1
|
Kaufman AR, Tu EY. Advances in the management of Acanthamoeba keratitis: A review of the literature and synthesized algorithmic approach. Ocul Surf 2022; 25:26-36. [DOI: 10.1016/j.jtos.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 01/01/2023]
|
2
|
Tu EY, Thulasi P. Reply to Comment on "Oral Miltefosine as Salvage Therapy for Recalcitrant Acanthamoeba Keratitis". Am J Ophthalmol 2021; 232:109-110. [PMID: 34256012 DOI: 10.1016/j.ajo.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
|
3
|
Valikodath NG, Al-Khaled T, Cole E, Ting DSW, Tu EY, Campbell JP, Chiang MF, Hallak JA, Chan RVP. Evaluation of pediatric ophthalmologists' perspectives of artificial intelligence in ophthalmology. J AAPOS 2021; 25:164.e1-164.e5. [PMID: 34087473 PMCID: PMC8328946 DOI: 10.1016/j.jaapos.2021.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To survey pediatric ophthalmologists on their perspectives of artificial intelligence (AI) in ophthalmology. METHODS This is a subgroup analysis of a study previously reported. In March 2019, members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) were recruited via the online AAPOS discussion board to voluntarily complete a Web-based survey consisting of 15 items. Survey items assessed the extent participants "agreed" or "disagreed" with statements on the perceived benefits and concerns of AI in ophthalmology. Responses were analyzed using descriptive statistics. RESULTS A total of 80 pediatric ophthalmologists who are members of AAPOS completed the survey. The mean number of years since graduating residency was 21 years (range, 0-46). Overall, 91% (73/80) reported understanding the concept of AI, 70% (56/80) believed AI will improve the practice of ophthalmology, 68% (54/80) reported willingness to incorporate AI into their clinical practice, 65% (52/80) did not believe AI will replace physicians, and 71% (57/80) believed AI should be incorporated into medical school and residency curricula. However, 15% (12/80) were concerned that AI will replace physicians, 26% (21/80) believed AI will harm the patient-physician relationship, and 46% (37/80) reported concern over the diagnostic accuracy of AI. CONCLUSIONS Most pediatric ophthalmologists in this survey viewed the role of AI in ophthalmology positively.
Collapse
Affiliation(s)
- Nita G Valikodath
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Tala Al-Khaled
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Emily Cole
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Daniel S W Ting
- Singapore National Eye Center, Duke-NUS Medical School Singapore, Singapore
| | - Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Joelle A Hallak
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois.
| |
Collapse
|
4
|
Thulasi P, Saeed HN, Rapuano CJ, Hou JH, Appenheimer AB, Chodosh J, Kang JJ, Morrill AM, Vyas N, Zegans ME, Zuckerman R, Tu EY. Oral Miltefosine as Salvage Therapy for Refractory Acanthamoeba Keratitis. Am J Ophthalmol 2021; 223:75-82. [PMID: 33045218 DOI: 10.1016/j.ajo.2020.09.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To report a case series of patients with treatment-resistant Acanthamoeba keratitis (AK) using oral miltefosine, often as salvage therapy. DESIGN Descriptive, retrospective multicenter case series. METHODS We reviewed 15 patients with AK unresponsive to therapy who were subsequently given adjuvant systemic miltefosine between 2011 and 2017. The main outcome measures were resolution of infection, final visual acuity, tolerance of miltefosine, and clinical course of disease. RESULTS All patients were treated with biguanides and/or diamidines or azoles without resolution of disease before starting miltefosine. Eleven of 15 patients retained count fingers or better vision, and all were considered disease free at last follow-up. Eleven of 15 patients had worsening inflammation with miltefosine, with 10 of them improving with steroids. Six patients received multiple courses of miltefosine. Most tolerated oral miltefosine well, with mild gastrointestinal symptoms as the most common systemic side effect. CONCLUSIONS Oral miltefosine is a generally well-tolerated treatment adjuvant in patients with refractory AK. The clinician should be prepared for a steroid-responsive inflammatory response frequently encountered during the treatment course.
Collapse
|
5
|
Abstract
OBJECTIVES Myopia progression is a significant public health issue. Methods to halt myopia progression in minors continue to gain momentum. Orthokeratology, with market penetrance estimates approximating 1%, is a corneal reshaping therapy and potential myopia progression treatment. Our objective was to explore whether orthokeratology may increase the frequency of Acanthamoeba keratitis compared with other lens modalities. METHODS Individuals less than 18 years diagnosed with Acanthamoeba keratitis (AK) at the University of Illinois at Chicago (UIC) Cornea Service between January 1st, 2003, and December 31st, 2016, were retrospectively reviewed. Subjects were grouped by lens modality (soft, rigid gas permeable [RGP], and orthokeratology), and all cases with orthokeratology lens use were reviewed. The primary outcome was a history of orthokeratology lens use in minors diagnosed with AK. RESULTS Forty-seven contact lens users less than 18 years were diagnosed with AK. The mean age was 15.0 years (range 12-17), 26 (55%) were women, and 4 (8.5%) had bilateral disease. Lens modality included 6 (13%) with orthokeratology, 39 (83%) with soft contact lenses, 0 with nonorthokeratology RGP (0%), and 2 (4%) unknown. CONCLUSIONS The proportion of orthokeratology cases among AK minors (13%) in our case series exceeds the expected proportion of orthokeratology cases expected based on orthokeratology market penetrance (1%). Results from this case series suggest a potential increased risk of AK in orthokeratology users compared with other lens modalities. In the context of the current myopia epidemic and concerns for halting myopia progression in minors, caution should be exercised when selecting appropriate treatment options to minimize the risk of AK.
Collapse
Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Elmer Y. Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Charlotte E. Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
6
|
Yazdanpanah G, Bohm KJ, Hassan OM, Karas FI, Elhusseiny AM, Nonpassopon M, Niparugs M, Tu EY, Sugar J, Rosenblatt MI, Cortina MS, Djalilian AR. Management of Congenital Aniridia-Associated Keratopathy: Long-Term Outcomes from a Tertiary Referral Center. Am J Ophthalmol 2020; 210:8-18. [PMID: 31730836 DOI: 10.1016/j.ajo.2019.11.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the outcomes of medical and surgical management for congenital aniridia-associated keratopathy (AAK) over a long-term follow-up period. DESIGN Retrospective, comparative case series. METHODS Medical records of patients diagnosed with congenital aniridia were retrospectively reviewed. Age, sex, ethnicity, follow-up time, AAK stage, noncorneal abnormalities, ocular surgeries, and complications were recorded. The visual acuity equivalent (VAE), approximate Early Treatment Diabetic Retinopathy Study (appETDRS) letter score, was calculated using recorded Snellen visual acuities. RESULTS A total of 92 eyes of 47 patients (31 females) with mean age of 48.0 ± 18.0 years and mean follow-up of 78.6 ± 42.2 months were included. At the initial visit, 12 eyes (13%) were classified as Stage I AAK, 33 eyes (35.9%) were Stage II, 25 eyes (27.2%) were Stage III, 17 eyes (18.5%) were Stage IV, and 5 eyes (5.4%) were Stage V. Limbal stem cell transplantation (LSCT) and Boston keratoprosthesis (KPro) were frequently performed in eyes with Stages III-V. These advanced corneal surgeries significantly improved the median (95% confidence interval [CI]) of calculated appETDRS scores from 2 (0-20) to 26 (15-41) (Snellen values, 20/20,000 to 20/300; P = 0.0004). Patients with earlier Stages (I-II) of AAK were managed medically and had stable visual acuity through their final visits (appETDRS score of 26 [20-35] to 35 [26-35]; Snellen, 20/300 to 20/200; P > 0.05). The appETDRS VAE was significantly improved from 20 (0-35) to 30 (20-55), Snellen, 20/400 to 20/250, following LSCT (P = 0.021) and from 2 (0-20) to 2 (0-41) after KPro; Snellen, 20/20,000 VAE but with improved 95% CI after follow-up (P = 0.019). CONCLUSIONS With proper characterization and staging of AAK, individualized medical and advanced surgical interventions preserves and improves visual acuity.
Collapse
Affiliation(s)
- Ghasem Yazdanpanah
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kelley J Bohm
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Omar M Hassan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Faris I Karas
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Manachai Nonpassopon
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Muanploy Niparugs
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joel Sugar
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria S Cortina
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA.
| |
Collapse
|
7
|
Avdagic E, Chew HF, Veldman P, Tu EY, Jafri M, Doshi R, Boggild AK, Reidy JJ, Farooq AV. Resolution of Acanthamoeba Keratitis with Adjunctive Use of Oral Miltefosine. Ocul Immunol Inflamm 2019; 29:278-281. [PMID: 31829774 DOI: 10.1080/09273948.2019.1695853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To report a series of cases demonstrating the resolution of Acanthamoeba keratitis (AK) with adjunctive use of oral miltefosine.Methods: Retrospective case series.Results: The first case was a 27-year-old female who presented with severe pain and photophobia. The diagnosis of AK was made with confocal microscopy, which revealed a significant burden of stromal cysts. After approximately 2 weeks of adjunctive oral miltefosine therapy, there was a severe inflammatory response within the cornea followed by quick resolution of the AK. The second case was a 31-year-old male in whom the diagnosis of AK was confirmed by culture and polymerase chain reaction. Adjunctive oral miltefosine was started 3 months after presentation, leading to a quick resolution.Conclusions: Oral miltefosine may have cysticidal properties and should be considered as adjunctive therapy for the treatment of AK, particularly in cases with a significant burden of cysts or in cases recalcitrant to other treatments.
Collapse
Affiliation(s)
- Ema Avdagic
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Hall F Chew
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Canada
| | - Peter Veldman
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mansab Jafri
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Rutvi Doshi
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Andrea K Boggild
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Tropical Disease Unit, Toronto General Hospital, Toronto, Canada.,Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada
| | - James J Reidy
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Asim V Farooq
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
8
|
Ung L, Acharya NR, Agarwal T, Alfonso EC, Bagga B, Bispo PJM, Burton MJ, Dart JKG, Doan T, Fleiszig SMJ, Garg P, Gilmore MS, Gritz DC, Hazlett LD, Iovieno A, Jhanji V, Kempen JH, Lee CS, Lietman TM, Margolis TP, McLeod SD, Mehta JS, Miller D, Pearlman E, Prajna L, Prajna NV, Seitzman GD, Shanbhag SS, Sharma N, Sharma S, Srinivasan M, Stapleton F, Tan DTH, Tandon R, Taylor HR, Tu EY, Tuli SS, Vajpayee RB, Van Gelder RN, Watson SL, Zegans ME, Chodosh J. Infectious corneal ulceration: a proposal for neglected tropical disease status. Bull World Health Organ 2019; 97:854-856. [PMID: 31819296 PMCID: PMC6883276 DOI: 10.2471/blt.19.232660] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, Massachusetts 02114United States of America (USA)
| | - Nisha R Acharya
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, USA
| | - Tushar Agarwal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Eduardo C Alfonso
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, USA
| | - Bhupesh Bagga
- Tej Kohli Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Paulo JM Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, Massachusetts 02114United States of America (USA)
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, England
| | | | - Thuy Doan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, USA
| | | | - Prashant Garg
- Tej Kohli Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Michael S Gilmore
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, Massachusetts 02114United States of America (USA)
| | - David C Gritz
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Linda D Hazlett
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, USA
| | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - John H Kempen
- MCM Eye Unit, MyungSung Medical School, Addis Ababa, Ethiopia
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, USA
| | - Todd P Margolis
- Department of Ophthalmology and Visual Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, USA
| | - Stephen D McLeod
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, USA
| | - Jod S Mehta
- Singapore National Eye Centre, Duke-NUS Graduate Medical School, Singapore
| | - Darlene Miller
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, USA
| | - Eric Pearlman
- Institute of Immunology, University of California, Irvine, USA
| | | | | | - Gerami D Seitzman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, USA
| | - Swapna S Shanbhag
- Tej Kohli Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Namrata Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L.V. Prasad Eye Institute, Hyderabad, India
| | | | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Donald TH Tan
- Singapore National Eye Centre, Duke-NUS Graduate Medical School, Singapore
| | - Radhika Tandon
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, USA
| | - Sonal S Tuli
- Department of Ophthalmology, University of Florida, Gainesville, USA
| | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Russell N Van Gelder
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, USA
| | - Stephanie L Watson
- Save Sight Institute, University of Sydney Medical School, Sydney, Australia
| | - Michael E Zegans
- Department of Surgery (Ophthalmology), Geisel School of Medicine at Dartmouth, Hanover, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, Massachusetts 02114United States of America (USA)
| |
Collapse
|
9
|
Rosenwasser GO, Szczotka-Flynn LB, Ayala AR, Liang W, Aldave AJ, Dunn SP, McCall T, Navarro LC, Pramanik S, Ross KW, Stulting RD, Terry MA, Tu EY, Verdier DD, Kollman C, Gal RL, Beck RW, Lass JH. Effect of Cornea Preservation Time on Success of Descemet Stripping Automated Endothelial Keratoplasty: A Randomized Clinical Trial. JAMA Ophthalmol 2019; 135:1401-1409. [PMID: 29127431 DOI: 10.1001/jamaophthalmol.2017.4989] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Demonstrating that success of Descemet stripping automated endothelial keratoplasty is similar across donor cornea preservation times (PTs) could increase the donor pool. Objective To determine whether the 3-year rate of graft success using corneal donor tissue preserved 8 to 14 days is noninferior to that of donor tissue preserved 7 days or less. Design, Setting, and Participants A multicenter, double-masked, randomized noninferiority clinical trial was conducted from April 16, 2012, to June 5, 2017, at 40 clinical sites (70 surgeons) in the United States, with donor corneas provided by 23 US eye banks. A total of 1090 individuals (1330 study eyes) underwent Descemet stripping automated endothelial keratoplasty (1255 eyes [94.4%] for Fuchs endothelial corneal dystrophy). Interventions Descemet stripping automated endothelial keratoplasty with random assignment of a donor cornea with a PT of 7 days or less (0-7d PT) or 8 to 14 days (8-14d PT). Main Outcomes and Measures Graft success at 3 years. Results Of the 1090 participants (1330 study eyes; 60.2% women and 39.8% men; median age at enrollment, 70 years [range, 42-90 years]), the 3-year cumulative probability of graft success was 95.3% (95% CI, 93.6%-96.9%) in the 0-7d PT group and 92.1% (95% CI, 89.9%-94.2%) in the 8-14d PT group (difference, 3.2%). The upper limit of the 1-sided 95% CI on the difference was 5.4%, exceeding the prespecified noninferiority limit of 4%. The difference was mostly owing to more primary donor failures in the 8-14d PT group, with the conditional probability of failure after the first month being 2.4% in the 0-7d PT group and 3.1% in the 8-14d PT group. In preplanned secondary analyses, longer PT was associated with a lower rate of graft success (unadjusted hazard ratio for graft failure per additional day of PT, 1.10; 95% CI, 1.03-1.18; P = .008 [PT analyzed as days]), with success rates of 96.5% (95% CI, 92.3%-98.4%) for PT of 4 days or less, 94.9% (95% CI, 92.5%-96.6%) for PT of 5 to 7 days, 93.8% (95% CI, 91.0%-95.8%) for PT of 8 to 11 days, and 89.3% (95% CI, 84.4%-92.7%) for PT of 12 to 14 days (P = .01 [PT analyzed as categorical variable]). Conclusions and Relevance The 3-year success rate in eyes undergoing Descemet stripping automated endothelial keratoplasty was high irrespective of PT. However, the study was unable to conclude that the success rate with donor corneas preserved 8 to 14 days was similar to that of corneas preserved 7 days or less with respect to the prespecified noninferiority limit. Although longer PT was associated with a lower success rate, the difference in rates was small when PT was less than 12 days.
Collapse
Affiliation(s)
| | - Loretta B Szczotka-Flynn
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio,University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Wendi Liang
- Jaeb Center for Health Research, Tampa, Florida
| | | | | | | | | | | | | | | | | | - Elmer Y Tu
- University of Illinois Chicago Eye and Ear Infirmary, Chicago
| | | | | | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
| | - Jonathan H Lass
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio,University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | |
Collapse
|
10
|
Affiliation(s)
- Amy A. Mehta
- Illinois Eye and Ear Infirmary, University of Illinois, Chicago
| | - Elmer Y. Tu
- Illinois Eye and Ear Infirmary, University of Illinois, Chicago
| | | |
Collapse
|
11
|
Khor WB, Prajna VN, Garg P, Mehta JS, Xie L, Liu Z, Padilla MDB, Joo CK, Inoue Y, Goseyarakwong P, Hu FR, Nishida K, Kinoshita S, Puangsricharern V, Tan AL, Beuerman R, Young A, Sharma N, Haaland B, Mah FS, Tu EY, Stapleton FJ, Abbott RL, Tan DTH. The Asia Cornea Society Infectious Keratitis Study: A Prospective Multicenter Study of Infectious Keratitis in Asia. Am J Ophthalmol 2018; 195:161-170. [PMID: 30098351 DOI: 10.1016/j.ajo.2018.07.040] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/26/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To survey the demographics, risk factors, microbiology, and outcomes for infectious keratitis in Asia. DESIGN Prospective, nonrandomized clinical study. METHODS Thirteen study centers and 30 sub-centers recruited consecutive subjects over 12-18 months, and performed standardized data collection. A microbiological protocol standardized the processing and reporting of all isolates. Treatment of the infectious keratitis was decided by the managing ophthalmologist. Subjects were observed for up to 6 months. Main outcome measures were final visual acuity and the need for surgery during infection. RESULTS A total of 6626 eyes of 6563 subjects were studied. The majority of subjects were male (n = 3992). Trauma (n = 2279, 34.7%) and contact lens wear (n = 704, 10.7%) were the commonest risk factors. Overall, bacterial keratitis was diagnosed in 2521 eyes (38.0%) and fungal keratitis in 2166 eyes (32.7%). Of the 2831 microorganisms isolated, the most common were Fusarium species (n = 518, 18.3%), Pseudomonas aeruginosa (n = 302, 10.7%), and Aspergillus flavus (n = 236, 8.3%). Cornea transplantation was performed in 628 eyes to manage ongoing infection, but 289 grafts (46%) had failed by the end of the study. Moderate visual impairment (Snellen vision less than 20/60) was documented in 3478 eyes (53.6%). CONCLUSION Demographic and risk factors for infection vary by country, but infections occur predominantly in male subjects and are frequently related to trauma. Overall, a similar percentage of bacterial and fungal infections were diagnosed in this study. Visual recovery after infectious keratitis is guarded, and corneal transplantation for active infection is associated with a high failure rate.
Collapse
|
12
|
Terry MA, Aldave AJ, Szczotka-Flynn LB, Liang W, Ayala AR, Maguire MG, Croasdale C, Daoud YJ, Dunn SP, Hoover CK, Macsai MS, Mauger TF, Pramanik S, Rosenwasser GOD, Rose-Nussbaumer J, Stulting RD, Sugar A, Tu EY, Verdier DD, Yoo SH, Lass JH. Donor, Recipient, and Operative Factors Associated with Graft Success in the Cornea Preservation Time Study. Ophthalmology 2018; 125:1700-1709. [PMID: 30098353 PMCID: PMC6196643 DOI: 10.1016/j.ophtha.2018.08.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To associate donor, recipient, and operative factors with graft success 3 years after Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS). DESIGN Cohort study within a multicenter, double-masked, randomized clinical trial. PARTICIPANTS One thousand ninety individuals (1330 study eyes) with a median age of 70 years undergoing DSAEK for Fuchs endothelial corneal dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (PACE; 6% of eyes). METHODS Eyes undergoing DSAEK were randomized to receive a donor cornea with preservation time (PT) of 0 to 7 days (n = 675) or 8 to 14 days (n = 655). Donor, recipient, and operative parameters were recorded prospectively. Graft failure was defined as regraft for any reason, a graft that failed to clear by 8 weeks after surgery, or an initially clear graft that became and remained cloudy for 90 days. Failure in the first 8 weeks was classified further as primary donor failure or early failure, in the absence or presence of operative complications, respectively. Proportional hazards and logistic regression models were used to estimate risk ratios (RR) and 99% confidence intervals (CIs) for graft failure. MAIN OUTCOME MEASURES Graft success at 3 years. RESULTS One thousand two hundred fifty-one of 1330 grafts (94%) remained clear at 3 years and were considered successful. After adjusting for PT, tissue from donors with diabetes (RR, 2.35; 99% CI, 1.03-5.33) and operative complications (RR, 4.21; 99% CI, 1.42-12.47) were associated with increased risk for primary or early failure. Preoperative diagnosis of PACE (RR, 3.59; 99% CI, 1.05-12.24) was associated with increased risk for late failure by 3 years after surgery compared with Fuchs dystrophy. Graft success showed little variation among other factors evaluated, including donor age (RR, 1.19 per decade; 99% CI, 0.91-1.56 per decade), preoperative donor endothelial cell density (RR, 1.10 per 500 cells; 99% CI, 0.74-1.63 per 500 cells), graft diameter (RR, 1.22 per 1 mm; 99% CI, 0.39-3.76 per 1 mm), and injector use for graft insertion (RR, 0.92; 99% CI, 0.40-2.10). CONCLUSIONS Descemet stripping automated endothelial keratoplasty success in the early and entire postoperative period is more likely when the donor did not have diabetes and was without operative complications and in the long-term postoperative period in recipients with Fuchs dystrophy compared with those with PACE. Mechanisms whereby diabetic donors and PACE recipients reduce the rate of graft success after DSAEK warrant further study.
Collapse
Affiliation(s)
| | - Anthony J Aldave
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Loretta B Szczotka-Flynn
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio
| | - Wendi Liang
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Maureen G Maguire
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Yassine J Daoud
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Steven P Dunn
- Michigan Cornea Consultants, PC, Southfield, Michigan
| | | | | | - Thomas F Mauger
- The Ohio State University Wexner Medical Center, Havener Eye Institute, Columbus, Ohio
| | | | | | - Jennifer Rose-Nussbaumer
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | | | - Alan Sugar
- University of Michigan, Kellogg Eye Center, Ann Arbor, Michigan
| | - Elmer Y Tu
- University of Illinois Chicago Eye and Ear Infirmary, Chicago, Illinois
| | | | - Sonia H Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jonathan H Lass
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio.
| |
Collapse
|
13
|
Mian SI, Aldave AJ, Tu EY, Ayres BD, Jeng BH, Macsai MS, Nordlund ML, Penta JG, Pramanik S, Szczotka-Flynn LB, Ayala AR, Liang W, Maguire MG, Lass JH. Incidence and Outcomes of Positive Donor Rim Cultures and Infections in the Cornea Preservation Time Study. Cornea 2018; 37:1102-1109. [PMID: 29912040 PMCID: PMC6081243 DOI: 10.1097/ico.0000000000001654] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess donor rim culture results and outcomes of ocular infections in the Cornea Preservation Time Study (CPTS). METHODS Donor corneal rim cultures were optional. Donor characteristics were assessed for association with positive cultures using the Fisher exact test and Poisson regression analyses. Incidence rates of ocular infections were estimated, and 95% confidence intervals were calculated. RESULTS Cultures were performed in 784 (58.9%) of the 1330 cases. For the 0 to 7-day versus 8 to 14-day preservation time groups, respectively, positive fungal growth occurred in 10 of 397 (2.5%) versus 5 of 387 (1.3%) corneas (P = 0.30), whereas positive bacterial cultures occurred in 6 of 397 (1.5%) versus 4 of 387 (1.0%) corneas (P = 0.75). Surgeon-prepared tissue remained a significant risk for positive fungal cultures [relative risk (RR) of surgeon- versus eye-bank-prepared, 2.85; 95% CI (1.02-7.98)], whereas younger donors [RR per year of age, 0.96; 95% CI (0.93-1.00)] and accidental death donors [RR of accident versus disease, 3.71; 95% CI (1.36-10.13)] were at a greater risk for positive bacterial cultures. Fungal infection (Candida glabrata) developed in 1 (6.7%) of 15 recipients with a positive fungal culture, and no recipient infections occurred with positive bacterial culture. With one additional fungal keratitis (Candida albicans) and one bacterial endophthalmitis (E. coli) with no rim culture performed, a total of 2 of 1330 eyes (0.15%) developed fungal and 1/1330 eyes (0.08%) developed bacterial postkeratoplasty infections. CONCLUSIONS A longer preservation time was not associated with a higher rate of positive donor rim cultures. The overall rate of infection across the entire cohort was low.
Collapse
Affiliation(s)
| | - Anthony J. Aldave
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA
| | - Elmer Y. Tu
- University of Illinois Chicago Eye and Ear Infirmary, Chicago, IL
| | | | - Bennie H. Jeng
- University of California, San Francisco, San Francisco, CA (now at the University of Maryland, Baltimore, MD)
| | | | | | | | | | - Loretta B. Szczotka-Flynn
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, OH
| | | | | | - Maureen G. Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA
| | - Jonathan H. Lass
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, OH
| |
Collapse
|
14
|
Gosalia NR, Dikopf MS, Lim JI, Lin AY, Tu EY, Aref AA. Cyst Masquerading as Inadvertent Bleb After a Scleral-Fixated Intraocular Lens in Marfan Syndrome: A Case Report. Ophthalmol Ther 2018; 7:437-441. [PMID: 30117112 PMCID: PMC6258571 DOI: 10.1007/s40123-018-0142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION To present a case of an epithelial inclusion cyst masquerading as an inadvertent bleb in a patient with Marfan syndrome. CASE REPORT A woman with Marfan syndrome presented with a subluxed crystalline lens in her right eye, which progressively subluxed over the following 2 years. A lensectomy was performed with placement of an anterior chamber intraocular lens (IOL); however, the patient experienced blurred vision and photopsias and preferred IOL explantation. The IOL was removed and a scleral-fixated posterior chamber IOL was placed. Vision improved with an uncomplicated postoperative course. Five months later, the patient experienced sudden onset redness and sharp pain in this eye. A 3-mm cystic lesion with tan material was found over a prior scleral incision site. Intraocular pressure was normal and no aqueous leaked from the lesion. Owing to concerns of an infected inadvertent bleb, treatment with topical and oral antibiotics was started, but the lesion did not change in appearance and the patient experienced persistent pain. The lesion was surgically excised and histopathology revealed a conjunctival epithelial inclusion cyst with intralesional keratin. A month later, another conjunctival inclusion cyst developed and was excised per patient preference. CONCLUSION Marfan syndrome is characterized by defects in the FBN1 gene and may theoretically lead to an abnormal sclera, increasing the risk of bleb formation after scleral incision. Distinguishing between a filtering bleb and an epithelial inclusion cyst is critical in patient care. Although retained keratin from a cyst may mimic a bleb with purulence, intraocular pressure, aqueous leakage, and response to topical antibiotics may help distinguish between the two.
Collapse
Affiliation(s)
| | - Mark S Dikopf
- Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, IL, USA
| | - Jennifer I Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, IL, USA
| | - Amy Y Lin
- Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, IL, USA
| | - Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, IL, USA
| | - Ahmad A Aref
- Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, IL, USA.
| |
Collapse
|
15
|
Brothers KM, Shanks RMQ, Hurlbert S, Kowalski RP, Tu EY. Association Between Fungal Contamination and Eye Bank-Prepared Endothelial Keratoplasty Tissue: Temperature-Dependent Risk Factors and Antifungal Supplementation of Optisol-Gentamicin and Streptomycin. JAMA Ophthalmol 2017; 135:1184-1190. [PMID: 28973097 DOI: 10.1001/jamaophthalmol.2017.3797] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Fungal contamination and infection from donor tissues processed for endothelial keratoplasty is a growing concern, prompting analysis of donor tissues after processing. Objective To determine whether eyebank-processed endothelial keratoplasty tissue is at higher risk of contamination than unprocessed tissue and to model eyebank processing with regard to room temperature exposure on Candida growth in optisol-gentamicin and streptomycin (GS) with and without antifungal supplementation. Design, Setting, and Participants An examination of the 2013 Eversight Eyebank Study follow-up database for risk factors associated with post-keratoplasty infection identified an increased risk of positive fungal rim culture results in tissue processed for endothelial keratoplasty vs unprocessed tissue. Processing steps at room temperature were hypothesized as a potential risk factor for promotion of fungal growth between these 2 processes. Candida albicans, Candida glabrata, and Candida parapsilosis endophthalmitis isolates were each inoculated into optisol-GS and subjected to 2 different room temperature incubation regimens reflective of current corneal tissue handling protocols. Main Outcomes and Measures Eversight Eyebank Study outcomes and measures were follow-up inquiries from 6592 corneal transplants. Efficacy study outcomes and measures were fungal colony-forming units from inoculated vials of optisol-GS taken at 2 different processing temperatures. Results Donor rim culture results were 3 times more likely to be positive for fungi in endothelial keratoplasty-processed eyes (1.14%) than for other uses (0.37%) (difference, 0.77%; 95% CI, 0.17-.1.37) (P = .009). In vitro, increased room temperature incubation of optisol-GS increased growth of Candida species over time. The addition of caspofungin and voriconazole decreased growth of Candida in a species-dependent manner. Conclusions and Relevance Detectable Candida growth in donor rim cultures, associated with a higher rate of post keratoplasty infection, is seen in endothelial keratoplasty tissue vs other uses at the time of transplantation, likely owing in part to eyebank preparation processes extending the time of tissue warming. Reduced room temperature incubation and the addition of antifungal agents decreased growth of Candida species in optisol-GS and should be further explored to reduce the risk of infection.
Collapse
Affiliation(s)
- Kimberly M Brothers
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert M Q Shanks
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Regis P Kowalski
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago
| |
Collapse
|
16
|
Farooq AV, Tu EY, D'jalilian AR, Traish AS, Hou JH. Persistent staining of lattice lines after intraoperative trypan blue use in patients with lattice corneal dystrophy. Cornea 2014; 33:1235-7. [PMID: 25255137 DOI: 10.1097/ico.0000000000000261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to report the persistent staining of corneal lattice lines resulting from the intraoperative use of trypan blue. METHODS This is a case series. RESULTS Four patients with lattice corneal dystrophy (LCD) who underwent either deep anterior lamellar keratoplasty or cataract extraction with intraoperative trypan blue use demonstrated persistent, postoperative trypan staining of lattice lines on slit-lamp examination out to final follow-up (range, 176 to 541 days postoperatively). CONCLUSIONS This case series demonstrates the previously unreported finding that intraoperative trypan blue stains corneal lattice lines in LCD. Trypan blue staining, localized in previous laboratory studies to amyloid deposits, seems to persist for months or longer and may be permanent in human tissue. Although the staining was not visually significant, animal models suggest a stimulatory effect on progression of amyloidosis. Clinicians should be aware of the potential for permanent corneal staining and possible disease progression with the use of intraoperative trypan blue in patients with LCD.
Collapse
Affiliation(s)
- Asim V Farooq
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, Illinois.
| |
Collapse
|
18
|
Tu EY. Balancing antimicrobial efficacy and toxicity of currently available topical ophthalmic preservatives. Saudi J Ophthalmol 2014; 28:182-7. [PMID: 25278794 DOI: 10.1016/j.sjopt.2014.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/27/2014] [Accepted: 06/15/2014] [Indexed: 12/01/2022] Open
Abstract
Medical treatment of ophthalmic diseases relies primarily on the use of multidose drugs. Short term use is highly effective usually with little local toxicity. However, chronic use of these preparations not only increases the likelihood of microbial contamination and secondary ocular infection, but also of toxicity from the drug formulation itself. Increasing awareness of the toxicity of ophthalmic preservatives has led to an increasing variety of preservative schemes ranging from "self-preservation" to ionic buffer systems. Beyond outdated testing methods, the anti-microbial efficacy of most of these systems is poorly defined, potentially placing these preparations at an unknown risk of contamination by unmonitored, untested organisms. No uniformity in toxicity testing exists which further complicates the clinician's judgment of the risk-benefit of using a particular drug formulation. In this manuscript we examine in detail each of the current employed ophthalmic preservative regimens with respect to their known antimicrobial activity and potential toxicity, where known. We also survey the most popular ophthalmic preparations, detailing their preservation schemes as well as concentrations to help the clinician in choosing an appropriate formulation for the treatment of various ophthalmic diseases.
Collapse
Affiliation(s)
- Elmer Y Tu
- University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
| |
Collapse
|
19
|
Tu EY, Shoff ME, Gao W, Joslin CE. Effect of low concentrations of benzalkonium chloride on acanthamoebal survival and its potential impact on empirical therapy of infectious keratitis. JAMA Ophthalmol 2013; 131:595-600. [PMID: 23519403 DOI: 10.1001/jamaophthalmol.2013.1644] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The significant antiacanthamoebal effect of benzalkonium chloride, at or below concentrations used for preservation of common ophthalmic preparations, should be understood both when choosing empiric antibiotic therapy for infectious keratitis and when assessing the persistent rise in Acanthamoeba cases in the United States since 2003. OBJECTIVE To characterize the antiacanthamoebal efficacy of low concentrations of benzalkonium chloride (BAK) for drug preservation and therapeutic effect against Acanthamoeba. DESIGN Experimental study with a review of the literature. SETTING Laboratory. EXPOSURES A concentration of 10(4) trophozoites of 3 well-characterized clinical strains of Acanthamoeba were exposed at 0.5, 2.0, 3.5, 5.0, and 6.5 hours to BAK (0.001%, 0.002%, and 0.003%), moxifloxacin hydrochloride (0.5%), and moxifloxacin (0.5%) + BAK (0.001% and 0.003%) with hydrogen peroxide (3%) and amoeba saline controls. MAIN OUTCOMES AND MEASURES Amoeba survival was calculated using the most probable number method recorded as log kill values. The relationship of BAK concentration and exposure time as well as the relative effect of BAK and moxifloxacin on acanthamoebal survival were analyzed. RESULTS Amoebicidal activity of BAK is both time dependent and concentration dependent in pooled and strain-stratified analyses (P < .001). Moxifloxacin demonstrated no significant independent inhibitory effect or additive effect to BAK efficacy on acanthamoebal survival. The profound antiacanthamoebal effect of BAK, 0.003%, was similar to that of hydrogen peroxide for certain strains. CONCLUSIONS AND RELEVANCE Low concentrations of BAK, previously demonstrated to concentrate and persist in ocular surface epithelium, exhibit significant antiacanthamoebal activity in vitro at or below concentrations found in commercially available ophthalmic anti-infectives. The unexplained persistence of the Acanthamoeba keratitis outbreak in the United States, clusters abroad, and clinical studies reporting resolution or modification of Acanthamoeba keratitis without specific antiacanthamoebal therapy suggests that other contributing factors should be considered, including changes in the formulations used for empirical therapy of presumed infectious keratitis occurring in the same period.
Collapse
Affiliation(s)
- Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | | | | |
Collapse
|
20
|
Schultz KL, Vajaranant TS, Suhr K, Wilensky JT, Tu EY. Surgical technique for excisional bleb revision using a rotational conjunctival flap for a large conjunctival defect. Middle East Afr J Ophthalmol 2013; 20:98-101. [PMID: 23580864 PMCID: PMC3617541 DOI: 10.4103/0974-9233.106409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bleb dysesthesia is a common but under recognized late complication of trabeculectomy, sometimes requiring surgical revision if conservative measures fail. We describe in detail a surgical technique for closure of a large conjunctival defect following bleb excision for refractory dysesthesia. Two subconjunctival 5-fluorouracil injections were given to improve bleb function. Eight months post-operatively, the intraocular pressure is well controlled on two agents, and the patient has had resolution of dysesthesia.
Collapse
Affiliation(s)
- Kara L Schultz
- Department of Ophthalmology and Visual Sciences, University of Illinois-Chicago, Chicago, IL 60612, USA
| | | | | | | | | |
Collapse
|
21
|
See CW, Srinivasan M, Saravanan S, Oldenburg CE, Esterberg EJ, Ray KJ, Glaser TS, Tu EY, Zegans ME, McLeod SD, Acharya NR, Lietman TM. Prior elicitation and Bayesian analysis of the Steroids for Corneal Ulcers Trial. Ophthalmic Epidemiol 2013; 19:407-13. [PMID: 23171211 DOI: 10.3109/09286586.2012.735332] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To elicit expert opinion on the use of adjunctive corticosteroid therapy in bacterial corneal ulcers. To perform a Bayesian analysis of the Steroids for Corneal Ulcers Trial (SCUT), using expert opinion as a prior probability. METHODS The SCUT was a placebo-controlled trial assessing visual outcomes in patients receiving topical corticosteroids or placebo as adjunctive therapy for bacterial keratitis. Questionnaires were conducted at scientific meetings in India and North America to gauge expert consensus on the perceived benefit of corticosteroids as adjunct treatment. Bayesian analysis, using the questionnaire data as a prior probability and the primary outcome of SCUT as a likelihood, was performed. For comparison, an additional Bayesian analysis was performed using the results of the SCUT pilot study as a prior distribution. RESULTS Indian respondents believed there to be a 1.21 Snellen line improvement, and North American respondents believed there to be a 1.24 line improvement with corticosteroid therapy. The SCUT primary outcome found a non-significant 0.09 Snellen line benefit with corticosteroid treatment. The results of the Bayesian analysis estimated a slightly greater benefit than did the SCUT primary analysis (0.19 lines verses 0.09 lines). CONCLUSION Indian and North American experts had similar expectations on the effectiveness of corticosteroids in bacterial corneal ulcers; that corticosteroids would markedly improve visual outcomes. Bayesian analysis produced results very similar to those produced by the SCUT primary analysis. The similarity in result is likely due to the large sample size of SCUT and helps validate the results of SCUT.
Collapse
Affiliation(s)
- Craig W See
- FI Proctor Foundation, University of California, San Francisco, CA 94143-0412, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Batta P, Tu EY. Atopic Keratoconjunctivitis. Ocular Surface Disease: Cornea, Conjunctiva and Tear Film 2013:103-110. [DOI: 10.1016/b978-1-4557-2876-3.00015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
|
23
|
Tu EY, Pham M, Chow CC, Badawi D. Reply. Am J Ophthalmol 2012. [DOI: 10.1016/j.ajo.2011.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
24
|
Abstract
Parasitic organisms are increasingly recognized as human corneal pathogens. A notable increase in both well-defined Acanthamoeba keratitis and a more dramatic increase in reported cases of Microsporidia keratitis have suggested significant outbreaks of parasitic keratitis around the world. Historical and contemporary baselines as well as a familiar associated clinical presentation reinforce the significant outbreak of Acanthamoeba keratitis in the United States. The remarkable rise in cases of Microsporidia keratitis, however, lacks these established baselines and, further, describes a disease that is inconsistent with previous definitions of disease. While a well-defined, abrupt increase strongly suggests temporally related risk factors, most likely environmental, involved in the Acanthamoeba outbreak, the rise in Microsporidia keratitis suggests that increased awareness and improved diagnostic acumen are a significant factor in case ascertainment. Regardless, recent evidence indicates that both parasitic diseases are likely underreported in various forms of infectious keratitis, which may have unrecognized but significant implications in the pathogenesis of both primary protozoal and polymicrobial keratitis. Further understanding of the incidence and interaction of these organisms with current therapeutic regimens and more commonly recognized pathogens should significantly improve diagnosis and alter clinical outcomes.
Collapse
Affiliation(s)
- E Y Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, IL 60612, USA.
| | | |
Collapse
|
25
|
Pham M, Chow CC, Badawi D, Tu EY. Use of infliximab in the treatment of peripheral ulcerative keratitis in Crohn disease. Am J Ophthalmol 2011; 152:183-188.e2. [PMID: 21652024 DOI: 10.1016/j.ajo.2011.01.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 01/28/2011] [Accepted: 01/29/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE To report the effectiveness of infliximab in the treatment of peripheral ulcerative keratitis (PUK) associated with Crohn disease. DESIGN Retrospective, interventional case series. METHODS SETTING Institutional, academic referral setting. patient or study population: Six eyes of 3 patients with PUK associated with Crohn disease that failed or were intolerant to traditional immunosuppression such as oral prednisone and cyclophosphamide. INTERVENTION OR OBSERVATION PROCEDURE(S): Infliximab intravenous infusion 5 mg/kg every 2 to 8 weeks. MAIN OUTCOME MEASURE(S) Subjective outcome such as pain improvement and objective outcomes such as visual acuity, signs of inflammation, and progression of corneal thinning. RESULTS Symptom of pain improved in all patients. Visual acuity remained stable in 4 of 6 eyes, improved in 1 of 6 eyes, and worsened in 1 of 6 eyes (secondary to stromal scar). Rapid resolution of inflammation and arrest of further thinning were observed in all 6 eyes. Similar effects were observed on recurrence treated with repeat dosing of infliximab in 5 of 6 eyes. CONCLUSIONS Infliximab produced a rapid, dramatic, repeatable suppression of corneal inflammation, pain, and keratolysis in PUK associated with Crohn disease. Although the effect of long-term therapy with these agents is unknown, infliximab should be considered in patients with Crohn-associated PUK not amenable to traditional therapy. Larger prospective studies are needed to determine the efficacy of infliximab in this aggressive disease entity.
Collapse
|
26
|
|
27
|
Abbott RL, Adrean SD, Al-Muammar A, Akhtar J, Alfonso EC, Allen RC, Almond MC, Alvarenga L, Alward WLM, Ambrósio R, Anwar M, Azar DT, Ball JL, Barney NP, Bartow RM, Baum J, Belin MW, Bell JH, Benetz BA, Berbos Z, Beuerman RW, Bhasin AK, Bhat PV, Biber JM, Bidros M, Birnbaum AD, Bouchard CS, Bradley JC, Brandt JD, Brasington RD, Brilakis HS, Burkat CN, Calatayud M, Cameron JD, Campos M, Carpel EF, Cavanagh HD, Chan C, Chang RI, Chang BH, Chern KC, Ching S, Chodosh J, Choo PH, Chung G, Ciolino JB, Clayton JA, Cohen EJ, Comyn O, Cortina MS, Cowden JW, Croasdale CR, Davidson RS, Davis EA, Daya SM, Freitas DD, DeMill DL, de Oliveira LA, de Smet MD, de Sousa LB, Djalilian AR, Dohlman CH, Donnenfeld ED, Dortzbach RK, Driebe WT, Dunn SP, Eagle RC, Edelstein SL, Eiferman RA, Eliason JA, Farid M, Faulkner WJ, Feder RS, Feiz V, Feng MT, Fingert JH, Florakis GJ, Fontana L, Forster RK, Foster CS, Foster FS, Foulks GN, Friedlander MH, Fukuda M, Galor A, Gan TJ, Garg P, Garg S, Glasser DB, Goins KM, Goldstein DA, Gottlieb C, Grimmett MR, Gris O, Groos EB, Gruzensky WD, Güell JL, Gupta PK, Hamill MB, Hammersmith KM, Hamrah P, Hannush SB, Hardten DR, Harrison A, Heck EL, Heidemann DG, Herman DC, Heur JM, Hodge WG, Hoffman CJ, Holland EJ, Holland GN, Honig MA, Hood CT, Hoskins EN, Huang AJW, Huang D, Hui JI, Iuorno JD, Jackson WB, Jakobiec FA, Jeng BH, Jester JV, Jordan DR, Kaiura TL, Karp CL, Katz DG, Kaufman SC, Kersten RC, Khachikian SS, Kim JH, Kim JY, Kim SK, Kim T, Kirkness CM, Klyce SD, Koch DD, Kowalski RP, Krachmer JH, Laibson PR, Lane SS, Lass JH, Lee WB, Lee OA, Lemp MA, Lenhart PD, Li Y, Liesegang TJ, Lim MC, Lin LK, Lin MP, Lindquist TD, Lindstrom RL, Litoff D, Liu C, Lowder CY, Lubniewski AJ, McGee HT, McLean IW, Macsai MS, Manero F, Mannis MJ, Mantopoulos D, Martinez CE, Mártonyi CL, Mashor RS, Mathers WD, Mehta MN, Meisler DM, Mian SI, Miller D, Miller CA, Montoya M, Morral M, Moyes AL, Murphy ML, Nassiri N, Neff KD, Nelson JD, Nerad JA, Netto MV, Newton CJ, Nijm LM, Nishida T, Noble BA, Nordlund ML, Nussenblatt RB, O'Day DG, Ongkosuwito JV, Oxford KW, Palay DA, Palmon FE, Paranjpe DR, Parikh M, Park DH, Park DJJ, Parsons MR, Pavlin CJ, Pearlstein ES, Perry A, Petroll WM, Pfister DR, Pfister RR, Pflugfelder SC, Price FW, Price MO, Probst LE, Purcell JJ, Pyott AAE, Raizman MB, Raju LV, Randleman JB, Rao GN, Rapuano CJ, Reilly CD, de Candelaria Renesto A, Rezende RA, Robertson DM, Rootman DS, Rothman JS, Rubinfeld RS, Sadowsky AE, Saika S, Sakhalkar MV, Salz JJ, Sangwan VS, Scarpi M, Scharf BH, Schmidt G, Schmitt A, Schmitt FP, Schteingart MT, Schwab IR, Schwam BL, Schwartz GS, Sen HN, Shapiro MB, Shimmura S, Singal N, Skeens HM, Skolnick CA, Slomovic AR, Smith JA, Snyder ME, Solomon R, Soukiasian SH, Srinivasan S, Stamler JF, Steinert RF, Stoller GL, Streeten BW, Stulting RD, Sugar A, Sugar J, Tan D, Tauber J, Terry MA, Tessler HH, Torrabadella M, Traboulsi EI, Trattler WB, Tsai JH, Tse DT, Tu EY, Ursea R, Vaddavalli PK, Van Meter WS, Varley GA, Vasaiwala R, Verachtert AJ, Verdier DD, Vieira AC, Virasch VV, Wang L, Waring GO, Waring GO, Warner MA, Warrian KJ, Webster GF, Weikert MP, Weisenthal RW, Weiss JS, Wichiensin P, Wilhelmus KR, Wilson SE, Woodward MA, Yee RW, Yoo S. Contributors. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
28
|
Abstract
PURPOSE To describe the treatment of chronic stromal Acanthamoeba keratitis (AK) with oral voriconazole monotherapy. METHODS All cases of chronic stromal AK recalcitrant to traditional therapy subsequently treated with systemic voriconazole seen at the University of Illinois Eye and Ear Infirmary between June 2003 and July 2009 were reviewed for clinical presentation, clinical course, and outcome. RESULTS Three eyes of 2 patients were identified with culture-confirmed chronic stromal AK unresponsive to traditional antiacanthamoebal therapies, requiring topical corticosteroids to maintain corneal clarity. Oral voriconazole 200 mg twice daily achieved a rapid but transient reduction of inflammation and elimination of corticosteroid dependency but, in both patients, recrudesced approximately 6 weeks after its discontinuation. Subsequent repeated and/or extended use of oral voriconazole alone resulted in complete resolution ranging from 7 to 11 months off all medications with final best-corrected visual acuity ranging from 20/20 to 20/25. CONCLUSIONS Recalcitrant chronic Acanthamoeba stromal keratitis was successfully treated with extended systemic voriconazole administration with good preservation of vision. The clinical resolution of chronic stromal keratitis in our 2 cases suggests that voriconazole may have a larger role in the treatment of AK.
Collapse
Affiliation(s)
- Elmer Y Tu
- Department of Ophthalmology and Visual Science, University of Illinois at Chicago, 60612, USA.
| | | | | |
Collapse
|
29
|
Davis LT, Kumar N, Nijm LM, Ulanski LJ, Tu EY, Fiscella RG, Peterson RJ, Glickman RD. An adaptable HPLC method for the analysis of frequently used antibiotics in ocular samples. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:2421-6. [DOI: 10.1016/j.jchromb.2010.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 07/29/2010] [Accepted: 08/02/2010] [Indexed: 10/19/2022]
|
30
|
|
31
|
Chow CC, Kapur R, Wood MG, Setabutr P, Tu EY. Septo-optic dysplasia with bilateral congenital corneal anesthesia. J AAPOS 2009; 13:494-5. [PMID: 19840731 DOI: 10.1016/j.jaapos.2009.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Revised: 08/16/2009] [Accepted: 08/17/2009] [Indexed: 10/20/2022]
Abstract
Septo-optic dysplasia, or de Morsier syndrome, is characterized by optic nerve hypoplasia with an absent septum pellucidum and/or pituitary abnormalities. Congenital corneal anesthesia is a rare disorder that has been associated with many neurological disorders. Here we present a patient with both conditions who was successfully treated with permanent lateral tarsorrhaphy and aggressive lubrication. To our knowledge, congenital corneal anesthesia has not been reported in association with septo-optic dysplasia. The purpose of this report is to make pediatric ophthalmologists aware of a potential association since the diagnosis of congenital corneal anesthesia is often difficult and delayed.
Collapse
Affiliation(s)
- Clement C Chow
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
| | | | | | | | | |
Collapse
|
32
|
Tu EY, Joslin CE, Nijm LM, Feder RS, Jain S, Shoff ME. Polymicrobial keratitis: Acanthamoeba and infectious crystalline keratopathy. Am J Ophthalmol 2009; 148:13-9.e2. [PMID: 19327742 DOI: 10.1016/j.ajo.2009.01.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 01/15/2009] [Accepted: 01/22/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the early presentation, cause, and successful medical management of combined Acanthamoeba keratitis (AK) and infectious crystalline keratopathy (ICK). DESIGN Interventional case series. METHODS Retrospective review of 111 AK patients diagnosed and managed at the University of Illinois Eye and Ear Infirmary between June 1, 2003 and November 30, 2008 for an additional diagnosis of infectious keratitis. RESULTS Of 5 AK patients with microbiologic evidence of an additional bacterial keratitis during their active AK treatment, concomitant ICK developed in 3 patients. All patients were examined within 3 weeks of their AK diagnosis and were found to have characteristic signs and symptoms consistent with ICK. Bacterial culture results at the time of AK diagnosis were negative in 2 patients, but subsequent culture results were positive for Streptococcus oralis. Initial culture results demonstrated light growth of methicillin-sensitive Staphylococcus aureus in the remaining patient, who had received partial antibiotic treatment. Topical corticosteroids were used before diagnosis in 2 patients and were in use in only 1 patient after AK diagnosis. All infections resolved with medical therapy alone. One patient later required penetrating keratoplasty for visual rehabilitation. CONCLUSIONS In patients with AK, ICK can develop early and without either the use of corticosteroids or a preexisting epithelial defect, inconsistent with previously suggested mechanisms and major risk factors for secondary infection. Combined AK and ICK may exhibit increased pathogenicity with the onset of severe, often new, pain and acceleration of localized tissue loss and resultant scarring. Although early recognition and aggressive medical treatment were successful in resolving the combined infections in our cases, Acanthamoeba coinfection, and perhaps endosymbiosis, should be considered in the evaluation and clinical management of AK, especially in those cases progressing atypically. Further research is needed to understand the precise mechanism of the introduction of coinfectious pathogens and their role in the pathogenicity of AK.
Collapse
|
33
|
Tu EY, Joslin CE, Sugar J, Booton GC, Shoff ME, Fuerst PA. The relative value of confocal microscopy and superficial corneal scrapings in the diagnosis of Acanthamoeba keratitis. Cornea 2008; 27:764-72. [PMID: 18650660 DOI: 10.1097/ico.0b013e31816f27bf] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the relative diagnostic value of confocal microscopy and superficial corneal cultures in the diagnosis of Acanthamoeba keratitis by using clinical and microbiologic definitions of disease. METHODS Results of confocal microscopy, superficial corneal smear, and superficial corneal culture were analyzed for validity against 2 different microbiologic and a clinical composite standard for Acanthamoeba keratitis. RESULTS In patients with both clinical characteristics and objective evidence of Acanthamoeba keratitis, confocal microscopy exhibited a sensitivity of 90.6% (95% confidence interval [CI]: 79.3%-96.9%) and a specificity of 100% (95% CI: 95.0%-100%). In patients with either positive culture or smear evidence of Acanthamoeba keratitis, confocal microscopy showed a sensitivity of 90.9% (95% CI: 78.3%-97.5%) and specificity of 90.1% (95% CI: 81.5%-95.6%). In strictly culture-positive patients, confocal microscopy showed a sensitivity of 92.9% (95% CI: 76.5%-99.1%) and a specificity of 77.3% (95% CI: 67.7%-85.2%). Of the 53 patients with Acanthamoeba keratitis, confocal microscopy was positive in 48 patients, whereas corneal smears and cultures were positive in 30 of 41 and 23 of 42 patients, respectively. Sensitivity of Acanthamoeba culture was 52.8% (95% CI: 38.6%-66.7%) in patients with a clinical diagnosis of Acanthamoeba keratitis. Simultaneous testing of smear and superficial corneal scraping resulted in a sensitivity of 83.0% (95% CI: 70.2%-91.9%), independent of the results of confocal microscopy. CONCLUSIONS As confocal microscopy comes into wider clinical use, it remains in need of clinical and pathologic correlation. When performed and interpreted by an experienced operator, confocal microscopy is both sensitive and specific in the diagnosis of Acanthamoeba keratitis. Contemporaneous corneal scrapings are independently sensitive in the detection of Acanthamoeba keratitis, and a combination of both diagnostic modalities offers the highest likelihood of rapidly and accurately diagnosing Acanthamoeba keratitis in patients with atypical keratitis.
Collapse
Affiliation(s)
- Elmer Y Tu
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Tu EY, Joslin CE, Sugar J, Shoff ME, Booton GC. Prognostic factors affecting visual outcome in Acanthamoeba keratitis. Ophthalmology 2008; 115:1998-2003. [PMID: 18571729 DOI: 10.1016/j.ophtha.2008.04.038] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 03/15/2008] [Accepted: 04/25/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To identify clinical and demographic factors associated with a worse visual outcome in Acanthamoeba keratitis (AK). DESIGN Retrospective, case control study. PARTICIPANTS A total of 72 eyes of 65 patients with AK who were diagnosed at the University of Illinois Eye and Ear Infirmary between May of 2003 and May of 2007 with treatment complete by October of 2007. The first affected eye was analyzed in bilateral disease. METHODS Patient demographic, clinical characteristics, treatment methods, and final visual outcome data were collected through medical record reviews for all patients diagnosed with AK. Cases were defined as patients with AK with a visual outcome worse than 20/25 or those requiring penetrating keratoplasty (PKP). Controls were defined as patients with AK with a visual outcome of 20/25 or better. Logistic regression was used to estimate the odds ratio (OR) identifying prognostic factors associated with a worse visual outcome. MAIN OUTCOME MEASURES Final visual outcome worse than 20/25. RESULTS AK was confirmed through microbiologic evidence in 48 of 65 eyes (73.8%) or with confocal microscopy in 62 of 65 eyes (95.4%). Final visual acuity data were available in 61 of 65 eyes (93.8%); of these 61 eyes, 40 (65.6%) achieved a final visual acuity of 20/25 or better. In multivariable analysis, deep stromal involvement or the presence of a ring infiltrate at presentation was independently associated with worse visual outcomes (OR, 10.27; 95% confidence interval [CI], 2.91-36.17). Symptom duration before diagnosis was statistically predictive of disease stage at presentation (OR, 4.43; 95% CI, 0.99-19.83; multivariable analysis) but not final visual outcome (OR, 2.55; 95% CI, 0.83-7.88; univariate analysis). PKP was performed in 11 of 12 eyes with active disease. CONCLUSIONS Corneal disease staging at presentation with slit-lamp examination was highly predictive of worse outcomes, allowing the identification of patients who might benefit from more aggressive medical or surgical intervention. Unlike in previous reports, patient-reported duration of symptoms before treatment was not reliable in predicting the final visual result in our series.
Collapse
Affiliation(s)
- Elmer Y Tu
- University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
| | | | | | | | | |
Collapse
|
35
|
Abstract
PURPOSE To report the clinical, confocal microscopic, and histologic appearance of a case of Beauveria bassiana keratitis and response to medical therapy. METHODS A 58-year-old woman with a 1-month history of a recalcitrant contact lens-related corneal ulcer was evaluated by confocal microscopy and corneal scraping for histology and culture. RESULTS Confocal microscopy and histology revealed a filamentous fungal keratitis confirmed by culture as B. bassiana resistant to amphotericin B. The keratitis was unresponsive to multiple topical and systemic antifungals but resolved after the addition of oral posaconazole. CONCLUSIONS B. bassiana is a rare cause of keratitis that may show significant resistance to topical and systemic antifungals but was treated successfully with the addition of oral posaconazole to topical voriconazole. Confocal microscopy and corneal smears may be of benefit in identifying and directing therapy for this slow-growing fungus.
Collapse
Affiliation(s)
- Elmer Y Tu
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
| | | |
Collapse
|
36
|
Joslin CE, Tu EY, Shoff ME, Booton GC, Fuerst PA, McMahon TT, Anderson RJ, Dworkin MS, Sugar J, Davis FG, Stayner LT. The association of contact lens solution use and Acanthamoeba keratitis. Am J Ophthalmol 2007; 144:169-180. [PMID: 17588524 PMCID: PMC2692658 DOI: 10.1016/j.ajo.2007.05.029] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 05/25/2007] [Accepted: 05/28/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate Acanthamoeba keratitis (AK) risk factors. Diagnosis of AK, a rare but serious corneal infection, has recently increased significantly at the University of Illinois at Chicago (UIC) Cornea Service. DESIGN Retrospective case-control study. METHODS settings: University, tertiary care hospital. patients: Fifty-five AK cases with contact lens use were diagnosed between May 1, 2003 and September 15, 2006. Clinic-matched controls with contact lens use were recruited. Subjects completed surveys targeting lens hygiene, contact lens solution use, and water exposure. main outcome measure: Acanthamoeba keratitis. RESULTS Thirty-nine (73.6%) cases and 113 (65.3%) controls participated; 38 cases had complete contact lens data. Thirty-five of 38 cases (92.1%) and 47 of 100 controls (47.0%) used soft lenses. Analysis was performed on 30 cases and 39 controls with matched pairs with soft lens use. Exclusive use of Advance Medical Optics (AMO) Complete MoisturePlus Multi-Purpose Solution was independently associated with AK in multivariable analysis (55.2% vs 10.5%; odds ratio [OR], 16.67; 95% confidence interval [CI] 2.11 to 162.63; P = .008). However, 38.8% of cases reported no use of AMO Complete MoisturePlus Multi-Purpose Solution either alone or in combination with other solutions. Although not statistically significant, additional hygiene-related variables (solution "reuse," lack of "rubbing," and showering with lenses) suggest a pattern of risk. CONCLUSIONS AMO Complete MoisturePlus Multi-Purpose Solution use is independently associated with AK among soft contact lens users. However, it does not explain all cases, suggesting additional factors. Further research into environmental risk factors and hygiene practices is warranted, especially considering this is the second outbreak of an atypical, contact lens-related infection.
Collapse
Affiliation(s)
- Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
PURPOSE To report a case of infectious crystalline keratopathy caused by Gemella haemolysans. METHODS Observational case report. A 65-year-old woman underwent penetrating keratoplasty for contact lens-related Acanthamoeba keratitis and developed a nonhealing epithelial defect. Despite continued prophylaxis with topical gatifloxacin, small superficial stromal opacities were noted and cultured 6 months after penetrating keratoplasty. The opacities coalesced into a fine, crystalline keratopathy in the superficial stroma with persistent overlying epithelial defect. RESULTS Culture results from corneal scraping showed more than 100 colonies of G. haemolysans. Topical vancomycin was instituted, with complete resolution of the crystalline keratopathy and epithelial defect over the next 2 months. CONCLUSIONS G. haemolysans can be a causative organism of infectious crystalline keratopathy. This infection can arise in a postkeratoplasty patient despite prophylaxis with a fourth-generation fluoroquinolone.
Collapse
Affiliation(s)
- Mohammed K Elmallah
- Department of Ophthalmology and Visual Sciences, University of Illinois Medical Center, Chicago Eye and Ear Infirmary, Chicago, IL, USA
| | | | | | | |
Collapse
|
38
|
Tu EY, McCartney DL, Beatty RF, Springer KL, Levy J, Edward D. Successful treatment of resistant ocular fusariosis with posaconazole (SCH-56592). Am J Ophthalmol 2007; 143:222-227. [PMID: 17258521 DOI: 10.1016/j.ajo.2006.10.048] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 10/16/2006] [Accepted: 10/26/2006] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the successful treatment with systemic posaconazole of a series of Fusarium ocular infections refractory to other antifungal agents. DESIGN Retrospective, interventional case series. METHODS We identified three patients from three different centers who received diagnoses of Fusarium keratitis and who received systemic posaconazole after their infections failed to respond to maximal tolerated medical and surgical therapy. All patients received multiple systemic, intracameral, and topical antifungal agents, which were ineffective in controlling their infection. RESULTS Two patients were contact lens wearers. Two patients developed endophthalmitis. The infections of all three patients failed to respond to systemic and/or topical voriconazole treatment. One patient could not tolerate systemic voriconazole, and another experienced no marked improvement. The third discontinued treatment for both reasons. All patients were treated with oral posaconazole and experienced rapid reduction of intraocular inflammation and pain, as well as resolution of the infection without additional intervention. CONCLUSIONS Deep Fusarium keratitis is difficult to treat and carries a high risk of progression to endophthalmitis. Posaconazole, which exhibits excellent tissue penetration and demonstrates efficacy in the treatment of systemic Fusarium infection, was successful in treating three cases of pan-resistant keratitis and/or endophthalmitis.
Collapse
Affiliation(s)
- Elmer Y Tu
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, Illinois, USA.
| | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Abstract
A 15-year-old boy presented with left-sided ptosis, upper eyelid swelling, proptosis, conjunctivitis, and a central corneal epithelial defect with thinning. MRI demonstrated an enhancing orbital mass associated with the lacrimal gland. Biopsy findings were consistent with orbital inflammatory syndrome. Topical cyclosporine and 1% methylprednisolone eliminated the anterior segment inflammation; subsequent treatment with systemic prednisone reduced the ptosis and edema. To our knowledge, this is the only reported case of orbital inflammatory syndrome associated with a corneal epithelial defect and thinning.
Collapse
Affiliation(s)
- Manishi A Desai
- Oculoplastics and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois 60612, USA
| | | | | | | | | | | |
Collapse
|
41
|
Joslin CE, Tu EY, McMahon TT, Passaro DJ, Stayner LT, Sugar J. Epidemiological characteristics of a Chicago-area Acanthamoeba keratitis outbreak. Am J Ophthalmol 2006; 142:212-7. [PMID: 16876498 DOI: 10.1016/j.ajo.2006.04.034] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Revised: 04/08/2006] [Accepted: 04/11/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterize Acanthamoeba keratitis (AK) cases and analyze the geographical distribution within the Chicago-Gary-Kenosha metropolitan area, Chicago, Illinois, USA. DESIGN Retrospective, population-based cohort study. METHODS All AK cases diagnosed at the University of Illinois at Chicago Cornea Service from June 1, 2003, to November 30, 2005, were included in analysis. Patients with keratitis were defined as cases through confocal microscopy, histology, and/or positive cultures. Exploratory analyses were performed to evaluate whether AK cases were unequally distributed geographically. County population data were extracted from US Census 2000 data, and rates were age-standardized to Cook County. Poisson regression analysis was used to estimate the age-standardized rate ratio (RR) between AK cases and county of residence. Current cases (June 1, 2003 to November 30, 2005) were compared with historical cases (June 1, 2000 to November 30, 2002) to determine if the current rate of AK diagnosis differed from historical rates. RESULTS Forty AK cases were diagnosed between June 1, 2003 and November 30, 2005. The average (+/-SD) age of patients with AK was 28.0 +/- 15.0 years (range, 13 to 70 years), 52.5% were men, and 95.0% wore contact lenses. Estimated RR measures demonstrated increased rates for all counties relative to Cook, and were significant for both DuPage County (RR 3.59; 95% confidence interval [95% CI] 1.44, 8.39) and Will County (RR 3.66; 95% CI 1.18 to 9.56). Current AK diagnosis rates were significantly higher than historical rates (RR 6.67; 95% CI 3.05 to 17.52). CONCLUSIONS AK cases are increasing in frequency. The increased rates are unevenly distributed in the study area. Further research is warranted to better understand the increase and unusual geographical distribution.
Collapse
Affiliation(s)
- Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
PURPOSE To determine the survival of different bacteria inoculated in Optisol-GS at refrigerated storage temperature (6 degrees C) and after subsequent warming to room temperature (19-22 degrees C). METHODS Staphylococcus aureus, Enterococcus faecium, Streptococcus pneumoniae, and Pseudomonas aeruginosa were chosen from stock clinical isolates for inclusion in the study. The first group consisted of 12 Optisol-GS vials. The second group consisted of 12 Optisol-GS vials containing corneas inappropriate for transplantation according to the Eye Bank Association of America (EBAA) protocols. Each group was inoculated with 3 concentrations of approximately 10, 10, and 10 colony-forming units (CFU)/mL of each bacterial species and then refrigerated per EBAA protocol. After 48 hours of refrigeration, all vials were placed at room temperature (RT) and counts were performed at 48, 50 (2 hour RT), 54 (6 hour RT), 60 (12 hour RT), 72 (24 hour RT), and 96 (48 hour RT) hours. At 96 hours, the corneal tissue from 10 and 10 inocula were cultured. All samples underwent serial dilution, spiral plating on blood agar plates, and incubation at 35 degrees C. Viable colony counts were determined at 24 hours. RESULTS Except for the 10 CFU/mL inocula of P. aeruginosa, all isolates were viable after 48 hours of refrigeration. Rapid bactericidal activity was observed against P. aeruginosa after 2 hours at RT, with complete sterilization by 6 hours. The rate and extent of killing against S. aureus were influenced by the initial inoculum. Bactericidal activity was achieved after 2 hours at RT with 10 CFU/mL of S. aureus versus 24 hours with the 10 inoculum. Of note, bactericidal activity was not observed against S. pneumoniae and E. faecium following 24 hours of storage at RT. The presence of corneal tissue did not affect viable counts, with counts from corneal tissue cultures reflecting the counts seen from Optisol-GS after 48 hours at RT. CONCLUSIONS The antimicrobial activity of Optisol-GS was reduced at refrigerated temperature and enhanced at RT. Bactericidal activity was not observed against E. faecium at either refrigerated temperature or RT.
Collapse
Affiliation(s)
- Rashmi Kapur
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | | | | | | | | |
Collapse
|
43
|
Joslin CE, Koster J, Tu EY. Contact lens overrefraction variability in corneal power estimation after refractive surgery. J Cataract Refract Surg 2005; 31:2287-92. [PMID: 16473219 DOI: 10.1016/j.jcrs.2005.06.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the accuracy and precision of the contact lens overrefraction (CLO) method in determining corneal refractive power in post-refractive-surgery eyes. SETTING Refractive Surgery Service and Contact Lens Service, University of Illinois, Chicago, Illinois, USA. METHODS Fourteen eyes of 7 subjects who had a single myopic laser in situ keratomileusis procedure within 12 months with refractive stability were included in this prospective case series. The CLO method was compared with the historical method of predicting the corneal power using 4 different lens fitting strategies and 3 refractive pupil scan sizes (3 mm, 5 mm, and total pupil). Rigid lenses included 3 9.0 mm overall diameter lenses fit flat, steep, and an average of the 2, and a 15.0 mm diameter lens steep fit. Cycloplegic CLO was performed using the autorefractor function of the Nidek OPD-Scan ARK-10000. Results with each strategy were compared with the corneal power estimated with the historical method. The bias (mean of the difference), 95% limits of agreement, and difference versus mean plots for each strategy are presented. RESULTS In each subject, the CLO-estimated corneal power varied based on lens fit. On average, the bias between CLO and historical methods ranged from -0.38 to +2.42 diopters (D) and was significantly different from 0 in all but 3 strategies. Substantial variability in precision existed between fitting strategies, with the range of the 95% limits of agreement approximating 0.50 D in 2 strategies and 2.59 D in the worst-case scenario. The least precise fitting strategy was use of flat-fitting 9.0 mm diameter lenses. CONCLUSIONS The accuracy and precision of the CLO method of estimating corneal power in post-refractive-surgery eyes was highly variable on the basis of how rigid lense were fit. One of the most commonly used fitting strategies in clinical practice--flat-fitting a 9.0 diameter lens-resulted in the poorest accuracy and precision. Results also suggest use of large-diameter lenses may improve outcomes.
Collapse
Affiliation(s)
- Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois, Chicago, Illinois 60612, USA.
| | | | | |
Collapse
|
44
|
Abstract
Given that Hong Kong is one of the most densely populated cities in the world, the exposure of the Hong Kong people is one of the interesting research areas. In this study, an indirect approach was used to estimate the exposure to nitrogen dioxide (NO2), respiratory dust (PM10) and carbon monoxide (CO) pollutants experienced by different age groups of people in Hong Kong. The average concentrations of the 20 major microenvironments obtained from our measurement survey data, together with the people activity pattern data obtained from 7-day recall questionnaires, were used to predict frequency distributions to exposure assessment. Our results showed that Hong Kong people spent more than 86% of their time indoors. Homes were shown to be the one of the major exposure sites to NO2, CO and PM10 for all age groups. Our results also indicate that the 24-h NO2 exposure for individuals, irrespective of age, spending more than 2 h in commuting daily, was observed to be exceeding the 24-h NO2 exposure standards. This study was one of the pioneering studies with valuable contribution for modeling the estimates of exposures to NO2, PM10 and CO of different age groups in Hong Kong.
Collapse
Affiliation(s)
- C K Chau
- Department of Building Services Engineering, The Hong Kong Polytechnic University, Hung Hom, SAR, China.
| | | | | | | |
Collapse
|
45
|
Tu EY. Update on refractive surgery. Manag Care 2002; 11:21-3; discussion 24-7. [PMID: 11842588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
|
46
|
Abstract
PURPOSE Wavefront analysis has demonstrated that refractive surgery-induced corneal first surface aberrations are large, are dominated by symmetric aberrations (spherical-like aberrations), and are correlated to measures of visual performance. It is not clear whether the correlation between corneal first surface aberrations and visual performance can be generalized to other corneal conditions where large asymmetric aberrations (coma-like aberrations) may dominate the aberration structure. The purpose of the research reported here was to determine the general utility of corneal first surface wavefront analysis in predicting visual performance. METHODS Patients were 13 normals and 78 patients with a variety of corneal conditions including surgically removed pterygia, penetrating keratoplasty, keratoconus, radial keratotomy, laser in situ keratomileusis, and others. Videokeratographs were taken for all patients and used to calculate corneal first surface wavefront variance for 3 and 7 mm pupils. Similarly, visual performance was quantified by measurements of contrast sensitivity and high and low contrast acuities through both 3 and 7 mm pupils. RESULTS Statistically significant correlations existed between all three measures of visual performance and the corneal wavefront variance. All relationships were stronger for the 7 mm diameter-pupil condition than the 3 mm pupil. CONCLUSION Regardless of the cause, corneas with increased wavefront variance showed a quantifiable decrease in visual performance that was pupil size dependent.
Collapse
Affiliation(s)
- R A Applegate
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, 78230-6230, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Affiliation(s)
- J Chodosh
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Fla., USA
| | | | | | | |
Collapse
|
48
|
Tu EY, Culbertson WW, Pflugfelder SC, Huang A, Chodosh JC. Therapy of nonnecrotizing anterior scleritis with subconjunctival corticosteroid injection. Ophthalmology 1995; 102:718-24. [PMID: 7777270 DOI: 10.1016/s0161-6420(95)30963-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To determine the safety and efficacy of subconjunctival triamcinolone (Kenalog) in treating nonnecrotizing anterior scleritis. DESIGN The authors conducted a retrospective review of all patients treated with depot subconjunctival corticosteroid injection for scleritis from January 1988 to May 1993. Response to therapy was determined by subjective improvement in pain and a decrease in clinical signs of ocular inflammation. All patients received subconjunctival injections of triamcinolone by the same technique, and the minimum observation period for complications was 6 weeks. RESULTS Eighteen patients (90%) had relief of their symptoms with clinically observable improvement in inflammation, whereas two patients (10%) responded poorly. Nine patients (45%) required no further therapy. Average symptom-free interval was 18 weeks in patients with recurrent scleritis. No complications of scleral thinning, perforation, or glaucoma occurred in any patients. CONCLUSION Subconjunctival triamcinolone injection is highly efficacious in treating nonnecrotizing anterior scleritis without unreasonable risk of thinning and/or perforation and should be considered as adjunctive therapy in localized disease.
Collapse
Affiliation(s)
- E Y Tu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, USA
| | | | | | | | | |
Collapse
|