Eye & Contact Lens-Science and Clinical Practice最新文献

Abstract: This case report presents the successful diagnosis and management of a rare case of Mycobacterium immunogenum keratitis. A 34-year-old immunocompetent female presented with a 6-month history of recurrent right eye redness and blurred vision. Previous treatment at other hospitals with oral antivirals, topical corticosteroids, and ganciclovir ointment for presumed herpetic keratitis had failed, with progressive vision decline from 20/20 to 20/50. The causative pathogen identification revealed Mycobacterium immunogenum through comprehensive diagnostic workup including microbiological culture, acid-fast staining, and metagenomic next-generation sequencing (mNGS). Initial therapy with topical amikacin proved ineffective and caused significant ocular toxicity, whereas adjunctive oral azithromycin showed no clinical benefit. Subsequent treatment with 0.3% gatifloxacin eye gel resulted in dramatic improvement. During the healing phase, 0.02% fluorometholone was added to control scarring. Complete resolution was achieved within 4 months, with only mild residual scarring and final uncorrected visual acuity of 20/30. The patient remained recurrence-free throughout 4 years of follow-up. This case demonstrates that Mycobacterium immunogenum keratitis does not necessarily occur in immunocompromised individuals or those with a history of trauma or surgery. It is easily misdiagnosed in the early stages, whereas mNGS can aid in pathogen identification. Treatment with 0.3% gatifloxacin eye gel suggests potentially superior efficacy and safety in such condition.

Abstract: Corneal infection is a leading cause of blindness globally. Prompt identification of the causative microbe and initiation of appropriate antimicrobial agents is essential for preserving vision. However, diagnosis can be hampered by lengthy microbiological culture and the failure of empiric antibiotic treatment to target rare, aggressive microbes. This case series describes two patients with keratitis, one involving infection with the anaerobic bacteria Eikenella corrodens and the other involving Capnocytophaga species. In both cases, the anaerobes were isolated as a part of polymicrobial infections and required antibiotic treatment tailored to their susceptibility profiles. Despite this effort, both infections resulted in permanent vision loss.

Objectives: Contact lens (CL) contamination carries the risk of viral keratoconjunctivitis transmission, particularly to CL users. Inadequate disinfection and viral stability in CL disinfectants of Human adenovirus (HAdV-D) and Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can contribute to ocular infections. In this study, we evaluated the antiviral efficacy of commercial CL disinfectants against these viruses.

Methods: Before the experiment, the cytotoxicity of CL disinfectants was assessed in A549 and Vero E6/TMPRSS2 cells to determine the detection limits. Stock viruses and each CL disinfectant were mixed in a 1:9 ratio and incubated according to the manufacturer's protocol. After the reactions, infectious viral titers were determined and compared with those of mock samples without disinfectants.

Results: Sodium hypochlorite- and hydrogen peroxide-based CL disinfectants reduced both enveloped SARS-CoV-2 and nonenveloped HAdV-D56 to below the detection limits. Salicylic acid and some polyhexamethylene biguanide (PHMB)-based disinfectants effectively inactivated enveloped SARS-CoV-2 but not nonenveloped HAdV-D56. Other kinds of PHMB, ɛ-polylysine, PQ-1, and alexidine hydrochloride did not exhibit efficient inactivation against both viruses.

Conclusions: Sodium hypochlorite- and hydrogen peroxide-based CL disinfectants have potent virucidal activities against enveloped and nonenveloped viruses. Human adenovirus is the most important causative agent of conjunctivitis. Contact lens disinfectants are recommended to sanitize contact lenses on a daily basis, following the manufacturer's protocol.

Objectives: To assess limbal vascular changes 1 year after ocular surface chemical injury using anterior segment optical coherence tomography angiography (AS-OCTA), and to evaluate its potential for guiding long-term clinical management.

Methods: This prospective longitudinal study included 10 patients with recent ocular surface chemical injury. All subjects underwent initial and 1-year follow-up evaluations using clinical slit-lamp examination and AS-OCTA imaging. Limbal ischemia was quantified in clock hours from en-face OCTA images and compared with clinical findings. Correlations with visual acuity and Dua classification grades were analyzed.

Results: The mean clinically observed limbal ischemia at baseline was 5.5 clock hours, whereas AS-OCTA revealed a broader mean ischemic area of 7 clock hours. At 1-year follow-up, the ischemic areas significantly regressed in both assessments, and AS-OCTA values were closely correlated with final visual acuity (r=0.683). In two severe cases, persistent ischemia and limbal stem cell deficiency were accurately predicted by OCTA.

Conclusions: AS-OCTA enables precise, noninvasive quantification of limbal ischemia and may overcome limitations of subjective clinical grading systems. Beyond acute evaluation, it provides insight into revascularization dynamics, supporting more informed decisions on the timing of stem cell transplantation. Anterior segment optical coherence tomography angiography holds strong promise as a standard imaging tool in both acute management and long-term follow-up of chemical ocular injuries.

Purpose: To evaluate corneal densitometry changes in the eyes 3 years after allograft corneal inlay (ACI) implantation for refractive treatment of presbyopia.

Methods: This retrospective case series included 32 nondominant eyes of 32 patients who underwent allograft corneal lenticle implantation. Corneal densitometry was performed preoperatively and postoperatively at 1, 3, 6, 12, and 36 months using a Scheimpflug tomography device. The results were analyzed in four different layers and four different zones of the cornea.

Results: The mean age of the 32 included patients was 49.8±3.3 (range 45-56) years. The densitometric changes measured at 36 months were more prominent in zones 1 and 2, especially in the anterior layer (AL). The AL mean baseline densitometry values were 19.02±2.20 grayscale unit (GSU) for zone 1 and 17.50±1.89 for zone 2. Densitometry values increased significantly at 1-month (to zone 1:23.37±3.71 GSU, P <0.001 and zone 2:18.90±2.39 GSU, P =0.001) and 3-month follow-up (to zone 1:23.68±4.35 GSU, P <0.001 and zone 2:18.80±2.46 GSU, P =0.006). Between the 3-month and 6-month follow-up periods, the densitometry values returned to baseline levels and remained constant throughout the 36-month follow-up (to zone 1:19.98±1.96 GSU, P =0.414 and zone 2:18.11±2.13 GSU, P =1.000). No significant densitometric changes were observed in zone 3 at any time. Densitometric values returned to baseline levels in all layers and zones at 6 months postoperatively.

Conclusion: These results support the notion that ACI implantation is relatively safe regarding corneal transparency.

Background: Dupilumab, approved for treating moderate-to-severe atopic dermatitis (AD), has been linked to a group of ocular surface adverse effects collectively called dupilumab-associated ocular surface diseases (DAOSDs). Although DAOSDs have been described in various populations, data regarding age- and sex-related differences in Latin American cohorts are scarce. This study aimed to describe the frequency and clinical features of DAOSDs in Colombian patients with AD, with a particular focus on variations by age and sex.

Methods: We conducted a cross-sectional study of 56 patients with AD receiving dupilumab. A single ophthalmologist assessed ocular surface parameters, including tear break-up time, superficial punctate keratitis (SPK), and Meibomian gland dysfunction. Conjunctivitis was defined as the appearance of new symptoms after treatment onset and conjunctival hyperemia. Pre- and post-treatment symptoms were compared, and associations with age and sex were analyzed.

Results: Conjunctivitis was observed in 32.1% of patients. Pruritus (75%) and redness (53.6%) were the most frequent symptoms. Meibomian gland dysfunction and SPK were present in 46.4% and 41.1%, respectively. No sex-related differences were found. Patients aged ≥20 years showed significantly higher rates of symptoms, MGD, and SPK.

Conclusion: DAOSDs were frequent, particularly in older patients, supporting the need for early ophthalmologic evaluation.

Objectives: Polydeoxyribonucleotide (PDRN) activates adenosine A2A receptors, subsequently stimulating the release of growth factors such as fibroblast growth factor and epidermal growth factor, which promote anti-inflammatory effects, cell proliferation, and tissue regeneration. This study investigated the effects of 0.1% PDRN-releasing contact lenses (PDRN-CL) on corneal wound healing in an animal model.

Methods: After corneal epithelial injury induced by 20% alcohol and a #15 blade in six New Zealand White rabbits, control lenses were worn in one eye and PDRN-releasing lenses (Neovision, Korea) in the other eye were applied daily for 6 hr every day over 4 days. Fluorescein staining was used to assess wound area, expressed as a percentage of the initial defect. On fourth day, corneas were harvested for hematoxylin and eosin (H&E), Ki67, and matrix metalloproteinase-9 (MMP-9) staining. Differences in epithelial defect area were analyzed using independent t tests, with P <0.05 considered statistically significant.

Results: Corneal epithelial defects decreased over time, and from the first day to the morning of the third day, wound healing was significantly accelerated in the PDRN-CL group compared with the control contact lens group ( P <0.05). By the afternoon of the third day, corneal epithelial defects were not observed in either group. Tissue examination showed that the epithelial cell layer was thicker in the PDRN-CL group ( P <0.05), and Ki67 expression was significantly higher in the PDRN-CL group ( P <0.05). The PDRN-CL group exhibits significantly lower MMP-9 levels and MMP-2 expressions ( P =0.023 and P <0.0001, respectively).

Conclusions: Polydeoxyribonucleotide-CL was effective in promoting corneal wound healing and epithelial cell proliferation and in reducing inflammation. Therefore, it may be useful for treating contact lens complications or corneal injuries.

Abstract: A 19-year-old male patient presented to our clinic with complaints of foreign-body sensation, pain, redness, tearing, and decreased vision in the right eye. One day prior, a bee struck his eye while he was riding a motorcycle. Biomicroscopic examination of the right eye showed periorbital edema, chemosis, ciliary injection, corneal edema with radiating Descemet folds, paracentral corneal infiltrate, and a brown needle-like foreign body resembling a bee stinger. Anterior segment optical coherence tomography (AS-OCT) confirmed corneal edema with Descemet folds, whereas in vivo confocal microscopy (IVCM) revealed multiple hyporeflective, round cyst-like structures within the superficial corneal epithelium, hyperreflective, round inflammatory cells around the subbasal nerves, a honeycomb pattern, and a hyperreflective, needle-like linear opacity in the stroma. The patient was treated with topical moxifloxacin 0.5%, dexamethasone 0.1%, and fluconazole 0.2% eye drops and oral moxifloxacin (400 mg) and cetirizine (10 mg) tablets. The patient's signs and symptoms improved significantly within 1 week. At the 18-month examination, the patient's vision was 20/20, with only a faint stromal opacity remaining. No stinger fragments were detected on biomicroscopic examination, AS-OCT, or IVCM examination. Anterior segment optical coherence tomography and IVCM are highly valuable for monitoring corneal edema, inflammation, cellular changes, and the embedded stinger within the cornea throughout the follow-up period.

Abstract: Neurotrophic keratopathy (NK) is a serious condition that can lead to significant visual morbidity. One of the greatest challenges of treating NK is that there are a wide variety of underlying conditions that affect the corneal nerves, and the root cause of the NK for any given individual is necessary in order to provide the best possibility of treatment success. NK is noted to be frequently caused by herpetic disease, including herpes zoster ophthalmicus (HZO), and studies have demonstrated that the risk of developing NK increases with recurrences of HZO. As such, vaccination to prevent HZO, as well as suppressive valacyclovir to reduce the chance of multiple recurrences of HZO in individuals who have had HZO, can decrease the risk of NK from HZO as well as the subsequent vision loss. These preventative therapies are therefore highly recommended.