Journal of Ophthalmic Inflammation and Infection最新文献

Purpose: To report a rare case of severe keratitis followed by SARS-CoV-2 infection after minimally invasive corneal neurotization (MICN) surgery for the first time.

Methods: Retrospective single case report.

Results: A 59-year-old female presented to ophthalmology department of our hospital with facial paralysis induced by neurosurgeries. After detailed ophthalmological examination, she was diagnosed with Mackie stage III neurotrophic keratopathy (NK) in the right eye and subsequently underwent MICN and amniotic membrane transplantation. Postoperatively, corneal sensation and the epithelial defect showed gradual improvement, with corneal sensation recovering to 30 mm (measured by Cochet-Bonnet esthesiometer). However, thirteen months after MICN, she developed a corneal ulcer in the right eye one week after contracting SARS-CoV-2 (COVID-19). Supplementary investigations, including anterior segment photography, in vivo confocal microscopy (IVCM), and corneal scraping for pathogen detection, revealed recurrent corneal anesthesia and loss of corneal nerves, with no pathogens identified. After two weeks of empirical antiviral and antibacterial therapy yielded no significant improvement, a diagnosis of COVID-19-induced neurotrophic keratitis (Stage III Mackie) was established. Management consisted of prolonged medical therapy (including antiviral agents, antibiotics, nutritional supplementation, corticosteroids, and artificial tears), two amniotic membrane transplants, and one temporary tarsorrhaphy. Following two years of treatment and follow-up, the corneal lesion achieved complete healing with corneal nerve regeneration and restoration of corneal sensation.

Conclusion: This study presents the first documented case of COVID-19-related NK following MICN established as a diagnosis of exclusion. This case underscores the critical need for comprehensive differential diagnosis to rule out infectious etiologies in post-MICN keratitis, ultimately leading to a diagnosis of exclusion for COVID-19-induced disease. The diagnostic approach outlined may offer valuable insights for similar presentations. After a protracted clinical course, the patient ultimately achieved restoration of corneal sensation and reinnervation, demonstrating the preserved regenerative potential of MICN-reconstructed neural pathways even after severe viral infection.

Introduction: Herpes simplex keratitis (HSK) is a recurrent infection with a high risk of corneal blindness. The aim of the study is to investigate the HSV-PCR-positive smear rate, the ocular and systemic comorbidities and the impact of these comorbidities on the clinical outcome in a group of patients with pathologic corneal findings such as keratitis, persistent epithelial defects and corneal ulcers.

Methods: In this retrospective study, we recruited 194 eyes who underwent PCR testing for HSV-1 DNA in our tertiary eye clinic from 2015 to 2021 due to suspected HSK. A poor outcome was defined as final visual acuity > 0.4 according to the Logarithm of the Minimum Angle of Resolution (LogMAR) or the need for at least one corneal surgery.

Results: HSV-1-DNA was detected in 18.6% of the eyes. Corneal scarring (28.8%) and persistent epithelial defects (PED) (8.5%) were the most common complications. The highest recurrence rate (11.6%) was documented 3 months after sampling. 41.2% received systemic antiviral therapy at the first visit after collecting the sample. 75 eyes (38.7%) required at least one corneal surgery, of which amniotic membrane transplantation was the most common corneal procedure in 45 eyes (23.2%). 151 eyes (77.8%) had at least one ocular comorbidity, including previous ocular and corneal procedures (32% and 19.1% respectively) and blepharitis (26.3%). The most common systemic comorbidities were atopic diseases (10.8%), systemic immunosuppression (9.3%) and diabetes mellitus (8.8%). Previous ocular and corneal surgery, glaucoma and diabetes mellitus correlated with a poor outcome (P < 0,001). The average BCVA at the last follow-up (0.76 ± 0.83 LogMAR) was significantly better than at the time of sample collection (0.94 ± 0.76 LogMAR) (P < 0.001).

Conclusion: Our data confirm that HSK should be treated based on clinical findings regardless of the PCR result. We demonstrate for the first time, that comorbidities are very common and especially previous ocular and corneal surgery, glaucoma and diabetes mellitus are associated with a poor outcome. Although corneal surgery was necessary in almost 40% of the eyes during the follow-up due to a complicated course, a significant overall improvement in visual acuity was achieved compared to the initial findings.

Purpose: Non-infectious uveitis (NIU) can arise from various inflammatory disorders and can cause vision loss. Patients with mild NIU are typically treated with corticosteroid eye drops to reduce intraocular inflammation; however, other local/systemic treatments (corticosteroids, immunosuppressants, biologics) may be required for moderate-to-severe NIU, which may cause ocular complications. Here, we investigated real-world treatment patterns for NIU in Japan.

Methods: Patients were selected from a large, Japanese insurance claims database using International Classification of Diseases, Tenth Revision codes; diagnosis of NIU was confirmed via ophthalmological examination (October 2016-October 2023). Sankey diagrams were used to describe treatment transitions. Post-treatment ocular complications, potentially related surgeries, and fundus findings associated with uveitis were determined.

Results: The majority of patients (68.7%; 37,869/55,091) were treated with corticosteroid eye drops only for mild NIU; 19.0% (10,449/55,091) were given other treatments for moderate-to-severe NIU, mostly oral corticosteroids (7,473/10,449) and posterior sub-Tenon's corticosteroid injections (1,636/10,449). In patients treated with corticosteroids orally or via sub-Tenon's injections, common transitions were to corticosteroid eye drops or censor (end of treatment/dataset or insurance withdrawal). A higher incidence of treatment-related ocular complications and potentially related surgeries (including glaucoma) was observed during the first year of NIU treatment compared with subsequent years (for moderate-to-severe NIU, estimated incidence of prescription of glaucoma drugs was 106 per 1,000 person-years [at 1 year], 73 per 1,000 person-years [at 2 years], and 52 per 1,000 person-years [at 5 years]).

Conclusion: Our comprehensive analysis of a large claims database included all prescribed medications and medical procedures (including local injections) for NIU treatment in Japan up to October 2023. Although corticosteroids are a mainstay of NIU treatment in Japan, we found that a number of treatments for moderate-to-severe NIU, other than corticosteroid eye drops, are frequently used in combination with or when switching from corticosteroid eye drops. These findings are of importance when assessing the treatment landscape and may help identify unmet clinical needs in patients with NIU.

Purpose: Tubulointerstitial nephritis and uveitis (TINU) syndrome, characterised by the co-occurrence of tubulointerstitial nephritis and uveitis in the absence of other systemic diseases, presents a diagnostic challenge due to its non-specific symptoms. This case series aims to shed light on TINU syndrome's clinical features, underlying causes, and management strategies. The prevalence of TINU syndrome is relatively low with estimates of 3.5 cases/ million people with an incidence of 0.2 cases/ million/ year and it often goes underdiagnosed. The ratio of males to females reported was 4:1. Histological confirmation through renal biopsy is crucial, while systemic conditions such as systemic lupus erythematosus, tuberculosis, sarcoidosis, and Sjogren's disease should be excluded. In most cases, TINU appears to be an idiopathic immune-mediated process, but it may be precipitated by drugs or infections. Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with some cases of TINU syndrome. Genetic markers, particularly HLA subtypes, have shown a strong association with TINU syndrome. Uveitis which is characterised by intraocular inflammation is a common feature of TINU syndrome. Anterior uveitis, the most prevalent form, presents with symptoms such as red eye, eye pain, photophobia, and keratic precipitates which are subdivided into granulomatous and non-granulomatous. Corticosteroids represent the primary treatment for ocular inflammation, while immunosuppressant medications may be employed for treatment of nephritis.

Observations: Through the analysis of five TINU syndrome cases, this case series provides insights into the clinical presentations, laboratory findings, and biopsy results of patients with TINU syndrome. The cases include individuals with associated systemic conditions such as asthma, psoriasis and hyperthyroidism.

Conclusion and importance: In conclusion, TINU syndrome is a rare condition characterised by the simultaneous occurrence of tubulointerstitial nephritis and uveitis. Increased awareness among healthcare professionals is necessary for early recognition and appropriate management of this syndrome. Further research is needed to elucidate the pathogenesis, optimise diagnostic criteria, and explore more targeted therapeutic approaches for TINU syndrome.

Purpose: Ocular injuries caused by wasp stings are rare but potentially devastating. This report describes a case of severe retinal and choroidal detachment secondary to corneal wasp envenomation, with a focus on pathogenesis and management challenges.

Case presentation: A 63-year-old female sustained a left corneal wasp sting, progressing to corneal edema, hypopyon, retinal-choroidal detachment, and eventual light perception loss. Despite medical therapy (topical corticosteroids, antibiotics), the patient declined surgical intervention, ultimately resulting in evisceration.

Conclusion: Wasp venom triggers synergistic neurotoxic and immune-mediated damage, emphasizing the necessity of individualized management. Clinicians should prioritize multimodal approaches to mitigate irreversible vision loss in such cases.

Purpose: To study the clinical picture, outcomes and the complications of acute retinal necrosis (ARN) in a tertiary eye hospital.

Methods: This is retrospective chart review of all patients who were diagnosed with ARN and were treated and followed up at King Khaled Eye Specialist Hospital (KKESH). Details of clinical examinations, Polymerase Chain Reaction (PCR) results, systemic and topical treatments, complications and managements of complications were obtained.

Results: Twenty eight eyes of 26 patients were included. The results of PCR were positive in 22 eyes. Systemic antiviral therapy with intravenous Acyclovir 10 mg/Kg three times daily was given to all cases. Eight patients were treated with intravitreal ganciclovir injections. Fifteen eyes (56.3%) had rhegmatogenous retinal detachment (RRD) and 11 of them had surgical interventions. The risk of developing RRD was significantly high in severe vitritis (P = 0.007, OR = 3.825), diffuse or multifocal retinitis (P = 0.010, OR = 1.04) and the larger extent of retinitis (P = 0.016). The final visual outcome was worse among eyes which developed RRD (LogMAR 1.6 ± 0.94, Snellen = 20/800) than eyes which did not develop RRD (LogMAR 0.81 ± 0.84, Snellen = 20/125) and the difference was statistically significant (P = 0.031).

Conclusion: The visual outcomes of ARN are significantly worse in eyes which develop RRD. More severe and larger extent of posterior segment involvement confer higher risks of RRD development in ARN.

Purpose: To identify prognostic factors and their optimal thresholds influencing the treatment outcome of low-temperature plasma ablation therapy in patients with fungal keratitis (FK).

Methods: The clinical information of fifty-one patients with FK treated with low-temperature plasma ablation at Xiamen Eye Center from 2018 to 2024 was retrospectively analyzed. Patients were categorized into Responder and Non-Responder groups based on their response to treatment: complete/partial healing (Responder group) versus disease progression or need for additional surgery (Non-Responder group). Differences in demographic and clinical characteristics between the two groups were compared. Additionally, exact univariate and multivariate logistic regression were performed to identify prognostic factors. Lastly, receiver operating characteristic (ROC) curve analysis was utilized to determine the cut-off value for significant prognostic factors.

Results: Among the 51 patients, 37 were classified in the Responder group and 14 in the Non-Responder group. Univariate analysis revealed significant differences in the presence of hypopyon (p = 0.038), ulcer size (p = 0.002), infiltration depth (p = 0.001), and paracentral ulcer location (p = 0.030) between the groups. Multivariate analysis identified infiltration depth (adjusted odds ratio [aOR] = 1.41, 95% CI: 1.05-1.91, p = 0.024) as the sole significant independent prognostic factor. ROC analysis demonstrated excellent discrimination ability for infiltration depth, with an area under the curve of 0.966. Finally, the optimal threshold for infiltration depth was determined to be 0.48, exhibiting a sensitivity of 92.86% and specificity of 91.89%.

Conclusions: Low-temperature plasma ablation represents an effective treatment for FK, with infiltration depth serving as a crucial prognostic indicator. The identified threshold provides valuable guidance for patient selection. Nonetheless, larger prospective studies are warranted to validate these findings.