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Venugopal A, Christy J, Raut V, P P, Patwardhan V, V V, Madkaikar A, P M, Meenakshi R, Ramakrishnan R. Viral Keratitis, Surgical Intervention in Viral Keratitis, Challenges in Diagnosis and Treatment of Viral Keratitis, HSV, HZV. Semin Ophthalmol 2024; 39:340-352. [PMID: 38303587 DOI: 10.1080/08820538.2024.2309533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
Viral keratitis is a significant cause of ocular morbidity and visual impairment worldwide. In recent years, there has been a growing understanding of the pathogenesis, clinical manifestations, and diagnostic modalities for viral keratitis. The most common viral pathogens associated with this condition are adenovirus, herpes simplex (HSV), and varicella-zoster virus (VZV). However, emerging viruses such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Vaccinia virus can also cause keratitis. Non-surgical interventions are the mainstay of treatment for viral keratitis. Antiviral agents such as Acyclovir, Ganciclovir, and trifluridine have effectively reduced viral replication and improved clinical outcomes. Additionally, adjunctive measures such as lubrication, corticosteroids, and immunomodulatory agents have alleviated symptoms by reducing inflammation and facilitating tissue repair. Despite these conservative approaches, some cases of viral keratitis may progress to severe forms, leading to corneal scarring, thinning, or perforation. In such instances, surgical intervention becomes necessary to restore corneal integrity and visual function. This review article aims to provide an overview of the current perspectives and surgical interventions in managing viral keratitis. The choice of surgical technique depends on the extent and severity of corneal involvement. As highlighted in this article, on-going research and advancements in surgical interventions hold promise for further improving outcomes in patients with viral keratitis.
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Affiliation(s)
- Anitha Venugopal
- Department of Cornea & Refractive services, Aravind Eye, Hospital and postgraduate institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Josephine Christy
- Department of Cornea & Refractive services, Aravind Eye Hospital, Pondicherry, India
| | - Vaidehi Raut
- Post-Graduate in Ophthalmology Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Preethi P
- Post-Graduate in Ophthalmology Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Veena Patwardhan
- Medical Consultant, Cornea and Refractive Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Veeramma V
- Fellow in Cornea and Refractive surgery, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Aditee Madkaikar
- Department of Cornea & Refractive services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Mangala P
- Department of Cornea & Refractive services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Musa M, Enaholo E, Aluyi-Osa G, Atuanya GN, Spadea L, Salati C, Zeppieri M. Herpes simplex keratitis: A brief clinical overview. World J Virol 2024; 13:89934. [PMID: 38616855 PMCID: PMC11008405 DOI: 10.5501/wjv.v13.i1.89934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/28/2023] [Accepted: 01/22/2024] [Indexed: 03/11/2024] Open
Abstract
The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding herpes simplex keratitis (HSK). This type of corneal viral infection is caused by the herpes simplex virus (HSV), which can affect several tissues, including the cornea. One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea. After the initial infection, the HSV can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye. The virus may remain dormant for extended periods. Periodic reactivation of the virus can occur, leading to recurrent episodes of HSK. Factors triggering reactivation include stress, illness, immunosuppression, or trauma. Recurrent episodes can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease. The severity and frequency of recurrences vary among individuals. Severe cases of HSK, especially those involving the stroma and leading to scarring, can result in vision impairment or even blindness in extreme cases. The cornea's clarity is crucial for good vision, and scarring can compromise this, potentially leading to visual impairment. The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization. Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis. The immune response to the virus can contribute to corneal damage. Inflammation, caused by the body's attempt to control the infection, may inadvertently harm the corneal tissues. Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation. In summary, the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
- Department of Ophthalmology, Africa Eye Laser Centre, Km 7, Benin 300105, Nigeria
| | - Ehimare Enaholo
- Department of Ophthalmology, Africa Eye Laser Centre, Km 7, Benin 300105, Nigeria
- Department of Ophthalmology, Centre for Sight Africa, Nkpor 434101, Nigeria
| | - Gladness Aluyi-Osa
- Department of Ophthalmology, Africa Eye Laser Centre, Km 7, Benin 300105, Nigeria
| | | | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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3
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Yin XT, Hartman A, Sirajuddin N, Shukla D, Leger AS, Keadle TL, Stuart PM. UVB induced reactivation leads to HSV1 in the corneas of virtually all latently infected mice and requires STING to develop corneal disease. Sci Rep 2024; 14:6859. [PMID: 38514671 PMCID: PMC10957950 DOI: 10.1038/s41598-024-52597-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/21/2024] [Indexed: 03/23/2024] Open
Abstract
Reactivation of latent herpes simplex type 1 results in virus returning to the cornea leading to recurrent herpetic stromal keratitis (rHSK). We compare two competing models to reactivate viruses from latency, UV-B irradiation and cyclophosphamide (CP). Results revealed that while both result in corneal recrudescence, only UV-B irradiation results in rHSK. To better understand the dynamics of reactivation, we analyzed corneas for both the presence of infectious viruses and the dynamics of exposure to multiple reactivations using UV-B. We noted that multiple reactivations result in progressively worse corneal disease. We also noted that expression of IFNα and STING, surragate markers for the presence of virus, are induced by the presence of reactivated virus. Studies to determine the importance of STING to the development of HSK revealed that in the absence of STING, mice do not develop significant HSK and the magnitude of the infiltrate of CD45+ cells in these corneas is significantly reduced. The resulting paucity of CD45+CD11b+GR-1+F4/80-neutrophils, and to a lesser extent CD45+CD11b+GR-1-F4/80+ macrophages in B6-STING KO mice following reactivation is likely the underlying cause for lack of rHSK as has been noted by ourselves and others. These results underscore the critical importance of STING's role in developing rHSK.
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Affiliation(s)
- Xiao-Tang Yin
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Alexis Hartman
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Nadia Sirajuddin
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Deepak Shukla
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, USA
| | - Anthony St Leger
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tammie L Keadle
- Department of Biology, Washington University, St. Louis, MO, USA
| | - Patrick M Stuart
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA.
- Washington University, 7569 Amherst Avenue, University City, MO, 63130-2805, USA.
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Nidhi V, Sangwan J, Sood S, Mondal M, Sangwan B, Vohra M, Gour A, Mathur U, Sangwan VS, Acharya M, Tiwari A. Krupple-like factor 4 (KLF4) methylation signature in host cell in active viral keratitis with epithelial manifestation. Exp Eye Res 2024; 240:109771. [PMID: 38163580 DOI: 10.1016/j.exer.2023.109771] [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: 10/08/2023] [Revised: 12/11/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
HSV1 presents as epithelial or stromal keratitis or keratouveitis and can lead to sight-threatening complications. KLF4, a critical transcription factor, and regulator of cell growth and differentiation, is essential in corneal epithelium stratification and homeostasis. Here, we want to understand the epigenetic modification specifically the methylation status of KLF4 in epithelium samples of HSV1 keratitis patients. After obtaining consent, epithelial scrapes were collected from 7 patients with clinically diagnosed HSV1 keratitis and 7 control samples (patients undergoing photorefractive keratectomy). Genomic DNA was isolated from the collected samples using the Qiagen DNeasy Kit. Subsequently, bisulfite modification was performed. The bisulphite-modified DNA was then subjected to PCR amplification using specific primers designed to target the KLF4, ACTB gene region, allowing for the amplification of methylated and unmethylated DNA sequences. The amplified DNA products were separated and visualized on a 3% agarose gel. KLF4 hypermethylation was found in 6 out of 7 (85.71%) eyes with viral keratitis, while 1 eye showed hypomethylation compared to PRK samples. Out of these 6, there were 2 each of epithelial dendritic keratitis, epithelial geographical keratitis, and neurotrophic keratitis. The patient with hypomethylated KLF4 had a recurrent case of HSV1 keratitis with multiple dendrites and associated vesicular lesions of the lip along with a history of fever. KLF4 hypermethylation in most viral keratitis cases indicated the under functioning of KLF4 and could indicate a potential association between KLF4 hypermethylation and the development or progression of HSV1 keratitis.
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Affiliation(s)
- Vatsala Nidhi
- Cornea and Refractive Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Jyoti Sangwan
- Eicher Shroff Center for Stem Cells Research (ES-CSCR), Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Swati Sood
- Eicher Shroff Center for Stem Cells Research (ES-CSCR), Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Moumita Mondal
- Eicher Shroff Center for Stem Cells Research (ES-CSCR), Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Bharti Sangwan
- Shroff-Pandorum Centre for Ocular Regeneration (SP-CORE), Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Mehak Vohra
- Shroff-Pandorum Centre for Ocular Regeneration (SP-CORE), Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Abha Gour
- Cornea and Refractive Services, Dr Shroff's Charity Eye Hospital, New Delhi, India; Eicher Shroff Center for Stem Cells Research (ES-CSCR), Dr. Shroff's Charity Eye Hospital, New Delhi, India; Shroff-Pandorum Centre for Ocular Regeneration (SP-CORE), Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Umang Mathur
- Cornea and Refractive Services, Dr Shroff's Charity Eye Hospital, New Delhi, India; Eicher Shroff Center for Stem Cells Research (ES-CSCR), Dr. Shroff's Charity Eye Hospital, New Delhi, India; Shroff-Pandorum Centre for Ocular Regeneration (SP-CORE), Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Virender Singh Sangwan
- Cornea and Refractive Services, Dr Shroff's Charity Eye Hospital, New Delhi, India; Eicher Shroff Center for Stem Cells Research (ES-CSCR), Dr. Shroff's Charity Eye Hospital, New Delhi, India; Shroff-Pandorum Centre for Ocular Regeneration (SP-CORE), Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Manisha Acharya
- Cornea and Refractive Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Anil Tiwari
- Eicher Shroff Center for Stem Cells Research (ES-CSCR), Dr. Shroff's Charity Eye Hospital, New Delhi, India; Shroff-Pandorum Centre for Ocular Regeneration (SP-CORE), Dr Shroff's Charity Eye Hospital, New Delhi, India.
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Safir M, Mimouni M. Atopic Disease as a Risk Factor for Recurrent Herpetic Keratitis. Microorganisms 2024; 12:220. [PMID: 38276205 PMCID: PMC10820065 DOI: 10.3390/microorganisms12010220] [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: 12/25/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Recurrent herpetic keratitis is a leading cause of blindness worldwide. In this population-based cross-sectional study, the medical records of Israeli adolescents and young adults who underwent systematic preconscription evaluation for mandatory military service were reviewed. The prevalence of atopic conjunctival disease was evaluated in cases with and without documented recurrent herpetic keratitis. The association was tested using uni- and multivariant analyses. Overall, 940,892 adolescents and young adults were included. The mean age was 17.57 ± 1.50 years (range 16-20 years), and 40.70% of participants were female. Recurrent herpetic keratitis was documented in 160 cases, with a prevalence of 0.017% in this age group. Compared to the general population, patients with recurrent herpetic keratitis were significantly more likely to be males (p = 0.003) with a concomitant diagnosis of atopic conjunctival disease (p < 0.0001). Patients with atopic conjunctival disease were 10.60-fold more likely to experience recurrent herpetic keratitis (95% confidence interval (CI): 6.76-16.64, p < 0.0001). Upon multivariate analysis, the results remained significant (p < 0.001). Cases of severe atopic conjunctival disease were more prone to recurrent HSV keratitis compared to mild cases (p < 0.001). These findings suggest that the timely appropriate treatment of atopic conjunctival disease may help reduce the frequency and severity of recurrent HSV keratitis and its complications.
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Affiliation(s)
- Margarita Safir
- Ophthalmology Department, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91905, Israel
| | - Michael Mimouni
- Ophthalmology Department, Rambam Health Care Campus, Haifa 3109601, Israel
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Cabrera-Aguas M, Watson SL. Updates in Diagnostic Imaging for Infectious Keratitis: A Review. Diagnostics (Basel) 2023; 13:3358. [PMID: 37958254 PMCID: PMC10647798 DOI: 10.3390/diagnostics13213358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Infectious keratitis (IK) is among the top five leading causes of blindness globally. Early diagnosis is needed to guide appropriate therapy to avoid complications such as vision impairment and blindness. Slit lamp microscopy and culture of corneal scrapes are key to diagnosing IK. Slit lamp photography was transformed when digital cameras and smartphones were invented. The digital camera or smartphone camera sensor's resolution, the resolution of the slit lamp and the focal length of the smartphone camera system are key to a high-quality slit lamp image. Alternative diagnostic tools include imaging, such as optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM). OCT's advantage is its ability to accurately determine the depth and extent of the corneal ulceration, infiltrates and haze, therefore characterizing the severity and progression of the infection. However, OCT is not a preferred choice in the diagnostic tool package for infectious keratitis. Rather, IVCM is a great aid in the diagnosis of fungal and Acanthamoeba keratitis with overall sensitivities of 66-74% and 80-100% and specificity of 78-100% and 84-100%, respectively. Recently, deep learning (DL) models have been shown to be promising aids for the diagnosis of IK via image recognition. Most of the studies that have developed DL models to diagnose the different types of IK have utilised slit lamp photographs. Some studies have used extremely efficient single convolutional neural network algorithms to train their models, and others used ensemble approaches with variable results. Limitations of DL models include the need for large image datasets to train the models, the difficulty in finding special features of the different types of IK, the imbalance of training models, the lack of image protocols and misclassification bias, which need to be overcome to apply these models into real-world settings. Newer artificial intelligence technology that generates synthetic data, such as generative adversarial networks, may assist in overcoming some of these limitations of CNN models.
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Affiliation(s)
- Maria Cabrera-Aguas
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia;
- Sydney Eye Hospital, Sydney, NSW 2000, Australia
| | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia;
- Sydney Eye Hospital, Sydney, NSW 2000, Australia
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Antony F, Pundkar C, Sandey M, Mishra A, Suryawanshi A. Role of IL-27 in HSV-1-Induced Herpetic Stromal Keratitis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2023; 211:474-485. [PMID: 37326494 PMCID: PMC10495105 DOI: 10.4049/jimmunol.2200420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
Herpetic stromal keratitis (HSK) is a painful and vision-impairing disease caused by recurrent HSV-1 infection of the cornea. The virus replication in the corneal epithelium and associated inflammation play a dominant role in HSK progression. Current HSK treatments targeting inflammation or virus replication are partially effective and promote HSV-1 latency, and long-term use can cause side effects. Thus, understanding molecular and cellular events that control HSV-1 replication and inflammation is crucial for developing novel HSK therapies. In this study, we report that ocular HSV-1 infection induces the expression of IL-27, a pleiotropic immunoregulatory cytokine. Our data indicate that HSV-1 infection stimulates IL-27 production by macrophages. Using a primary corneal HSV-1 infection mouse model and IL-27 receptor knockout mice, we show that IL-27 plays a critical role in controlling HSV-1 shedding from the cornea, the optimum induction of effector CD4+ T cell responses, and limiting HSK progression. Using in vitro bone marrow-derived macrophages, we show that IL-27 plays an antiviral role by regulating macrophage-mediated HSV-1 killing, IFN-β production, and IFN-stimulated gene expression after HSV-1 infection. Furthermore, we report that IL-27 is critical for macrophage survival, Ag uptake, and the expression of costimulatory molecules involved in the optimum induction of effector T cell responses. Our results indicate that IL-27 promotes endogenous antiviral and anti-inflammatory responses and represents a promising target for suppressing HSK progression.
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Affiliation(s)
- Ferrin Antony
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, AL, 36849, USA
| | - Chetan Pundkar
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, AL, 36849, USA
| | - Maninder Sandey
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, AL, 36849, USA
| | - Amarjit Mishra
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, AL, 36849, USA
| | - Amol Suryawanshi
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, AL, 36849, USA
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8
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Yin XT, Hartman A, Sirajuddin N, Shukla D, St Leger A, Keadle TL, Stuart PM. UV-B induced HSV-1 reactivation leads to infectious virus in the corneas of virtually all latently infected mice and requires an intact STING to develop herpetic stromal keratitis. RESEARCH SQUARE 2023:rs.3.rs-3097720. [PMID: 37502845 PMCID: PMC10371093 DOI: 10.21203/rs.3.rs-3097720/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Reactivation of latent herpes simplex type 1 results in virus returning to the cornea leading to recurrent herpetic stromal keratitis (rHSK). We compare two competing models to reactivate viruses from latency, UV-B irradiation and cyclophosphamide. Results revealed that while both result in corneal recrudescence, only UV-B irradiation results in rHSK. To better understand the dynamics of reactivation, we analyzed corneas for both the presence of infectious viruses and the dynamics of exposure to multiple reactivations using UV-B. We noted that multiple reactivations result in progressively worse corneal disease. We also noted that expression of IFNα and STING, surragate markers for the presence of virus, are induced by the presence of reactivated virus. Studies to determine the importance of STING to the development of HSK revealed that in the absence of STING, mice do not develop significant HSK and the magnitude of the infiltrate of CD45 + cells in these corneas is significantly reduced. The resulting paucity of CD45 + CD11b + GR-1 + F4/80-neutrophils, and to a lesser extent CD45 + CD11b + GR-1-F4/80 + macrophages in B6-STING KO mice following reactivation is likely the underlying cause for lack of rHSK as has been noted by ourselves and others. These results underscore the critical importance of STING's role in developing rHSK.
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Subramaniam R, Sonny Teo KS, Muhammed J. Atypical Presentation of Herpes Stromal Keratitis in a Contact Lens Wearer. Cureus 2023; 15:e38438. [PMID: 37273371 PMCID: PMC10234223 DOI: 10.7759/cureus.38438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/06/2023] Open
Abstract
This article describes the case of a 21-year-old female habitual contact lens wearer who complained of left eye pain, redness, and decreased vision for one week. When a ring-shaped corneal infiltration indicative of an Acanthamoeba infection was discovered, standard anti-amoebic topical therapy with polyhexamethylene biguanide and chlorhexidine was commenced. However, her keratitis worsened. At the same time, corneal scraping revealed no pathogens. An anterior chamber examination revealed a loss of corneal sensation, and a positive herpes simplex virus (HSV) immunoglobulin G serology test indicated HSV keratitis. She was eventually treated with oral anti-viral medication and recovered completely. Her case was unusual, as she had a history of contact lens use, painful corneal ulceration, and the development of Acanthamoeba keratitis-like corneal ring infiltration. This case also reinforces the various manifestations of HSV keratitis, which lead to delayed diagnosis and treatment.
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Affiliation(s)
- Ruknesvary Subramaniam
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Khairy Shamel Sonny Teo
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Julieana Muhammed
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
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Suryawanshi RK, Patil CD, Agelidis A, Koganti R, Yadavalli T, Ames JM, Borase H, Shukla D. Pathophysiology of reinfection by exogenous HSV-1 is driven by heparanase dysfunction. SCIENCE ADVANCES 2023; 9:eadf3977. [PMID: 37115924 PMCID: PMC10146881 DOI: 10.1126/sciadv.adf3977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/23/2023] [Indexed: 05/03/2023]
Abstract
Limited knowledge exists on exogenous DNA virus reinfections. Herpes simplex virus-1 (HSV-1), a prototype DNA virus, causes multiple human diseases including vision-threatening eye infections. While reinfection with an exogenous HSV-1 strain is considered plausible, little is known about the underlying mechanisms governing its pathophysiology in a host. Heparanase (HPSE), a host endoglycosidase, when up-regulated by HSV-1 infection dictates local inflammatory response by destabilizing tissue architecture. Here, we demonstrate that HSV-1 reinfection in mice causes notable pathophysiology in wild-type controls compared to the animals lacking HPSE. The endoglycosidase promotes infected cell survival and supports a pro-disease environment. In contrast, lack of HPSE strengthens intrinsic immunity by promoting cytokine expression, inducing necroptosis of infected cells, and decreasing leukocyte infiltration into the cornea. Collectively, we report that immunity from a recent prior infection fails to abolish disease manifestation during HSV-1 reinfection unless HPSE is rendered inactive.
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Affiliation(s)
- Rahul K. Suryawanshi
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Chandrashekhar D. Patil
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Alex Agelidis
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Raghuram Koganti
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Tejabhiram Yadavalli
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Joshua M. Ames
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Hemant Borase
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Deepak Shukla
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL 60612, USA
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11
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Bhattaru A, Blanchard I, Kunamneni S, Rojulpote C, Iskander P, Nasr S, Klamp D. Acrophialophora: A Comprehensive Review of Clinical Guidelines and Diagnosis. Cureus 2023; 15:e37614. [PMID: 37197132 PMCID: PMC10184873 DOI: 10.7759/cureus.37614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/19/2023] Open
Abstract
Acrophialophora is a saprotrophic genus of fungi found in both temperate and tropical regions. The genus is comprised of 16 species, with the subspecies A. fusispora and A. levis necessitating the most clinical concern. Acrophialophora is an opportunistic pathogen with a broad range of clinical manifestations; the fungus has been implicated in cases of fungal keratitis, lung infection, and brain abscess. Acrophialophora infection is particularly of concern for immunocompromised patients, who often present with a more severe disease course involving disseminated infection and may not exhibit typical symptoms. Early diagnosis and therapeutic intervention are critical to the successful clinical management of Acrophialophora infection. Guidelines for antifungal treatment have yet to be established, partially due to the lack of documented cases. Aggressive use of antifungal agents and long-term treatment is required, especially in immunocompromised patients and patients with systemic involvement, due to the potential for morbidity and mortality. In addition to outlining the rarity and epidemiology of the disease, this review provides an overview of the diagnosis and clinical management of Acrophialophora infection to facilitate an early diagnosis and appropriate interventions.
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Affiliation(s)
- Abhijit Bhattaru
- Radiology, University of Pennsylvania, Philadelphia, USA
- Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | | | | | - Chaitanya Rojulpote
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
- Nuclear Cardiology and Cardiovascular Molecular Imaging, University of Pennsylvania, Philadelphia, USA
| | - Peter Iskander
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Simin Nasr
- Family Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Douglas Klamp
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
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12
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Role of Innate Interferon Responses at the Ocular Surface in Herpes Simplex Virus-1-Induced Herpetic Stromal Keratitis. Pathogens 2023; 12:pathogens12030437. [PMID: 36986359 PMCID: PMC10058014 DOI: 10.3390/pathogens12030437] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Herpes simplex virus type 1 (HSV-1) is a highly successful pathogen that primarily infects epithelial cells of the orofacial mucosa. After initial lytic replication, HSV-1 enters sensory neurons and undergoes lifelong latency in the trigeminal ganglion (TG). Reactivation from latency occurs throughout the host’s life and is more common in people with a compromised immune system. HSV-1 causes various diseases depending on the site of lytic HSV-1 replication. These include herpes labialis, herpetic stromal keratitis (HSK), meningitis, and herpes simplex encephalitis (HSE). HSK is an immunopathological condition and is usually the consequence of HSV-1 reactivation, anterograde transport to the corneal surface, lytic replication in the epithelial cells, and activation of the host’s innate and adaptive immune responses in the cornea. HSV-1 is recognized by cell surface, endosomal, and cytoplasmic pattern recognition receptors (PRRs) and activates innate immune responses that include interferons (IFNs), chemokine and cytokine production, as well as the recruitment of inflammatory cells to the site of replication. In the cornea, HSV-1 replication promotes type I (IFN-α/β) and type III (IFN-λ) IFN production. This review summarizes our current understanding of HSV-1 recognition by PRRs and innate IFN-mediated antiviral immunity during HSV-1 infection of the cornea. We also discuss the immunopathogenesis of HSK, current HSK therapeutics and challenges, proposed experimental approaches, and benefits of promoting local IFN-λ responses.
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13
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Altman J, Jones G, Ahmed S, Sharma S, Sharma A. Tear Film MicroRNAs as Potential Biomarkers: A Review. Int J Mol Sci 2023; 24:3694. [PMID: 36835108 PMCID: PMC9962948 DOI: 10.3390/ijms24043694] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
MicroRNAs are non-coding RNAs that serve as regulatory molecules in a variety of pathways such as inflammation, metabolism, homeostasis, cell machinery, and development. With the progression of sequencing methods and modern bioinformatics tools, novel roles of microRNAs in regulatory mechanisms and pathophysiological states continue to expand. Advances in detection methods have further enabled larger adoption of studies utilizing minimal sample volumes, allowing the analysis of microRNAs in low-volume biofluids, such as the aqueous humor and tear fluid. The reported abundance of extracellular microRNAs in these biofluids has prompted studies to explore their biomarker potential. This review compiles the current literature reporting microRNAs in human tear fluid and their association with ocular diseases including dry eye disease, Sjögren's syndrome, keratitis, vernal keratoconjunctivitis, glaucoma, diabetic macular edema, and diabetic retinopathy, as well as non-ocular diseases, including Alzheimer's and breast cancer. We also summarize the known roles of these microRNAs and shed light on the future progression of this field.
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Affiliation(s)
- Jeremy Altman
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Garrett Jones
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Saleh Ahmed
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Shruti Sharma
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Ashok Sharma
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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14
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Impact of the use of anti-glaucoma medications on the risk of herpetic keratitis recurrence. Int Ophthalmol 2022; 43:1559-1564. [PMID: 36224301 DOI: 10.1007/s10792-022-02552-7] [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: 04/26/2022] [Accepted: 10/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Numerous case reports have associated anti-glaucoma medications with recurrence of herpes simplex virus (HSV) and herpes zoster virus (HZV) keratitis. The aim of our study was to determine whether different anti-glaucoma agents are associated with recurrence of herpetic keratitis. METHODS This was a retrospective cohort study using health databases from a Canadian province from January 2001 to December 2012. A new cohort of users on topical prostaglandins (PGs), beta blockers (BBs), alpha-2 agonists (AAs) and carbonic anhydrase inhibitors (CAIs) was created. The date of the third anti-glaucoma drug dispensation within 90 days was deemed the index date of the case. Herpetic keratitis events, as defined by an ICD-9/10 code for HSV or HZV keratitis, or the dispensation of an anti-viral medication by either an ophthalmologist or an optometrist, were examined prior to and following the index date. Risk ratios (RRs) were computed to compare the risk of HSV/HZV keratitis among the PG, BB, AA, and CAI groups individually and collectively while adjusting for age and sex. RESULTS Among 19,986 users of glaucoma medications identified, there were 684 cases of HSV/HZV keratitis. There was no increased risk of HSV/HZV keratitis recurrence for any of the four glaucoma medications classes individually or collectively when adjusted for age and sex. There was also no increased risk for redeveloping either HSV keratitis only or HZV keratitis only amongst all anti-glaucoma users. CONCLUSION There is no association between the use of topical ocular hypotensive therapies and HSV/HZV keratitis recurrence. Further studies are needed to confirm these findings.
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15
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Labib BA, Chigbu DI. Clinical Management of Herpes Simplex Virus Keratitis. Diagnostics (Basel) 2022; 12:diagnostics12102368. [PMID: 36292060 PMCID: PMC9600940 DOI: 10.3390/diagnostics12102368] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
Herpes simplex virus (HSV) keratitis is one of the leading causes of blindness worldwide. Additionally, up to 90% of the population in some countries is seropositive for HSV. HSV can cause a wide spectrum of ocular disease ranging from blepharitis to retinitis. Although the initial clinical expressions of HSV-1 and HSV-2 are similar, HSV-2 has been reported more frequently in association with recurrent HSV disease. Besides irreversible vision loss from keratitis, HSV also causes encephalitis and genital forms of the disease. Despite these statistics, there remains no vaccine against HSV. Current treatment therapies for related ocular diseases include the use of oral and topical antivirals and topical corticosteroids. While effective in many cases, they fail to address the latency and elimination of the virus, making it ineffective in addressing recurrences, a factor which increases the risk of vision loss. As such, there is a need for continued research of other potential therapeutic targets. This review utilized several published articles regarding the manifestations of HSV keratitis, antiviral immune responses to HSV infection, and clinical management of HSV keratitis. This review will summarize the current knowledge on the host–virus interaction in HSV infections, as well as highlighting the current and potential antiviral therapeutics.
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16
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Fortin P, Wickas T, Perry HD, Wawrzusin P, Morcos M. Bell's palsy with Herpes simplex disciform keratitis: A case report. Am J Ophthalmol Case Rep 2022; 27:101575. [PMID: 35599948 PMCID: PMC9115121 DOI: 10.1016/j.ajoc.2022.101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 10/26/2022] Open
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17
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Natarajan R, Matai HD, Raman S, Kumar S, Ravichandran S, Swaminathan S, Rani Alex JS. Advances in the diagnosis of herpes simplex stromal necrotising keratitis: A feasibility study on deep learning approach. Indian J Ophthalmol 2022; 70:3279-3283. [PMID: 36018103 DOI: 10.4103/ijo.ijo_178_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Infectious keratitis, especially viral keratitis (VK), in resource-limited settings, can be a challenge to diagnose and carries a high risk of misdiagnosis contributing to significant ocular morbidity. We aimed to employ and study the application of artificial intelligence-based deep learning (DL) algorithms to diagnose VK. Methods A single-center retrospective study was conducted in a tertiary care center from January 2017 to December 2019 employing DL algorithm to diagnose VK from slit-lamp (SL) photographs. Three hundred and seven diffusely illuminated SL photographs from 285 eyes with polymerase chain reaction-proven herpes simplex viral stromal necrotizing keratitis (HSVNK) and culture-proven nonviral keratitis (NVK) were included. Patients having only HSV epithelial dendrites, endothelitis, mixed infection, and those with no SL photographs were excluded. DenseNet is a convolutional neural network, and the two main image datasets were divided into two subsets, one for training and the other for testing the algorithm. The performance of DenseNet was also compared with ResNet and Inception. Sensitivity, specificity, receiver operating characteristic (ROC) curve, and the area under the curve (AUC) were calculated. Results The accuracy of DenseNet on the test dataset was 72%, and it performed better than ResNet and Inception in the given task. The AUC for HSVNK was 0.73 with a sensitivity of 69.6% and specificity of 76.5%. The results were also validated using gradient-weighted class activation mapping (Grad-CAM), which successfully visualized the regions of input, which are significant for accurate predictions from these DL-based models. Conclusion DL algorithm can be a positive aid to diagnose VK, especially in primary care centers where appropriate laboratory facilities or expert manpower are not available.
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Affiliation(s)
- Radhika Natarajan
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, Tamil Nadu, India
| | - Hiren D Matai
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, Tamil Nadu, India
| | - Sundaresan Raman
- Department of Computer Science and Information Systems, Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | - Subham Kumar
- Department of Computer Science and Information Systems, Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | - Swetha Ravichandran
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, Tamil Nadu, India
| | - Samyuktha Swaminathan
- Department of Computer Science and Engineering, Meenakshi Sundararajan Engineering College, Chennai, Tamil Nadu, India
| | - John Sahaya Rani Alex
- Centre for Healthcare Advancement, Innovation and Research, VIT, Chennai, Tamil Nadu, India
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18
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Cometa S, Zannella C, Busto F, De Filippis A, Franci G, Galdiero M, De Giglio E. Natural Formulations Based on Olea europaea L. Fruit Extract for the Topical Treatment of HSV-1 Infections. Molecules 2022; 27:molecules27134273. [PMID: 35807518 PMCID: PMC9268399 DOI: 10.3390/molecules27134273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 01/27/2023] Open
Abstract
In the present study, a hydroxytyrosol-rich Olea europaea L. fruit extract (OFE) was added to three thoroughly green formulations—hydrogel, oleogel, and cream—in order to evaluate their antiviral activity against HSV-1. The extract was characterized by different analytical techniques, i.e., FT-IR, XPS, and TGA. HPLC analyses were carried out to monitor the content and release of hydroxytyrosol in the prepared formulations. The total polyphenol content and antioxidant activity were investigated through Folin–Ciocâlteu’s reagent, DPPH, and ABTS assays. The ability of the three formulations to convey active principles to the skin was evaluated using a Franz cell, showing that the number of permeated polyphenols in the hydrogel (272.1 ± 1.8 GAE/g) was significantly higher than those in the oleogel and cream (174 ± 10 and 179.6 ± 2 GAE/g, respectively), even if a negligible amount of hydroxytyrosol crossed the membrane for all the formulations. The cell viability assay indicated that the OFE and the three formulations were not toxic to cultured Vero cells. The antiviral activity tests highlighted that the OFE had a strong inhibitory effect against HSV-1 with a 50% inhibitory concentration (IC50) at 25 µg/mL, interfering directly with the viral particles. Among the three formulations, the hydrogel exhibited the highest antiviral activity also against the acyclovir-resistant strain.
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Affiliation(s)
| | - Carla Zannella
- Department of Experimental Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.Z.); (A.D.F.)
| | - Francesco Busto
- Department of Chemistry, University of Bari, Via Orabona 4, 70126 Bari, Italy;
| | - Anna De Filippis
- Department of Experimental Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.Z.); (A.D.F.)
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Massimiliano Galdiero
- Department of Experimental Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.Z.); (A.D.F.)
- Correspondence: (M.G.); (E.D.G.)
| | - Elvira De Giglio
- Department of Chemistry, University of Bari, Via Orabona 4, 70126 Bari, Italy;
- INSTM, National Consortium of Materials Science and Technology, Via G. Giusti 9, 50121 Florence, Italy
- Correspondence: (M.G.); (E.D.G.)
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19
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Cabrera‐Aguas M, Khoo P, Watson SL. Infectious keratitis: A review. Clin Exp Ophthalmol 2022; 50:543-562. [PMID: 35610943 PMCID: PMC9542356 DOI: 10.1111/ceo.14113] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
Globally, infectious keratitis is the fifth leading cause of blindness. The main predisposing factors include contact lens wear, ocular injury and ocular surface disease. Staphylococcus species, Pseudomonas aeruginosa, Fusarium species, Candida species and Acanthamoeba species are the most common causal organisms. Culture of corneal scrapes is the preferred initial test to identify the culprit organism. Polymerase chain reaction (PCR) tests and in vivo confocal microscopy can complement the diagnosis. Empiric therapy is typically commenced with fluoroquinolones, or fortified antibiotics for bacterial keratitis; topical natamycin for fungal keratitis; and polyhexamethylene biguanide or chlorhexidine for acanthamoeba keratitis. Herpes simplex keratitis is mainly diagnosed clinically; however, PCR can also be used to confirm the initial diagnosis and in atypical cases. Antivirals and topical corticosteroids are indicated depending on the corneal layer infected. Vision impairment, blindness and even loss of the eye can occur with a delay in diagnosis and inappropriate antimicrobial therapy.
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Affiliation(s)
- Maria Cabrera‐Aguas
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Corneal Unit Sydney Eye Hospital Sydney New South Wales Australia
| | - Pauline Khoo
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Corneal Unit Sydney Eye Hospital Sydney New South Wales Australia
| | - Stephanie L. Watson
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Corneal Unit Sydney Eye Hospital Sydney New South Wales Australia
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20
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Chaloulis SK, Mousteris G, Tsaousis KT. Incidence and Risk Factors of Bilateral Herpetic Keratitis: 2022 Update. Trop Med Infect Dis 2022; 7:tropicalmed7060092. [PMID: 35736971 PMCID: PMC9229676 DOI: 10.3390/tropicalmed7060092] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/27/2022] [Accepted: 06/05/2022] [Indexed: 12/04/2022] Open
Abstract
Simultaneously occurring bilateral herpetic keratitis is a rare clinical manifestation of ocular herpes. Immunocompromised patients are more susceptible to develop bilateral disease. The purpose of this study is to review recent literature on the topic and to highlight latest updates, regarding risk factors and possible correlations to the disease, as well as new therapeutic options.
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21
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Yin XT, Baugnon NK, Krishnan R, Potter CA, Yarlagadda S, Keadle TL, Stuart PM. CD137 costimulation is associated with reduced herpetic stromal keratitis and with developing normal CD8 + T cells in trigeminal ganglia. J Gen Virol 2022; 103. [PMID: 35766977 PMCID: PMC10027025 DOI: 10.1099/jgv.0.001756] [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] [Indexed: 11/18/2022] Open
Abstract
Costimulatory interactions can be critical in developing immune responses to infectious agents. We recently reported that herpes simplex type 1 (HSV-1) infections of the cornea require a functional CD28-CD80/86 interaction to not only reduce the likelihood of encephalitis, but also to mediate herpetic stromal keratitis (HSK) following viral reactivation. In this same spirit we decided to determine the role that CD137 costimulation plays during HSK. Using both B6-CD137L-/- mice, as well as antagonistic and agonistic antibodies to CD137 we characterize the immune response and to what extent CD137 plays an important role during this disease. Immune responses were measured in both the cornea and in the trigeminal ganglia where the virus forms a latent infection. We demonstrate that CD137 costimulation leads to reduced corneal disease. Interestingly, we observed that lack of CD137 costimulation resulted in significantly reduced CD8+ T expansion and function in the trigeminal ganglia. Finally, we showed that viruses that have been genetically altered to express CD137 display significantly reduced corneal disease, though they did present similar levels of trigeminal infection and peripheral virus production following reactivation of a latent infection. CD137 interactions lead to reduced HSK and are necessary to develop robust trigeminal CD8+ T cell responses.
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Affiliation(s)
- Xiao-Tang Yin
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Nicholas K Baugnon
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Rohini Krishnan
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Chloe A Potter
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Sudha Yarlagadda
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Tammie L Keadle
- Department of Biology, Washington University, St. Louis, MO, USA
| | - Patrick M Stuart
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, MO, USA
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22
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Alimbarova L, Egorova A, Riabova O, Monakhova N, Makarov V. A proof-of-concept study for the efficacy of dispirotripiperazine PDSTP in a rabbit model of herpes simplex epithelial keratitis. Antiviral Res 2022; 202:105327. [PMID: 35487465 DOI: 10.1016/j.antiviral.2022.105327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/02/2022]
Abstract
Herpes simplex keratitis is an important infectious cause of blindness worldwide. The mainstay of antiviral therapy is treatment with long-established nucleoside analogues orally or topically. However, the emergence of resistant strains may become a major health concern in the future. Therefore, the development of backup antiherpetic medicines is urgently needed. Small molecule PDSTP is known to be active against herpes simplex type 1 strains in vitro, affecting early host-pathogen interactions. Here, we evaluated its preclinical efficacy in a rabbit model of herpes simplex epithelial keratitis. The mean course of keratitis and the corneal lesions in the 1.0% PDSTP gel group was statistically significantly less than in the negative control group and was comparable to that in the aciclovir group. These findings open up new opportunities for the development of antiherpetic drugs with an original mechanism of action.
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Affiliation(s)
- Lyudmila Alimbarova
- Gamaleya National Research Centre of Epidemiology and Microbiology of the Ministry of Health of Russia, 18 Gamaleya Street, 123098, Moscow, Russia
| | - Anna Egorova
- Research Centre of Biotechnology RAS, 33-2 Leninsky Prospect, 119071, Moscow, Russia
| | - Olga Riabova
- Research Centre of Biotechnology RAS, 33-2 Leninsky Prospect, 119071, Moscow, Russia
| | - Natalia Monakhova
- Research Centre of Biotechnology RAS, 33-2 Leninsky Prospect, 119071, Moscow, Russia
| | - Vadim Makarov
- Research Centre of Biotechnology RAS, 33-2 Leninsky Prospect, 119071, Moscow, Russia.
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23
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Tsai YE, Weng TH. Dendritic epithelial keratitis in primary herpes simplex infection. QJM 2022; 114:820-821. [PMID: 34373909 DOI: 10.1093/qjmed/hcab220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y-E Tsai
- Department of Ophthalmology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - T-H Weng
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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24
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Kuan HC, Ivan Cheng EY, Yong MH, Wan Abdul Halim WH, Othman O. Corneal Nodules and Possible Pathologies: A Case Series. Cureus 2021; 13:e20822. [PMID: 35141078 PMCID: PMC8800144 DOI: 10.7759/cureus.20822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/05/2022] Open
Abstract
Corneal nodular lesions are not uncommon in clinical practice. Diagnosing and managing this condition can be challenging due to its variable causes. This article highlights three cases of corneal nodular lesions. A common clinical pathway for the diagnosis and treatment of cornea nodular lesions is discussed. Two young females and an elderly man presented with a unilateral corneal nodule of variable duration, which was further demonstrated on anterior segment optical coherence tomography (AS-OCT). Several diagnoses were made after thorough history and examination which include herpetic stromal keratitis, phlyctenular keratoconjunctivitis secondary to blepharitis, and Salzmann nodular degeneration. All cases were initiated on topical antibiotics and topical steroids with additional medication or surgical procedure onboard according to their clinical condition. The corneal nodules resolved with scarring after a period of treatment. In conclusion, corneal nodular lesions can be associated with various pathologies. Thorough history, examination, and appropriate investigations are needed to reveal the underlying causes. Serial anterior segment images and AS-OCT are useful to monitor progression and treatment response. Prompt diagnosis and initiation of treatment are crucial to prevent further complications.
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25
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Mohanty A, Behera HS, Barik MR, Kaur A, Sharma S, Das S, Fernandes M, Panda S, Sahu SK. Microsporidia-induced stromal keratitis: a new cause of presumed immune stromal (interstitial) keratitis. Br J Ophthalmol 2021; 107:607-613. [PMID: 34937694 DOI: 10.1136/bjophthalmol-2021-319784] [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: 06/03/2021] [Accepted: 11/14/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the clinical features, diagnosis and management of immune stromal keratitis/interstitial keratitis (IK) associated with microsporidial epithelial keratitis. METHODS Between October 2020 and January 2021, medical records of IK patients microbiologically proven as microsporidia from samples collected from corneal epithelium on smear examination, and/ or molecular analysis were reviewed. Demography, clinical profile and treatment were analysed. Real-time PCR (RT-PCR) for adenovirus (ADV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) and varicella-zoster virus (VZV) was done. RESULTS Twenty of 152 (13%) microbiologically proven cases of microsporidial keratitis were diagnosed as IK during the study period, the mean age and duration of symptoms were 35.7±11.4 years and 46.3±27.7 days, respectively. Half had predisposing risk factors, like trauma; and 30% had prior recurrences. One-fourth of patients were using antivirals on presentation. Characteristic presentations included disciform keratitis(n=12), incomplete/complete ring(n=5), and combination(n=3), along with variable subepithelial infiltrates (n=14). All cases had stromal oedema, with an intact epithelium and fine pigment dusting on endothelium. Corneal epithelial scrapings had scanty microsporidia spores in smears of 17/20 (85%), and pan-microsporidial DNA was identified in 14/20 (70%), with Vittaforma corneae by sequencing in 11/20 (55%). Other viruses detected were ADV (14,70%), VZV (2,10%), EBV (1,5%) and HSV (1,5%). Rapid resolution of inflammation and oedema within 2 weeks of starting steroids was seen in all cases. CONCLUSION Microsporidia epithelial keratitis induced stromal inflammatory keratitis; is distinguished from microsporidial keratoconjunctivitis and stromal keratitis, by characteristic clinical features, and response to topical steroids.
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Affiliation(s)
- Amrita Mohanty
- Cornea and Anterior Segment, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Manas Ranjan Barik
- Ocular Microbiology Services, LV Prasad Eye Institute, Bhubaneswar, Orissa, India
| | - Amanjot Kaur
- Cornea and Anterior Segment, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Sujata Das
- Cornea and Anterior Segment, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Merle Fernandes
- Cornea and Anterior Segment, L V Prasad Eye Institute, Vishakapatnam, Andhra Pradesh, India
| | | | - Srikant K Sahu
- Cornea and Anterior Segment, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
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26
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Fritz B, Paschko E, Young W, Böhringer D, Wahl S, Ziemssen F, Egert M. Comprehensive Compositional Analysis of the Slit Lamp Bacteriota. Front Cell Infect Microbiol 2021; 11:745653. [PMID: 34869057 PMCID: PMC8635730 DOI: 10.3389/fcimb.2021.745653] [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: 07/29/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Slit lamps are routinely used to examine large numbers of patients every day due to high throughput. Previous, cultivation-based results suggested slit lamps to be contaminated with bacteria, mostly coagulase-negative staphylococci, followed by micrococci, bacilli, but also Staphylococcus aureus. Our study aimed at obtaining a much more comprehensive, cultivation-independent view of the slit lamp bacteriota and its hygienic relevance, as regularly touched surfaces usually represent fomites, particularly if used by different persons. We performed extensive 16S rRNA gene sequencing to analyse the bacteriota, of 46 slit lamps from two tertiary care centers at two sampling sites, respectively. 82 samples yielded enough sequences for downstream analyses and revealed contamination with bacteria of mostly human skin, mucosa and probably eye origin, predominantly cutibacteria, staphylococci and corynebacteria. The taxonomic assignment of 3369 ASVs (amplicon sequence variants) revealed 19 bacterial phyla and 468 genera across all samples. As antibiotic resistances are of major concern, we screened all samples for methicillin-resistant Staphylococcus aureus (MRSA) using qPCR, however, no signals above the detection limit were detected. Our study provides first comprehensive insight into the slit lamp microbiota. It underlines that slit lamps carry a highly diverse, skin-like bacterial microbiota and that thorough cleaning and disinfection after use is highly recommendable to prevent eye and skin infections.
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Affiliation(s)
- Birgit Fritz
- Faculty of Medical and Life Sciences, Institute of Precision Medicine, Microbiology and Hygiene Group, Furtwangen University, Villingen-Schwenningen, Germany
| | - Edita Paschko
- Faculty of Medical and Life Sciences, Institute of Precision Medicine, Microbiology and Hygiene Group, Furtwangen University, Villingen-Schwenningen, Germany
| | - Wayne Young
- Food Informatics Team, AgResearch Ltd., Palmerston North, New Zealand
| | - Daniel Böhringer
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegfried Wahl
- Carl Zeiss Vision International GmbH, Aalen, Germany.,Institute for Ophthalmic Research, Eberhard-Karls University, Tuebingen, Germany
| | - Focke Ziemssen
- Center for Ophthalmology, Eberhard-Karls University, Tuebingen, Germany
| | - Markus Egert
- Faculty of Medical and Life Sciences, Institute of Precision Medicine, Microbiology and Hygiene Group, Furtwangen University, Villingen-Schwenningen, Germany
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Sinha P, Dash M, Bhatkoti B, Krishnan L. Epithelial herpes simplex keratitis in a patient on treatment with secukinumab for psoriasis: An effect of interleukin-17 blockade? Indian J Dermatol Venereol Leprol 2021; 88:225-227. [PMID: 34877851 DOI: 10.25259/ijdvl_496_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/01/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Preema Sinha
- Department of Dermatology, Base Hospital, Lucknow, Uttar Pradesh, India
| | - Mahashweta Dash
- Department of Dermatology, Base Hospital, Lucknow, Uttar Pradesh, India
| | - Bhupesh Bhatkoti
- Department of Ophthalmology, Command Hospital, Lucknow, Uttar Pradesh, India
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McCormick I, James C, Welton NJ, Mayaud P, Turner KME, Gottlieb SL, Foster A, Looker KJ. INCIDENCE OF HERPES SIMPLEX VIRUS KERATITIS AND OTHER OCULAR DISEASE: GLOBAL REVIEW AND ESTIMATES. Ophthalmic Epidemiol 2021; 29:353-362. [PMID: 34622738 PMCID: PMC9397127 DOI: 10.1080/09286586.2021.1962919] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose: We aimed to review available data on the incidence of herpes simplex virus (HSV) keratitis and other HSV ocular disease and to estimate the global burden of HSV ocular disease. Methods: We searched Medline and Embase databases to October 2020 for studies reporting on the incidence of HSV ocular disease. Study quality was evaluated using a four-point checklist. Pooled estimates were applied to 2016 population data to estimate global HSV ocular disease burden. Numbers with uniocular vision impairment (any visual acuity <6/12) were estimated by applying published risks to case numbers. Results: Fourteen studies had incidence data; seven met our quality criteria. In 2016, an estimated 1.7 (95% confidence interval, 95% CI 1.0–3.0) million people had HSV keratitis, based on a pooled incidence of 24.0 (95% CI 14.0–41.0; N = 2; I2 = 97.7%) per 100,000 person-years. The majority had epithelial keratitis (pooled incidence 16.1 per 100,000; 95% CI 11.6–22.3; N = 3; I2 = 92.6%). Available studies were few and limited to the USA and Europe. Data were even more limited for HSV uveitis and retinitis, although these conditions may collectively contribute a further >0.1 million cases. Based on global incidence, some 230,000 people may have newly acquired uniocular vision impairment associated with HSV keratitis in 2016. Conclusion: Over 1.8 million people may have herpetic eye disease annually. Preventing HSV infection could therefore have an important impact on eye health. Herpetic eye disease burden is likely to have been underestimated, as many settings outside of the USA and Europe have higher HSV-1 prevalence and poorer access to treatment.
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Affiliation(s)
- Ian McCormick
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Charlotte James
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Philippe Mayaud
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sami L Gottlieb
- Department of Sexual and Reproductive Health And Research, World Health Organization, Geneva, Switzerland
| | - Allen Foster
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharine J Looker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Wang X, Gu Y, He Y, Sang L, Dai Y, Wang D. Preparation and optimization formulation of zedoary turmeric oil nanoemulsion based thermo-sensitive gel for improved application in ophthalmology. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Greenan E, Gallagher S, Khalil R, Murphy CC, Ní Gabhann-Dromgoole J. Advancing Our Understanding of Corneal Herpes Simplex Virus-1 Immune Evasion Mechanisms and Future Therapeutics. Viruses 2021; 13:v13091856. [PMID: 34578437 PMCID: PMC8473450 DOI: 10.3390/v13091856] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 12/24/2022] Open
Abstract
Herpes stromal keratitis (HSK) is a disease that commonly affects the cornea and external eye and is caused by Herpes Simplex Virus type 1 (HSV-1). This virus infects approximately 66% of people worldwide; however, only a small portion of these people will develop symptoms in their lifetime. There is no cure or vaccine available for HSV-1; however, there are treatments available that aim to control the inflammation caused by the virus and prevent its recurrence. While these treatments are beneficial to those suffering with HSK, there is a need for more effective treatments to minimise the need for topical steroids, which can have harmful effects, and to prevent bouts of disease reactivation, which can lead to progressive corneal scarring and visual impairment. This review details the current understanding of HSV-1 infection and discusses potential novel treatment options including microRNAs, TLRs, mAbs, and aptamers.
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Affiliation(s)
- Emily Greenan
- Department of Ophthalmology, Royal College of Surgeons in Ireland, D02 XK51 Dublin, Ireland; (E.G.); (C.C.M.)
- School of Pharmacy and Biomolecular Sciences (PBS), RSCI Research Institute, Royal College of Surgeons in Ireland, D02 XK51 Dublin, Ireland;
| | - Sophie Gallagher
- School of Biological and Health Sciences, Technological University (TU) Dublin, Kevin Street, D02 XK51 Dublin, Ireland;
| | - Rana Khalil
- School of Pharmacy and Biomolecular Sciences (PBS), RSCI Research Institute, Royal College of Surgeons in Ireland, D02 XK51 Dublin, Ireland;
| | - Conor C. Murphy
- Department of Ophthalmology, Royal College of Surgeons in Ireland, D02 XK51 Dublin, Ireland; (E.G.); (C.C.M.)
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, D02 XK51 Dublin, Ireland
| | - Joan Ní Gabhann-Dromgoole
- Department of Ophthalmology, Royal College of Surgeons in Ireland, D02 XK51 Dublin, Ireland; (E.G.); (C.C.M.)
- School of Pharmacy and Biomolecular Sciences (PBS), RSCI Research Institute, Royal College of Surgeons in Ireland, D02 XK51 Dublin, Ireland;
- Correspondence:
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Antony F, Pundkar C, Sandey M, Jaiswal AK, Mishra A, Kumar A, Channappanavar R, Suryawanshi A. IFN-λ Regulates Neutrophil Biology to Suppress Inflammation in Herpes Simplex Virus-1-Induced Corneal Immunopathology. THE JOURNAL OF IMMUNOLOGY 2021; 206:1866-1877. [PMID: 33811102 DOI: 10.4049/jimmunol.2000979] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
HSV-1 infection of the cornea causes a severe immunoinflammatory and vision-impairing condition called herpetic stromal keratitis (SK). The virus replication in corneal epithelium followed by neutrophil- and CD4+ T cell-mediated inflammation plays a dominant role in SK. Although previous studies demonstrate critical functions of type I IFNs (IFN-α/β) in HSV-1 infection, the role of recently discovered IFN-λ (type III IFN), specifically at the corneal mucosa, is poorly defined. Our study using a mouse model of SK pathogenesis shows that HSV-1 infection induces a robust IFN-λ response compared with type I IFN production at the corneal mucosal surface. However, the normal progression of SK indicates that the endogenous IFN responses are insufficient to suppress HSV-1-induced corneal pathology. Therefore, we examined the therapeutic efficacy of exogenous rIFN-λ during SK progression. Our results show that rIFN-λ therapy suppressed inflammatory cell infiltration in the cornea and significantly reduced the SK pathologic condition. Early rIFN-λ treatment significantly reduced neutrophil and macrophage infiltration, and IL-6, IL-1β, and CXCL-1 production in the cornea. Notably, the virucidal capacity of neutrophils and macrophages measured by reactive oxygen species generation was not affected. Similarly, ex vivo rIFN-λ treatment of HSV-1-stimulated bone marrow-derived neutrophils significantly promoted IFN-stimulated genes without affecting reactive oxygen species production. Collectively, our data demonstrate that exogenous topical rIFN-λ treatment during the development and progression of SK could represent a novel therapeutic approach to control HSV-1-induced inflammation and associated vision impairment.
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Affiliation(s)
- Ferrin Antony
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849
| | - Chetan Pundkar
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849
| | - Maninder Sandey
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849
| | - Anil K Jaiswal
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849
| | - Amarjit Mishra
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI 48201; and
| | | | - Amol Suryawanshi
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849;
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Cabrera‐Aguas M, Kerdraon Y, Watson SL. Diagnosis using polymerase chain reaction and outcomes in herpes simplex keratitis. Acta Ophthalmol 2021; 99:e770-e771. [PMID: 32930506 DOI: 10.1111/aos.14601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Maria Cabrera‐Aguas
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health Sydney NSW Australia
- Sydney Eye Hospital Sydney NSW Australia
| | - Yves Kerdraon
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health Sydney NSW Australia
- Sydney Eye Hospital Sydney NSW Australia
| | - Stephanie L. Watson
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health Sydney NSW Australia
- Sydney Eye Hospital Sydney NSW Australia
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Abstract
PURPOSE To introduce the concept of using a Bowman layer (BL) onlay graft to manage superficial herpetic corneal scarring and to describe the clinical outcomes of the first 2 cases undergoing this procedure. METHODS Two patients with a quiescent superficial corneal scar after herpes (varicella zoster virus [n = 1] and herpes simplex virus [n = 1]) keratitis underwent BL onlay transplantation. After the removal of the host epithelium and limited superficial keratectomy, an isolated BL graft was placed onto the host corneal surface. The cornea was then covered with an amniotic membrane and a bandage contact lens. Best spectacle-corrected visual acuity (VA) and/or best contact lens-corrected VA (BCLVA), biomicroscopy, corneal tomography, and anterior segment optical coherence tomography were recorded at 1 week, 1 month, and 3, 6, 9, 12, and 18 months postoperatively. RESULTS In both cases, the surgical and postoperative courses were uneventful. An improvement of the corneal clarity was observed at biomicroscopy, and no varicella zoster virus/herpes simplex virus reactivation occurred throughout the follow-up period. Biomicroscopy, Scheimpflug imaging, and anterior segment optical coherence tomography showed a completely epithelialized and well-integrated graft postoperatively. In case 1, BCLVA with a scleral lens improved from 20/100 (0.1) preoperatively to 20/32 (0.6) postoperatively. For case 2, no preoperative BCLVA was available, but a BCLVA of 20/36 (0.55) was achieved after the procedure. CONCLUSIONS A BL onlay graft may be a feasible surgical procedure, which may have the potential to reduce superficial corneal scarring and/or anterior corneal irregularities without resorting to deeper keratoplasty in these complex cases.
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Abolhosseini M, Moshtaghion SM, Rezaei Kanavi M, Hosseini SB. A triad of microscopes for rapid and proper diagnosis of infectious keratitis. Clin Exp Optom 2021; 105:333-335. [PMID: 34134595 DOI: 10.1080/08164622.2021.1932430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Mohammad Abolhosseini
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohamadmehdi Moshtaghion
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Confocal Scan, Central Eye Bank of Iran, Tehran, Iran
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Obisesan O, Katata-Seru L, Mufamadi S, Mufhandu H. Applications of Nanoparticles for Herpes Simplex Virus (HSV) and Human Immunodeficiency Virus (HIV) Treatment. J Biomed Nanotechnol 2021; 17:793-808. [PMID: 34082867 DOI: 10.1166/jbn.2021.3074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In recent years, the growing studies focused on the immunotherapy of hepatocellular carcinoma and proved the preclinical and clinical promises of host antitumor immune response. However, there were still various obstacles in meeting satisfactory clinic need, such as low response rate, primary resistance and secondary resistance to immunotherapy. Tackling these barriers required a deeper understanding of immune underpinnings and a broader understanding of advanced technology. This review described immune microenvironment of liver and HCC which naturally decided the complexity of immunotherapy, and summarized recent immunotherapy focusing on different points. The ever-growing clues indicated that the instant killing of tumor cell and the subsequent relive of immunosuppressive microenvironment were both indis- pensables. The nanotechnology applied in immunotherapy and the combination with intervention technology was also discussed.
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Affiliation(s)
- Oluwafemi Obisesan
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110000, China
| | - Lebogang Katata-Seru
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110000, China
| | - Steven Mufamadi
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110000, China
| | - Hazel Mufhandu
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110000, China
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Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Ocular Infections. Clin Microbiol Rev 2021; 34:e0007019. [PMID: 34076493 DOI: 10.1128/cmr.00070-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The variety and complexity of ocular infections have increased significantly in the last decade since the publication of Cumitech 13B, Laboratory Diagnosis of Ocular Infections (L. D. Gray, P. H. Gilligan, and W. C. Fowler, Cumitech 13B, Laboratory Diagnosis of Ocular Infections, 2010). The purpose of this practical guidance document is to review, for individuals working in clinical microbiology laboratories, current tools used in the laboratory diagnosis of ocular infections. This document begins by describing the complex, delicate anatomy of the eye, which often leads to limitations in specimen quantity, requiring a close working bond between laboratorians and ophthalmologists to ensure high-quality diagnostic care. Descriptions are provided of common ocular infections in developed nations and neglected ocular infections seen in developing nations. Subsequently, preanalytic, analytic, and postanalytic aspects of laboratory diagnosis and antimicrobial susceptibility testing are explored in depth.
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Arshad S, Petsoglou C, Lee T, Al-Tamimi A, Carnt NA. 20 years since the Herpetic Eye Disease Study: Lessons, developments and applications to clinical practice. Clin Exp Optom 2021; 104:396-405. [PMID: 33689622 DOI: 10.1080/08164622.2021.1877531] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Herpes Simplex Virus (HSV) is the most common virus that causes eye disease. Although around 60% of the world's population are seropositive for HSV antigens, fortunately, it is estimated that only 1% of seropositive individuals develop eye disease. The most common ocular manifestation of HSV is keratitis, while uveitis and retinal necrosis occur in a small number of cases. HSV keratitis is a debilitating disease, for several reasons: pain , photophobia, and vision loss in acute disease, latency of the virus which leads to infection reactivation from various triggers, scarring, and neovascularisation, leading to permanent vision loss with poor visual rehabilitation prospects. The Herpetic Eye Disease Study (HEDS) was a landmark series of randomised controlled trials in the 1990s that set the benchmark for evidence-based treatment guidelines for anterior eye herpetic disease. Since this time, there has been a change in the distribution of seroprevalence of herpes in the community, a simplified diagnostic classification, advances in treatment options, an emergence of new and a better understanding of risk factors, and discoveries in science that show promise for vaccine and novel future treatments. However, many of the principles of the HEDS study remain rightly entrenched in clinical practice. In this article, the HEDS study is revisited 20 years on through the lens of published literature, to determine current best practise and look towards the future.
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Affiliation(s)
- Sana Arshad
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Centre for Vision Research, Westmead Institute for Medical Research, Sydney, Australia
| | | | - Taehwan Lee
- Faculty of Medicine and Health, UNSW, Sydney, Australia
| | | | - Nicole A Carnt
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Centre for Vision Research, Westmead Institute for Medical Research, Sydney, Australia.,Faculty of Medicine and Health, UNSW, Sydney, Australia.,Institute of Ophthalmology, University College London, London, UK
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Mohammadpour M, Alizadeh L, Jabbarvand Behrouz M, Khorrami-Nejad M. Quantitative real-time polymerase chain reaction analysis in herpes simplex virus keratitis with and without epithelial involvement. Int Ophthalmol 2021; 41:1807-1813. [PMID: 33630251 DOI: 10.1007/s10792-021-01741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the quantitative real-time polymerase chain reaction (qRT-PCR) analysis in herpes simplex virus (HSV) keratitis with and without epithelial involvement. METHODS This cross-sectional study was performed on 70 patients with different HSV types and an active ocular lesion in Farabi Eye Hospital, Tehran, Iran. From these 70 patients, 171 samples were collected, including seventy tear samples and 33 scraping samples from involved eyes; and 68 samples from uninvolved fellow eyes. Samples were frozen at - 70 °C until DNA extraction was performed. Quantity of HSV was measured using qRT-PCR in all three samples. RESULTS The mean age of HSV patients was 52.19 ± 20.42 years (range, 4-85 years). Forty-one (58.6%) HSV patients had epithelial involvement, and 29 (41.4%) patients did not have epithelial involvement. In PCR-positive cases, the mean number of viruses in affected eyes' tears (8,831,234 ± 4,051,979) was significantly higher than uninvolved eyes' tears (182,603 ± 69,141) (P = 0.02). The mean of PCR in HSV patients with and without epithelial involvement was 10,320,269 ± 5,329,800 and 1,469,419 ± 1,070,396, respectively (P = 0.04). The qRT-PCR of involved tears in both groups (with and without epithelial involvement) was significantly higher than unaffected eyes' tears (P < 0.0001 and P = 0.01, respectively). In cases with and without epithelial involvement, the cutoff points of viral load in involved eyes' tears were 281,000 and 126,000 copies, respectively. CONCLUSION The results indicated that qRT-PCR is an excellent method for the detection of herpes simplex keratitis.
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Affiliation(s)
- Mehrdad Mohammadpour
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Leyla Alizadeh
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabbarvand Behrouz
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Optometry, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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The Role of Tissue Resident Memory CD4 T Cells in Herpes Simplex Viral and HIV Infection. Viruses 2021; 13:v13030359. [PMID: 33668777 PMCID: PMC7996247 DOI: 10.3390/v13030359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
Tissue-resident memory T cells (TRM) were first described in 2009. While initially the major focus was on CD8+ TRM, there has recently been increased interest in defining the phenotype and the role of CD4+ TRM in diseases. Circulating CD4+ T cells seed CD4+ TRM, but there also appears to be an equilibrium between CD4+ TRM and blood CD4+ T cells. CD4+ TRM are more mobile than CD8+ TRM, usually localized deeper within the dermis/lamina propria and yet may exhibit synergy with CD8+ TRM in disease control. This has been demonstrated in herpes simplex infections in mice. In human recurrent herpes infections, both CD4+ and CD8+ TRM persisting between lesions may control asymptomatic shedding through interferon-gamma secretion, although this has been more clearly shown for CD8+ T cells. The exact role of the CD4+/CD8+ TRM axis in the trigeminal ganglia and/or cornea in controlling recurrent herpetic keratitis is unknown. In HIV, CD4+ TRM have now been shown to be a major target for productive and latent infection in the cervix. In HSV and HIV co-infections, CD4+ TRM persisting in the dermis support HIV replication. Further understanding of the role of CD4+ TRM and their induction by vaccines may help control sexual transmission by both viruses.
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Alfaro Rangel R, Lepper S, Szentmáry N, Langenbucher A, Seitz B. Herpes Simplex Virus Keratitis in a University Tertiary Referral Centre - Clinical Features and Surgical Approaches. Klin Monbl Augenheilkd 2021; 238:989-995. [PMID: 33607690 DOI: 10.1055/a-1306-0896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess prevalence, clinical manifestations, required keratoplasties, follow-up, and outcome in patients with Herpes Simplex Virus Keratitis (HSK) attending a University Tertiary Referral Center. DESIGN Retrospective (12 years), descriptive, observational study. METHODS A total of 817 eyes with clinical diagnosis of HSK from 779 patients were classified by the type of presentation. We gathered data on the visual acuity, refraction, IOP, and required surgical procedures. RESULTS Stromal involvement including scars represented the most common diagnosis in our department and the main indication of penetrating keratoplasty (PKP). Epithelial keratitis (16%) presented with the best visual acuity at the first visit. Necrotizing keratitis represented 17% of the patients, 78% of whom required PKP; this group also had the worst visual acuity at first examination and was the main indication for emergency PKP. Among all eyes, 288 (35%) required PKP. A total of 230 (28%) PKPs were elective procedures and 58 (7%) PKPs were performed as emergency procedures. Two patients with quiet endothelial decompensations after recurrent HSV endotheliitis were treated with DMEK and had good visual outcomes without HSV recurrence at last follow-up. CONCLUSIONS HSK is a prevalent disease with severe consequences when not treated appropriately and on time. Even when making an accurate diagnosis, the disease can be extremely aggressive, with all the implications it brings to the patients and health system. Elective PKP had better outcomes in terms of visual acuity and clear graft percentage compared to emergency PKP.
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Affiliation(s)
- Raul Alfaro Rangel
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Sabine Lepper
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Nóra Szentmáry
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Germany
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
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Koganti R, Yadavalli T, Naqvi RA, Shukla D, Naqvi AR. Pathobiology and treatment of viral keratitis. Exp Eye Res 2021; 205:108483. [PMID: 33556334 DOI: 10.1016/j.exer.2021.108483] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022]
Abstract
Keratitis is one of the most prevalent ocular diseases manifested by partial or total loss of vision. Amongst infectious (viz., microbes including bacteria, fungi, amebae, and viruses) and non-infectious (viz., eye trauma, chemical exposure, and ultraviolet exposure, contact lens) risk factors, viral keratitis has been demonstrated as one of the leading causes of corneal opacity. While many viruses have been shown to cause keratitis (such as rhabdoviruses, coxsackieviruses, etc.), herpesviruses are the predominant etiologic agent of viral keratitis. This chapter will summarize current knowledge on the prevalence, diagnosis, and pathobiology of viral keratitis. Virus-mediated immunomodulation of host innate and adaptive immune components is critical for viral persistence, and dysfunctional immune responses may cause destruction of ocular tissues leading to keratitis. Immunosuppressed or immunocompromised individuals may display recurring disease with pronounced severity. Early diagnosis of viral keratitis is beneficial for disease management and response to treatment. Finally, we have discussed current and emerging therapies to treat viral keratitis.
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Affiliation(s)
- Raghuram Koganti
- Department of Ophthalmology and Visual Sciences, University of Illinois Medical Center, Chicago, IL, 60612, USA
| | - Tejabhiram Yadavalli
- Department of Ophthalmology and Visual Sciences, University of Illinois Medical Center, Chicago, IL, 60612, USA
| | - Raza Ali Naqvi
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Deepak Shukla
- Department of Ophthalmology and Visual Sciences, University of Illinois Medical Center, Chicago, IL, 60612, USA; Department of Microbiology and Immunology, University of Illinois at Chicago, IL, 60612, USA.
| | - Afsar R Naqvi
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, 60612, USA.
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Hung KH, Lan YH, Lin JY, Kang EYC, Tan HY, Chen HC, Hsiao CH, Yeh LK. Potential Role and Significance of Ocular Demodicosis in Patients with Concomitant Refractory Herpetic Keratitis. Clin Ophthalmol 2021; 14:4469-4482. [PMID: 33380781 PMCID: PMC7767725 DOI: 10.2147/opth.s282059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/27/2020] [Indexed: 01/17/2023] Open
Abstract
Purpose To evaluate the role of Demodex infestation of the eyelids in patients with recurrent herpetic keratitis. Patients and Methods This is a retrospective and noncomparative case series. Twenty-seven patients with ocular demodicosis and recurrent herpetic keratitis under conventional treatments were enrolled. Demographic data and clinical photographs were collected. Ocular demodicosis was confirmed by eyelash examination under a microscope. Eyelid scrub was initiated in these patients after proving Demodex infestation. Response after treatment was reviewed. Results Herpetic keratitis was characterized by epithelial defect, including dendritic lesions (seven eyes, 25.9%), geographic ulcer (three eyes, 11.1%), and neurotrophic ulcer (two eyes, 7.4%), associated with stromal involvement in 12 cases. Six cases with stromal reactivation, including disciform keratitis (two eyes, 7.4%), immune ring (three eyes, 11.1%), and ghost vessel (one eye, 3.7%), presented no epithelial defect. Active anterior uveitis with keratic precipitates was found in 15 cases. Demodex blepharitis was diagnosed with cylindrical dandruff along their lashes in all patients. Other ocular findings include meibomian gland dysfunction (15 eyes, 55.6%), mal-aligned lashes (eight eyes, 29.6%), telangiectasia (14 eyes, 51.9%), conjunctivitis (18 eyes, 66.7%), and ocular rosacea (three eyes, 11.1%). Initial unstable clinical presentations showed deterioration of corneal melting into descemetocele, corneal perforation, recalcitrant stromal infiltration/uveitis, and uncontrollable IOP, despite antiherpetic medication. After treatment of Demodex blepharitis, infestation was under control, followed by subjective improvement of ocular symptoms and a stable clinical outcome. Conclusion Ocular demodicosis should be considered in patients with unstable recurrent herpetic keratitis. A prompt diagnosis and appropriate treatment may curb the progression of herpetic corneal infection.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei City 112, Taiwan
| | - Yu-Hsiang Lan
- Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Jui-Yen Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
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Skarentzos K, Chatzimichael E, Panagiotopoulou EK, Taliantzis S, Konstantinidis A, Labiris G. Corneal Graft Success Rates in HSV Keratitis: A Systematic Review. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 63:150-158. [PMID: 33355075 DOI: 10.14712/18059694.2020.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Herpes Simplex Virus (HSV) has worldwide prevalence. The primary objective of this systematic review was to compare penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) regarding the efficacy and complications of the treatment of corneal scarring caused by herpes simplex keratitis. Out of the 469 articles identified during the combined search of the literature based on the PubMed and Cochrane libraries, 10 retrospective and 2 prospective studies published from January 2010 to December 2019 were included. The study outcomes indicated that both surgical approaches resulted in a comparable improvement of visual acuity (VA). However, DALK demonstrated fewer complications in the majority of studies. Higher graft survival rates were associated with higher acyclovir (ACV) doses (above 800 mg/day), topical steroid and antibiotic drops. In conclusion, in terms of postoperative VA, both PK and DALK demonstrate comparable efficacy. However, DALK, which is applied in less severe HSK cases, is associated with fewer complications and better graft survival rates. High dosages of ACV, topical steroids and antibiotics contribute significantly to improved postoperative outcomes.
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Affiliation(s)
- Konstantinos Skarentzos
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Eleftherios Chatzimichael
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | | | - Sergios Taliantzis
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Aristeidis Konstantinidis
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
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Poon SHL, Wong WHL, Lo ACY, Yuan H, Chen CF, Jhanji V, Chan YK, Shih KC. A systematic review on advances in diagnostics for herpes simplex keratitis. Surv Ophthalmol 2020; 66:514-530. [PMID: 33186564 DOI: 10.1016/j.survophthal.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
Herpes simplex keratitis (HSK) is a significant cause of vision impairment worldwide. Currently, there are no set diagnostic criteria, and popular diagnostic methods, including clinical examination of the eye via slit lamp examination, could lead to false-negatives and misdiagnoses. Molecular testing with polymerase chain reaction (PCR) may lack concordance with clinical findings, posing a great challenge to ophthalmologists. We evaluate recent studies on techniques for the diagnosis of HSK. We included a total of 23 studies published between 2010 and 2020 in English on diagnostic techniques, including in vivo confocal microscopy, polymerase PCR testing, protein detection in tear film with enzyme-linked immunosorbent assay, and various other protein assays. Although PCR has been widely used as one of the current diagnostic methods for HSK, most studies evaluated its efficacy after including alterations to its normal protocol. Tear sample analysis was performed using multiple tools, although corneal scrapings demonstrated a higher positive detection rate. Diagnostic tools identified were able to detect HSK with varying accuracy. Newer diagnostic techniques like multiplex dot hybridization assay and immunochromatographic assays may be considered as the point-of-care preliminary diagnostic tools. More reliable results may be generated by developing a standardized diagnostic protocol.
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Affiliation(s)
- Stephanie Hiu Ling Poon
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR
| | - William Ho Lam Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Amy Cheuk Yin Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Hao Yuan
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - Chien-Fu Chen
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yau Kei Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR.
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Jairath N, Commiskey P, Kaplan A, Paulus YM. FLASH: A Novel Tool to Identify Vision-Threating Eye Emergencies. INTERNATIONAL JOURNAL OF OPHTHALMIC RESEARCH 2020; 6:336-343. [PMID: 34141947 PMCID: PMC8208706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Two million patients visit emergency departments due to eye complaints annually in the United States, yet nearly one-quarter of these visits are for non-urgent ocular problems. Other patients often present a significant length of time after the onset of their symptoms, which may cause progression to irreversible vision loss. A major reason for this discrepancy is that many patients are unsure what symptoms constitute eye emergencies. The challenge is helping patients understand what constitutes a vision-threatening eye emergency, as well as the risks and complications that are associated with delaying their visit to the ophthalmologist or Emergency Department. OBJECTIVES To describe relevant literature on incidence, prevalence, presentation times, associated prognoses, risks, and complications of individual vision-threating eye emergencies, and present a novel acronym, FLASH (Floaters and flashes, Loss of vision, Aching pain, Second Image, Help), to better educate patients at risk for these conditions, fostering better symptom recognition and timely care. This manuscript is aimed at reaching public health departments, educational institutions, primary care offices and eye care centers as part of a dedicated patient education effort for vision-threatening eye emergencies. DESIGN / METHODS Narrative overview of the available literature on specific eye conditions presenting with the aforementioned symptoms, synthesizing findings retrieved from searches of computerized databases and authoritative texts. CONCLUSIONS In each condition presented in this article, symptom interval significantly impacts treatment prognoses. The cited literature demonstrates that patients often present late in emergent eye conditions resulting in vision loss.
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Affiliation(s)
- Neil Jairath
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Patrick Commiskey
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Ariane Kaplan
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Yannis M. Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
- Department of Biomedical Engineering, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
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46
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Ocular surgery after herpes simplex and herpes zoster keratitis. Int Ophthalmol 2020; 40:3599-3612. [PMID: 32910331 DOI: 10.1007/s10792-020-01539-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/25/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The recurrence of herpetic stromal keratitis (HSK) and herpes zoster ophthalmicus (HZO) has been reported after a variety of ocular surgeries. The aim of this study was to review the evidence on the preventive methods employed in the perioperative period in patients having undergone HSK/HZO. METHODS The PubMed and Web of Science databases were the main resources used to conduct the medical literature search. An extensive search was performed to identify relevant articles concerning the prophylaxis against and risk of HSK/HZO recurrence in patients undergoing ocular surgery up to December 31, 2019. RESULTS The disturbance of the corneal nerve plexus occurs during several ocular surgeries including penetrating keratoplasty, lamellar keratoplasty, corneal cross-linking, cataract surgery, as well as photorefractive and phototherapeutic procedures. Such trauma, as well as modulation of the ocular immunological response caused by steroids applied postoperatively, might engender the HSK/HZO reactivation which is not uncommon. There is strong evidence that oral prophylaxis should be recommended just after surgery in patients undergoing penetrating keratoplasty and having suffered from HSK/HZO. For other types of surgeries, the evidence is less compelling; nevertheless, a period of disease quiescence and oral prophylaxis should still be considered. CONCLUSIONS Within the article, we discuss the available evidence for HSK/HZO prophylaxis in ocular surgery. Additional studies would be required to define the real risk of HSK/HZO recurrence following eye surgeries, and particularly cataract surgery, and to confirm the utility of perioperative HSK/HZO prophylaxis.
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47
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Sudharshan S, Nair N, Curi A, Banker A, Kempen JH. Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy - An update. Indian J Ophthalmol 2020; 68:1787-1798. [PMID: 32823395 PMCID: PMC7690468 DOI: 10.4103/ijo.ijo_1248_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
Intraocular inflammation in patients with human immunodeficiency virus (HIV) infection is commonly due to infectious uveitis. Ocular lesions due to opportunistic infections (OI) are the most common and have been described extensively in the pre highly active antiretroviral therapy (HAART) era. Many eye lesions were classified as acquired immunodeficiency syndrome (AIDS) defining illnesses. HAART-associated improvement in immunity of the individual has changed the pattern of incidence of these hitherto reported known lesions leading to a marked reduction in the occurrence of ocular OI. Newer ocular lesions and newer ocular manifestations of known agents have been noted. Immune recovery uveitis (IRU), the new menace, which occurs as part of immune recovery inflammatory syndrome (IRIS) in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. Balancing the treatment of inflammation with the risk of reactivation of OI is a task by itself. Ocular involvement in the HAART era can be due to the adverse effects of some systemic drugs used in the management of HIV/AIDS. Drug-associated retinal toxicity and other ocular side effects are being increasingly reported. In this review, we discuss the ocular manifestations in HIV patients and its varied presentations following the introduction of HAART, drug-associated lesions, and the current treatment guidelines.
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Affiliation(s)
| | - Nivedita Nair
- Department of Uveitis, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Andre Curi
- André Luiz Land Curi, National Institute of Infectious Diseases - INI/ Fiocruz, Brazil
- Clinical Research Laboratory of Infectious, Diseases in Ophthalmology - INI / Fiocruz, Brazil
| | - Alay Banker
- Banker's Retina Clinic and Laser Centre, Ahmedabad, Gujarat, India
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, Ethiopia
- Schepens Eye Research Institute, Boston, Massachusetts, USA
- MCM Eye Unit, MyungSung Christian Medical Center (MCM) General Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
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48
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Dhillon HK, Raj A, Bahadur H. Response to comments on: A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects. Indian J Ophthalmol 2020; 68:1504-1505. [PMID: 32587225 PMCID: PMC7574120 DOI: 10.4103/ijo.ijo_163_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hennaav Kaur Dhillon
- Clinical Fellow, Medical Research Foundation, Department of Pediatric Ophthalmology and Strabismus, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Anuradha Raj
- Associate Professor, Department of Ophthalmology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Harsh Bahadur
- Professor, Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India
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49
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Fritz B, Schäfer K, März M, Wahl S, Ziemssen F, Egert M. Eye-Catching Microbes-Polyphasic Analysis of the Microbiota on Microscope Oculars Verifies Their Role as Fomites. J Clin Med 2020; 9:jcm9051572. [PMID: 32455878 PMCID: PMC7290821 DOI: 10.3390/jcm9051572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
Microscopes are used in virtually every biological and medical laboratory. Previous cultivation-based studies have suggested that direct contact with microscope eyepieces increases the risk of eye infections. To obtain a deeper insight into the microbiota on oculars, we analysed 10 recently used university microscopes. Their left oculars were used for a cultivation-based approach, while the right oculars served for massive gene sequencing. After cleaning with isopropyl alcohol, the oculars were re-sampled and analysed again. All oculars were found to be contaminated with bacteria, with a maximum load of 1.7 × 103 CFU cm-2. MALDI Biotyping revealed mainly Cutibacterium (68%), Staphylococcus (14%) and Brevibacterium (10%), with the most abundant species being Cutibacterium acnes (13%) and Staphylococcus capitis (6%). Cleaning reduced the microbial load by up to 2 log scales. Within 10 uncleaned and 5 cleaned samples, 1480 ASVs were assigned to 10 phyla and 262 genera. The dominant genera before cleaning were Cutibacterium (78%), Paracoccus (13%), Pseudomonas (2%) and Acinetobacter (1%). The bacteriota composition on the cleaned oculars was similar; however, it probably largely represented dead bacteria. In summary, used oculars were significantly contaminated with skin and environmental bacteria, including potential pathogens. Regular cleaning is highly recommended to prevent eye and skin infections.
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Affiliation(s)
- Birgit Fritz
- Faculty of Medical and Life Sciences, Institute of Precision Medicine, Microbiology and Hygiene Group, Furtwangen University, Jakob-Kienzle-Strasse 17, 78054 Villingen-Schwenningen, Germany; (B.F.); (K.S.); (M.M.)
| | - Karin Schäfer
- Faculty of Medical and Life Sciences, Institute of Precision Medicine, Microbiology and Hygiene Group, Furtwangen University, Jakob-Kienzle-Strasse 17, 78054 Villingen-Schwenningen, Germany; (B.F.); (K.S.); (M.M.)
| | - Melanie März
- Faculty of Medical and Life Sciences, Institute of Precision Medicine, Microbiology and Hygiene Group, Furtwangen University, Jakob-Kienzle-Strasse 17, 78054 Villingen-Schwenningen, Germany; (B.F.); (K.S.); (M.M.)
| | - Siegfried Wahl
- Carl Zeiss Vision International GmbH, Turnstrasse 27, 73430 Aalen, Germany;
- Institute for Ophthalmic Research, Eberhard-Karls University, Elfriede-Aulhorn-Strasse 7, 72076 Tuebingen, Germany
| | - Focke Ziemssen
- Center for Ophthalmology, Eberhard-Karls University, Elfriede-Aulhorn-Strasse 7, 72076 Tuebingen, Germany;
| | - Markus Egert
- Faculty of Medical and Life Sciences, Institute of Precision Medicine, Microbiology and Hygiene Group, Furtwangen University, Jakob-Kienzle-Strasse 17, 78054 Villingen-Schwenningen, Germany; (B.F.); (K.S.); (M.M.)
- Correspondence: ; Tel.: +49-7720-307-4554
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50
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Parekh M, Romano V, Franch A, Leon P, Birattari F, Borroni D, Kaye SB, Ponzin D, Ahmad S, Ferrari S. Shotgun sequencing to determine corneal infection. Am J Ophthalmol Case Rep 2020; 19:100737. [PMID: 32435720 PMCID: PMC7229483 DOI: 10.1016/j.ajoc.2020.100737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/30/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To investigate if shotgun-sequencing method could be useful in detailed diagnosis of herpes simplex virus (HSV) infection and compare it with the conventional diagnostic method. Observations Using a sterile scraper, the infectious part of the ocular surface was scraped gently and placed on a glass slide for conventional diagnosis using PCR and histology and in RNA stabilizing reagent for shotgun sequencing respectively. Concentration of the DNA was determined using a sensitive fluorescence dye-based Qubit dsDNA HS Assay Kit. Shotgun-sequencing libraries were generated using the NEBNext DNA ultra II protocol. The samples were sequenced on the Illumina NextSeq 500 in high output mode with 2X150 bp paired-end sequencing. Taxonomic and functional profiles were generated. Conventional diagnostic method suspected herpetic keratitis. The results indicated presence of an amplified product of 92 bp positive HSV-DNA. Conventional diagnostic method detected the presence of Herpes Simplex Virus DNA (type 1). Shotgun sequencing confirmed the diagnosis of HSV along with the taxonomical profiling of the virus. These results were achieved using 1.9 ng/μL of DNA concentration (114 ng in 60 μL) of the total sample volume. Conclusions and importance Shotgun sequencing is a hypothesis-free approach that identifies full taxonomic and functional profile of an organism. This technology is advantageous as it requires smaller sample size compared to conventional diagnostic methods.
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Affiliation(s)
- Mohit Parekh
- Institute of Ophthalmology, University College London, London, United Kingdom.,International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
| | - Vito Romano
- Department of Ophthalmology, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.,Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom.,Istituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion on Oftalmologica, Oviedo, Spain
| | - Antonella Franch
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy.,Department of Ophthalmology, SS Giovanni e Paolo Hospital ULSS12, Venice, Italy
| | - Pia Leon
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy.,Department of Ophthalmology, SS Giovanni e Paolo Hospital ULSS12, Venice, Italy
| | - Federica Birattari
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy.,Department of Ophthalmology, SS Giovanni e Paolo Hospital ULSS12, Venice, Italy
| | - Davide Borroni
- Department of Ophthalmology, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Stephen B Kaye
- Department of Ophthalmology, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Diego Ponzin
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
| | - Sajjad Ahmad
- Institute of Ophthalmology, University College London, London, United Kingdom.,Moorfields Eye Hospital NHS Trust Foundation, London, United Kingdom
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
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