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Ocular loaiasis in France: the first case report from Brittany. 法国的眼孢子虫病:布列塔尼的首例病例报告。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-11-06 DOI: 10.1186/s12348-024-00437-7
Sarah Kerkouri, Thomas Monfort, Dorothée Quinio, Béatrice Cochener-Lamard

We report the case of a 21-year-old Cameroonian woman residing in France for one year, who presented to our department with left eye discomfort and itching. Examination revealed a mobile translucent cord beneath the nasal-inferior conjunctiva, prompting suspicion of loaiasis. Anesthesia was administered for extraction, revealing a 31 mm male Loa loa. A positive microfilarial load, albeit low, confirmed the diagnosis and the diagnostic workup excluded other locations. Treatment with diethylcarbamazine was well-tolerated. This case highlights the importance of considering loaiasis in non-endemic regions and underscores the need for interdisciplinary collaboration in its diagnosis and management.

我们报告了一例在法国居住了一年的 21 岁喀麦隆妇女的病例,她因左眼不适和瘙痒到我科就诊。检查发现,她的鼻下结膜下有一条活动的半透明线状物,因此怀疑是卢埃虫。麻醉后进行了摘除,发现了一条 31 毫米长的雄性 Loa loa。尽管微丝蚴载量较低,但阳性结果证实了诊断,而且诊断工作排除了其他部位。使用乙胺嗪治疗效果良好。该病例强调了在非流行地区考虑洛艾病的重要性,并强调了在诊断和管理中进行跨学科合作的必要性。
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引用次数: 0
Effect of intravitreal injection of anti-interleukin (IL)-6 antibody in experimental autoimmune uveitis in mice. 玻璃体内注射抗白细胞介素(IL)-6 抗体对实验性自身免疫性葡萄膜炎小鼠的影响
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-11-04 DOI: 10.1186/s12348-024-00441-x
Kristin Hösel, Büsra Chasan, Jan Tode, Stefan Rose-John, Johann Baptist Roider, Christoph Ehlken

Purpose: The aim of this study was to assess the functional and clinical impact of intravitreal administration of a neutralizing anti-IL-6 antibody in the treatment of experimental autoimmune uveitis (EAU) in mice.

Methods: EAU was induced in 17 female B10.RIII mice by administering Inter-Photoreceptor-Binding-Protein (IRBP) in complete Freund's adjuvant, followed by a boost with Pertussis toxin. Intravitreal injections of anti-Interleukin (IL)-6 antibody were administered on days 10, 13, and 16 after EAU induction (day 0) into the randomized treatment eye, with an isotype antibody similarly injected into the fellow control eye. Visual acuity was assessed using the optomotor reflex via OptoDrum, and clinical scoring was performed via fundus imaging (utilizing 6 EAU grades) in a single-blinded manner on days 0, 10, 13, 16, and 18.

Results: Uveitis developed in all 17 mice. Significantly higher visual acuity was observed in treated eyes compared to control eyes on days 13, 16, and 18. The most pronounced effect was noted on days 16 and 18 (p < 0.001). On days 13, 16, and 18 the number of eyes with lower EAU-score was significantly higher in the treatment group, with the most notable effect observed on day 18 (p < 0.003).

Conclusion: Intravitreal administration of anti-IL-6 treatment notably mitigates experimental autoimmune uveitis in mice, both functionally and clinically. Further investigations are warranted to assess the potential of intravitreal anti-IL-6 therapy as a treatment option for non-infectious uveitis in humans.

目的:本研究旨在评估玻璃体内注射中和性抗IL-6抗体治疗小鼠实验性自身免疫性葡萄膜炎(EAU)的功能和临床影响:方法:在17只雌性B10.RIII小鼠体内注射完全弗氏佐剂中的光感受器间结合蛋白(IRBP),然后注射百日咳毒素,诱发EAU。在EAU诱导(第0天)后的第10、13和16天,向随机治疗眼进行抗白细胞介素(IL)-6抗体的玻璃体内注射,同时向同组对照眼注射同型抗体。在第 0、10、13、16 和 18 天,通过 OptoDrum 使用视运动反射评估视力,并以单盲方式通过眼底成像(采用 6 个 EAU 等级)进行临床评分:结果:17 只小鼠均发生了葡萄膜炎。在第 13、16 和 18 天,与对照组相比,治疗组小鼠的视力明显提高。第 16 天和第 18 天的效果最明显(P玻璃体内注射抗IL-6可显著减轻小鼠实验性自身免疫性葡萄膜炎的功能和临床症状。有必要进行进一步研究,以评估玻璃体内抗IL-6疗法作为人类非感染性葡萄膜炎治疗方案的潜力。
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引用次数: 0
Safety and efficacy of intravitreal dexamethasone implantation along with phacoemulsification and intraocular lens implantation in children with uveitis. 在葡萄膜炎儿童中进行玻璃体内地塞米松植入术以及超声乳化术和眼内人工晶体植入术的安全性和有效性。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-24 DOI: 10.1186/s12348-024-00440-y
Hui Feng, Weixin Chen, Jianzhu Yang, Haorong Kong, Hongyu Li, Meng Tian, Jing Mo, Yuan He, Hong Wang

Purpose: To evaluate the safety and efficacy of intravitreal dexamethasone implantation during phacoemulsification and intraocular lens implantation in pediatric uveitis.

Methods: A retrospective analysis was conducted on pediatric uveitis patients undergoing phacoemulsification and intraocular lens implantation with intravitreal dexamethasone implantation. Patients with a minimum follow-up of 6 months were included. Primary outcome measures included ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis.

Results: 36 eyes of 28 patients were ultimately included in this study. The mean preoperative BCVA was 1.00 (0.40-1.50) LogMAR. BCVA significantly improved to 0.40 (0.20-0.54) LogMAR at 1 month postoperatively (P = 0.006), further improving to 0.30 (0.20-0.40) LogMAR at 3 months postoperatively (P = 0.001). BCVA remained stable at 0.30 (0.20-0.70) LogMAR at 6 months postoperatively (P = 0.005). Mean IOP showed no statistically significant difference during the follow-up period of three to six months after surgery. Eight children experienced recurrence of ocular inflammation during the 6-month follow-up period. No cases of worsening macular edema, glaucoma, or elevated IOP were observed in any patient.

Conclusion: Intravitreal dexamethasone implantation during phacoemulsification and intraocular lens implantation is a safe and effective method for preventing and treating postoperative inflammation in children with uveitis.

目的:评估在小儿葡萄膜炎患者接受超声乳化术和眼内人工晶体植入术期间植入玻璃体内地塞米松的安全性和有效性:对接受超声乳化和眼内人工晶体植入术的小儿葡萄膜炎患者进行回顾性分析。患者的随访时间至少为 6 个月。主要结果指标包括眼部炎症、眼压(IOP)、最佳矫正视力(BCVA)和葡萄膜炎恶化:本研究最终纳入了 28 名患者的 36 只眼睛。术前 BCVA 的平均值为 1.00 (0.40-1.50) LogMAR。术后 1 个月,BCVA 明显改善至 0.40 (0.20-0.54) LogMAR(P = 0.006),术后 3 个月进一步改善至 0.30 (0.20-0.40) LogMAR(P = 0.001)。术后 6 个月时,BCVA 稳定在 0.30 (0.20-0.70) LogMAR(P = 0.005)。术后三到六个月的随访期间,平均眼压没有明显的统计学差异。在 6 个月的随访期间,有 8 名患儿的眼部炎症复发。没有发现任何患者出现黄斑水肿恶化、青光眼或眼压升高的情况:结论:在超声乳化和眼内人工晶体植入术中植入地塞米松是预防和治疗葡萄膜炎患儿术后炎症的一种安全有效的方法。
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引用次数: 0
Efficacy and tolerability of subcutaneous repository corticotropin injection in refractory ocular inflammatory diseases. 皮下注射复方促肾上腺皮质激素治疗难治性眼炎的疗效和耐受性。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-24 DOI: 10.1186/s12348-024-00428-8
Negin Yavari, Hashem Ghoraba, Christopher Or, Zheng Xian Thng, S Saeed Mohammadi, Irmak Karaca, Azadeh Mobasserian, Amir Akhavanrezayat, Anthony Le, Xun Lyu, Anadi Khatri, Woong Sun Yoo, Dalia El Feky, Ngoc Trong Tuong Than, Osama Elaraby, Aim-On Saengsirinavin, Xiaoyan Zhang, Frances Andrea Anover, Ankur Sudhir Gupta, Muhammad Sohail Halim, Louis A Jison, Quan Dong Nguyen

Background: Repository corticotropin injection (RCI) has been suggested to exert immunomodulatory and anti-inflammatory effects in ocular inflammation. The index retrospective study aimed to evaluate the efficacy and tolerability of subcutaneous RCI in patients with active scleritis or uveitis.

Main body: Medical records of patients who were diagnosed with different types of active scleritis or uveitis and received RCI for more than six months at a tertiary eye center were reviewed. Patient characteristics including age, sex, comorbidities, clinical findings, treatment details, and adverse events were recorded. A total of 17 eyes of 17 patients were included. Median age was 43 years old and 53% of patients were male. Mean treatment duration was 25.4 ± 15.5 months. Indications for RCI therapy were scleritis (7 anterior and 1 posterior) (47.8%), panuveitis (17.4%), retinal vasculitis (17.4%), chronic/recurrent anterior uveitis (13%), and posterior uveitis (4.35%). RCI was initiated at a dose of 40 to 80 units 3 times weekly. Given the adequate control of inflammation, RCI was successfully discontinued in four patients (23.5%). Prior to RCI therapy, 14 (82.3%) patients were on oral prednisone at an average of 10 mg daily (range 2.5-40 mg), and two (11.7%) patients discontinued prednisone immediately before initiating RCI due to side effects. After six months of therapy, the prednisone dose was reduced in four (23.5%) patients to an average of 3 mg daily (range 1-5 mg) and was stopped in eight (53%) patients. Concomitant immunomodulatory therapies (IMTs) included mycophenolate mofetil (23.5%) and methotrexate (23.5%), and adalimumab (23.5%). Ten patients were on IMTs prior to using RCI, and during the course of treatment, IMT was stopped in two patients and reduced in one. Side effects included insomnia (23%), hypertension (11.7%), lower extremity edema (11.7%), hyperglycemia (11.7%), weight gain (11.7%), and infection (5.8%).

Conclusion: RCI may be considered as a potential therapy with acceptable tolerability for patients with non-infectious scleritis or uveitis.

背景:有研究认为,注射存留促肾上腺皮质激素(RCI)可在眼部炎症中发挥免疫调节和抗炎作用。本研究旨在评估皮下注射促肾上腺皮质激素对活动性巩膜炎或葡萄膜炎患者的疗效和耐受性:主要内容:研究人员查阅了一家三级眼科中心确诊为不同类型的活动性巩膜炎或葡萄膜炎并接受 RCI 治疗超过 6 个月的患者的病历。记录了患者的特征,包括年龄、性别、合并症、临床表现、治疗细节和不良反应。共纳入了 17 名患者的 17 只眼睛。中位年龄为 43 岁,53% 的患者为男性。平均治疗时间为(25.4 ± 15.5)个月。RCI 治疗的适应症包括巩膜炎(7 例前葡萄膜炎和 1 例后葡萄膜炎)(47.8%)、泛葡萄膜炎(17.4%)、视网膜血管炎(17.4%)、慢性/复发性前葡萄膜炎(13%)和后葡萄膜炎(4.35%)。开始使用的 RCI 剂量为 40 至 80 单位,每周 3 次。由于炎症得到了充分控制,4 名患者(23.5%)成功停用了 RCI。在接受 RCI 治疗前,14 名患者(82.3%)平均每天口服 10 毫克(范围为 2.5-40 毫克)泼尼松,其中 2 名患者(11.7%)因副作用在接受 RCI 治疗前立即停用了泼尼松。治疗 6 个月后,4 名患者(23.5%)的泼尼松剂量降至平均每天 3 毫克(1-5 毫克不等),8 名患者(53%)停止使用泼尼松。同时使用的免疫调节疗法(IMT)包括霉酚酸酯(23.5%)、甲氨蝶呤(23.5%)和阿达木单抗(23.5%)。10 名患者在使用 RCI 之前服用了 IMT,在治疗过程中,两名患者停止了 IMT,一名患者减少了 IMT。副作用包括失眠(23%)、高血压(11.7%)、下肢水肿(11.7%)、高血糖(11.7%)、体重增加(11.7%)和感染(5.8%):结论:RCI 可作为非感染性巩膜炎或葡萄膜炎患者的一种潜在疗法,其耐受性可以接受。
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引用次数: 0
Foscarnet eyedrops for the treatment of refractory herpetic keratitis. 治疗难治性疱疹性角膜炎的 Foscarnet 眼药水。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-23 DOI: 10.1186/s12348-024-00395-0
Caroline C Awh, Austen N Knapp, Jeffrey M Goshe, Craig W See, Careen Y Lowder

Purpose: The purpose of this case series is to describe the clinical course of patients receiving foscarnet eyedrops for the treatment of refractory herpetic keratitis.

Observations: Six patients diagnosed with herpetic keratitis were treated with foscarnet 24 mg/mL (2.4%) eyedrops with resulting improvement in keratitis.

Conclusion: Topical foscarnet may be a safe and effective treatment for herpetic keratitis in conjunction with, or as an alternative to, conventional antiviral therapy. This is an off-label use of foscarnet.

目的:本系列病例旨在描述接受福斯卡尼眼药水治疗难治性疱疹性角膜炎患者的临床过程:六名确诊为疱疹性角膜炎的患者接受了福斯卡尼 24 毫克/毫升(2.4%)眼药水的治疗,结果角膜炎得到了改善:结论:局部使用福斯卡尼可能是治疗疱疹性角膜炎的一种安全有效的方法,可与传统抗病毒疗法结合使用或作为其替代疗法。这是福斯奈特的标签外使用。
{"title":"Foscarnet eyedrops for the treatment of refractory herpetic keratitis.","authors":"Caroline C Awh, Austen N Knapp, Jeffrey M Goshe, Craig W See, Careen Y Lowder","doi":"10.1186/s12348-024-00395-0","DOIUrl":"https://doi.org/10.1186/s12348-024-00395-0","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this case series is to describe the clinical course of patients receiving foscarnet eyedrops for the treatment of refractory herpetic keratitis.</p><p><strong>Observations: </strong>Six patients diagnosed with herpetic keratitis were treated with foscarnet 24 mg/mL (2.4%) eyedrops with resulting improvement in keratitis.</p><p><strong>Conclusion: </strong>Topical foscarnet may be a safe and effective treatment for herpetic keratitis in conjunction with, or as an alternative to, conventional antiviral therapy. This is an off-label use of foscarnet.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Persistent syphilitic ocular manifestations despite treatment: a case series. 虽经治疗但仍有梅毒眼部表现:一个病例系列。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-18 DOI: 10.1186/s12348-024-00435-9
Sairi Zhang, Kaersti L Rickels, Vignesh Krishnan, Sami H Uwaydat

Background: Penicillin has remained the most effective treatment for syphilis for several decades. Syphilitic retinal manifestations may persist following treatment and cause visual problems. In this case series, we describe three syphilis patients with persistent posterior segment manifestations due to chronic inflammation, incomplete treatment, and reinfection.

Case series: Recommended initial treatment for all patients was 14 days of intravenous penicillin. Oral prednisone was added 48 h after initiation of penicillin therapy. Case 1: A 48-year-old female presented with gradual vision loss for two months. Fundus imaging revealed syphilitic outer retinopathy (SOR), papillitis, and acute syphilitic posterior placoid chorioretinopathy (ASPPC). After treatment, she had persistent cystoid macular edema (CME) and was treated with intravitreal triamcinolone injections and ketorolac drops.

Case 2: A 24-year-old male presented with sudden vision loss for two days. On imaging, he had ASPPC, papillitis, and SOR. IV penicillin treatment was given for 10 days only. He had persistent SOR and was retreated with doxycycline and prednisone. Case 3: A 52-year-old male presented with eye pain and visual loss for one week. There was evidence of ASPPC and papillitis on imaging. One month after treatment, he had persistent papillitis and was restarted on oral prednisone. One year later, he was found to have recurrent ASPPC and was confirmed to be reinfected with syphilis, for which he was retreated.

Conclusion: When treating persistent syphilitic ocular manifestations, we recommend checking that the penicillin treatment was complete and the RPR titers are declining. If both hold true, then the affected eye should be treated with anti-inflammatory therapy. Other factors that contribute to poor visual prognosis include treatment delay, poor initial visual acuity, macular edema, and HIV coinfection.

背景:几十年来,青霉素一直是治疗梅毒最有效的药物。梅毒性视网膜表现可能在治疗后持续存在,并导致视力问题。在本病例系列中,我们描述了三名梅毒患者因慢性炎症、治疗不彻底和再感染而导致后段表现持续存在:所有患者的最初治疗都是静脉注射青霉素14天。病例系列:建议所有患者的初始治疗均为静脉注射青霉素 14 天,在开始青霉素治疗 48 小时后再口服泼尼松。病例 1:一名 48 岁女性患者的视力逐渐下降,已持续两个月。眼底造影显示梅毒性外视网膜病变(SOR)、乳头炎和急性梅毒性后胎盘脉络膜视网膜病变(ASPPC)。治疗后,她出现了持续性囊样黄斑水肿(CME),并接受了玻璃体内曲安奈德注射和酮咯酸滴眼液治疗。病例 2:一名 24 岁男性患者突然视力下降两天。影像学检查显示,他患有 ASPPC、乳头炎和 SOR。他只接受了 10 天的青霉素静脉注射治疗。他的 SOR 持续存在,并接受了强力霉素和泼尼松治疗。病例 3:一名 52 岁的男性患者因眼部疼痛和视力下降就诊一周。影像学检查显示他患有 ASPPC 和乳头炎。治疗一个月后,他出现持续性乳头炎,于是重新开始口服泼尼松。一年后,他被发现复发了ASPPC,并被证实再次感染了梅毒,因此他接受了再次治疗:结论:在治疗持续性梅毒眼部表现时,我们建议检查青霉素治疗是否彻底,RPR滴度是否下降。结论:在治疗梅毒眼部顽固表现时,我们建议检查青霉素治疗是否彻底,RPR 滴度是否下降,如果两者都成立,则应对患眼进行抗炎治疗。导致视力预后不良的其他因素包括治疗延误、初始视力差、黄斑水肿和艾滋病病毒合并感染。
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引用次数: 0
First report of uncommon mycobacteria in post LASIK keratitis: Mycobacterium wolinskyi. 首次报告 LASIK 术后角膜炎中的不常见分枝杆菌:沃林斯基分枝杆菌。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-16 DOI: 10.1186/s12348-024-00438-6
Sébastien van Delden, Hélène Buvelot, Giorgio Enrico Bravetti, Truong-Thanh Pham, Gabriele Thumann, Horace Massa

Laser assisted in situ keratomileusis (LASIK) surgery is the leading and most performed refractive surgery nowadays. A possible complication of LASIK surgery is infectious keratitis which can lead to disastrous corneal damage and result in permanent loss of vision. LASIK procedures have become increasingly accessible, and the demand for refractive surgery has risen among patients, challenging the medical field to improve the prevention of post-operative infections. Nevertheless, a wide range of pathogens have been described as responsible for post-LASIK keratitis. However, non-tuberculous mycobacterial keratitis remains an infrequent occurrence and is poorly described in the literature. To the best of our knowledge, this is the first ever reported case of post-LASIK keratitis caused by Mycobacterium wolinskyi. We describe the clinical and microbial characteristics, leading to its challenging treatment choice.

激光辅助原位角膜磨镶术(LASIK)是目前最主要、最常用的屈光手术。LASIK 手术可能出现的并发症是感染性角膜炎,它会导致灾难性的角膜损伤,导致永久性视力丧失。LASIK 手术越来越普及,患者对屈光手术的需求也越来越高,这对医学界提高术后感染预防能力提出了挑战。然而,LASIK 术后角膜炎的病原体种类繁多。然而,非结核分枝杆菌性角膜炎仍然很少发生,文献中也鲜有描述。据我们所知,这是第一例由 Wolinskyi 分枝杆菌引起的角膜切割激光术后角膜炎。我们描述了该病例的临床和微生物特征,从而为其治疗选择提出了挑战。
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引用次数: 0
Orbital tuberculosis presenting as vision loss and headache: early management is paramount. 眼眶结核表现为视力下降和头痛:早期治疗至关重要。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-14 DOI: 10.1186/s12348-024-00425-x
Sandeep Pal, Narendra Patidar, Gunjan Tomar, Himanshu Gaikwad

Orbital tuberculosis is a rare form of extra pulmonary TB and may arise either by hematogenous route or spread directly from the paranasal sinus. We herein report two cases of orbital TB with a vision threatening complication. Case-1 is a 31-year-old female with a headache, a diminution of vision in the right eye, and pain in ocular movement. On examination, there was no proptosis with RAPD present in right eye and tenderness on palpation. CEMRI revealed a diffuse infiltrating lesion at the orbital apex, suggesting of inflammatory pathology. Case-2 is a 40-year-old male with similar complaints in the left eye, CECT showed edema and swelling in the optic nerve and extraocular muscle of the left eye. A detailed investigation was done, and a diagnosis of orbital tuberculosis was made in both patients. They were started on ATT and oral steroids but lost follow-up initially and due to delayed treatment, it led to irreversible vision loss. A long-term follow-up showed resolution of ocular symptoms with occasional headaches.

眼眶结核是一种罕见的肺外结核,可通过血源性途径或直接从副鼻窦扩散。我们在此报告两例眼眶结核并发危及视力的并发症。病例 1 是一名 31 岁女性,头痛、右眼视力下降、眼球活动疼痛。经检查,右眼无突眼,右眼存在 RAPD,触诊时有压痛。CEMRI 显示眼眶顶部有弥漫性浸润病变,提示炎症性病变。病例 2 是一名 40 岁的男性,左眼也有类似症状,CECT 显示左眼视神经和眼外肌水肿。经过详细检查,两名患者均被诊断为眼眶结核。他们开始接受 ATT 和口服类固醇治疗,但最初失去了随访机会,而且由于治疗延误,导致了不可逆的视力丧失。长期随访显示,患者的眼部症状有所缓解,但偶尔会出现头痛。
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引用次数: 0
Cytomegalovirus chronic retinal necrosis with ganciclovir resistance: a case report. 巨细胞病毒慢性视网膜坏死伴更昔洛韦耐药:病例报告。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-08 DOI: 10.1186/s12348-024-00434-w
Julia Xia, Sanjana Kantipudi, Christopher C Striebich, Andrés F Henao-Martinez, Niranjan Manoharan, Alan G Palestine, Amit K Reddy

Background: Cytomegalovirus (CMV) chronic retinal necrosis (CRN) is a rare viral retinal infection that occurs in mildly immunocompromised people. It shares some features with both acute retinal necrosis and CMV retinitis. It is typically treated with combination intravitreal and systemic ganciclovir. We discuss the management of a case of CMV CRN with ganciclovir resistance.

Case presentation: An 80-year-old female presented with one month of blurry vision in the left eye. She was being treated with abatacept, methotrexate, and prednisone for rheumatoid arthritis. Examination revealed anterior chamber and vitreous cell along with peripheral retinal whitening. Fluorescein angiogram showed diffuse retinal non-perfusion. Aqueous fluid PCR testing returned positive for CMV. The retinitis was initially controlled with oral and intravitreal ganciclovir, but then recurred and progressed despite these therapies. Ganciclovir resistance was suspected and the patient was switched to intravitreal foscarnet injections, along with oral letermovir and leflunomide, which lead to resolution of the retinitis. The patient has now continued with letermovir and leflunomide for approximately 2.5 years without reactivation of the retinitis or need for further intravitreal anti-viral injections and with adequate control of her rheumatoid arthritis.

Conclusion: The incidence of CMV CRN may increase in the future as the use of non-cytotoxic immunosuppressive therapies that result in relatively mild immunosuppression also increases. Treatment with ganciclovir is effective but frequently leads to resistance, as in our case. In this situation, combination therapy with letermovir and leflunomide, particularly in the setting of rheumatoid arthritis where leflunomide can also have an anti-inflammatory effect, can be considered.

背景:巨细胞病毒(CMV)慢性视网膜坏死(CRN)是一种罕见的病毒性视网膜感染,好发于免疫力轻度低下的人群。它与急性视网膜坏死和巨细胞病毒视网膜炎有一些共同特征。通常采用玻璃体内和全身用更昔洛韦联合治疗。我们将讨论一例对更昔洛韦耐药的 CMV CRN 的治疗方法:一名 80 岁的女性患者因左眼视力模糊一个月前来就诊。她正在接受阿巴他赛、甲氨蝶呤和泼尼松治疗类风湿性关节炎。检查发现,前房和玻璃体细胞以及周边视网膜变白。荧光素血管造影显示视网膜弥漫性非灌注。眼液 PCR 检测显示 CMV 呈阳性。视网膜炎最初通过口服和玻璃体内注射更昔洛韦得到了控制,但后来尽管使用了这些疗法,病情还是复发和进展。怀疑患者对更昔洛韦产生了耐药性,于是改用玻璃体内注射福斯卡尼,同时口服来特莫韦和来氟米特,结果视网膜炎得到缓解。目前,该患者已继续服用来曲米韦和来氟米特约 2.5 年,视网膜炎未再复发,也无需再进行玻璃体内抗病毒注射,类风湿性关节炎也得到了充分控制:结论:随着导致相对轻度免疫抑制的非细胞毒性免疫抑制疗法的使用增加,CMV CRN 的发病率今后可能会增加。更昔洛韦治疗有效,但经常会导致耐药,我们的病例就是如此。在这种情况下,可以考虑使用来曲米韦和来氟米特联合治疗,尤其是在类风湿性关节炎的情况下,因为来氟米特也有抗炎作用。
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引用次数: 0
Characterization of infectious bacterial keratitis in Östergötland County, Sweden: a 10-year retrospective study. 瑞典Östergötland县传染性细菌性角膜炎的特征:一项为期10年的回顾性研究。
IF 2.9 Q1 OPHTHALMOLOGY Pub Date : 2024-10-07 DOI: 10.1186/s12348-024-00432-y
Jenny Roth, Baris Toprak, Sofia Somajo, Antonio Filipe Macedo, Neil Lagali

Background: The aim of this study was to characterize bacterial species, aetiology and antibiotic susceptibility connected to bacterial keratitis infections in Östergötland, Sweden.

Methods: Retrospective cross-sectional study based on electronic health records for the period 2010-2019. Records of patients diagnosed with infectious keratitis were screened for microbiology confirmed infectious bacterial keratitis. Bacterial species and their susceptibility to antibiotics were determined from microbiology test results.

Results: One-hundred and ninety patients with lab culture-confirmed infectious bacterial keratitis were included in the analysis. The most frequently found bacterial species were coagulase-negative staphylococci (39%), Staphylococcus aureus (17%) and Cutibacterium acnes (10%). Pseudomonas spp. was the most frequently found Gram-negative bacterial species (7%). Contact lens wear and severely ill/blind eye were the top two aetiologies associated with bacterial keratitis, 22% of the patients with bacterial keratitis were also diagnosed with glaucoma. Most isolates, 157 out of 173, were susceptible to fluoroquinolones, and 145 out of 155 isolates were susceptible to chloramphenicol.

Conclusion: Our results revealed a positive rate of bacterial keratitis of 59% for the samples sent to the laboratory. There was a high susceptibility of the bacterial species to the recommended antibiotics. Our results indicate that it is likely that patients are receiving the correct treatment. Future studies are necessary to monitor changes in antibiotic susceptibility.

背景:本研究旨在分析瑞典厄斯特哥特兰地区细菌性角膜炎感染的细菌种类、病原学和抗生素敏感性:本研究旨在分析瑞典Östergötland地区细菌性角膜炎感染的细菌种类、病因和抗生素敏感性:方法:基于 2010-2019 年期间的电子健康记录进行回顾性横断面研究。对诊断为感染性角膜炎的患者记录进行了微生物学确诊感染性细菌性角膜炎的筛查。根据微生物学检测结果确定细菌种类及其对抗生素的敏感性:分析对象包括 190 名经实验室培养证实患有传染性细菌性角膜炎的患者。最常发现的细菌种类是凝固酶阴性葡萄球菌(39%)、金黄色葡萄球菌(17%)和痤疮杆菌(10%)。假单胞菌属是最常见的革兰氏阴性细菌(7%)。戴隐形眼镜和重病/盲眼是与细菌性角膜炎相关的两大病因,22%的细菌性角膜炎患者同时被诊断患有青光眼。173个分离株中有157个对氟喹诺酮类药物敏感,155个分离株中有145个对氯霉素敏感:我们的研究结果表明,在送往实验室的样本中,细菌性角膜炎的阳性率为 59%。细菌种类对推荐抗生素的敏感性很高。我们的结果表明,患者很可能接受了正确的治疗。今后有必要开展研究,监测抗生素敏感性的变化。
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Journal of Ophthalmic Inflammation and Infection
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