiology. The corneal infiltrate size may be an important indicator of the course of disease and response to treatment. A closer and longer follow-up period should be planned for older patients.
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Stapleton F. Contact lens‐related corneal infection in Australia. Clin Exp Optom 2021; 103:408-417. [DOI: 10.1111/cxo.13082] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
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20
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Green M, Apel A, Stapleton F. Microbial keratitis in a tertiary centre in Queensland, Australia (1999-2015). Clin Exp Optom 2021; 104:486-490. [PMID: 33689640 DOI: 10.1080/08164622.2021.1878824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Clinical relevance: Keratitis is common and studies of blindness throughout the world have found that corneal disease is the second most common cause of blindness.Background: Microbial keratitis a bacterial, fungal, or protozoan disease of the cornea, characterised by a corneal infiltrate with an overlying epithelial defect and associated anterior chamber reaction.Methods: Patients were identified through the hospital pathology database and a retrospective chart review of all patients with a positive corneal culture between 1999 and 2015 at Princess Alexandra Hospital was carried out.Results: There were 895 records from 779 patients included and additional 107 records excluded. The average age of the included patients was 58.9 years (SD 21.0). Males made up 498 (55.6%) of the included patients. Contact lens microbial keratitis (CLMK) was the most common risk factor for MK and was significantly more common in younger patients. CLMK was significantly associated with cultures positive for Pseudomonas aeruginosa (p < 0.001) while MK secondary to ocular surface disease and prior ocular surgery were more commonly associated with gram-positive organisms (p < 0.001). Monotherapy with a fluoroquinolone was the most common treatment for patients with MK. Good outcomes were seen in 57% of patients.Conclusion: In this patient group, contact lens wear was the most common risk factor for MK. Pseudomonas aeruginosa was the most common isolate.
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Affiliation(s)
- Matthew Green
- Gold Coast University Hospital, Southport, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Andrew Apel
- Princess Alexandra Hospital, Brisbane, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Konda N, Garg P, Sharma S, Willcox MDP. Risk Factors for Contact Lens-Related Microbial Keratitis and Associated Vision Loss in a South Indian Population. Eye Contact Lens 2021; 47:118-126. [PMID: 33009258 DOI: 10.1097/icl.0000000000000737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify risk factors associated with contact lens-related microbial keratitis (CL-MK) and subsequent vision loss in a south Indian population. METHODS A retrospective study of medical records at the LV Prasad Eye Institute in Hyderabad, India, of patients diagnosed with CL-MK and of controls who had no history of corneal inflammation during contact lens wear was undertaken. Variables such as demographic data, contact lens wear details, duration of the event, visual acuity, epithelial defect and infiltrate size, and microbiology of the cornea during the event were collected. Differences between cases and controls were analyzed using parametric and nonparametric tests. Logistic regression was used to calculate the odds ratio (OR) and associated 95% confidence intervals in univariate and multivariate analyses for cases vs. controls and for factors associated with vision loss. RESULTS One hundred sixty-seven cases of CL-MK and 153 controls were included in the analyses. Risk factors associated with the greatest increased OR for CL-related MK were: being in professional employment vs. a student (OR=3.9), disposing lenses yearly versus monthly or biweekly (OR=2.2), and any overnight wear (OR=2.8). Risk factors associated with vision loss were: high myopia (OR=3.6), severe vs. mild severity (OR=16.0), and hypopyon (OR=4.3). CONCLUSIONS Identification of these risk factors may help inform safe contact lens wear habits and management strategies.
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Affiliation(s)
- Nagaraju Konda
- School of Optometry and Vision Science (N.K., M.D.P.W.), University of New South Wales, Australia; Brien Holden Vision Institute (N.K.), Sydney, Australia; Cornea Service (P.G.), L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; and Jhaveri Microbiology Centre (S.S.), Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
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Clinical and Microbiological Profile of Bacterial and Fungal Suspected Corneal Ulcer at University of Gondar Tertiary Eye Care and Training Centre, Northwest Ethiopia. J Ophthalmol 2021. [DOI: 10.1155/2021/3940151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. A corneal ulcer is a major cause of monocular blindness in developing countries, including Ethiopia. Its etiology varies based on its geographical location and climatic conditions. Therefore, the main objective of this research was to assess the clinical and microbiological profile of suspected bacterial and fungal corneal ulcers at the Tertiary Eye Care and Training Centre at Gondar University. Methods. A cross-sectional hospital-based study of corneal ulcer cases was performed from February to October 2019. Sociodemographic and clinical data were collected using a standardized questionnaire. Corneal scrapings were used to classify bacterial and fungal pathogens. The specimens were inoculated on BHI media and sub-cultured on culture media for the separate cultivation of bacteria and fungi. Biochemical tests have been carried out to classify bacteria. Following CLSI, the antimicrobial resistance pattern of bacterial isolates was carried out. Wet mounting, Lactophenol cotton blue staining, and colony characteristics on SDA were used to classify fungal species. The data were analyzed with version 20 of the SPSS. Results. A total of 30 suspected bacterial and fungal keratitis patients have been enrolled in this study. The visual acuity presented in 90% of the affected eyes was in the category of blindness (<3/60). In 71% of the cases, clinically presumed risk factors were identified. Trauma was the most common risk factor found in 46% of cases, followed by keratitis exposure (13%). Of the corneal scrape tests, 76.6% were positive for bacteria and fungi. Fungi were identified in 53.3% of corneal ulcers followed by 33.3% of bacterial growth. The commonest fungi and bacteria isolated were Aspergillus species (69%) and S. aureus, respectively. The prevalence of Methicillin-resistant S. aureus (MRSA) was 2 (40%). The identified Pseudomonas species were susceptible to Gentamicin and Ciprofloxacin but resistant to Ceftriaxone. Conclusion. The primary microbial agents for corneal ulcers were fungi, and trauma was the most significant risk factor associated with corneal ulcers. To avoid chronic ocular morbidity and blindness, early identification of the etiologic agent and the provision of adequate management are recommended.
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Gulias-Cañizo R, Benatti A, De Wit-Carter G, Hernández-Quintela E, Sánchez-Huerta V. Photoactivated Chromophore for Keratitis-Corneal Collagen Cross-Linking (PACK-CXL) Improves Outcomes of Treatment-Resistant Infectious Keratitis. Clin Ophthalmol 2020; 14:4451-4457. [PMID: 33376299 PMCID: PMC7762451 DOI: 10.2147/opth.s284306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/04/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the efficacy of photoactivated chromophore corneal collagen cross-linking (PACK)-CXL in the management of treatment-resistant infectious keratitis. Design Observational cohort study. Participants Forty-two eyes from 41 patients with treatment-resistant infectious keratitis. Methods Eyes underwent PACK-CXL treatment with the Dresden modified protocol in addition to standard antimicrobial therapy. The primary endpoint was the size of the corneal ulcer. Descriptive statistics, Wilcoxon rank test, McNemar test and Spearman correlation coefficient were used for statistical analysis, and p values lower than 0.05 were considered statistically significant. Results Success rate at third postoperative month was of 90.5%. Statistical analyses showed a significant effect of (PACK)‑CXL with standard antimicrobial therapy to reduce corneal ulcer size (p=0.031). Conclusion As adjuvant therapy to standard antimicrobial treatment, PACK-CXL improves the outcomes in patients with treatment-resistant corneal ulcers.
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Affiliation(s)
| | - Andres Benatti
- Cordoba Eye Clinic, Cornea and Refractive Surgery Department, Cordoba, Argentina
| | - Guillermo De Wit-Carter
- Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sanchez Bulnes, Cornea Department, Mexico City 04030, Mexico
| | - Everardo Hernández-Quintela
- Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sanchez Bulnes, Cornea Department, Mexico City 04030, Mexico
| | - Valeria Sánchez-Huerta
- Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sanchez Bulnes, Cornea Department, Mexico City 04030, Mexico
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Koh YY, Sun CC, Hsiao CH. Epidemiology and the Estimated Burden of Microbial Keratitis on the Health Care System in Taiwan: A 14-Year Population-Based Study. Am J Ophthalmol 2020; 220:152-159. [PMID: 32707204 DOI: 10.1016/j.ajo.2020.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the epidemiologic characteristics of microbial keratitis and its overall burden on the health care system in Taiwan. DESIGN Retrospective, population-based study. METHODS We conducted a study using claims data in the Taiwan National Health Insurance Research Database in 2000-2013, employing diagnoses, drugs, and procedure codes to define diseases and procedures. Participants were classified into groups according to the requirement of hospitalization and surgical intervention. The main outcome measures were incidence, risk factors, predictive factors for hospitalization and surgical intervention, and health care expenditure. RESULTS A total of 2,071 patients were included. The overall incidence significantly increased from 8.4 in 2000 to 20.2 per 100,000 person-years in 2013. The peak age range of incidence was between 18 and 40 years, but the peak age group for health care expenditures was those older than 65 years. A total of 704 patients (33.99%) had analyzable risk factors, of which the top 3 were diabetes mellitus (DM, 11.52%), eye trauma (10.55%), and dry eye (8.72%). Older patients, those using steroid and antiglaucoma agents, and those with ocular and systemic diseases were susceptible to further hospitalization and surgical intervention for the treatment of microbial keratitis. CONCLUSIONS In Taiwan, DM, eye trauma, and dry eye were key predisposing factors for microbial keratitis. Older patients (>40 years) accounted for approximately 80% of health care expenditure for the management of infectious keratitis. Special care may be required for older patients with medication-related risk factors and ocular and systemic comorbidities because they are likely to have severe diseases leading to hospitalization and surgical interventions.
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Affiliation(s)
- Yeo-Yang Koh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Hsi Hsiao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
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DeCory HH, Sanfilippo CM, Proskin HM, Blondeau JM. Characterization of baseline polybacterial versus monobacterial infections in three randomized controlled bacterial conjunctivitis trials and microbial outcomes with besifloxacin ophthalmic suspension 0.6. PLoS One 2020; 15:e0237603. [PMID: 32841261 PMCID: PMC7447040 DOI: 10.1371/journal.pone.0237603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/29/2020] [Indexed: 01/27/2023] Open
Abstract
Background/Purpose To date, studies examining polymicrobial infections in ocular disease have mostly been limited to keratitis or endophthalmitis. We characterized polybacterial infections compared to monobacterial infections in prior clinical studies evaluating besifloxacin ophthalmic suspension 0.6% for the treatment of bacterial conjunctivitis and report on associated microbiological outcomes. Methods In this post-hoc analysis, microbiological data for subjects with conjunctivitis due to one or more than one bacterial species in three previous studies (two vehicle-, one active-controlled) of besifloxacin were extracted. Bacterial species identified at baseline were deemed causative if their colony count equaled or exceeded species-specific prespecified threshold criteria. In subjects with polybacterial infections, the fold-increase over threshold was used to rank order the contribution of individual species. Baseline pathogens and their minimum inhibitory concentrations (MICs) for common ophthalmic antibiotics were compared by infection type, as were microbial eradication rates following treatment with besifloxacin. Results Of 1041 subjects with culture-confirmed conjunctivitis, 17% had polybacterial and 83% had monobacterial conjunctivitis at baseline. In polybacterial compared to monobacterial infections, Haemophilus influenzae and Streptococcus pneumoniae were identified less frequently as the dominant infecting species (P = 0.042 and P<0.001, respectively), whereas Streptococcus mitis/S. mitis group was identified more frequently as dominant (P<0.001). Viral coinfection was also identified more frequently in polybacterial infections (P<0.001). Staphylococcus aureus was the most common coinfecting species in polybacterial infections and the second most common dominant species in such infections. With few exceptions, MICs for individual species were comparable regardless of infection type. Clinical microbial eradication rates with besifloxacin were high regardless of infection type (P≤0.016 vs vehicle at follow-up visits). Conclusions Approximately one in five subjects with bacterial conjunctivitis are infected with more than one bacterial species underscoring the need for a broad-spectrum antibiotic for such infections. Besifloxacin treatment resulted in robust eradication rates of these infections comparable to monobacterial infections. Trial registration NCT000622908, NCT00347932, NCT00348348
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Affiliation(s)
- Heleen H. DeCory
- Medical Affairs, Bausch + Lomb, Rochester, New York, United States of America
- * E-mail:
| | | | - Howard M. Proskin
- Howard M. Proskin & Associates, Rochester, New York, United States of America
| | - Joseph M. Blondeau
- Clinical Microbiology, Royal University Hospital, Saskatoon, Saskatchewan, Canada
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Tawfik EA, Craig DQM, Barker SA. Dual drug-loaded coaxial nanofibers for the treatment of corneal abrasion. Int J Pharm 2020; 581:119296. [PMID: 32247813 DOI: 10.1016/j.ijpharm.2020.119296] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
Corneal abrasion is a scratch wound on the surface of the anterior segment of the eye, which can predispose a patient to corneal infection and scarring, particularly if the cut penetrates to the deep corneal layers. Here we investigate a novel approach to co-administer an anti-scarring agent and an antibiotic, both being incorporated into one dosage form so as to accelerate wound closure and to treat any associated infection. More specifically, we have used electrospun fibers as a means of incorporating the two drugs into distinct compartments via coaxial electrospinning. Samples were characterised using a range of imaging, spectroscopic and thermal methods, while an HPLC assay has been developed to allow measurement of the concentration of both drug components in both the initial fibers and on release. Fibers loaded with pirfenidone in the hydrophobic polymer, PLGA, as the outer layer and moxifloxacin in the hydrophilic polymer PVP as the inner layer were successfully prepared, with smooth and non-porous surfaces and a mean diameter of circa 630 nm. TEM image demonstrated clear distinctive layers (a core and a shell), suggesting the successful preparation of the drug-loaded coaxial fibers, supported by HPLC entrapment studies, while fluorescence microscopy confirmed the presence of the moxifloxacin within the fibers. The fibers were capable of extending the release of both drugs, hence raising the possibility of a single daily dose of the drug-loaded coaxial fibers for the treatment of corneal abrasion.
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Affiliation(s)
- Essam A Tawfik
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, United Kingdom; National Center for Pharmaceutical Technology, King Abdulaziz City for Science and Technology, 6086, Riyadh 11442, Saudi Arabia
| | - Duncan Q M Craig
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, United Kingdom.
| | - Susan A Barker
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, United Kingdom
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Zeng W, Zhang Y, Duan F, Lin T, Liu X, Li D, Wu K. Lipopolysaccharide enhances human herpesvirus 1 replication and IL-6 release in epithelial cells. Microb Pathog 2020; 140:103961. [PMID: 31904451 DOI: 10.1016/j.micpath.2019.103961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/02/2019] [Accepted: 12/31/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the effect of lipopolysaccharide (LPS) on human herpesvirus 1 (HHV-1) infection in epithelial cells. METHODS Two strains of HHV-1, HHV-1 F strain (HHV-1f) and HHV-1 strain-H129 with GFP knock-in (HHV-g4), were used to infect HCE-T and VERO cells at MOIs of 0.04 and 0.02, respectively. After 1 h, 0, 10, 50, and 100 μg/ml LPS was added to serum-free medium and the cells were cultured for up to 24 h. GFP fluorescence of HHV-g4 in cells was examined under a fluorescence microscope and imaged. HHV-1f titer was determined by quantitative real-time polymerase chain reaction (qPCR) in HCE-T cells and plaque assays in VERO cells. The expression of the viral ICP4 protein of HHV-1f was detected by Western blot assay. IL-6 and IL-10 levels in culture medium were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS Similar changes but at different degrees were found in HCE-T and VERO cells that were infected with HHV-1. GFP fluorescence of HHV-g4 and cell lesions increased in a dose-dependent manner. Virus titer was also enhanced by LPS stimulation in HCE-T and VERO cells. ICP4 expression was promoted at higher LPS concentrations (P = 0.04). In addition, viral infection resulted in increased expression of IL-6 in a dose-dependent manner at 12 and 24 h (P = 0.01), while IL-10 expression was unaffected by either HHV-1 infection or LPS stimulation. CONCLUSION LPS promotes HHV-1 infection in epithelial cells, which suggests that gram-negative bacteria on ocular surfaces may aggravate HHV-1 infection.
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Affiliation(s)
- Weiting Zeng
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, the Key Lab of Ophthalmology and Visual Science of Guangdong, Sun Yat-sen University, Guangzhou, China
| | - Yafang Zhang
- Department of Ophthalmology, Hubei University of Science and Technology, Xianning, China
| | - Fang Duan
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, the Key Lab of Ophthalmology and Visual Science of Guangdong, Sun Yat-sen University, Guangzhou, China
| | - Tianlan Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, the Key Lab of Ophthalmology and Visual Science of Guangdong, Sun Yat-sen University, Guangzhou, China
| | - Xiuping Liu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, the Key Lab of Ophthalmology and Visual Science of Guangdong, Sun Yat-sen University, Guangzhou, China
| | - Dai Li
- Department of Ophthalmology, Hubei University of Science and Technology, Xianning, China.
| | - Kaili Wu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, the Key Lab of Ophthalmology and Visual Science of Guangdong, Sun Yat-sen University, Guangzhou, China.
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AlMahmoud T, Elhanan M, Elshamsy MH, Alshamsi HN, Abu-Zidan FM. Management of infective corneal ulcers in a high-income developing country. Medicine (Baltimore) 2019; 98:e18243. [PMID: 31860971 PMCID: PMC6940151 DOI: 10.1097/md.0000000000018243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Microbial keratitis is a major risk for corneal blindness worldwide. We aimed to study the clinical presentation and outcome of hospitalized patients having infective corneal ulcers.All patients who were diagnosed as microbial keratitis and were admitted to Al-Ain Hospital during the period July 2011-Dec 2016 were retrospectively studied. Patients' demography, predisposing factors, symptoms and signs at presentation, time to presentation after onset of symptoms, microbial isolates, hospital stay, and visual acuity (VA) outcome were studied.74 patients with corneal ulcers were hospitalized. 79.7% were males. The median (range) age was 44 years (1-91). 36.5% had trauma as a risk factor. The main presenting symptoms were pain (90.5%), red eye (79.7%), and decreased vision (63.5%). All patients had stromal infiltrate while 39.2% had hypopyon at presentation. The average time from the start of the symptoms to hospital presentation was 11 (1-90) days. The mean (range) hospital stay was 10.6 (1-60) days. Forty eyes were culture positive. Bacteria were identified in 27 eyes and fungus in 16. Pseudomonas aeruginosa (9 eyes) and Staphylococcus epidermis (5 eyes) were the most common bacterial islolates. Aspergillus (6 eyes) was the most common fungus species. 95.2% of the bacterial isolates were susceptible to the quinolone antibiotics group. Twenty eight (51.9%) patients had a vision worse than 6/60 in the affected eye.Corneal ulcer poses a significant threat to the sight of an affected eye. Trauma was the most common risk factor for corneal ulcers. Usage of eyes personal protective equipment for high risk occupations and earlier accessibility to health care may reduce the impact of corneal ulcers in our community.
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Affiliation(s)
- Tahra AlMahmoud
- Department of Surgery, College of Medicine and Health Sciences, Khalifa Bin Zayed Street, United Arab Emirates University
- Department of Ophthalmology, Al-Ain Hospital, Al Jimi District, Al-Ain, UAE
| | - Mohamed Elhanan
- Department of Ophthalmology, Al-Ain Hospital, Al Jimi District, Al-Ain, UAE
| | | | - Hanan N. Alshamsi
- Department of Ophthalmology, Al-Ain Hospital, Al Jimi District, Al-Ain, UAE
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, Khalifa Bin Zayed Street, United Arab Emirates University
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An L-fucose specific lectin from Aspergillus niger isolated from mycotic keratitis patient and its interaction with human pancreatic adenocarcinoma PANC-1 cells. Int J Biol Macromol 2019; 134:487-497. [DOI: 10.1016/j.ijbiomac.2019.04.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 11/21/2022]
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Green M, Sara S, Hughes I, Apel A, Stapleton F. Trends in contact lens microbial keratitis 1999 to 2015: a retrospective clinical review. Clin Exp Ophthalmol 2019; 47:726-732. [PMID: 30801907 DOI: 10.1111/ceo.13484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/18/2019] [Accepted: 02/10/2019] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Contact lens microbial keratitis (CLMK) is the most common cause of microbial keratitis in our community. BACKGROUND Define the trend in rate of CLMK and define patient demographics/culture results that may have a predictive value in patients with CLMK. DESIGN Retrospective review of clinical records of patients with MK. PARTICIPANTS All patients with positive corneal scraping between 1999 and 2015 at the Princess Alexandra Hospital, Brisbane, Queensland identified through local microbiology database. METHODS Trend in CLMK tested with chi-squared test of peak 3 years vs other years and Poisson regression of interrupted time series. Patient characteristics predictive of CLMK were defined by creating a polynomial regression model by stepwise variable selection. MAIN OUTCOME MEASURES Yearly rate of CLMK. RESULTS Records of 895 episodes of MK were included. The most common: risk factor was contact lens wear (324, 36.2%), isolated organism was Pseudomonas aeruginosa (P. aeruginosa 181, 55.9%) and treatment was monotherapy with a fluoroquinolone 172, 53%). CLMK was most common between 2009 and 2011 (49.5% vs other years 32%, P < 0.001). Poisson regression of the interrupted time series showed there was a significant decrease in the rate over time after 2010 (P < 0.001). Independent factors predictive of CLMK in multivariate regression were young age (15-49 years) and corneal culture positive for P. aeruginosa CONCLUSIONS AND RELEVANCE: The rate of CLMK in our community ranged between 32% and 50% and the rate of disease appears to have peaked during 2009 to 2011 and subsequently declined.
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Affiliation(s)
- Matthew Green
- Ophthalmology department, Gold Coast University Hospital, Southport, Queensland, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Sergio Sara
- Ophthalmology department, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Ian Hughes
- Ophthalmology department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Andrew Apel
- Ophthalmology department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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Wu L, Ye M, Zhang J. Vincamine prevents lipopolysaccharide induced inflammation and oxidative stress via thioredoxin reductase activation in human corneal epithelial cells. Am J Transl Res 2018; 10:2195-2204. [PMID: 30093956 PMCID: PMC6079141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/28/2018] [Indexed: 06/08/2023]
Abstract
Lipopolysaccharide (LPS) induced keratitis is a progressive infectious ocular disease in which innate inflammatory responses often cause clinical tissue damage and vision loss. In this study, the potential protective effects of vincamine, a plant alkaloid used clinically as a peripheral vasodilator, against LPS induced inflammation and oxidative stress were investigated on human corneal epithelial cells (HCECs). HCECs were treated with LPS and vincamine at various concentrations. Cell viability, reactive oxygen species (ROS) levels, and the gene expression levels of interleukin-6 (IL-6), IL-8, IL-1β, TNF-α, transforming growth factor-β (TGF-β) in HCECs, were assessed. The antioxidant potential of vincamine was evaluated by measuring the levels of malondialdehyde (MDA), total antioxidant capacity (T-AOC), and superoxide dismutase (SOD). The effects of vincamine on intracellular activities of thioredoxin reductase (TrxR) as well as other anti-oxidant proteins were also investigated in LPS treated HCECs. The results showed that vincamine protected HCECs from LPS induced cell viability reduction and ameliorated the inflammation. Vincamine exhibited a strong antioxidant activity, decreasing ROS levels and regulating the levels of SOD, T-AOC and MDA. Vincamine also exerted anti-inflammatory activities by decreasing IL-6, IL-8, IL-1β, TNF-α, TGF-β expression. Intracellular TrxR activity was significantly activated by vincamine. These findings suggest that vincamine exerts positive effects against LPS induced oxidative stress and inflammation and may be useful in protecting corneal epithelial cells from LPS induced keratitis.
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Affiliation(s)
- Li Wu
- Department of Ophthalmology, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
| | - Meihong Ye
- Department of Ophthalmology, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
| | - Jie Zhang
- Shanghai University of Traditional Chinese MedicineNo. 1200 Cailun Road, Shanghai 201203, China
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Samarawickrama C, Li YC, Carnt N, Willcox M, Dutta D, Watson S. Reducing oral contamination during corneal scrapes. BMJ Open Ophthalmol 2018; 1:e000044. [PMID: 29354701 PMCID: PMC5721650 DOI: 10.1136/bmjophth-2016-000044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/05/2016] [Accepted: 12/24/2016] [Indexed: 12/05/2022] Open
Abstract
Aims To identify potential contaminants of the corneal sampling procedure and examine the effect of wearing surgical face masks on the rate of contamination. Methods Ten surgeons recited out loud a 30 s standardised script for corneal scraping with blood agar plates positioned 30 cm away from them. Three groups were identified: in group 1 a surgical mask was worn; group 2 had no mask worn; and group 3 had no mask but used agar plates pretreated with 5% povidone-iodine as a negative control. Each surgeon repeated the process 10 times for all groups, totalling 30 plates per surgeon and 300 plates for the experiment. All plates were masked and incubated aerobically at 37°C for 24 hours, and the number of colony forming units (CFUs) was determined. Results At 24 hours, group 1 had a mean of 0.3 CFUs per surgeon; group 2 had 6.4 CFUs per surgeon and group 3 had 0.1 CFUs per surgeon. The difference between group 1 and group 2 was significant (p<0.001) whereas the difference between group 1 and group 3 was non-significant (p=0.4). Use of face masks decreased the number of plates with CFUs by 93% (from 29 to 2 plates) and decreased the total number of CFUs by 95% (from 63 to 3 CFUs). The most common microbiota identified was Streptococcus species. Conclusions Oral bacterial microbiota may contaminate the slides and media used to collect samples during corneal sampling. Use of a face mask can significantly decrease the rate of contamination of such samples.
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Affiliation(s)
- Chameen Samarawickrama
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Corneal Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Yi-Chiao Li
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Corneal Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Nicole Carnt
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Debarun Dutta
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephanie Watson
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Corneal Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
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Diagnostic Approach to Ocular Infections Using Various Techniques From Conventional Culture to Next-Generation Sequencing Analysis. Cornea 2018; 36 Suppl 1:S46-S52. [PMID: 28902722 DOI: 10.1097/ico.0000000000001338] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ocular infection is caused by both endogenous (resident) and exogenous (environmental) microbes. As the ocular surface interacts with both outer environment and its own resident microbiota, clinical ocular samples are predicted to contain a diverse set of microorganisms. Microscopy of sample smears is an important step in the diagnostic process of infectious diseases to interpret the culture results. Traditional culture techniques have several limitations in the detection and/or identification of uncharacterized bacteria of environmental origin. Molecular biological techniques, such as polymerase chain reaction of pathogen-specific virulence genes, 16S rRNA gene clone library analysis, and next-generation sequencing of 16S rDNA amplicons, compensate for diagnostic culture techniques in diagnosing infectious diseases. These techniques are expected to provide novel insights into the ocular microbiota and pathology of ocular infections. In this article, we describe various ocular infections, including contact lens-related keratitis, silicone buckle infection, and dacryocystitis, which were analyzed using molecular biological techniques. The advantages and disadvantages of these highly sensitive and inclusive microbiological detection systems for ocular infections are discussed.
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Ngoie Maloba V, Ngayuna Nkiene J, Tunku Kabamba G, Chenge Borasisi G. [Frequency of corneal ulcer: Retrospective study of 380 cases carried out in two centers in the DR Congo]. J Fr Ophtalmol 2018; 41:57-61. [PMID: 29305170 DOI: 10.1016/j.jfo.2017.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the frequency of corneal ulcer in our practice environment. METHODOLOGY This study was conducted at Saint-Joseph Hospital in Kinshasa and at the Lubumbashi University Clinics in the Democratic Republic of Congo from January 2011 to December 2014. We studied the frequency, demographic and clinical variables of corneal ulcer patients. RESULTS A total of 380 cases of corneal ulcers were recorded out of 44,722 ophthalmologic consultations performed, with a frequency of 0.85% and a sex ratio ranging from 1.4 to 1.7 men to women. Corneal ulcer was diagnosed in patients of all ages; the mean age was 38.67±18.67 years. Patients with corneal ulcers presented for eye pain (80%), followed by tearing, photophobia, eye redness and blurred vision. The frequency of visual impairment was 10.30%; 2.1% of patients had vision reduced to light perception, and 1% of patients had no light perception. Corneal dystrophy was present in 41.6% of cases. Perforation of the globe and endophthalmitis were observed in 3.4% of cases each. CONCLUSION Corneal ulceration is one of the leading causes of visual impairment and blindness in our practice environment. An early ophthalmologic consultation at the onset of symptoms and adequate management would improve the visual prognosis of patients.
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Affiliation(s)
- V Ngoie Maloba
- Service d'ophtalmologie, clinique universitaire de Lubumbashi, université de Lubumbashi, route kasapa, 1825 Lubumbashi, République démocratique du Congo.
| | - J Ngayuna Nkiene
- Centre hospitalier Monkole, Kinshasa, République démocratique du Congo
| | - G Tunku Kabamba
- Hôpital général de Mukanga, Mukanga, République démocratique du Congo
| | - G Chenge Borasisi
- Service d'ophtalmologie, clinique universitaire de Lubumbashi, université de Lubumbashi, route kasapa, 1825 Lubumbashi, République démocratique du Congo
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Marasini S, Wang MTM, Swift S, Dean SJ, Ormonde SE, Gamble GD, Craig JP. Clinical and microbiological profile of Pseudomonas aeruginosa
keratitis admitted to a New Zealand tertiary centre. Clin Exp Ophthalmol 2017; 46:441-444. [DOI: 10.1111/ceo.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Sanjay Marasini
- Department of Ophthalmology, New Zealand National Eye Centre; The University of Auckland; Auckland New Zealand
| | - Michael TM Wang
- Department of Ophthalmology, New Zealand National Eye Centre; The University of Auckland; Auckland New Zealand
- Department of Medicine; The University of Auckland; Auckland New Zealand
| | - Simon Swift
- Department of Molecular Medicine and Pathology; The University of Auckland; Auckland New Zealand
| | - Simon J Dean
- Department of Ophthalmology, New Zealand National Eye Centre; The University of Auckland; Auckland New Zealand
| | - Susan E Ormonde
- Department of Ophthalmology, New Zealand National Eye Centre; The University of Auckland; Auckland New Zealand
| | - Greg D Gamble
- Department of Medicine; The University of Auckland; Auckland New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre; The University of Auckland; Auckland New Zealand
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Tacrolimus downregulates inflammation by regulating pro‑/anti‑inflammatory responses in LPS‑induced keratitis. Mol Med Rep 2017; 16:5855-5862. [PMID: 28849181 PMCID: PMC5865761 DOI: 10.3892/mmr.2017.7353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/12/2017] [Indexed: 01/28/2023] Open
Abstract
Lipopolysaccharide (LPS)-induced keratitis is a progressive infectious ocular disease in which innate inflammatory responses often cause clinical tissue damage and vision loss. The present study aimed to investigate the effects of tacrolimus, an effective immunomodulator, on LPS-induced innate immune responses. The effects of tacrolimus on the apoptotic rate and viability of human corneal epithelial cells (HCECs), polymorphonuclear neutrophils (PMNs) and monocytes (THP-1 cells) were examined using flow cytometry and MTT assays. Subsequently, the role of tacrolimus on LPS-induced inflammation in HCECs, PMNs and THP-1 cells was evaluated by detecting the expression levels of pro-inflammatory cytokines, including interleukin (IL)-1β, IL-6 and matrix metallopeptidase 9; anti-inflammatory cytokines, including IL-10 and transforming growth factor-β; and proangiogenic factors, including vascular endothelial growth factor and tumor necrosis factor-α using quantitative polymerase chain reaction. The results demonstrated that tacrolimus had good biocompatibility with HCECs, while promoting apoptosis and decreasing the viability of PMNs and THP-1 cells. Furthermore, tacrolimus effectively reduced the expression levels of pro-inflammatory cytokines and increased anti-inflammatory cytokines in LPS-induced keratitis in vitro. Notably, tacrolimus decreased the levels of proangiogenic factors, which are highly increased following LPS stimulation. Conclusively, tacrolimus appears to be a safe and effective treatment to suppress neutrophil and monocyte activity, modulate the balance of pro-/anti-inflammatory cytokines, and reduce the inflammatory response and angiogenic activity in LPS-induced bacterial keratitis.
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Abstract
INTRODUCTION Infectious keratitis is a common ophthalmic disease with the potential for severe ocular morbidity. Multiple studies have described various risk factors for the development of infectious keratitis. The purpose of this study was to analyze the seasonal variation in the presentation of infectious keratitis, and also seasonal changes in its etiologies and risk factors. METHODS A retrospective chart review was performed on consecutive patients presenting to the emergency department at our tertiary care urban hospital center who were diagnosed with infectious keratitis from 2008 to 2013. A chi-square analysis was performed to determine whether a significant seasonal variation existed between the month, season, frequency of presentation of ulcers, and other risk factors. RESULTS A total of 155 patients-53 men and 102 women-with a mean age of 40 (range, 3-97; median, 36) diagnosed with infectious keratitis were included in the analysis. Sixty-nine (44.5%) ulcers presented in the summer, 19 (12.3%) in the fall, 34 (21.9%) in the winter, and 33 (21.3%) in the spring (P<0.0001). Seventeen (11%) patients experienced diabetes mellitus, 60 (39%) were contact lens wearers, 12 (8%) ulcers occurred in the setting of trauma, and 19 (12%) patients underwent previous ocular surgery. A total of 92 ulcers were cultured, of which 53.8% were positive in the summer, 42.9% in the fall, 55.0% in the winter, and 42.1% in the spring. A significant seasonal variation in the frequency of 1 organism, Pseudomonas aeruginosa, was identified (P=<0.0001); up to 47.6% of culture-positive ulcers in the summer were P. aeruginosa positive, whereas cultures in the remaining seasons were 0, 9.1% and 12.5% positive for this organism. DISCUSSION The summer months have a higher frequency of infectious keratitis and P. aeruginosa positivity in this study. Possible factors leading to this increased summer presentation include warmer temperatures, higher humidity, and greater ocular exposure to water. Clinicians should increase their vigilance and education to high-risk patients during these periods and potentially modify empiric treatment regimens.
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Badawi AE, Moemen D, El-Tantawy NL. Epidemiological, clinical and laboratory findings of infectious keratitis at Mansoura Ophthalmic Center, Egypt. Int J Ophthalmol 2017; 10:61-67. [PMID: 28149778 DOI: 10.18240/ijo.2017.01.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 09/29/2016] [Indexed: 12/15/2022] Open
Abstract
AIM To analyze the epidemiological, clinical and laboratory findings of infectious keratitis. METHODS A retrospective study on cases of infective keratitis, attended our institution from Mar. 2013 to Feb. 2015, was done at Mansoura Ophthalmic Center, Egypt. Corneal scrapings were performed and processed for direct microscopy and culture in appropriate media using standard laboratory protocols. RESULTS Out of 245 patients enrolled for study, 247 corneal scrapings were obtained. Ocular trauma was the most common predisposing factor (51.4%), followed by diabetes mellitus (15.1%). Cultures were positive in 110 scraping samples (44.5%): 45.5% samples had pure fungal infection, 40% had pure bacterial infections and 10% had mixed fungal and bacterial growths. Acanthamoeba was detected in 5 (4.5%) samples. The most common fungal pathogen was Aspergillus spp. (41%). The most common bacterial isolates were Staphylococcus aureus (38.2%) and Pseudomonas aeruginosa (21.8%). CONCLUSION Incidence of fungal keratitis is high in our region. Therapeutic approach can initially be based on clinical features and sensitivity/resistance patterns. Microbiological research should direct the antimicrobial treatment. Antibiotic resistance to fluoroquinolones and aminoglycosides is an important consideration.
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Affiliation(s)
- Amani E Badawi
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Dalia Moemen
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Nora L El-Tantawy
- Department of Parasitology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
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Kackar S, Suman E, Kotian MS. Bacterial and Fungal Biofilm formation on Contact Lenses and their Susceptibility to Lens Care Solutions. Indian J Med Microbiol 2017; 35:80-84. [DOI: 10.4103/ijmm.ijmm_16_273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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40
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McGhee CN, Kim BZ. Fungal keratitis: dealing with a diverse kingdom of ocular assailants. Clin Exp Ophthalmol 2016; 44:755-756. [PMID: 28001007 DOI: 10.1111/ceo.12848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Charles Nj McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bia Z Kim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Watters GA, Turnbull PR, Swift S, Petty A, Craig JP. Ocular surface microbiome in meibomian gland dysfunction. Clin Exp Ophthalmol 2016; 45:105-111. [PMID: 27473509 DOI: 10.1111/ceo.12810] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/13/2016] [Accepted: 07/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To investigate the ocular microbiome in meibomian gland dysfunction in Auckland, New Zealand. DESIGN Prospective, cross-sectional, observational, university-based study. PARTICIPANTS Participants resident in New Zealand for ≥2 years (n = 157) were classified as normal (n = 66), mild (n = 41) or moderate-to-severe meibomian gland dysfunction (n = 50). Contact lens wear and anterior blepharitis status were recorded, as well as symptoms and clinical features. METHODS Bacteria collected from lid margin swabs, before and after gland expression, were isolated and identified by conventional microbiological culture techniques. Aerobic isolates were identified in all 157 participants, and both aerobic and anaerobic bacteria isolated in a subset of 87 subjects. MAIN OUTCOME MEASURES Bacterial incidence according to meibomian gland dysfunction status RESULTS: Symptoms, bulbar hyperaemia, conjunctival staining, lipid layer grade and tear film stability, but not corneal staining, showed moderate association with meibomian gland dysfunction severity. Participants with and without meibomian gland dysfunction showed a similar microbiome, unaffected by gland expression. Anterior blepharitis, a common co-morbidity, was not an independent predictor of the microbiome. Sterile cultures were more common in contact lens wearers than non-wearers. The incidence of Staphylococcus aureus was higher than anticipated across all severity groups, and that of coagulase-negative Staphylococcus, Corynebacterium and streptococci was lower. CONCLUSIONS Modest differences in relative proportions of bacteria compared with other studies support climatic variations in the ocular surface microbiome. Similarity in microbiome profile, irrespective of meibomian gland dysfunction severity, anterior blepharitis presence or contact lens wear, suggests potential for commonality in treatment.
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Affiliation(s)
- Grant A Watters
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.,School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Philip R Turnbull
- School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Simon Swift
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Alex Petty
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.,School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Lee R, Manche EE. Trends and Associations in Hospitalizations Due to Corneal Ulcers in the United States, 2002–2012. Ophthalmic Epidemiol 2016; 23:257-63. [DOI: 10.3109/09286586.2016.1172648] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rachel Lee
- Stanford University School of Medicine, Palo Alto, CA, USA
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Spectrum and Sensitivity of Bacterial Keratitis Isolates in Auckland. J Ophthalmol 2016; 2016:3769341. [PMID: 27213052 PMCID: PMC4861789 DOI: 10.1155/2016/3769341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/03/2016] [Accepted: 04/10/2016] [Indexed: 12/02/2022] Open
Abstract
Background. The bacteria isolated from severe cases of keratitis and their antibiotic sensitivity are recognised to vary geographically and over time. Objectives. To identify the most commonly isolated bacteria in keratitis cases admitted over a 24-month period to a public hospital in Auckland, New Zealand, and to investigate in vitro sensitivity to antibiotics. Methods. Hospital admissions for culture-proven bacterial keratitis between January 2013 and December 2014 were identified. Laboratory records of 89 culture positive cases were retrospectively reviewed and antibiotic sensitivity patterns compared with previous studies from other NZ centres. Results. From 126 positive cultures, 35 species were identified. Staphylococcus was identified to be the most common isolate (38.2%), followed by Pseudomonas (21.3%). Over the last decade, infection due to Pseudomonas species, in the same setting, has increased (p ≤ 0.05). Aminoglycosides, cefazolin, ceftazidime, erythromycin, tetracycline, and doxycycline were 100% effective against tested isolates in vitro. Amoxicillin (41.6%), cefuroxime (33.3%), and chloramphenicol (94.7%) showed reduced efficacy against Gram-negative bacteria, whereas penicillin (51%) and ciprofloxacin (98.8%) showed reduced efficacy against Gram-positive bacteria. Conclusions. Despite a shift in the spectrum of bacterial keratitis isolates, antibiotic sensitivity patterns have generally remained stable and show comparability to results within the last decade from NZ centres.
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Assessment of biofilm formation of E. meningoseptica, D. acidovorans, and S. maltophilia in lens cases and their growth on recovery media. Cont Lens Anterior Eye 2016; 39:117-23. [DOI: 10.1016/j.clae.2015.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/12/2015] [Accepted: 09/01/2015] [Indexed: 11/20/2022]
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Li G, Guo J, Liu R, Hu W, Xu L, Wang J, Cai S, Zhang H, Zhu Y. Lacrimal Duct Occlusion Is Associated with Infectious Keratitis. Int J Med Sci 2016; 13:800-805. [PMID: 27766030 PMCID: PMC5069416 DOI: 10.7150/ijms.16515] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background: To explore the prevalence of lacrimal duct obstruction in patients with infectious keratitis, and the necessity of lacrimal duct dredge in the treatment of human infectious keratitis. Methodology/Principle Findings: The design is prospective, non-control case series. Thirty-one eyes from twenty-eight continuous patients with infectious keratitis were included in this study. The presence/absence of lacrimal duct obstruction was determined by the lacrimal duct irrigation test. The diagnosis of infectious keratitis was made based on clinical manifestations, cornea scraping microscopic examination and bacterial/fungus culture. Diagnosis of viral keratitis was set up based on the recurrent history, deep neovascularization and typical outlook of the cornea scar. The treatment of keratitis included drugs, eye drops or surgery, while treatment of chronic dacryocystitis was lacrimal duct dredging with supporting tube implantation surgery. In the thirty-one eyes with infectious keratitis, fifteen suffered from fungal keratitis (48%), two bacterial keratitis (6%), and fourteen viral keratitis (45%). Eleven eyes (35%) from ten patients with infectious keratitis also suffered from lacrimal duct obstruction. In those cases, six eyes also suffered from lower canalicular obstruction, three nasolacrimal duct obstruction and chronic dacryocystitis, one a combination of upper and lower canalicular obstruction, one upper canalicular obstruction. After local and systemic applications of anti-bacterial, anti-viral, anti-fungal and anti-inflammatory drugs, twenty-eight eyes (90%) recovered within three weeks, while the ulceration of three patients required the lacrimal duct dredging and supporting tube implantation surgery for the healing. Conclusions: Herein, we first report that the prevalence of infectious keratitis is closely correlated to the occurrence of lacrimal duct obstruction. When both confirmed, simultaneous treatment of keratitis and lacrimal duct obstruction promptly is required. Further evaluation of mechanism, prevention and control of the diseases are warranted.
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Affiliation(s)
- Guigang Li
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Jingmin Guo
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Rong Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Weikun Hu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Lingjuan Xu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Juan Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Subo Cai
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Hong Zhang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Saraswathi P, Beuerman RW. Corneal Biofilms: From Planktonic to Microcolony Formation in an Experimental Keratitis Infection with Pseudomonas Aeruginosa. Ocul Surf 2015. [DOI: 10.1016/j.jtos.2015.07.001 [pii]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lin TY, Yeh LK, Ma DH, Chen PY, Lin HC, Sun CC, Tan HY, Chen HC, Chen SY, Hsiao CH. Risk Factors and Microbiological Features of Patients Hospitalized for Microbial Keratitis: A 10-Year Study in a Referral Center in Taiwan. Medicine (Baltimore) 2015; 94:e1905. [PMID: 26512612 PMCID: PMC4985425 DOI: 10.1097/md.0000000000001905] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We conducted a retrospective, cross-sectional study to analyze predisposing factors, clinical features, and microbiological characteristics of patients with microbial keratitis hospitalized over 10 years.The medical records of 558 patients who were diagnosed with microbial keratitis and admitted to Chang Gung Memorial Hospital (CGMH), a referral center in Taiwan, from January 1, 2003 to December 31, 2012 were reviewed. Demographics, predisposing factors, isolated organisms, treatment, and hospital stay were recorded. Yearly trends were tested using a linear-by-linear association.Contact lens wear was the most common predisposing factor (31.4%), followed by ocular and systemic diseases (26.3%) and trauma (23.5%). Contact lens-related infectious keratitis increased year by year (P = 0.011). Pseudomonas aeruginosa was the most commonly isolated organism (28%), followed by fungi (17.6%) and coagulase-negative Staphylococcus (5.4%). Except for Serratia marcescens, the identified organisms did not change over 10 years. Most bacterial infections were controlled using antimicrobial treatment, but more than half of patients with fungal keratitis required surgical interventions. The mean hospital stay was 13.7 ± 11.5 days. Previous ocular surgery, large ulcer size, nontuberculous myycobacteris infection, and surgery during admission were related to prolonged hospital stay.In Taiwan, contact lens-related pseudomonal keratitis remained the most common cause of microbial keratitis in patients hospitalized from 2003 to 2012.
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Affiliation(s)
- Tzu-Yu Lin
- From the Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou (T-YL, L-KY, DHM, PYC, H-CL, H-YT, H-CC, S-YC, C-HH); Department of Ophthalmology, Taipei Medical University-Shuang Ho Hospital, New Taipei City (T-YL); College of Medicine, Chang Gung University, Taoyuan (L-KY, D HM, PYC, H-CL, C-C S, H-YT, H-CC, S-YC, C-HH); and Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan (C-CS)
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Ong HS, Corbett MC. Corneal infections in the 21st century. Postgrad Med J 2015; 91:565-71. [PMID: 26354125 DOI: 10.1136/postgradmedj-2015-133323] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/14/2015] [Indexed: 11/04/2022]
Abstract
Ninety years ago, the first issue of the Postgraduate Medical Journal published a review of an article written by Mr Robert Lindsay-Rea, a consultant ophthalmic surgeon in the Western Ophthalmic Hospital and an oculist in the West End Hospital for Nervous Diseases, entitled "A preliminary report on the treatment of keratitis". Today, microbial keratitis remains an important cause of avoidable visual impairment in the world. The aetiology of microbial keratitis has changed greatly over the past century due to the discovery of antibiotics, improvement in sanitation and education, the rising trend of contact lens wear and increased air travel. Significant advances have also been made in our understanding and management of this important disorder. This article highlights some of these changes and discusses the current management and research.
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Affiliation(s)
- Hon Shing Ong
- Department of Corneal and Ocular Surface Disease, The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Melanie C Corbett
- Department of Corneal and Ocular Surface Disease, The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
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Rahimi F, Hashemian MN, Khosravi A, Moradi G, Bamdad S. Bacterial keratitis in a tertiary eye centre in Iran: a retrospective study. Middle East Afr J Ophthalmol 2015; 22:238-44. [PMID: 25949085 PMCID: PMC4411624 DOI: 10.4103/0974-9233.151870] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To report the characteristics and laboratory findings of 182 patients with bacterial keratitis diagnosed at Farabi Eye Hospital in Tehran, Iran. MATERIALS AND METHODS In this retrospective study, data were collected on demographics, risk factors, location, size and depth of the ulcer, height of the hypopyon, uncorrected visual acuity, results of smear and culture tests, and antibiotic sensitivity of cultured bacteria. RESULTS There were 110 (60.4%) males and 72 (39.6%) females with an average age of 56.0 ± 2.3 years. Ocular trauma (17.6%) and positive history of corneal surgery (14.3%) were major risk factors. The mean age of contact lens users was 22.5 ± 7.7 years. Sixty patients (33%) used topical antibiotics, 21 (11.5%) patients utilized topical steroid, and 26 (14.3%) cases used both topical antibiotic and steroid at presentation. Culture results were, 81 (44.5%) cases were Gram-positive, 63 (34.6%) were Gram-negative, 10 (5.5%) were mixed bacteria and in 28 (15.4%) cases had detected growth. The isolated bacterial species from the corneal ulcers were less resistant to ceftazidime (6%) and amikacin (6%). The majority of patients were treated with medical therapy; however, 81 cases (44.5%) received at least one surgical procedure. CONCLUSION Among the patients with bacterial corneal ulcers, trauma was the most common risk factor. Over-the-counter antibiotic and steroid were commonly used in the majority of patients. The most common bacteria isolated were Gram-positives, and they were less resistant to ceftazidime and amikacin. Penetrating keratoplasty was the most common surgical procedure in patient who required surgery.
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Affiliation(s)
- Firoozeh Rahimi
- Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nasser Hashemian
- Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Khosravi
- Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Golnaz Moradi
- Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Bamdad
- Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Saraswathi P, Beuerman RW. Corneal Biofilms: From Planktonic to Microcolony Formation in an Experimental Keratitis Infection with Pseudomonas Aeruginosa. Ocul Surf 2015. [PMID: 26220579 DOI: 10.1016/j.jtos.2015.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Microbial biofilms commonly comprise part of the infectious scenario, complicating the therapeutic approach. The purpose of this study was to determine in a mouse model of corneal infection if mature biofilms formed and to visualize the stages of biofilm formation. METHODS A bacterial keratitis model was established using Pseudomonas aeruginosa ATCC 9027 (1 × 10(8) CFU/ml) to infect the cornea of C57BL/6 black mouse. Eyes were examined post-infection (PI) on days 1, 2, 3, 5, and 7, and imaged by slit lamp microscopy, and light, confocal, and electron microscopy to identify the stages of biofilm formation and the time of appearance. RESULTS On PI day 1, Gram staining showed rod-shaped bacteria adherent on the corneal surface. On PI days 2 and 3, bacteria were seen within webs of extracellular polymeric substance (EPS) and glycocalyx secretion, imaged by confocal microscopy. Scanning electron microscopy demonstrated microcolonies of active infectious cells bound with thick fibrous material. Transmission electron microscopy substantiated the formation of classical biofilm architecture with P. aeruginosa densely packed within the extracellular polymeric substances on PI days 5 and 7. CONCLUSION Direct visual evidence showed that biofilms routinely developed on the biotic surface of the mouse cornea. The mouse model can be used to develop new approaches to deal therapeutically with biofilms in corneal infections.
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Affiliation(s)
| | - Roger W Beuerman
- Singapore Eye Research Institute (SERI), Singapore; Duke-NUS SRP Neuroscience and Behavioural Disorders and Emerging Infectious Diseases, Singapore; Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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