Journal of Ophthalmic Inflammation and Infection最新文献

Purpose: To determine the impact of long COVID diagnosis on the risk of developing uveitis among individuals vaccinated and not vaccinated against COVID.

Methods: We conducted a population-based retrospective cohort study using an aggregate healthcare database, TriNetX, which includes data from over 127 million patients across 95 international healthcare organizations. Four cohorts were compared: (1) Unvaccinated, Long COVID; (2) Unvaccinated, No Long COVID; (3) Vaccinated, Long COVID; and (4) Vaccinated, No Long COVID. Patients with any history of uveitis prior to initial COVID diagnosis were excluded. The primary outcome was the risk of new-onset uveitis at 1 and 2 years following the diagnosis of long COVID.

Results: Unvaccinated, long COVID patients demonstrated an increased risk of developing new-onset uveitis compared to unvaccinated, no long COVID controls at 1 year (aHR: 2.01, 95% CI: 1.19-3.38) and 2 years (aHR: 1.60, 95% CI: 1.08-2.37). The highest risk was seen for anterior uveitis at 1 year (aHR: 1.96, 95% CI: 1.13-3.41) and 2 years (aHR: 1.59, 95% CI: 1.06-2.40). Other uveitis subtypes did not show an increased risk in this cohort. Among vaccinated individuals, there was not increased risk in those with long COVID compared to those without at 1 year (aHR: 0.95, 95% CI: 0.58-1.55) and 2 years (aHR: 0.97, 95% CI: 0.65-1.46).

Conclusion: Unvaccinated individuals with long COVID have an increased risk of developing new uveitis, particularly anterior uveitis. Vaccinated individuals with long COVID did not have an increased risk of developing uveitis compared to vaccinated non-long COVID individuals.

Background: Choroidal granuloma is one of the common manifestations of ocular tuberculosis. Tubercles indicate hematogenous dissemination of the disease. Tubercular granulomas respond to Anti-Tubercular Treatment (ATT) and systemic corticosteroids. However, in some patients with large granulomas involving macula, adjunct treatment with intravitreal anti-VEGF may be required for prompt management of the granuloma.

Findings: We report a case of bilateral Tubercular granuloma in a patient with miliary Tuberculosis (TB). The patient was an immunocompetent young female with miliary tuberculosis. Mantoux was positive. HRCT chest suggested miliary TB. The patient was already on ATT. Clinical examination showed multiple TB granulomas in both eyes, with a large granuloma involving the fovea in the left eye. She underwent intravitreal injection of the anti-VEGF drug bevacizumab (1.25 mg/0.05 mL) (off-label use) with moxifloxacin (500 µg/0.1 mL) (off-label use) in the left eye. She was continued on ATT and was started on oral steroids. After seven weekly intravitreal injections in the left eye at the second-month follow-up, lesions were consolidated and scarred. Optical coherence tomography showed a decrease in the size of the choroidal bump.

Conclusion: Weekly administration of intravitreal Anti-Vascular endothelial growth factor(VEGF) and moxifloxacin, along with ATT and oral corticosteroids, has controlled inflammation and has caused consolidation and scarring of TB granulomas in a patient with miliary TB.

Introduction: Integrated evaluation of clinical records, radiologic imaging, and histologic slides was key in the diagnosis of a rare ophthalmic infection such as Dirofilaria repens, an emerging zoonosis in many Mediterranean regions, where it is endemic in cats and dogs and can spread to humans through mosquitos of the genera Anopheles, Aedex and Culex.

Case report: We present the case of a 64-year-old male with a subcutaneous nodule at the right medial canthus. Surgical excision was performed under the clinical suspicion of a sebaceous cyst, and the specimen was submitted for pathological examination. Histological analysis revealed a partially necrotic abscess with numerous eosinophils and multiple cross-sections of the body of a parasite. The integrated evaluation of CT, MRI and histologic sections were consistent with the diagnosis of infestation by a female Dirofilaria repens.

Discussion: In this report we discussed an illustrative case of Dirofilaria infestation, an uncommon condition, and illustrate the benefits of an integrated approach to the care of ophthalmic lesions. Indeed, direct access to digitalized images of different modalities is beneficial in reducing delays, increasing accuracy, and is beneficial for prompt medical care and accurate diagnosis. The rising incidence and the possibility of serious complications, especially for the less frequent localizations more typical of species other than Dirofilaria repens, translates the need for a more widespread knowledge of these zoonoses.

Purpose: To evaluate the clinical characteristics, risk factors, antimicrobial resistance patterns, and outcomes of Pseudomonas aeruginosa keratitis in patients referred to a tertiary eye care center over a ten-year period.

Methods: In this retrospective study, medical records of patients with culture-confirmed Pseudomonas aeruginosa keratitis between 2012 and 2022 at Farabi Eye Hospital, Tehran, were reviewed. Data collected included demographic and clinical features, antimicrobial susceptibility results, treatment modalities, and outcomes up to six months of follow-up.

Results: A total of 172 patients were included. The mean age was 52.33 ± 22.01 years, with a nearly balanced gender distribution (49.42% male, 50.58% female). Trauma was the most common predisposing factor (30.23%). Corneal perforation occurred in 23.84% and endophthalmitis in 13.95% of patients. Surgical intervention was required in 68.6% of patients, with penetrating keratoplasty (PKP) performed in 35.5%. Advanced age, worse baseline best corrected visual acuity (BCVA), diabetes mellites, and corneal perforation were significantly associated with poorer visual outcomes. Antimicrobial susceptibility testing revealed preserved sensitivity to amikacin (95.93%), ciprofloxacin (95.93%), ceftazidime (95.35%), and gentamicin (92.44%), while high resistance rates were noted for chloramphenicol (48.26%) and cefazolin (59.30%).

Conclusion: Pseudomonas aeruginosa keratitis remains a severe, sight-threatening condition associated with significant surgical burden and suboptimal visual outcomes. Despite retained sensitivity to key antibiotics, high rates of corneal perforation and endophthalmitis emphasize the need for timely diagnosis and aggressive management. Future prospective, multicenter studies with longer follow-up are warranted to better define long-term outcomes and guide treatment strategies.

Introduction: Pseudallescheria boydii with its asexual form, Scedosporium apiospermum, is now recognized as an important emerging opportunistic pheoid-hypomycosis. Usually results in invasive infections in immunocompromised patients but rarely can infect the eyes. Herein, we report a challenging case of Pseudallescheria boydii keratitis in a lady with traumatic injury.

Case report: A 38-year-old female presented with alleged history of penetrating injury to right eye with stick by her spouse for which she was started on antibiotic eye drops from nearby local hospital and became symptomatically better. Later she had alleged history of ashes thrown to her right eye 2 weeks ago. She was referred here from a nearby hospital, with complaints of pain, itching, watering of eye and blurring of vision. On examination, Limbal -limbal ulcer with peripherally thinned out cornea and mucoid discharge was present. Corneal scrapings revealed P boydii. She was managed with antibiotics such as moxifloxacin, tobramycin and antifungals such as Natamycin, fluconazole. She did not improve symptomatically. She was referred to a higher center for keratoplasty and the patient was thus discharged for the same.

Conclusion:  Pseudallescheria boydii is a soil saprophytic, uncommon fungi entering body via respiratory or penetrating injury. It is often mistaken as Aspergillosis, This fungi shows resistance to amphotericin B, flucytosine and susceptible to triazoles. Surgical resection of lesion shows better outcome. The response of disseminated infection to combination therapy with interferon gamma and antifungal agents is encouraging.

Background: Paraneoplastic ocular syndromes are rare, immune-mediated disorders triggered by malignancies. They may precede cancer diagnosis or signal its recurrence, highlighting their potential value as early warning signs. Their recognition is critical for timely diagnosis and appropriate management.

Methods: We performed a systematic review of case reports and case series published between 2010 and 2023 in PubMed database, focusing on six major syndromes: cancer-associated retinopathy (CAR), melanoma-associated retinopathy (MAR), bilateral diffuse uveal melanocytic proliferation (BDUMP), acute exudative polymorphous paraneoplastic vitelliform maculopathy (AEPPVM), paraneoplastic uveitis (PU), and paraneoplastic optic neuropathy (PON). We extracted demographic, clinical, immunologic, oncologic, therapeutic, and outcome-related data.

Results: A total of 132 articles comprising 147 patients were included: 53 with CAR, 22 with MAR, 26 with BDUMP, 16 with AEPPVM, 11 with PU, and 19 with PON. Visual impairment was bilateral in over 90% of cases. The most frequently associated malignancies were lung cancers (notably small-cell lung carcinoma), gynecological cancers, and melanoma. Onconeural autoantibodies were tested in serum-most commonly revealing anti-recoverin and anti-alpha-enolase in CAR, and anti-CRMP5 in PON-but were never assessed in cerebrospinal fluid (CSF), despite its potential diagnostic value. Therapeutic approach was highly heterogeneous and largely empirical, with systemic corticosteroids being the most commonly used treatment. Visual prognosis varied but was especially poor in CAR, for which 49.1% of patients experienced worsening vision. Notably, in CAR, an early oncologic diagnosis (within 6 months after symptom onset) was significantly associated with a favorable visual outcome (p = 0.03).

Conclusion: We identified a clinical profile of patients in whom paraneoplastic ocular syndromes should be suspected. These rare inflammatory disorders may serve as early indicators of malignancy. Further studies are needed to improve diagnostic pathways, optimize immunologic workup (including CSF testing), and guide therapeutic strategies.

Purpose: To investigate the safety and efficacy of rituximab in patients with refractory noninfectious uveitis and scleritis.

Methods: A retrospective review of 24 patients (47 eyes) treated with rituximab for refractory noninfectious uveitis and scleritis in the period between January 2018 and December 2024. The diagnosis of these patients included chronic recurrent uveitis associated with Vogt-Koyanagi-Harada disease (n = 16), idiopathic granulomatous uveitis (n = 3), multiple sclerosis-associated uveitis (n = 2), progressive subretinal fibrosis (n = 1) and scleritis (n = 2). The primary outcomes were disease quiescence and improvement in best-corrected visual acuity (BCVA). Secondary outcomes included reduction in corticosteroid and immunosuppressive therapy and adverse events.

Results: Rituximab was successful in inducing and maintaining disease quiescence and significantly improved visual acuity in patients presenting with uveitis and scleritis. After starting rituximab therapy, BCVA improved at 1 year from 0.93 ± 0.67 logMAR (Snellen: 20/160) to 0.63 ± 0.83 logMAR (Snellen: 20/80) (p < 0.001). Follow-up period ranged from 12 to 80 months (mean 41 ± SD 20.5). At the last follow-up, BCVA continued to improve to 0.46 ± 0.73 logMAR (Snellen: 20/60) (p < 0.001). Nine of twenty-four patients (37.5%) required more than 3 rituximab doses for disease control. Rituximab successfully reduced corticosteroid use, allowing 87.5% (21/24) of patients to discontinue steroids completely, with the remaining needing ≤ 7.5 mg/day. Mycophenolate mofetil dosage significantly decreased from a mean of 1840 ± SD 323 mg to 1045 ± SD 688 mg daily (p < 0.001), with two patients discontinuing all medications. All patients were flare-free at last follow-up.

Conclusions: Rituximab is an effective and safe treatment for refractory noninfectious uveitis and scleritis. It offers significant visual improvement, disease quiescence which potentially reduces reliance on corticosteroids and immunomodulatory therapy.