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Ting DSJ, Ho CS, Cairns J, Elsahn A, Al-Aqaba M, Boswell T, Said DG, Dua HS. 12-year analysis of incidence, microbiological profiles and in vitro antimicrobial susceptibility of infectious keratitis: the Nottingham Infectious Keratitis Study. Br J Ophthalmol 2021; 105:328-333. [PMID: 32580955 PMCID: PMC7907586 DOI: 10.1136/bjophthalmol-2020-316128] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIMS To examine the incidence, causative microorganisms and in vitro antimicrobial susceptibility and resistance profiles of infectious keratitis (IK) in Nottingham, UK. METHODS A retrospective study of all patients who were diagnosed with IK and underwent corneal scraping between July 2007 and October 2019 (a 12-year period) at a UK tertiary referral centre. Relevant data, including demographic factors, microbiological profiles and in vitro antibiotic susceptibility of IK, were analysed. RESULTS The estimated incidence of IK was 34.7 per 100 000 people/year. Of the 1333 corneal scrapes, 502 (37.7%) were culture-positive and 572 causative microorganisms were identified. Sixty (4.5%) cases were of polymicrobial origin (caused by ≥2 different microorganisms). Gram-positive bacteria (308, 53.8%) were most commonly isolated, followed by Gram-negative bacteria (223, 39.0%), acanthamoeba (24, 4.2%) and fungi (17, 3.0%). Pseudomonas aeruginosa (135, 23.6%) was the single most common organism isolated. There was a significant increase in Moraxella spp (p<0.001) and significant decrease in Klebsiella spp (p=0.004) over time. The in vitro susceptibilities of Gram-positive and Gram-negative bacteria to cephalosporin, fluoroquinolone and aminoglycoside were 100.0% and 81.3%, 91.9% and 98.1%, and 95.2% and 98.3%, respectively. An increase in resistance against penicillin was observed in Gram-positive (from 3.5% to 12.7%; p=0.005) and Gram-negative bacteria (from 52.6% to 65.4%; p=0.22). CONCLUSION IK represents a relatively common and persistent burden in the UK and the reported incidence is likely underestimated. Current broad-spectrum antimicrobial treatment provides a good coverage for IK, although challenged by some level of antimicrobial resistance and polymicrobial infection.
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Affiliation(s)
| | | | - Jessica Cairns
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ahmad Elsahn
- Academic Ophthalmology, University of Nottingham, Nottingham, UK
| | | | - Tim Boswell
- Department of Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dalia G Said
- Academic Ophthalmology, University of Nottingham, Nottingham, UK
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Harminder Singh Dua
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK
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Al-Aqaba M, Said DG, Dua HS. Delayed Recovery of Corneal Nerve Function and Structure Following Acoustic Neuroma Surgery. JAMA Ophthalmol 2020; 138:1320-1322. [PMID: 33090193 DOI: 10.1001/jamaophthalmol.2020.4279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mouhamed Al-Aqaba
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Department of Ophthalmology, University of Nottingham, Nottingham, United Kingdom
| | - Dalia G Said
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Department of Ophthalmology, University of Nottingham, Nottingham, United Kingdom
| | - Harminder S Dua
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Department of Ophthalmology, University of Nottingham, Nottingham, United Kingdom
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Ting DSJ, Ho CS, Cairns J, Gopal BP, Elsahn A, Al-Aqaba M, Boswell T, Said DG, Dua HS. Seasonal patterns of incidence, demographic factors and microbiological profiles of infectious keratitis: the Nottingham Infectious Keratitis Study. Eye (Lond) 2020; 35:2543-2549. [PMID: 33184491 DOI: 10.1038/s41433-020-01272-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purpose of this study is to examine the seasonal patterns of incidence, demographic factors and microbiological profiles of infectious keratitis (IK) in Nottingham, UK. METHODS A retrospective study of all patients who were diagnosed with IK and underwent corneal scraping during 2008-2019 at a UK tertiary referral centre. Seasonal patterns of incidence (in per 100,000 population-year), demographic factors, culture positivity rate and microbiological profiles of IK were analysed. RESULTS A total of 1272 IK cases were included. The overall incidence of IK was highest during summer (37.7, 95% confidence interval (CI): 31.3-44.1), followed by autumn (36.7, 95% CI: 31.0-42.4), winter (36.4, 95% CI: 32.1-40.8) and spring (30.6, 95% CI: 26.8-34.3), though not statistically significant (p = 0.14). The incidence of IK during summer increased significantly over the 12 years of study (r = 0.58, p = 0.049), but the incidence of IK in other seasons remained relatively stable throughout the study period. Significant seasonal variations were observed in patients' age (younger age in summer) and causative organisms, including Pseudomonas aeruginosa (32.9% in summer vs. 14.8% in winter; p < 0.001) and gram-positive bacilli (16.1% in summer vs. 4.7% in winter; p = 0.014). CONCLUSION The incidence of IK in Nottingham was similar among four seasons. No temporal trend in the annual incidence of IK was observed, as reported previously, but there was a significant yearly increase in the incidence of IK during summer in Nottingham over the past decade. The association of younger age, P. aeruginosa and gram-positive bacilli infection with summer was likely attributed to contact lens wear, increased outdoor/water activity and warmer temperature conducive for microbial growth.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | | | - Jessica Cairns
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Bhavesh P Gopal
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Ahmad Elsahn
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Mouhamed Al-Aqaba
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Tim Boswell
- Department of Microbiology, Nottingham University Hospital, Nottingham, UK
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK. .,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
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Dhillon VK, Elalfy MS, Messina M, Al-Aqaba M, Dua HS. Survival of corneal nerve/sheath structures in organ-cultured donor corneas. Acta Ophthalmol 2018; 96:e334-e340. [PMID: 29193851 DOI: 10.1111/aos.13614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/18/2016] [Accepted: 09/02/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the morphology of human corneal nerves in eye bank organ-cultured corneas and in corneal grafts post-transplantation. METHODS Thirty-seven organ-cultured corneas were divided into: Group-A, anterior 300-400 μm of 20 corneas used for Descemets stripping endothelial keratoplasty, and Group-B, 17 full-thickness corneas unsuitable for transplantation. Corneas whole mounts were stained for nerves using acetylcholinesterase technique and examined by NanoZoomer digital pathology microscope. Central and sub-Bowman's stromal nerves and the sub-basal nerve plexus including perforation sites and terminal bulbs were studied. Ten eyes were imaged following penetrating keratoplasty using in-vivo confocal microscopy (IVCM) for the presence of sub-basal and stromal nerves at 1, 4-5 and 7-8 weeks postoperatively (five eyes) and in all the other five eyes, the final follow-up was at 12 weeks. RESULTS Fifteen of twenty (75%) corneas had stromal nerves in Group-A and 15 of 17 (88.2%) in Group-B. Average number of stromal nerves entering peripherally were 9.1 (range: 1-36). 7.5 in Group-A and 10.8 in Group-B. Central stromal nerves were seen in eight samples in Group-A and nine in Group-B. Many stromal nerves terminated abruptly without demonstrable continuity through Bowman's membrane. No terminal bulbs or sub-basal nerves were detected. In-vivo confocal microscopy (IVCM) showed 4 of 5 in 9 of 10 (90%) donor corneas had stromal nerves 1 week postoperatively, which remained present in 8 of 10 (80%) corneas at 4-5 weeks and in 9 of 10 (90%) at 7-8 weeks postoperatively. All 5 corneas analysed at 12 weeks showed the same stromal nerves from 1 to 12 weeks postoperatively. Sub-basal nerves were absent in all corneas over the 12-week study period. CONCLUSION This study provides further insight into the behaviour of corneal nerves in transplanted corneas. Corneal stromal nerves/nerve-sheaths are preserved in organ-cultured eye bank eyes and persist post-transplantation up to 3 months. These could provide directional guidance to regenerating nerves from host stroma.
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Affiliation(s)
- Virinder K. Dhillon
- Department of Ophthalmology; Section of Academic Ophthalmology; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
| | - Mohamed S. Elalfy
- Department of Ophthalmology; Section of Academic Ophthalmology; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
| | - Marco Messina
- Department of Ophthalmology; Section of Academic Ophthalmology; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
| | - Mouhamed Al-Aqaba
- Department of Ophthalmology; Section of Academic Ophthalmology; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
| | - Harminder S. Dua
- Department of Ophthalmology; Section of Academic Ophthalmology; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
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Dua H, Al-Aqaba M. Normal and abnormal corneal innervation. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.03321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H.S. Dua
- Queens Medical Centre- Derby Road; Eye Ear Nose Throat Centre; Nottingham United Kingdom
| | - M. Al-Aqaba
- Ophthalmology and Visual Sciences; University of Nottingham; Nottingham United Kingdom
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Dhillon VK, Elalfy MS, Al-Aqaba M, Gupta A, Basu S, Dua HS. Corneal hypoesthesia with normal sub-basal nerve density following surgery for trigeminal neuralgia. Acta Ophthalmol 2016; 94:e6-10. [PMID: 25847294 DOI: 10.1111/aos.12697] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 10/15/2014] [Accepted: 01/12/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the corneal sub-basal nerve plexus in patients presenting with hypoesthesia following surgery for trigeminal neuralgia. METHODS Twenty-one patients who had unilateral medically uncontrolled trigeminal neuralgia and underwent ipsilateral surgery from 2006 to 2012 were included. Of these, 10 had microvascular decompression (MVD group) and 11 had balloon compression of the trigeminal ganglion (BC group). Slit lamp examination, Cochet-Bonnet aesthesiometery and in vivo confocal microscopy were carried out on both eyes of each patient. Nerve density data were statistically analysed. RESULTS Corneal sensations and sub-basal nerve densities in MVD group were normal and equal in both the operated and unoperated sides, indicating that there was no intra-operative damage of the ophthalmic division of the trigeminal nerve (V1). However, those in BC group, despite having significantly reduced corneal sensations on the operated side (p = 0.007), did not demonstrate any significant difference in their sub-basal nerve densities (p = 0.477). No patient had any ocular symptoms. CONCLUSIONS This study supports the hypothesis that complete ganglionic damage and/or postganglionic damage of V1 results in corneal hypoesthesia and neurotrophic keratitis, but partial ganglionic or preganglionic damage would preserve trophic function despite hypoesthesia and not result in clinically significant symptoms or signs of neurotrophic keratitis. The trophic and sensory functions of V1 are therefore independent and can be dissociated by disease or injury.
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Affiliation(s)
- Virinder K. Dhillon
- Division of Clinical Neuroscience; Academic Ophthalmology; University of Nottingham; England UK
| | - Mohamed S. Elalfy
- Division of Clinical Neuroscience; Academic Ophthalmology; University of Nottingham; England UK
- The Research Institute of Ophthalmology; Cairo Egypt
| | - Mouhamed Al-Aqaba
- Division of Clinical Neuroscience; Academic Ophthalmology; University of Nottingham; England UK
| | - Ankur Gupta
- Division of Clinical Neuroscience; Academic Ophthalmology; University of Nottingham; England UK
| | - Surajit Basu
- Department of Neurosurgery; Nottingham University Hospitals; Nottingham UK
| | - Harminder S. Dua
- Division of Clinical Neuroscience; Academic Ophthalmology; University of Nottingham; England UK
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Al-Aqaba M, Calienno R, Fares U, Otri AM, Mastropasqua L, Nubile M, Dua HS. The effect of standard and transepithelial ultraviolet collagen cross-linking on human corneal nerves: an ex vivo study. Am J Ophthalmol 2012; 153:258-266.e2. [PMID: 21930257 DOI: 10.1016/j.ajo.2011.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 07/17/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate the early effect of standard and transepithelial collagen cross-linking on human corneal nerves in donor eyes by ex vivo confocal microscopy and acetylcholinesterase staining. DESIGN Experimental laboratory investigation. METHODS Eight human eye bank corneal buttons (mean age, 73.6 years) were included. Ultraviolet A collagen cross-linking was performed postmortem on 3 corneas with the standard protocol involving epithelial debridement and 4 corneas by the transepithelial approach. One cornea served as a control. Corneal nerves were evaluated using confocal microscopy and acetylcholinesterase histology. RESULTS Confocal microscopy demonstrated the absence of subbasal nerves in corneas treated by the standard technique. These nerves were preserved in corneas treated by the transepithelial approach. Stromal nerves were visible in both groups. Histology of corneas treated by the standard technique revealed localized swellings of the stromal nerves with disruption of axonal membrane and loss of axonal continuity within the treatment zone. These changes were absent in corneas treated by the transepithelial approach. CONCLUSIONS This study highlights the immediate effects of collagen cross-linking on the corneal nerves in an ex vivo model. The absence of subbasal nerves in the early phase of treatment appears to be attributable mainly to mechanical removal of epithelium, rather than ultraviolet light-induced damage. Localized swelling of the stromal nerves was the main difference between the 2 treatment protocols. Further research on laboratory animals would be necessary to verify these changes over a specified time course without the super-addition of postmortem changes.
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Alomar TS, Al-Aqaba M, Gray T, Lowe J, Dua HS. Histological and confocal microscopy changes in chronic corneal edema: implications for endothelial transplantation. Invest Ophthalmol Vis Sci 2011; 52:8193-207. [PMID: 21896863 DOI: 10.1167/iovs.11-8047] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report in vivo confocal microscopic (IVCM) features in corneal edema supported by histopathologic correlation. METHODS This was an observational study with evaluation of diagnostic technology. Twenty patients with clinically diagnosed corneal edema were involved, including 11 with Fuchs' endothelial dystrophy (FED). All cases, in addition to a control group of six normal eyes, were examined with IVCM before keratoplasty. Four eyes were examined after surgery. Thirteen corneal samples obtained by penetrating keratoplasty were examined by light and/or electron microscopy. IVCM and histopathologic sections were then analyzed for correlation and proper interpretation. Seven patients underwent Descemet's stripping endothelial keratoplasty (DSEK). RESULTS Subepithelial fibroblasts were seen histologically and with IVCM in 7 (53.8%) of 13 full-thickness corneal samples. IVCM alone detected these changes in 11 (55%) subjects before surgery, as well as after postoperative clinical improvement. Other IVCM features included absent (30%) or reduced (70%) subbasal corneal nerves, expanded hyperreflective keratocyte cell bodies, and processes with small vacuoles and large extracellular lacunae (95%), seen on IVCM only. Endothelial changes with polymegathism and reduced cell density were seen in non-FED cases. CONCLUSIONS This is the first study in which IVCM features of corneal edema have been compared in detail with histopathologic findings. Subepithelial fibroblasts, reduced subbasal corneal nerves, and stromal keratocyte morphology were well documented in this study. With increasing popularity of DSEK this work supports the role of IVCM in quantitative evaluation of corneal edema in early preoperative stages, as well as after surgery, when the cornea appear clinically, but not histologically, normal.
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Affiliation(s)
- Thaer S Alomar
- Division of Ophthalmology and Visual Sciences, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom
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Al-Aqaba M, Alomar T, Lowe J, Dua HS. Corneal nerve aberrations in bullous keratopathy. Am J Ophthalmol 2011; 151:840-849.e1. [PMID: 21310389 DOI: 10.1016/j.ajo.2010.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 11/11/2010] [Accepted: 11/12/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To study the corneal nerves in patients with chronic bullous keratopathy. DESIGN Prospective observational case series with histologic evaluation. METHODS We studied 25 eyes of 25 bullous keratopathy patients of different etiologies (17 female, 8 male; mean age, 76.3 years) as well as 6 eyes of 6 normal control subjects (5 male, 1 female; mean age, 38 years). All subjects were scanned by laser scanning confocal microscope. Five corneal buttons obtained following penetrating keratoplasty from 5 of the above patients and 6 normal control corneal buttons were stained as whole mounts with acetylcholinesterase (AChE) method for corneal nerve demonstration and scanned in multiple layers with digital pathology scanning microscope. RESULTS The density, branching pattern, and diameter of sub-basal nerves were significantly lower in corneas with bullous keratopathy compared with normal corneas (density: 4.42 ± 1.91 mm/mm(2) vs 20.05 ± 4.24 mm/mm(2); branching pattern: 36.02% ± 26.57% vs 70.79% ± 10.53%; diameter: 3.07 ± 0.64 μm vs 4.57 ± 1.12 μm). Aberrations such as localized thickenings or excrescences, abnormal twisting, coiling, and looping of the (mid) stromal nerves were observed in the study group both by in vivo confocal microscopy and on histology. CONCLUSIONS Striking alterations in corneal innervation are present in corneas with bullous keratopathy that are unrelated to any specific etiology of bullous keratopathy. This study provides histologic confirmation of novel in vivo confocal microscopy findings related to corneal nerves in bullous keratopathy.
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Al-Aqaba M, Singh AD, Dua HS. 'Tell-ing Eyes' of Sumer. Br J Ophthalmol 2010. [DOI: 10.1136/bjo.2010.190983] [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: 11/04/2022]
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