Search

A large‐scale outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) occurred in Shanghai, China, in early December 2022. To study the incidence and characteristics of otitis media with effusion (OME) complicating SARS‐CoV‐2, we collected 267 middle ear effusion (MEE) samples and 172 nasopharyngeal (NP) swabs from patients. The SARS‐CoV‐2 virus was detected by RT‐PCR targeting. The SARS‐CoV‐2 virus, angiotensin‐converting enzyme 2 (ACE2), and transmembrane serine protease 2 (TMPRSS2) expression in human samples was examined via immunofluorescence. During the COVID‐19 epidemic in 2022, the incidence of OME (3%) significantly increased compared to the same period from 2020 to 2022. Ear symptoms in patients with SARS‐CoV‐2 complicated by OME generally appeared late, even after a negative NP swab, an average of 9.33 ± 6.272 days after COVID‐19 infection. The SARS‐CoV‐2 virus was detected in MEE, which had a higher viral load than NP swabs. The insertion rate of tympanostomy tubes was not significantly higher than in OME patients in 2019–2022. Virus migration led to high viral loads in MEE despite negative NP swabs, indicating that OME lagged behind respiratory infections but had a favorable prognosis. Furthermore, middle ear tissue from adult humans coexpressed the ACE2 receptor for the SARS‐CoV‐2 virus and the TMPRSS2 cofactors required for virus entry. [ABSTRACT FROM AUTHOR]

To identify viral pathogens in patients with secondary glaucoma associated with anterior segment uveitis and compare metagenomic deep sequencing (MDS) with enzyme-linked immunosorbent assay (ELISA) combined with Witmer-Desmonts coefficient (WDC) evaluation and real-time quantitative polymerase chain reaction (qPCR) on investigating pathogens in aqueous humor. Aqueous humor from 31 patients, including 22 Posner-Schlossman Syndrome and 9 other anterior uveitis, was assessed pathogens by ELISA combined with WDC evaluation, virus deoxyribonucleic acid (DNA) detection by real-time qPCR and MDS. Viral pathogens (HCMV or VZV or RV) were detected in 19 out of 31 eyes (61.3%) by real-time qPCR or WDC evaluation. MDS revealed the presence of HCMV DNA sequences in three PSS patients. Virus is an important pathogen in secondary glaucoma associated with anterior segment uveitis. MDS is a potential etiologic diagnosis tool to seek intraocular viral pathogens for secondary glaucoma associated anterior segment uveitis. [ABSTRACT FROM AUTHOR]

Purpose: To assess the immune status of acute retinal necrosis (ARN) patients and to investigate the immune cell types involved in the immunopathogenesis. Methods: Peripheral blood and intraocular fluid were collected from 17 ARN patients and 9 control subjects. The Percentage of immune cells was measured using flow cytometry, levels of complement and antibodies were determined by rate nephelometry, and cytokine levels in the serum and aqueous humor (AH) were detected using cytokine quantitative chips. Data were analyzed using SPSS 23.0. p <.05 was considered statistically significant. Results: Proportion of T-helper 17 cells (p =.034) in serum and concentrations of multiple cytokines associated with Th17 cells (IL-6, IL-17, IL-17 F, IL-21, IL-22) in AH and serum were elevated of ARN patients. Conclusion: Th17 cells appeared to participate in the development of ARN. We found inflammatory cytokines and cells were elevated in the serum and AH of ARN patients. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viruses is mainly transmitted through respiratory droplets. Notably, some coronavirus disease 2019 (COVID-19) patients have ocular manifestations, including conjunctival hyperaemia, chemosis, epiphora, and increased secretions. However, the association between SARS-CoV-2 and ocular surface diseases is poorly described. Between May 2020 and March 2021, a total of 2, 0157 participants from six districts of China were enrolled. Serum samples were tested for immunoglobulin G and M (IgG and IgM) antibodies against the SARS-CoV-2 spike protein and nucleoprotein using magnetic chemiluminescence enzyme immunoassays. Throat swabs were tested for SARS-CoV-2 RNA using RT-PCR assays in a designated virology laboratory. Fisher exact, χ2 test, and logistic regression analysis were performed. Of 2, 0157 serum samples tested, 1, 755 (8.71%) were from ocular surface diseases, 1, 2550 (62.26%) from no-ocular surface diseases (ocular diseases except ocular surface diseases), 5, 852 (29.03%) from no-ocular diseases. SARS-CoV-2 prevalence for the combined measure was 0.90% (182/2, 0157). Seroprevalence of SARS-CoV-2 was significantly (p<0.05) higher in the population with ocular surface diseases (2.28%, 40/1755) compared with no-ocular surface diseases (0.70%, 88/1, 2550), and no-ocular diseases (0.92%, 54/5, 852). Similar results were also observed with respect to sex, age, time, and districts. Logistic regression analyses revealed that ocular surface diseases [ocular surface diseases vs. no-ocular diseases (p=0.001, OR =1.467, 95% CI=1.174-1.834); ocular surface diseases vs. no-ocular surface diseases (p<0.001, OR =2.170, 95% CI=1.434-3.284)] were associated with increased risk of susceptible to SARS-CoV-2 infection. In a word, there was a significant association between ocular surface disease and SARS-CoV-2 infection. Therefore, increasing awareness of eye protection during the pandemic is necessary, especially for individuals with ocular surface diseases. [ABSTRACT FROM AUTHOR]

Purpose: To report antibiotic resistance rates and trends of common ocular isolates collected over a 15-year period. Methods: We collected 3533 isolates from July 1, 2005 to July 31, 2020. Antibiotic sensitivity was determined according to the guidelines of the Clinical and Laboratory Standards Institute. Chi-squared (χ2) test was used to analyze changes in antibiotic susceptibility over 15 years. Results: Among the 3533 isolates, the predominant pathogens were the staphylococcal species. Methicillin resistance was observed in 381 Staphylococcus aureus (S. aureus) isolates (46.4%) and 1888 coagulase-negative staphylococci (CoNS) isolates (61.1%), and methicillin-resistant (MR) isolates had a high probability of concurrent resistance to fluoroquinolones and aminoglycosides. The mean percentage of resistance in staphylococcal isolates did not reach statistical significance across patient age groups (P = 0.87). Methicillin resistance did not increase in the CoNS (P = 0.546) isolates, and resistance to methicillin slightly decreased among S. aureus (P = 0.04) isolates over 15 years. Additional exploratory analysis revealed a small decrease in resistance to tobramycin (P = 0.01) and chloramphenicol (P < 0.001) among the CoNS isolates. All staphylococcal isolates were susceptible to vancomycin. Conclusion: Staphylococci were the most common microorganisms responsible for causing ocular infections. Antibiotic resistance was high among staphylococci, with nearly half of these isolates were resistant to methicillin and these had a high probability of concurrent resistance among MR staphylococci to other antibiotics. Overall, ocular resistance did not significantly change during the 15-year study period. We conclude that continued surveillance of antibiotic resistance provides critical data to guide antibiotic selection. [ABSTRACT FROM AUTHOR]

Purpose. The objective of this study was to evaluate the microbiological spectrum and antibiotic susceptibilities of isolates in posttraumatic endophthalmitis over a 15-year period. Methods. A retrospective study of 3,163 posttraumatic endophthalmitis cases was conducted between July 2004 and July 2019. The outcome measures included the microbiological spectrum and antibiotic susceptibilities. Chi-squared tests were conducted to detect trends in changes in antibiotic sensitivity over the 15-year period. P values of <0.05 were considered statistically significant. Results. Of the 3,163 cases of posttraumatic endophthalmitis, 1,003 culture-positive isolates were identified. Among these, there were 848 (84.5%) Gram-positive isolates, 109 (10.9%) Gram-negative isolates, and 46 (4.6%) fungal isolates. The most common isolates were Staphylococcal species. There was a significant increase in the percentage of fungal isolates over the 15-year period (P = 0.02). Gram-positive organisms showed the greatest level of susceptibility to vancomycin (99.6%). The susceptibilities of the 109 Gram-negative isolated organisms were as follows: levofloxacin (95.8%), meropenem (95.7%), ciprofloxacin (93.5%), tobramycin (90.8%), imipenem (88.9%), trimethoprim-sulfamethoxazole (TMP-SMX) (87.7%), ertapenem (80%), and ceftazidime (79.1%). The susceptibility of Gram-positive organisms to several antibiotics, including levofloxacin (P = 0.004), ciprofloxacin (P < 0.001), and chloramphenicol (P = 0.001) decreased over time, whereas the susceptibility to TMP-SMX increased over time (P < 0.001). The susceptibility of Gram-negative bacilli to ceftazidime decreased over time (P = 0.03). Conclusions. Over the 15-year study period, most isolates were Gram-positive cocci, especially coagulase-negative staphylococci (CNS). Vancomycin seemed to be the most effective antibiotic for Gram-positive bacteria. Gram-negative bacteria appeared to be most susceptible to fluoroquinolones. A number of antibiotics showed an increasing trend of microbial resistance. [ABSTRACT FROM AUTHOR]

The Posner–Schlossman syndrome (PSS) is a disease with clinically recurrent unilateral anterior uveitis with markedly elevated intraocular pressure (IOP) and subsequent progression to optic neuropathy. Retrospective studies have reported increased annual incidence of PSS, especially in China. While currently, the clinical management of PSS is still challenging. Metabolomics is considered to be a sensitive approach for the development of novel targeted therapeutics because of its direct elucidation of pathophysiological mechanisms. Therefore, we adopted gas chromatography time-of-flight mass spectrometry (GC-TOF-MS) technology-based non-targeted metabolomics approach to measure comprehensive metabolic profiles of aqueous humor (AH) samples obtained from patients with PSS, with an aim to demonstrate the underlying pathophysiology, identify potential biomarkers specific to PSS, and develop effective treatment strategies. A comparative analysis was used to indicate the distinct metabolites of PSS. Pathway analysis was conducted using MetaboAnalyst 4.0 to explore the metabolic reprogramming pathways involved in PSS. Logistic regression and receiver-operating characteristic (ROC) analyses were employed to evaluate the diagnostic capability of selected metabolites. Comparative analysis revealed a clear separation between PSS and control groups. Fourteen novel differentiating metabolites from AH samples obtained from patients with PSS were highlighted. Pathway analysis identified 11 carbohydrate, amino acid metabolism and energy metabolism pathways as the major disturbed pathways associated with PSS. The abnormal lysine degradation metabolism, valine–leucine–isoleucine biosynthesis, and citrate circle were considered to weigh the most in the development of PSS. The ROC analysis implied that the combination of glycine and homogentisic acid could serve as potential biomarkers for the discrimination of control and PSS groups. In conclusion, these results revealed for the first time the identity of important metabolites and pathways contributing to the development/progression of PSS, enabled the better understanding of the mechanism of PSS, and might lead to the development of metabolic biomarkers and novel therapeutic strategies to restrict the development/progression of PSS. [ABSTRACT FROM AUTHOR]

Purpose: To review the microbiological spectrum and antibiotic sensitivities of the pathogens that cause culture-proven endophthalmitis and to understand the status and trends of antibiotic susceptibility at a public hospital over a 10-year period. Methods: The data of 577 culture-proven endophthalmitis isolates collected between April 2004 and April 2014 were reviewed retrospectively. The antibiotic sensitivities were determined according to the criteria of the Clinical and Laboratory Standards Institute. The changes in antibiotic susceptibility over the 10 years were subjected toχ2tests for trends. Results: Among these isolates, 65% were gram-positive organisms (375), 16.6% were gram-negative organisms (96), and 18.4% were fungi (106). The predominant pathogens wereStaphylococcalspecies (Staphylococcus epidermidisin 175, other coagulase-negativeStaphylococciin 41, andStaphylococcus aureusin 54 cases), followed byBacillus cereusisolates. TheAspergillusspecies was the most frequently isolated fungus, andPseudomonas aeruginosawas the most frequently isolated gram-negative bacteria. The antibiotic susceptibilities of gram-positive bacteria were as follows: vancomycin, 97.6%; levofloxacin, 85.1%; gentamicin, 78.7%; rifampin, 77.2%; ofloxacin, 77.2%; chloramphenicol, 76.4%; and ciprofloxacin, 73.7%. The antibiotic susceptibilities of gram-negative isolates were as follows: ceftazidime, 50.5%; ciprofloxacin, 82.2%; amikacin, 81.3%; tobramycin, 80.2%; imipenem, 79.7%; and gentamicin, 78%. Over the 10-year study, there were significant changes in the antibiotic susceptibilities to the following five antibiotics: vancomycin, imipenem, penicillin G, amikacin, and trimethoprim-sulfamethoxazole (TMP-SMX). Conclusions: Vancomycin remains the most appropriate empirical antibiotic for gram-positive bacteria. The susceptibilities of the gram-negative organisms to ciprofloxacin and amikacin were greater than that to ceftazidime. Trends toward increases in the susceptibilities to the following five antibiotics were observed: vancomycin, imipenem, penicillin G, amikacin, and TMP-SMX. [ABSTRACT FROM AUTHOR]

Objective: Immunity is associated with acute low tone hearing loss. However, the exact pathophysiology of immunity-mediated acute low tone hearing loss remains unknown. In this study, we evaluated the presence, therapeutic effectiveness, and immunopathological mechanisms of anti-endothelial cell autoantibodies (AECEs) in patients with acute low-frequency hearing loss. Material and Methods: Forty-nine patients who were treated as inpatients having acute low-frequency hearing loss and additional symptoms, such as ear fullness, tinnitus, dizziness, or hyperacusis, were enrolled in this study. Serum samples from these patients were collected for laboratory serum autoimmunity detection, including AECAs, antinuclear antibodies, immunoglobulin, and circular immune complex. Therapeutic responses to combination therapy in short-term outcome and serum cytokine levels were compared between AECA-positive and AECA-negative patients. Results: Anti-endothelial cell autoantibodies–positive patients tended to show significantly less response to standard therapy compared with AECAs controls (P <.05). Moreover, some serum cytokine levels elevated in both AECAs− and AECAs+ groups. Positive ratio of interleukin-8 and concentrations of macrophage inflammatory protein-1α were found higher in AECAs+ groups (P <.05). Conclusion: The results supported that AECAs might wield influence on the short-term outcome of acute low-tone hearing loss (ALHL) treatment. Furthermore, AECA-mediated acute low-frequency hearing loss possibly involved dysregulation of inflammation process and release of cytokines. [ABSTRACT FROM AUTHOR]

Purpose: To explore the expression of matrix metalloproteinase-3 (MMP-3) in the aqueous humor of patients with Posner-Schlossman syndrome (PSS), and the association between MMP-3 and PSS., Methods: Peripheral blood and aqueous humor were routinely collected from 29 patients with PSS (PSS group) and 30 patients with age-related-cataract (ARC) (control group). The content of MMP-3 in serum and aqueous humor was measured by immunoturbidimetry. The correlation between MMP-3 and ophthalmic examination results were verified by Spearman's correlation analysis., Results: The MMP-3 level in the aqueous humor of the PSS group was (25.86 ± 13.4)ng/ml, significantly higher than that in the control group (3.9 ± 2.7)ng/ml( p  < 0.001), while there was no significant difference in serum MMP-3 level between the two groups ( p  = 0.125). The endothelial cell density (ECD) in the aqueous humor of the PSS group was (2078 ± 440) cell/mm 2 , intraocular pressure (IOP) in the aqueous humor of the PSS group was (33 ± 12) mmHg. The correlation analysis of aqueous humor MMP-3 and various ophthalmic examination results showed that aqueous humor MMP-3 had a moderate correlation with IOP and the difference in ECD between the affected eye and the fellow eye., Conclusions: MMP-3 level is elevated in the aqueous humor of PSS patients, and it may play an important role in the pathogenesis of PSS.

Purpose: To analyze the trend of intraocular viral load after antiviral treatment in patients with varicella-zoster virus (VZV) induced acute retinal necrosis (ARN), and to explore the effect of viral genotypes on clinical manifestations., Methods: In this case series, viral load was detected using polymerase chain reaction from aqueous humor during treatment; viral load curves were fitted, and the time required to reach the inflection point between plateau phase and logarithmic reduction phase (Tinflection) was estimated. Variations in viral genomes were detected by metagenomic sequencing., Results: Twenty eyes of 20 patients were included. The median (interquartile range) initial viral load was 5.9×107 (1.1×107-1.1×108) copies/mL. The average duration of retinitis was 5±3 weeks. The average Tinflection was 4.2±1.6 days. Tinflection was correlated with the duration of retinitis (P=0.025). Patients with VZVs carrying the p.S715* variation in ribonucleotide reductase (RNR) subunit 1 gene had lower initial viral loads (median 1.3×107 copies/ml) than those without (median 1.1×108 copies/ml; adjusted P=0.030)., Conclusions: The inflection of viral load curve is helpful to estimate the length of plateau phase and the duration of retinitis during antiviral treatment in ARN patients. Loss-of-function variation in RNR gene might be correlated with lower virulence of VZV., Competing Interests: Conflict of Interest: None of the authors has any conflicting interest to disclosure., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Objectives: Polysomnography was class I test for who was suspected of obstructive sleep apnea (OSA) which would cost lots of time and money. This study aimed to develop a nomogram model mainly based on oxygen and blood routine indicators to predict OSA. Methods: We retrospectively analyzed 685 patients with suspected OSA at our hospital. Multivariate analysis was used to construct a nomogram. The performance of the nomogram was assessed using calibration and discrimination. Results: The multivariate analysis identified age, gender, body mass index, mean pulse oxygen saturation, percent nighttime with oxygen saturation less than 90%, red blood cell, hematocrit, and red blood cell distribution width SD as significant factors ( P < .05). A nomogram was created for the prediction of OSA using these clinical parameters and was internally validated using a bootstrapping method. Our nomogram model showed good discrimination and calibration in terms of predicting OSA, and had a C-index of 0.935 [95% confidence interval (CI), 0.917-0.954] according to the internal validation. Discrimination and calibration in the validation group were also good (C-index, 0.957; 95% CI, 0.930-0.984). Conclusion: The newly developed nomogram can effectively help physicians make better clinical decisions, which may save a lot of time and costs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aims: The aim of this observational study was to report the distribution of glycoprotein B (gB) genotypes in the eyes of cytomegalovirus (CMV) positive patients with Posner-Schlossman syndrome (PSS), and to investigate their clinical characteristics and outcomes., Methods: We collected aqueous humour samples from 165 patients clinically diagnosed with PSS between 2017 and 2019. PCR was performed to analyse the CMV DNA and identify the gB genotypes in the samples. Clinical characteristics and responses to antiviral treatment were compared among patients with different gB genotypes., Results: CMV DNA was detected in 94 (56.97%) of the 165 aqueous humour specimens analysed. Owing to the quantity requirement for CMV gB genotype analysis, results could be obtained from only 14 specimens. CMV gB type 1 was detected in 11 samples (78.6%), whereas CMV gB type 3 was detected in three samples (21.4%). No other gB genotypes or mixed genotypes were detected. Overall, 9.1% (1/11) of the patients in the gB type 1 group and 66.7% (2/3) of the patients in the gB type 3 group had bilateral attacks (p=0.093). The concentration of anti-CMV immunoglobulin G (IgG) in the type 1 group was 0.94±0.79 s/co (ratio of aqueous humour CMV IgG/serum CMV IgG to aqueous humour albumin concentration/serum albumin concentration), whereas that in the type 3 group was 0.67±0.71 s/co., Conclusion: Genotype 1 was the most prevalent genotype in the aqueous humour of CMV-infected patients with PSS. Bilateral attack was predominant among patients with gB genotype 3. CMV gB gene may be related to the pathogenicity of CMV virus strain in patients with PSS., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To investigate the clinical characteristics of acute retinal necrosis (ARN) with ultra-wide-field imaging (UWFI) and analyse their visual significance., Methods: Clinical and UWFI records of patients diagnosed with ARN at a single centre over 2 years were reviewed., Results: In 38 eyes of 35 patients, the clinical manifestations of ARN on UWFI included patchy (12 eyes) or fan-shaped necrotic lesions (26 eyes), retinal arterial obliteration (38 eyes), vitritis (38 eyes), retinal venous haemorrhage (19 eyes), and vitreous haemorrhage (6 eyes). Retinal detachment was associated with the number of retinal quadrants involved (β = 2.145, P = 0.005). LogMAR BCVA at last follow-up was associated with logMAR BCVA at presentation (β = 0.473, P = 0.004) and retinal detachment (β = 0.367, P = 0.020)., Conclusion: UWFI is useful for detecting retinal lesions in ARN, especially peripheral lesions or through opaque media, and provides valuable information concerning visual prognosis.

Objective: To investigate the clinical manifestations of syphilitic uveoretinitis in patients co-infected with human immunodeficiency virus (HIV)., Methods: Uveoretinitis patients presenting between January 2008 and December 2014 at Eye and ENT Hospital of Fudan University were collected. Patients were selected with positive serologic tests, including rapid plasma regain titer (RPR) > 1:8, treponema pallidum particle agglutination assay (TPPA) and human immunodeficiency virus (HIV). Other causes of uveoretinitis were excluded. Each patient underwent complete ophthalmologic examination including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, ophthalmoscopy, applanation tonometry and B-scan ultrasonography. Fundus fluorescein angiography were obtained in each case except for patients whose fundus was blurred with dense vitritis. Optical coherence tomography (OCT) was performed in selected patients. Thorough physical examination was performed simultaneously., Results: Twenty six patients were included in this study including 24 male (92.3%) and 2 female (7.7%). The mean age at presentation was 39.3 ± 13.2 (range 20 to 63 years). RPR titres ranged from 1:32 to 1:512. There were 49 eyes altogether and ocular involvement was bilateral in 23 patients (88.5%) and unilateral in 3 patients (11.5%). Panuveitis was the most common ophthalmic presentation (n = 39, 79.6%). Only two eyes were anterior uveitis (4.1%) and 8 eyes were posterior uveitis (16.3%). Anterior chamber cells+++ and mild to severe vitreous opacities were observed. Sixteen eyes presented with neuroretinitis (32.7%), 27 eyes had vitritis (55.1%), 5 eyes had retinochoroiditis (10.2%), 5 eyes had optic neuritis (10.2%), 5 eyes had retinitis (10.2%) including 2 eyes with necrotizing retinitis (4.1%), 4 eyes had retinal vasculitis (8.2%). Two eyes (11.5%) presented with posterior placoid chorioretinitis (4.1%) and multifocal choroiditis (4.1%). Systemic manifestations were detected. Five patients had a history of skin rash (19.2%), five (19.2%) had genital ulcers, three (11.5%) had chancre, two (7.7%) suffered from headache, two (7.7%) had a fever, one (3.8%) had oral ulcers and one patient (3.8%) lost his hair., Conclusions: The clinical features are protean and lack of specificity. The most common manifestations was neuroretinitis, ususlly with vitritis.