Pub Date : 2023-12-01DOI: 10.1097/coa.0000000000000024
R. Rashad, Hyunjoo J. Lee
The purpose of this report was to describe a case in which reticular epithelial edema secondary to topical netarsudil ophthalmic solution 0.2% occurred directly in relation to focal endothelial dysfunction in a post-endothelial keratoplasty eye. This was a case report. A 76-year-old man with a complex ocular history was diagnosed with pseudophakic bullous keratopathy of the left eye. Topical netarsudil was prescribed to treat his glaucoma and to attempt improvement of his corneal edema. The corneal examination remained stable for many months, but the patient eventually underwent a Descemet stripping automated endothelial keratoplasty (DSAEK) for worsening corneal edema. One week later, the patient was observed to have 360-degree reticular epithelial edema around the periphery of the DSAEK graft. Given the lack of visual significance and need for continued glaucoma treatment, the patient was continued on netarsudil. The reticular epithelial edema later became restricted to areas outside the graft zone as the peripheral DSAEK graft endothelial cell function improved. Two months post-DSAEK, the patient developed a partial inferior endothelial graft rejection related to inadvertent cessation of topical steroid, with keratic precipitates, stromal edema, and new overlying reticular epithelial edema. On treatment and resolution of the DSAEK graft rejection, the overlying reticular epithelial edema also resolved. This case clearly demonstrates that netarsudil-associated reticular epithelial edema is highly likely to be related to endothelial cell dysfunction and that if endothelial cell dysfunction improves, the reticular epithelial edema will also improve, despite the continuation of netarsudil.
{"title":"Netarsudil-Associated Reticular Epithelial Edema Directly Influenced by Endothelial Dysfunction in a Post-Endothelial Keratoplasty Patient","authors":"R. Rashad, Hyunjoo J. Lee","doi":"10.1097/coa.0000000000000024","DOIUrl":"https://doi.org/10.1097/coa.0000000000000024","url":null,"abstract":"\u0000 \u0000 The purpose of this report was to describe a case in which reticular epithelial edema secondary to topical netarsudil ophthalmic solution 0.2% occurred directly in relation to focal endothelial dysfunction in a post-endothelial keratoplasty eye.\u0000 \u0000 \u0000 \u0000 This was a case report.\u0000 \u0000 \u0000 \u0000 A 76-year-old man with a complex ocular history was diagnosed with pseudophakic bullous keratopathy of the left eye. Topical netarsudil was prescribed to treat his glaucoma and to attempt improvement of his corneal edema. The corneal examination remained stable for many months, but the patient eventually underwent a Descemet stripping automated endothelial keratoplasty (DSAEK) for worsening corneal edema. One week later, the patient was observed to have 360-degree reticular epithelial edema around the periphery of the DSAEK graft. Given the lack of visual significance and need for continued glaucoma treatment, the patient was continued on netarsudil. The reticular epithelial edema later became restricted to areas outside the graft zone as the peripheral DSAEK graft endothelial cell function improved. Two months post-DSAEK, the patient developed a partial inferior endothelial graft rejection related to inadvertent cessation of topical steroid, with keratic precipitates, stromal edema, and new overlying reticular epithelial edema. On treatment and resolution of the DSAEK graft rejection, the overlying reticular epithelial edema also resolved.\u0000 \u0000 \u0000 \u0000 This case clearly demonstrates that netarsudil-associated reticular epithelial edema is highly likely to be related to endothelial cell dysfunction and that if endothelial cell dysfunction improves, the reticular epithelial edema will also improve, despite the continuation of netarsudil.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"77 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139024940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-27DOI: 10.1097/coa.0000000000000021
Chanon Thanitcul, Asher Khan, Grant A. Justin, Divya Srikumaran, Uri S. Soiberman, K. Riaz, F. Woreta
To identify the 100 most-cited articles in cornea to provide a bibliometric perspective of highly relevant works in recent years. The ISI Web of Knowledge database was selected as a bibliographic database to search for cornea-related articles published between 2013 and 2021. The search was performed in June 2022 and was conducted in all medical and scientific journals available on the database. The search was also refined to include articles in the “Ophthalmology” category. Most articles were published in Ophthalmology (22%), followed by the American Journal of Ophthalmology (15%), Investigative Ophthalmology & Visual Science (12%), and Cornea (8%). The corresponding authors were from 22 countries, predominantly from the United States (22%), China (14%), and Japan (11%). The most common study types include case series (31%), randomized clinical trials (15%), and cross-sectional studies (12%). The major topics of these articles included dry eye disease (19%), crosslinking (16%), keratoconus (12%), and keratoplasty (11%). There was a statistically significant correlation between the number of years since publication and the number of citations per year (Pearson's correlation coefficient = −0.80, P < 0.001). COVID-related articles (5%) also demonstrated significantly higher numbers of citations per year compared to the rest of the articles (mean numbers of citations per year: 69.1 vs. 18.5, P = 0.003). There were 16 institutions that produced more than 1 article in the top 100 articles. This bibliometric study provided a unique perspective of the most relevant trends and themes of research in cornea in recent years.
{"title":"A Bibliometric Analysis of the 100 Most Cited Articles in Cornea","authors":"Chanon Thanitcul, Asher Khan, Grant A. Justin, Divya Srikumaran, Uri S. Soiberman, K. Riaz, F. Woreta","doi":"10.1097/coa.0000000000000021","DOIUrl":"https://doi.org/10.1097/coa.0000000000000021","url":null,"abstract":"To identify the 100 most-cited articles in cornea to provide a bibliometric perspective of highly relevant works in recent years. The ISI Web of Knowledge database was selected as a bibliographic database to search for cornea-related articles published between 2013 and 2021. The search was performed in June 2022 and was conducted in all medical and scientific journals available on the database. The search was also refined to include articles in the “Ophthalmology” category. Most articles were published in Ophthalmology (22%), followed by the American Journal of Ophthalmology (15%), Investigative Ophthalmology & Visual Science (12%), and Cornea (8%). The corresponding authors were from 22 countries, predominantly from the United States (22%), China (14%), and Japan (11%). The most common study types include case series (31%), randomized clinical trials (15%), and cross-sectional studies (12%). The major topics of these articles included dry eye disease (19%), crosslinking (16%), keratoconus (12%), and keratoplasty (11%). There was a statistically significant correlation between the number of years since publication and the number of citations per year (Pearson's correlation coefficient = −0.80, P < 0.001). COVID-related articles (5%) also demonstrated significantly higher numbers of citations per year compared to the rest of the articles (mean numbers of citations per year: 69.1 vs. 18.5, P = 0.003). There were 16 institutions that produced more than 1 article in the top 100 articles. This bibliometric study provided a unique perspective of the most relevant trends and themes of research in cornea in recent years.","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139230703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19eCollection Date: 2023-12-01DOI: 10.1097/coa.0000000000000022
Justin J Grassmeyer, Kellyn N Bellsmith, Allison R Bradee, Roma B Pegany, Travis K Redd
Purpose: To report and present images of a case in which discrete conjunctival lesions developed in the setting of primary varicella zoster virus infection (ie, chickenpox).
Methods: Case report and literature review.
Results: This report describes a young, unvaccinated male who developed an acutely painful, red eye in the setting of disseminated primary varicella zoster infection. The cutaneous rash was widespread and included lesions on both eyelids. The patient was found to have multiple discrete de-epithelialized lesions involving the palpebral and bulbar conjunctiva. Throughout the disease course, good visual function was maintained and there was no evidence of intraocular involvement. The ocular surface lesions resolved without sequelae after 1 week of treatment with topical antibiotic ointment.
Conclusions: Primary varicella zoster infection is an increasingly rare phenomenon in the setting of widespread vaccination. However, unvaccinated or undervaccinated individuals and other at-risk populations remain susceptible to developing severe infections. This case of chickenpox involved discrete conjunctival lesions that resolved without sequelae after conservative treatment with topical antibiotic ointment. While serious ophthalmic complications are uncommon in primary varicella infection, clinicians should be aware of the potential for ocular morbidity in this increasingly rare condition.
{"title":"Conjunctival Lesions Secondary to Systemic Varicella Zoster Virus Infection.","authors":"Justin J Grassmeyer, Kellyn N Bellsmith, Allison R Bradee, Roma B Pegany, Travis K Redd","doi":"10.1097/coa.0000000000000022","DOIUrl":"10.1097/coa.0000000000000022","url":null,"abstract":"<p><strong>Purpose: </strong>To report and present images of a case in which discrete conjunctival lesions developed in the setting of primary varicella zoster virus infection (ie, chickenpox).</p><p><strong>Methods: </strong>Case report and literature review.</p><p><strong>Results: </strong>This report describes a young, unvaccinated male who developed an acutely painful, red eye in the setting of disseminated primary varicella zoster infection. The cutaneous rash was widespread and included lesions on both eyelids. The patient was found to have multiple discrete de-epithelialized lesions involving the palpebral and bulbar conjunctiva. Throughout the disease course, good visual function was maintained and there was no evidence of intraocular involvement. The ocular surface lesions resolved without sequelae after 1 week of treatment with topical antibiotic ointment.</p><p><strong>Conclusions: </strong>Primary varicella zoster infection is an increasingly rare phenomenon in the setting of widespread vaccination. However, unvaccinated or undervaccinated individuals and other at-risk populations remain susceptible to developing severe infections. This case of chickenpox involved discrete conjunctival lesions that resolved without sequelae after conservative treatment with topical antibiotic ointment. While serious ophthalmic complications are uncommon in primary varicella infection, clinicians should be aware of the potential for ocular morbidity in this increasingly rare condition.</p>","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"2 4","pages":"e0022"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10586785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49694797","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}
Pub Date : 2023-10-03DOI: 10.1097/coa.0000000000000020
Sarah A. Commaroto, Jimmy Y. Hu
Purpose: To present a case of epithelial ingrowth in the graft–host interface after Descemet stripping endothelial keratoplasty (DSEK) surgery that was successfully treated with an Nd:YAG Laser. Methods: A 79-year-old Caucasian female underwent a repeat DSEK 9 months after a prior DSEK graft rejection and subsequent failure. At her regularly scheduled 1-month follow-up visit, an asymptomatic dense white interface opacity was observed within the stromal interface, with an appearance consistent with epithelial ingrowth. The depth and location was confirmed by anterior segment optical coherence tomography. After initial observation, the opacity was noted to be growing over 2 months. The epithelial ingrowth cells were then treated with an Nd:YAG Laser. Results: The patient remained stable 12 months post laser treatment with no recurrence of epithelial ingrowth. Focal stromal pits were noted at the site of Nd:YAG Laser treatment within the DSEK graft stromal interface, but were not visually significant. Conclusions: Nd:YAG laser treatment is a safe and effective way to treat early-stage epithelial ingrowth in the interface after DSEK surgery.
{"title":"Successful YAG Laser Treatment for Epithelial Ingrowth in Descemet Stripping Endothelial Keratoplasty Interface","authors":"Sarah A. Commaroto, Jimmy Y. Hu","doi":"10.1097/coa.0000000000000020","DOIUrl":"https://doi.org/10.1097/coa.0000000000000020","url":null,"abstract":"Purpose: To present a case of epithelial ingrowth in the graft–host interface after Descemet stripping endothelial keratoplasty (DSEK) surgery that was successfully treated with an Nd:YAG Laser. Methods: A 79-year-old Caucasian female underwent a repeat DSEK 9 months after a prior DSEK graft rejection and subsequent failure. At her regularly scheduled 1-month follow-up visit, an asymptomatic dense white interface opacity was observed within the stromal interface, with an appearance consistent with epithelial ingrowth. The depth and location was confirmed by anterior segment optical coherence tomography. After initial observation, the opacity was noted to be growing over 2 months. The epithelial ingrowth cells were then treated with an Nd:YAG Laser. Results: The patient remained stable 12 months post laser treatment with no recurrence of epithelial ingrowth. Focal stromal pits were noted at the site of Nd:YAG Laser treatment within the DSEK graft stromal interface, but were not visually significant. Conclusions: Nd:YAG laser treatment is a safe and effective way to treat early-stage epithelial ingrowth in the interface after DSEK surgery.","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135745214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/coa.0000000000000019
Jesus Guerrero-Becerril, Guillermo Raul Vera-Duarte, Hae Jin Kim, Carlos Adolfo Müller-Morales, Alejandro Navas, Enrique O. Graue-Hernandez
Purpose: To report an interesting and rare case of conjunctival Kaposi's sarcoma, which led to the diagnosis of acquired immunodeficiency syndrome (AIDS) in a 25-year-old male. Methods: Interventional case report. A 25-year-old male presented with an asymptomatic red-violaceous lesion on his left eye for approximately 3 weeks. He had a history of tattooing 2 years ago, otherwise, his medical history was unremarkable. Results: HIV viral load of 451,958 copies/mL and 74 CD4 + cells were reported, confirming the diagnosis of HIV infection. An excisional biopsy was performed which reported neoplastic cells, vascular channels lined up with red blood cells, and highly mitotic cells, immunohistochemical reactions were carried out as well and were all positive for human herpesvirus-8, factor VIII, and CD31, confirming Kaposi's sarcoma (KS). Conclusions: Nowadays KS is very rare. The clinical characteristics of the neoplasm, absence of remarkable medical history at the time of presentation, prompt diagnosis of AIDS, and rapid treatment make this an interesting and important case for all ophthalmologists to diagnose AIDS.
{"title":"Conjunctival Kaposi's Sarcoma as an Initial Diagnosis of AIDS","authors":"Jesus Guerrero-Becerril, Guillermo Raul Vera-Duarte, Hae Jin Kim, Carlos Adolfo Müller-Morales, Alejandro Navas, Enrique O. Graue-Hernandez","doi":"10.1097/coa.0000000000000019","DOIUrl":"https://doi.org/10.1097/coa.0000000000000019","url":null,"abstract":"Purpose: To report an interesting and rare case of conjunctival Kaposi's sarcoma, which led to the diagnosis of acquired immunodeficiency syndrome (AIDS) in a 25-year-old male. Methods: Interventional case report. A 25-year-old male presented with an asymptomatic red-violaceous lesion on his left eye for approximately 3 weeks. He had a history of tattooing 2 years ago, otherwise, his medical history was unremarkable. Results: HIV viral load of 451,958 copies/mL and 74 CD4 + cells were reported, confirming the diagnosis of HIV infection. An excisional biopsy was performed which reported neoplastic cells, vascular channels lined up with red blood cells, and highly mitotic cells, immunohistochemical reactions were carried out as well and were all positive for human herpesvirus-8, factor VIII, and CD31, confirming Kaposi's sarcoma (KS). Conclusions: Nowadays KS is very rare. The clinical characteristics of the neoplasm, absence of remarkable medical history at the time of presentation, prompt diagnosis of AIDS, and rapid treatment make this an interesting and important case for all ophthalmologists to diagnose AIDS.","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135394251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/coa.0000000000000016
Lawrence Chan, Jacqueline B. Lopez, Murtaza Saifee, Sriranjani Padmanabhan, Matilda F. Chan, Madeline Yung
Infectious keratitis is a serious cause of visual impairment, particularly in low-income communities. This study examines the associations between social risk factors and polymicrobial keratitis, multidrug resistance, pathogen spectrum, and outcomes at a county hospital. We performed a retrospective study of Zuckerberg San Francisco General Hospital patients treated for infectious keratitis from 2010 to 2021. Multivariable regression was performed to analyze the relationships between social, medical, and psychiatric risk factors with polymicrobial growth, multidrug resistance, and clinical outcomes. Of 174 patients with infectious keratitis, 44 (25%) had polymicrobial growth. Six patients (14%) with polymicrobial growth had multidrug-resistant organisms. Homeless patients were more likely to present with polymicrobial infection (odds ratio [OR] 3.4, P = 0.023), and polymicrobial infections were associated with multidrug-resistant organisms (P = 0.018). Smoking, drug use, HIV positivity, prior corneal pathology, and contact lens use were not associated with an increased risk of polymicrobial infection. Eleven patients (6.3%) were started on topical antibiotics before presentation; of these, none developed polymicrobial infections or multidrug-resistant organisms. Polymicrobial infections increased the likelihood to initiation of fortified antibiotics (OR 2.9, P = 0.011) but did not impact ulcer size, final visual acuity, time to resolution, or likelihood of emergent procedures. Homelessness correlates with an increased risk of polymicrobial keratitis and subsequent multidrug resistance, supporting initiation of broad antibiotic coverage in this population. Prior topical antibiotics did not increase risk of polymicrobial infection. Polymicrobial infection did not significantly worsen clinical outcomes.
目的:传染性角膜炎是视力损害的一个严重原因，特别是在低收入社区。本研究探讨了社会风险因素与多微生物角膜炎、多药耐药、病原体谱和县医院预后之间的关系。方法:我们对2010年至2021年在扎克伯格旧金山总医院接受感染性角膜炎治疗的患者进行回顾性研究。采用多变量回归分析社会、医学和精神危险因素与多微生物生长、多药耐药和临床结果之间的关系。结果:174例感染性角膜炎患者中，44例(25%)有多微生物生长。6例多菌生长患者(14%)存在多重耐药菌。无家可归的患者更容易出现多微生物感染(优势比[OR] 3.4, P = 0.023)，多微生物感染与多重耐药菌相关(P = 0.018)。吸烟、吸毒、HIV阳性、既往角膜病理和使用隐形眼镜与多微生物感染风险增加无关。11例患者(6.3%)在就诊前开始使用局部抗生素;在这些病例中，没有一例出现多微生物感染或耐多药微生物。多微生物感染增加了开始使用强化抗生素的可能性(OR 2.9, P = 0.011)，但不影响溃疡大小、最终视力、消退时间或紧急手术的可能性。结论:无家可归与多微生物性角膜炎的风险增加以及随后的多药耐药性相关，支持在这一人群中开始广泛覆盖抗生素。既往使用局部抗生素不会增加多微生物感染的风险。多微生物感染没有显著恶化临床结果。
{"title":"Characterization of Polymicrobial and Antibiotic-Resistant Infectious Keratitis in a County Hospital Setting","authors":"Lawrence Chan, Jacqueline B. Lopez, Murtaza Saifee, Sriranjani Padmanabhan, Matilda F. Chan, Madeline Yung","doi":"10.1097/coa.0000000000000016","DOIUrl":"https://doi.org/10.1097/coa.0000000000000016","url":null,"abstract":"Infectious keratitis is a serious cause of visual impairment, particularly in low-income communities. This study examines the associations between social risk factors and polymicrobial keratitis, multidrug resistance, pathogen spectrum, and outcomes at a county hospital. We performed a retrospective study of Zuckerberg San Francisco General Hospital patients treated for infectious keratitis from 2010 to 2021. Multivariable regression was performed to analyze the relationships between social, medical, and psychiatric risk factors with polymicrobial growth, multidrug resistance, and clinical outcomes. Of 174 patients with infectious keratitis, 44 (25%) had polymicrobial growth. Six patients (14%) with polymicrobial growth had multidrug-resistant organisms. Homeless patients were more likely to present with polymicrobial infection (odds ratio [OR] 3.4, P = 0.023), and polymicrobial infections were associated with multidrug-resistant organisms (P = 0.018). Smoking, drug use, HIV positivity, prior corneal pathology, and contact lens use were not associated with an increased risk of polymicrobial infection. Eleven patients (6.3%) were started on topical antibiotics before presentation; of these, none developed polymicrobial infections or multidrug-resistant organisms. Polymicrobial infections increased the likelihood to initiation of fortified antibiotics (OR 2.9, P = 0.011) but did not impact ulcer size, final visual acuity, time to resolution, or likelihood of emergent procedures. Homelessness correlates with an increased risk of polymicrobial keratitis and subsequent multidrug resistance, supporting initiation of broad antibiotic coverage in this population. Prior topical antibiotics did not increase risk of polymicrobial infection. Polymicrobial infection did not significantly worsen clinical outcomes.","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135394253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/coa.0000000000000018
Binh Cao, Puspa Giri, Raghunandan Byanju, Sangita Pradhan, Gopal Bhandari, Sadhan Bhandari, Ram Prasad Kandel, Bimal Poudyal, John A. Gonzales, Muthiah Srinivasan, Madan Upadhyay, John P. Whitcher, Kieran S. O'Brien, Thomas M. Lietman, Jeremy D. Keenan
Purpose: To evaluate the diagnostic accuracy of smartphone corneal photography in detecting corneal opacities in a community-based setting. Methods: A case-control, diagnostic accuracy study was nested in a cluster-randomized trial of a corneal ulcer prevention intervention in Nepal. Smartphone corneal photography was performed annually on community members self-reporting a potential risk factor for a corneal infection. Corneal photographs were graded for the presence or absence of an opacity. All cases with an opacity on smartphone photography and an equal number of controls were invited for a comprehensive eye examination with a slit lamp biomicroscope at an eye hospital. A mobile team visited participants unable to come to the hospital, conducting a limited examination with a penlight. Results: Of 1332 study participants (666 cases and 666 controls), 1097 had a penlight examination (535 cases and 562 controls) and 191 had a slit lamp examination (120 cases and 71 controls). When penlight examination was considered the reference standard, smartphone diagnosis of a corneal opacity had a positive predictive value (PPV) of 47% (95% confidence interval 43%–52%) and negative predictive value (NPV) of 95% (93%–97%). When slit lamp examination was considered the reference standard, the overall PPV and NPV were 71% (62%–78%) and 80% (70%–88%), respectively. The NPV was greater for detection of opacities >1 mm, estimated at 95% (90%–98%). Conclusions: Corneal photography performed in a resource-limited community-based setting using a smartphone coupled to an external attachment had acceptable diagnostic accuracy for detection of corneal opacities large enough to be clinically meaningful.
{"title":"Diagnostic Accuracy of Smartphone Corneal Photography for Detection of Corneal Opacities in a Resource-Limited Setting: A Community-Based Study","authors":"Binh Cao, Puspa Giri, Raghunandan Byanju, Sangita Pradhan, Gopal Bhandari, Sadhan Bhandari, Ram Prasad Kandel, Bimal Poudyal, John A. Gonzales, Muthiah Srinivasan, Madan Upadhyay, John P. Whitcher, Kieran S. O'Brien, Thomas M. Lietman, Jeremy D. Keenan","doi":"10.1097/coa.0000000000000018","DOIUrl":"https://doi.org/10.1097/coa.0000000000000018","url":null,"abstract":"Purpose: To evaluate the diagnostic accuracy of smartphone corneal photography in detecting corneal opacities in a community-based setting. Methods: A case-control, diagnostic accuracy study was nested in a cluster-randomized trial of a corneal ulcer prevention intervention in Nepal. Smartphone corneal photography was performed annually on community members self-reporting a potential risk factor for a corneal infection. Corneal photographs were graded for the presence or absence of an opacity. All cases with an opacity on smartphone photography and an equal number of controls were invited for a comprehensive eye examination with a slit lamp biomicroscope at an eye hospital. A mobile team visited participants unable to come to the hospital, conducting a limited examination with a penlight. Results: Of 1332 study participants (666 cases and 666 controls), 1097 had a penlight examination (535 cases and 562 controls) and 191 had a slit lamp examination (120 cases and 71 controls). When penlight examination was considered the reference standard, smartphone diagnosis of a corneal opacity had a positive predictive value (PPV) of 47% (95% confidence interval 43%–52%) and negative predictive value (NPV) of 95% (93%–97%). When slit lamp examination was considered the reference standard, the overall PPV and NPV were 71% (62%–78%) and 80% (70%–88%), respectively. The NPV was greater for detection of opacities >1 mm, estimated at 95% (90%–98%). Conclusions: Corneal photography performed in a resource-limited community-based setting using a smartphone coupled to an external attachment had acceptable diagnostic accuracy for detection of corneal opacities large enough to be clinically meaningful.","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-31DOI: 10.1097/coa.0000000000000015
X. Y. Li, Ayodele K. Maja, G. Sanchez, S. Srinivas, M. Zegans
To describe 3 adult cases of keratitis secondary to vitamin A deficiency (VAD) in relation to vitamin A levels Dartmouth-Hitchcock Medical Center (DHMC) population and published literature. Records of 3 patients with xerophthalmia were reviewed. All serum vitamin A levels obtained at DHMC during the same time period of our 3 cases (2019–2020) were analyzed. Outcomes were examined by age and range of deficiency. Three patients, with short gut syndrome, chronic esophagitis, and alcohol use disorder, presented with xerophthalmia over 1 year. Serum vitamin A levels were 6.4 μg/dL, 16.1 μg/dL, and undetectable (<5.0 μg/dL), respectively (normal: 32.5–78.0 μg/dL). Findings ranged from conjunctival keratinization to corneal perforation. Corneal cultures in patient 3 grew methicillin-sensitive Staphylococcus aureus. The ocular surface improved significantly in 2 patients following vitamin A supplementation. Two patients died during treatment. Analysis of 1596 vitamin A levels at DHMC revealed 431 patients with VAD, including 158 levels at or below those of our presented symptomatic cases. Vitamin A deficiency can occur in adults in high resource settings and lead to severe ocular morbidities, and is commonly associated with comorbidities such as alcohol use disorder and gastrointestinal disease. Vitamin A supplementation improved ocular findings in 2 of our patients. VAD was identified in 431 patients at DHMC over one year, indicating a surprisingly large population of patients at risk for xerophthalmia.
{"title":"Deficiency in the Midst of Abundance: Xerophthalmia Case Series and Vitamin A Levels in a New England Hospital","authors":"X. Y. Li, Ayodele K. Maja, G. Sanchez, S. Srinivas, M. Zegans","doi":"10.1097/coa.0000000000000015","DOIUrl":"https://doi.org/10.1097/coa.0000000000000015","url":null,"abstract":"\u0000 \u0000 To describe 3 adult cases of keratitis secondary to vitamin A deficiency (VAD) in relation to vitamin A levels Dartmouth-Hitchcock Medical Center (DHMC) population and published literature.\u0000 \u0000 \u0000 \u0000 Records of 3 patients with xerophthalmia were reviewed. All serum vitamin A levels obtained at DHMC during the same time period of our 3 cases (2019–2020) were analyzed. Outcomes were examined by age and range of deficiency.\u0000 \u0000 \u0000 \u0000 Three patients, with short gut syndrome, chronic esophagitis, and alcohol use disorder, presented with xerophthalmia over 1 year. Serum vitamin A levels were 6.4 μg/dL, 16.1 μg/dL, and undetectable (<5.0 μg/dL), respectively (normal: 32.5–78.0 μg/dL). Findings ranged from conjunctival keratinization to corneal perforation. Corneal cultures in patient 3 grew methicillin-sensitive Staphylococcus aureus. The ocular surface improved significantly in 2 patients following vitamin A supplementation. Two patients died during treatment. Analysis of 1596 vitamin A levels at DHMC revealed 431 patients with VAD, including 158 levels at or below those of our presented symptomatic cases.\u0000 \u0000 \u0000 \u0000 Vitamin A deficiency can occur in adults in high resource settings and lead to severe ocular morbidities, and is commonly associated with comorbidities such as alcohol use disorder and gastrointestinal disease. Vitamin A supplementation improved ocular findings in 2 of our patients. VAD was identified in 431 patients at DHMC over one year, indicating a surprisingly large population of patients at risk for xerophthalmia.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72568607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-31DOI: 10.1097/coa.0000000000000017
Yuwei Xu, Liangbo Zeng, Yuying Zhang, Miao Chen, Zhancong Ou, Jin Zhou, Kaichen Zhuo, Jiaqi Chen, Lixia Lin, J. Gu
This article presents a case series of microbial keratitis in eyes that underwent Boston keratoprosthesis implantation. A thorough examination of medical records and microbiology results was conducted for patients who experienced microbial keratitis subsequent to Boston keratoprosthesis (KPro) implantation from July 2019 to July 2023. The review included 3 eyes of 3 distinct patients. In case 1, a patient with a history of chemical burns in the right eye underwent type I KPro implantation. Infectious keratitis, caused by Corynebacterium amycolatum, developed 9 years post-implantation. Despite the keratitis, the KPro remained in place, and treatment with vancomycin and ceftazidime agents, along with a C-collar full-thickness corneal graft for corneal melt, was administered. In case 2, Streptococcus pneumoniae-induced keratitis occurred 2 months following a type I KPro implantation. The infiltration resolved entirely after 4 weeks of topical and systemic antimicrobial treatment. Case 3 involved a patient with a history of Stevens-Johnson syndrome who underwent type II KPro implantation with autologous auricular cartilage reinforcement in the left eye. Bacterial keratitis and endophthalmitis caused by Streptococcus mitis/oralis developed 2 years after the surgery, ultimately resulting in phthisis. Both C. amycolatum and S. mitis/oralis can breach commensalism barriers, leading to opportunistic infections in eyes with implanted keratoprosthesis and compromised ocular surfaces. Post-keratoprosthesis microbial keratitis remains a significant concern and is often associated with adverse outcomes.
{"title":"Microbial Infections After Boston Keratoprosthesis: A Case Series","authors":"Yuwei Xu, Liangbo Zeng, Yuying Zhang, Miao Chen, Zhancong Ou, Jin Zhou, Kaichen Zhuo, Jiaqi Chen, Lixia Lin, J. Gu","doi":"10.1097/coa.0000000000000017","DOIUrl":"https://doi.org/10.1097/coa.0000000000000017","url":null,"abstract":"\u0000 \u0000 This article presents a case series of microbial keratitis in eyes that underwent Boston keratoprosthesis implantation.\u0000 \u0000 \u0000 \u0000 A thorough examination of medical records and microbiology results was conducted for patients who experienced microbial keratitis subsequent to Boston keratoprosthesis (KPro) implantation from July 2019 to July 2023.\u0000 \u0000 \u0000 \u0000 The review included 3 eyes of 3 distinct patients. In case 1, a patient with a history of chemical burns in the right eye underwent type I KPro implantation. Infectious keratitis, caused by Corynebacterium amycolatum, developed 9 years post-implantation. Despite the keratitis, the KPro remained in place, and treatment with vancomycin and ceftazidime agents, along with a C-collar full-thickness corneal graft for corneal melt, was administered. In case 2, Streptococcus pneumoniae-induced keratitis occurred 2 months following a type I KPro implantation. The infiltration resolved entirely after 4 weeks of topical and systemic antimicrobial treatment. Case 3 involved a patient with a history of Stevens-Johnson syndrome who underwent type II KPro implantation with autologous auricular cartilage reinforcement in the left eye. Bacterial keratitis and endophthalmitis caused by Streptococcus mitis/oralis developed 2 years after the surgery, ultimately resulting in phthisis.\u0000 \u0000 \u0000 \u0000 Both C. amycolatum and S. mitis/oralis can breach commensalism barriers, leading to opportunistic infections in eyes with implanted keratoprosthesis and compromised ocular surfaces. Post-keratoprosthesis microbial keratitis remains a significant concern and is often associated with adverse outcomes.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84379507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-28DOI: 10.1097/coa.0000000000000014
R. Mencucci, Chiara De Vitto, Michela Cennamo, Samuela Pierucci, C. Adembri
Descemet's membrane endothelial keratoplasty (DMEK) is usually performed under topical or locoregional anesthesia; a sedation is often required. Several drugs are administered but undesirable side effects limit the use of each medication. Dexmedetomidine (DEX), a sedative-analgesic, has minimal respiratory depressant effects, and its use in DMEK surgery has not been reported. This study compares the use of DEX versus Remifentanil (REMI) during DMEK. Retrospective, observational, single-center study. Forty-two patients received sedation with DEX or REMI. Heart rate, blood pressure, oxygen saturation were always recorded during the procedure. The degree of sedation was evaluated using the Ramsay sedation scale; preoperative evaluation of anxiety disorders was carried out with the Hospital Anxiety and Depression Scale, while patients' and surgeon's satisfaction was evaluated using the 7-point Likert-like verbal rating scale. Baseline demographic and clinical characteristics, as well as the baseline anxiety trait were similar for the 2 groups. Patients and surgeons reported higher satisfaction scores with DEX compared to patients receiving REMI (P < 0.01; P < 0.001). The intraoperative Ramsay score was 3 in 62% of patients in Group DEX and 23% in Group REMI; conversely, it was 2 in 38% of DEX Group and 77% in REMI Group (P < 0.02). No statistical difference in the hemodynamic and respiratory parameters between the 2 groups was recorded. With similar stability of hemodynamic and respiratory parameters, Dexmedetomedine provided a deeper sedation than REMI without respiratory depression, resulting in better surgical performance in terms of the patients' and the surgeon's satisfaction, thus suggesting a possible role for sedation during DMEK surgery.
{"title":"Dexmedetomidine Versus Remifentanil Monitored Anesthesia Care During Endothelial Keratoplasty: A Retrospective Study","authors":"R. Mencucci, Chiara De Vitto, Michela Cennamo, Samuela Pierucci, C. Adembri","doi":"10.1097/coa.0000000000000014","DOIUrl":"https://doi.org/10.1097/coa.0000000000000014","url":null,"abstract":"\u0000 \u0000 Descemet's membrane endothelial keratoplasty (DMEK) is usually performed under topical or locoregional anesthesia; a sedation is often required. Several drugs are administered but undesirable side effects limit the use of each medication. Dexmedetomidine (DEX), a sedative-analgesic, has minimal respiratory depressant effects, and its use in DMEK surgery has not been reported. This study compares the use of DEX versus Remifentanil (REMI) during DMEK.\u0000 \u0000 \u0000 \u0000 Retrospective, observational, single-center study. Forty-two patients received sedation with DEX or REMI. Heart rate, blood pressure, oxygen saturation were always recorded during the procedure. The degree of sedation was evaluated using the Ramsay sedation scale; preoperative evaluation of anxiety disorders was carried out with the Hospital Anxiety and Depression Scale, while patients' and surgeon's satisfaction was evaluated using the 7-point Likert-like verbal rating scale.\u0000 \u0000 \u0000 \u0000 Baseline demographic and clinical characteristics, as well as the baseline anxiety trait were similar for the 2 groups. Patients and surgeons reported higher satisfaction scores with DEX compared to patients receiving REMI (P < 0.01; P < 0.001). The intraoperative Ramsay score was 3 in 62% of patients in Group DEX and 23% in Group REMI; conversely, it was 2 in 38% of DEX Group and 77% in REMI Group (P < 0.02). No statistical difference in the hemodynamic and respiratory parameters between the 2 groups was recorded.\u0000 \u0000 \u0000 \u0000 With similar stability of hemodynamic and respiratory parameters, Dexmedetomedine provided a deeper sedation than REMI without respiratory depression, resulting in better surgical performance in terms of the patients' and the surgeon's satisfaction, thus suggesting a possible role for sedation during DMEK surgery.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80004458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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