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Purpose To determine if smartphone photography could be a useful adjunct to blindness prevalence surveys by providing an accurate diagnosis of corneal opacity. Methods A total of 174 patients with infectious keratitis who had undergone corneal culturing over the past 5 years were enrolled in a diagnostic accuracy study at an eye hospital in South India. Both eyes had an ophthalmologist-performed slit lamp examination, followed by anterior segment photography with a handheld digital single lens reflex (SLR) camera and a smartphone camera coupled to an external attachment that provided magnification and illumination. The diagnostic accuracy of photography was assessed relative to slit lamp examination. Results In total, 90 of 174 enrolled participants had a corneal opacity in the cultured eye and no opacity in the contralateral eye, and did not have a penetrating keratoplasty or missing photographs. Relative to slit lamp examination, the sensitivity of corneal opacity diagnosis was 68% (95%CI 58-77%) using the smartphone's default settings and 59% (95%CI 49-69%) using the SLR, and the specificity was 97% (95%CI 93-100%) for the smartphone and 97% (95%CI 92-100%) for the SLR. The sensitivity of smartphone-based corneal opacity diagnosis was higher for larger scars (81% for opacities 2 mm in diameter or larger), more visually significant scars (100% for eyes with visual acuity worse than 20/400), and more recent scars (85% for eyes cultured in the past 12 months). Conclusion The diagnostic performance of a smartphone coupled to an external attachment, while somewhat variable, demonstrated high specificity and high sensitivity for all but the smallest opacities.

A 55-year-old Caucasian woman presented with a 1-week history of left eye redness and blurred vision. Her medical history included previous small bowel resection and ileostomy for ischaemic bowel. Ophthalmic examination revealed a left corneal ulcer requiring hospital admission for intensive topical antibiotics. Overnight she became systemically unwell and was diagnosed with urinary tract infection requiring intravenous antibiotics. Her corneal condition deteriorated resulting in corneal perforation, which required a surgical gluing procedure. Despite surgery, the cornea perforated on two further occasions. At this stage, vitamin A deficiency (VAD) was suspected, due to the corneal melting response that was occurring. VAD was subsequently confirmed by serology and had occurred in this case due to malabsorption as a result of short bowel syndrome caused by previous small bowel surgery. The patient was treated with intramuscular vitamin A and eventually made a good visual and systemic recovery.

This study quantifies the performance of an international cohort of cornea specialists in image-based differentiation of bacterial and fungal keratitis, identifying significant regional variation and establishing a reference standard for comparison against machine learning models.

Objective The aim of this retrospective study was to review the clinical data and outcomes of patients that suffered ectopic cilium (EC). Animals studied One hundred and twelve dogs from multiple private practices in France, with a clinical diagnosis of EC were included in the study. Results The mean age of affected dogs was 2.3 years. There were 64 females and 48 males. The most represented breeds were the Shi Tzu, the French Bulldog, the English Bulldog and the Chihuahua. Eleven dogs were affected bilaterally. The upper eyelid was implicated in 93.5% of the cases, with the median portion being the most affected. No statistical difference was observed between the right and the left eye. EC were associated with distichiasis in 50% of the cases. Pigmentation of the conjunctiva at the point of exit of the EC was present in 58% of the cases. EC were short in 75% and long in 25% of the cases. Corneal complications were statistically associated with short EC. The corneal lesions associated with EC were keratitis (94%), corneal granuloma (0.8%), corneal fibrosis (2.7%), corneal degeneration (0.8%), superficial corneal ulcer (68.7%), deep corneal ulcer (8%) and perforating corneal ulcer (0.8%). The surgeries which consisted of the removal of the hair follicle was successful in 88.4% of the cases. Conclusion EC is a rare condition which can be treated successfully by the removal of the hair follicles. It must be suspected in cases of corneal lesions unresponsive to medical treatment.

Purpose: We comparatively analyzed the microbiological profiles, predisposing factors, clinical aspects, and treatment outcomes of patients with polymicrobial and monomicrobial bacterial keratitis.Methods: A total of 194 cases of culture-proven bacterial keratitis treated between January 2007 and December 2016 were reviewed. Microbiological profiles, the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between the polymicrobial group (polymicrobial bacterial keratitis [PBK]; 29 eyes, 62 isolates) and monomicrobial (monomicrobial bacterial keratitis [MBK]; 165 eyes, 165 isolates) group.Results: The most common isolates were Enterobacter (24%) in the PBK group and Staphylococcus (22%) in the MBK group. There were no significant differences between the two groups in previous ocular surface disease, previous ocular surgery, prior topical steroid use, epithelial defect size, and hypopyon. Age ≥60 years (PBK vs. MBK, 31% vs. 51%, p = 0.048), symptom duration (4.7 days vs. 8.0 days, p = 0.009), and contact lens use (34% vs. 18%, p = 0.036) were significantly different between the two groups. Regarding treatment outcomes, epithelial healing time ≥10 days, the final best-corrected visual acuity (BCVA), a need for surgical intervention, and the rate of poor clinical outcome were not significantly different between the two groups. Significant risk factors for a poor clinical outcome in all patients were an initial BCVA Z = 6.33, two-proportion Z-test), an epithelial defect size ≥5 mm2 (Z = 4.56), and previous ocular surface disease (Z = 4.36).Conclusions: Polymicrobial bacterial keratitis, compared to monomicrobial bacterial keratitis, was more significantly associated with younger age, contact lens use, and shorter symptom duration.

Peripheral ulcerative keratitis (PUK) is an inflammatory condition of the peripheral cornea with hallmark features of epithelial defects and stromal destruction as a result of a complex interplay of factors including host autoimmunity and the peculiar anatomic and physiologic features of the peripheral cornea and environmental factors. PUK may be the result of local or systemic causes and infectious or noninfectious causes. Arriving at a specific etiological diagnosis requires a meticulous clinical workup that may include a battery of laboratory and radiological investigations. Management by a team of internists or rheumatologists and ophthalmologists and judicious use of immunosuppressive agents may yield favorable results minimizing adverse effects. We review current clinical knowledge on the diagnosis and management of PUK.

Whether patients with Mycoplasma infection have an increased risk of ocular surface ulcers. Using a nation-wide database, we identified patients with a new diagnosis of Mycoplasma infection between 1997 and 2013, and compared them with age-, sex-, and index year-matched subjects without the infection. Cox proportional regression was performed to compare the risk of corneal diseases between the two cohorts. The incidence of corneal diseases was significantly higher in the 4223 patients with Mycoplasma infection than in the 16,892 patients without (7.28 vs. 5.94 per 1000 person-years, P Mycoplasma infection might be a predisposing factor for patients with keratitis.

Purpose To describe a new technique for sutureless and glue-free amniotic membrane transplantation (AMT) and to investigate its effectiveness to treat corneal persistent epithelial defects (PEDs), compared to bandage contact lens (BCL) application alone. Methods We performed AMT with “contact lens sandwich technique” (CLS-AMT) in 8 consecutive patients with central/para-central (up to 4.00 mm from the geometrical centre) PED/ulceration and we retrospectively compared the results with 11 BCL procedures. Results The procedures were performed successfully with no complications. CLS-AMT showed significantly shorter healing time than BCL (24.0 ± 19.1 vs 42.9 ± 14.6 days; P Conclusion CLS-AMT technique, based on the suction effect due to the superposition of a bandage contact lens on the AM-ring complex, represents a quick, low cost, easy to perform and nearly non-invasive AMT technique. This approach is able to provide adequate fixation of AM, and it seems to be a safe and effective treatment for patients with PEDs.

PURPOSE The purpose of this study was to characterize rates of opioid prescription for different ulcerative keratitis types. METHODS This cohort study included patients diagnosed with ulcerative keratitis according to the University of Michigan electronic health record data between September 1, 2014 and December 22, 2020. Ulcerative keratitis was categorized by etiologic type (bacterial, fungal, viral, acanthamoeba, inflammatory, polymicrobial, or unspecified) using rule-based data classification that accounted for billing diagnosis code, antimicrobial or antiinflammatory medications prescribed, laboratory results, and manual chart review. Opioid prescriptions were converted to morphine milligram equivalent and summed over 90 days from diagnosis. Opioid prescription rate and amount were compared between ulcerative keratitis types. RESULTS Of 3322 patients with ulcerative keratitis, 173 (5.2%) were prescribed at least 1 opioid for pain management within 90 days of diagnosis. More patients with acanthamoeba (32.4%), fungal (21.1%), and polymicrobial (25.0%) keratitis were treated with opioids compared with bacterial (6.7%), unspecified (2.9%), or viral (1.8%) keratitis (all Bonferroni adjusted P < 0.05). For the 173 patients who were prescribed opioids, a total of 353 prescriptions were given within 90 days of diagnosis, with half given within the first week after diagnosis. The quantity of opioid prescribed within 90 days from diagnosis was not significantly different between ulcerative keratitis types (P = 0.6559). Morphine milligram equivalent units prescribed ranged from 97.5 for acanthamoeba keratitis to 112.5 for fungal keratitis. CONCLUSIONS The type of ulcerative keratitis may influence the opioid prescription rate. Providers can better serve patients needing opioids for pain management through improved characterization of pain and development of more tailored pain management regimens.

Microbial keratitis is devastating corneal morbidity with a variable spectrum of clinical manifestations depending on the infective etiology. Irrespective of the varied presentation delayed treatment can lead to severe visual impairment resulting from corneal ulceration, possible perforation, and subsequent scarring. Corticosteroids with a potent anti-inflammatory activity reduce host inflammation, thus minimizing resultant scarring while improving ocular symptoms. These potential effects of corticosteroids have been applied widely to treat various corneal diseases ranging from vernal keratoconjunctivitis to dry eye disease. However, antimicrobial therapy remains the mainstay of treatment in microbial keratitis, whereas the use of adjunctive topical corticosteroid therapy remains a matter of debate. Understandably, the use of topical corticosteroids is a double-edged sword with pros and cons in the treatment of microbial keratitis. Herein we review the rationale for and against the use and safety of topical corticosteroids in the treatment of infective keratitis. Important considerations, including type, dose, efficacy, the timing of initiation of corticosteroids, use of concomitant antimicrobial agents, and duration of corticosteroid therapy while prescribing corticosteroids for microbial keratitis, have been discussed. This review intends to provide new insights into the therapeutic utility of steroids as adjunctive treatment of corneal ulcer.

Background We present the results of penetrating keratoplasty (PKP) after previous treatment with a total conjunctival flap in two patients. Case reports Patient 1, a 66-year-old with a history of bilateral cement chemical burn in 1986 and external right-sided limbokeratoplasty in 2008 was treated externally with a total conjunctival flap in the right eye in 2014 due to a persistent corneal ulcer with imminent perforation. Best-corrected visual acuity (BCVA) in the right eye was light sensation, intraocular pressure on palpation was within normal range. Clinically, total conjunctival flap was present. Patient 2 was treated externally in May 2015 due to acanthamoeba keratitis in the left eye with a deep anterior lamellar keratoplasty (DALK). A re-DALK was also performed externally in the same month. A third DALK was performed externally in August 2015 due to a persistent corneal ulcer, followed by a total conjunctival flap 2 weeks later. BCVA of the left eye was light sensation and intraocular pressure on palpation was within the normal range. Results Patient 1 was treated with removal of the conjunctival flap in the right eye and penetrating central re-keratoplasty (hand-held Barron trephine; graft diameter 8.5/8.75 mm). Simultaneously, lens extraction and intraocular lens implantation were performed (as a triple procedure). Additionally, amniotic membrane transplantation (AMT) as patch and a temporal lateral tarsorrhaphy were performed. BCVA 6 months postoperatively was 0.1. The graft was clear, without any signs of rejection. Patient 2 was treated on the left eye with removal of the conjunctival flap and a penetrating central keratoplasty (hand-held Barron trephine; graft diameter 7.0/7.5 mm). An AMT as patch and a temporal lateral tarsorrhaphy were simultaneously performed. Cataract surgery was performed 3 months postoperatively and BCVA of the right eye was 0.1 thereafter. The graft was clear, without any signs of rejection. Conclusion The conjunctival flap is a treatment of last resort of the (almost) penetrated corneal ulcer, which is to be used only when a keratoplasty is technically impossible. Provided the eye structure and retinal function are preserved, partial visual rehabilitation can possibly be achieved through a PKP after excision of the conjunctival flap, even years after corneal blindness.

BACKGROUND: Usually, surgical intervention is needed to eradicate the fungal microorganism that cause fungal corneal ulcers. However, since surgical intervention is invasive, the latest technology uses cryotherapy in treating it. Cryotherapy plays a vital role in the wound healing process. We aimed to evaluate is to study the decreased expression of matrix metalloproteinase 9 (MMP-9) and transforming growth factor β1 (TGF-β1) in fungal corneal ulcers after the administration of cryotherapy. METHODS: Aspergillus flavus fungus was injected to the intrastromal corneas of all Sprague Dawley rats. The rats were divided into four groups, the first group was not given any therapy, the second group was given topical natamycin therapy, the third group was given cryotherapy, and the fourth group was given a combination between cryotherapy and topical natamycin therapy. Therapy was given after five days of follow up on the formation of a corneal ulcer. After four days of therapy, the eyes were enucleated to determine MMP-9 and TGF-β1 expression. RESULTS: The result in the third group showed lower MMP-9 expression (20.0±10.0% cells per field of view) compared to the second group (40.0±20.0% cells per field of view) and the fourth group (30.0±25.0% cells per field of view), but had the same MMP-9 expression value as the first group. There was no significant difference in MMP-9 expression between the four groups ( p =0.356). The third group reduced more TGF-β1 expression (10.0±12.50% cells per field of view) compared to the fourth group (30±27.5% cells per field of view) and the first group (30±32.5% cells per field of view). There was also no significant difference in TGF-β1 between the four groups ( p =0.315). CONCLUSION: There is no significant difference in the expression of TGF-β1 and MMP-9 after the cryotherapy treatment. KEYWORDS: corneal ulcer, cryotherapy, MMP-9, TGF-β1

It has recently been proposed to use ultraviolet (UVA) corneal collagen crosslinking as an alternative method of treating bacterial ulcerative lesions of the cornea. Ambivalent results regarding the efficacy and safety of this method of treatment limit its implementation in clinical practice so far.The purpose of this work is to analyze three clinical cases involving the use of a new device for local UVA crosslinking in the complex treatment of bacterial corneal protracted-course ulcers with the suspected development of mixed fungal infection.Material and methods. For a dynamic follow-up of patients, we used biomicroscopy with a fluorescein test, photo registration and optical coherence tomography of the anterior part of the eye. Inflammatory changes were assessed using a point scale.Results. 3–5 procedures of local UVA exposure (with instillations of 0.1% riboflavin solution) lasting 3–5 minutes each and given with an interval of 2–4 days ensured stable and fast epithelialization of the cornea and a significant increase in visual acuity in the inflammatory process outcome.Conclusion. The first results of treating bacterial corneal ulcers using a new portable device for local UVA crosslinking have shown its high therapeutic efficiency and good prospects for further use in clinical practice.

OBJECTIVE To document the effectiveness and outcome of corneal grafting using acellular porcine corneal stroma (APCS) for veterinary use (BioCorneaVet™ ) to restore corneal integrity in dogs. METHODS A review of medical records of patients that underwent keratoplasty with APCS graft to repair deep corneal defects, descemetoceles, and perforations between 2019 and 2021 was carried out. Only animals with intact dazzle reflex, consensual PLR before the surgery and a minimum follow-up of four weeks were considered for the study, with forty dogs (1 eye each) meeting the inclusion criteria. RESULTS Brachycephalic breeds were the most frequently represented, and 20 right eyes and 20 left eyes were affected with 25 perforations, 8 descemetoceles, and 9 deep stromal defects (1 eye had both perforation and descemetocele). Most of the patients had concurrent ocular diseases or had undergone previous surgery on the other eye. Two different thickness of xenograft was used (300 or 450 µm), and the diameter ranged from 3 to 10 mm. Postoperative complications included mild to severe corneal vascularization, partial dehiscence, melting, and glaucoma. Follow-up time ranged from 28 to 797 days (mean: 233 days). Ocular integrity was maintained in 37/40 cases (92.5%), and vision was preserved in 36 cases (90%). CONCLUSION The use of APCS (BioCorneaVet™ ) is an effective surgical treatment for deep stromal defects, descemetocele, and perforations in dogs, providing a good tectonic support and preserving anatomical integrity and vision. The cosmetic appearance was considered good in all the cases and continued to improve with time.

A 20-year-old male presented with acute lower limb oligoarthritis and enthesitis followed by acute onset redness, watering, pain and decreased vision in the right eye. He had recent history of diarrhoea with fever. Erythrocyte sedimentation rate and high-sensitivity C-reactive protein (hsCRP) were raised and human leukocyte antigen-B27 was positive. The best corrected visual acuity (BCVA) in the right eye was 20/120 and it showed a paracentral shallow corneal ulcer of size 3 x 4 mm with underlying dense stromal infiltrates and haze. Microbiological evaluation of corneal scrapings was reported as Staphylococcus hominis. The epithelium healed on topical antibiotics in one week, but there were persistent punctate erosions and pleomorphic anterior stromal infiltrates and haze. The residual keratitis healed completely on topical steroids in ten days, with BCVA improving to 20/20. A diagnosis of reactive arthritis with immune-mediated keratitis was made.

PURPOSE To report the successful treatment of 3 cases of recalcitrant fungal keratitis (FK) with high-dose oral posaconazole. METHODS This is a series of 3 patients from a single academic center with a culture-positive FK who were treated with oral posaconazole after failing to respond to conventional treatments. RESULTS All 3 patients had a history of contact lens wear. Two of the 3 cases were culture positive for Fusarium and the other for Paecilomyces. The infections of all 3 failed to respond to conventional antifungal therapies including varying combinations of topical, systemic, and intraocular antifungal therapies. All 3 cases rapidly responded to high-dose oral posaconazole ranging from 500 to 600 mg once daily. In 1 case, multiple courses of high-dose therapy were required to treat delayed recurrences of a latent infection. There were no significant adverse effects with the elevated dose, and treatment was administered with the guidance of an infectious disease specialist. CONCLUSIONS In cases of recalcitrant FK failing to respond to conventional therapies, high-dose posaconazole, in the delayed-release tablet formulation, can be an effective treatment option.

Background: Inflammation of the cornea is known as keratitis. Microbial keratitis is a great challenge for the physicians due to its varied presentation, overlapping symptoms and rapid progression. Though bacterial keratitis is the most prevalent in developing countries but recent increasing trend of fungal keratitis carries a significant risk factors and one of the leading causes of vision loss. Early diagnosis and treatment are the cornerstone for its effective control. Purpose: To determine the outcome and efficacy of treatment with topical natamycin and topical voriconazole in different groups. Materials and Methods: It was a randomised, prospective, comparative, experimental study. The study populations were selected according to inclusion and exclusion criteria after proper evaluation. The study populations were divided into Group A (treated with 1% topical natamycin) and group B (treated 5% topical voriconazole. The patients were followed up subsequently. Data were collected, tabulated in Excel sheet and analyzed in percentage, proportion, t-test and chi square (2) test. The statistically significant was considered if p value

PURPOSE To ascertain the clinicomicrobiological correlation and evaluate the prognostic factors associated with medical resolution in cases of Curvularia, Alternaria, and Scedosporium keratitis. METHODS A retrospective review of clinical and microbiological records of culture-proven cases of Curvularia, Alternaria, and Scedosporium keratitis from 2017 to 2019 was performed. Multivariate logistic regression analyses were performed to assess the predictive factors for medical resolution. RESULTS There were a total of 79 eyes of 79 patients. Among these, there were 56 (70.8%), 15 (18.9%), and 8 (10.1%) patients with Curvularia, Scedosporium, and Alternaria keratitis, respectively. Clinical resolution with medical treatment was achieved in 46 of 56 (82.1%) patients with Curvularia keratitis, 8 of 15 (53.3%) patients with Scedosporium, and 7 of 8 (87.5%) patients with Alternaria keratitis. In comparison between Curvularia and Scedosporium, macroscopic pigmentation [18/56 (32.1%)] of anterior stromal plaque-like infiltrate [20/56 (35.7%)] was clinically more in cases with Curvularia, whereas larger diameter of the infiltrate, P = 0.002, posterior stromal infiltrate (40%), P = 0.03, and hypopyon, P = 0.009, were more common with Scedosporium. Multivariate logistic regression analysis, by backward elimination, showed that maximum dimension of the infiltrate (P = 0.01; odds ratio = 0.52, 95% confidence interval, 0.31-0.86) and presence of a hypopyon (P = 0.02; odds ratio = 0.12, 95% confidence interval, 0.02-0.71) were significant factors that were not favoring medical resolution. CONCLUSIONS Larger size of the infiltrate, posterior stromal involvement, and presence of a hypopyon are poor prognostic indicators among all 3 species. Variation in species is not a predictor of clinical resolution.

Objectives: To study the current practice patterns and opinions in the treatment of corneal bacterial ulcers among Saudi ophthalmologists. Methods: A web-based online survey was conducted in Saudi Arabia to randomly selected ophthalmologists who were registered with Saudi commission for health specialties during the study period between August 2018 to December 2018 using a structured self-administered questionnaire. Results: Of the respondents, general ophthalmologists were 32 (58.2%) and cornea specialists were 23 (41.8%). The mean years of practice was 6.6±6.1 [mean±SD]. Among the respondents 53 (96.4%) treated corneal ulcer cases, most of them 51 (92.7%) agreed there is a relation between the use of contact lenses and ocular ulcers. Fifty respondents indicated that they prescribed antibiotics for the treatment of corneal ulcer. About 12 (52.2%) of the cornea specialist and 22 (68.8%) of general ophthalmologists prefer to use culture of ulcer (Scrapping and gram staining of ulcer) diagnostic tests prior to treatment of corneal ulcers. Fortified antibiotic used was given higher advantage and the management of ocular ulcers differed according to the severity of each case. Conclusion: In conclusion, results found that the management of corneal ulcers varies from specialist to general ophthalmologist. All the respondents agreed that they prescribed two broad spectrum antibiotics to treat an advanced corneal ulcer. Additionally, most of the respondents believed that fourth generation fluoroquinolones were less effective in comparison to fortified, broad-spectrum antibiotics. Key words: Corneal bacterial ulcers, Antibiotics, Fluoroquinolones, Broad spectrum antibiotics, Fortified antibiotics.

Background-Visual impairment due to corneal ulceration has for long been acknowledged as leading cause of blindness both worldwide and in India only next to Cataract. The aetiology for infective corneal ulcer varies considerably with occupation of patients in different regions of India. Thus, continuing with empirical management without lab diagnosis leads to protracted clinical course. So, understanding the microbial profile of corneal ulcers in agriculture dependent population of Southern Assam helps in improved management of this morbidity. Aims- To 1) Find the prevalence of infected corneal ulcers in untreated patients attending Ophthalmology department of a tertiary care hospital of Southern Assam. 2) Study the pattern of microbial aetiology in the infected corneal ulcer cases. 3) Find the association of infected corneal ulcers with various attributing factors. Method-Corneal scrapings from 86 routine untreated cases of corneal ulceration from Ophthalmology Department were studied prospectively from Dec2017 to Jan2019 and subjected to Gram staining and direct examination with 10%KOH. Culture on SDA and Blood Agar were incubated at 25°C and 37°C respectively and followed up for 3 weeks before declaring sterile. Antimicrobial sensitivity was performed for bacterial isolate and yeast-like species. Slide culture and LPCB tease mount were done for identification of moulds. Result- Out of the 86 cases, 58 were positive in direct microscopy, of which 44 were culture positive. Of the 28 samples negative in direct microscopy, 2 were positive by Culture. Bacterial isolates were found in 5 cases and fungal aetiology in 41 cases. Conclusion- The prevalence of infected corneal ulcer as per standard of Culture positivity is 53.5% (46/86). Mycotic involvement was found in 90% cases. Important fungal isolates identified were Aspergillus species, Penicillium species, Curvularia species, Fusarium species, Sarocladium species. Higher prevalence was significantly associated with harvesting season, agricultural practice and history of trauma while diabetes and steroid intake were not significantly associated with mycotic ulcers. Keywords: Corneal ulcer, Assam, Fungal, Fusarium, Sarocladium, Pseudomonas.

Made available in DSpace on 2022-04-28T19:41:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Objective: To evaluate outcomes associated with the use of an angularis oris axial pattern flap (AOAPF) for rostral facial reconstruction in cats. Animals: Nine adult client-owned cats. Study Design: Short case series. Methods: Ten AOAPF were performed in nine cats after resection of a tumor. Wounds were located at the nose, infraorbital, supraorbital, frontal, eye, and ear canal region. Orbital exenteration (n = 3), pinnectomy (n = 2), nasal planum resection, total ear canal ablation (n = 2), and partial eyelid reconstruction (n = 3) were performed. Results: Short-term postoperative complications included flap edema (n = 10), suture dehiscence (n = 3), and distal tip necrosis (n = 3). All wounds resulting from minor complications healed by second intention in 5–15 days. Long-term complications included epiphora (n = 2), frequent grooming around the eyes (n = 2), and enucleation due to corneal ulcer secondary to impaired postoperative eyelid function (n = 1). Tumor recurrence occurred in 3 cases. Conclusion: The AOAPF was a versatile and reliable option for rostral facial reconstruction in cats with acceptable long-term outcomes. School of Veterinary Medicine and Animal Science São Paulo State University Department of Clinical Studies Ontario Veterinary College University of Guelph School of Veterinary Medicine and Animal Science São Paulo State University

Purpose. The representation of the clinical case of corneal ulcer course with unknown etiology in presence of patient's acute toxic and allergic reaction. The patient was under long-term observation of the local ophthalmologist and didn't show positive response to treatment. Material and methods. Patient examination on the date of his encounter sug-gested bacterial etiology of the process. However, the etiological factor wasn't re-vealed by laboratory tests. The presence of toxic and allergic components in biomi-croscopy of both eyes, long-term prestudy antibacterial therapy, character of corneal ulcer gave rise to prescription of the therapy. Results. The main areas of the therapy are allergy medications, antibacterial and antifungal drugs. The positive response in the disease course allowed us to be-lieve that the treatment was accurately prescribed Conclusion. Protracted course of the corneal ulcer without positive response is the subject to estimate the presence of toxic and allergic components. Considering the duration of the disease the antifungal drugs were prescribed at the beginning of the therapy, in spite of the assumption that bacterial etiology of the process may take place. Keywords: corneal ulcer, toxic and allergic reaction.

Purpose The purpose of this study was to assess cryopreserved amniotic membrane (C-AM) versus chorion-free freeze-dried amniotic membrane (FD-AM) overlay transplantation for corneal ulcers in a French tertiary ophthalmology hospital. Methods Between March and July 2020, when C-AMs were not available because of the COVID-19 pandemic, 28 corneal ulcers underwent FD-AM overlay transplantation and were retrospectively compared with 22 corneal ulcers treated with C-AM during the same period in 2018. All patients had at least 3 months of follow-up, and those who underwent combined surgeries were excluded. Ulcers were assessed at baseline and then at 72 hours, 1 month, and 3 months. Population demographics, follow-up time, ulcer etiologies, epithelial defect size, ulcer depth, and complications were also recorded. Results Baseline characteristics and clinical features of both groups were comparable. There was no statistically significant difference in the number of overlay AM transplantations (P = 0.52) or early detachments (P = 0.57). At 3 months, the corneal healing rate was almost the same in both groups (89% and 91% for FD-AM and C-AM, respectively; P = 0.87). Complications were equally uncommon (11% and 9%, respectively; P = 0.92). In logistic regression, the type of the membrane did not influence corneal healing at 1 month (P = 0.42) or 3 months (P = 0.99), regardless of the depth of the ulcer. However, whatever the type of AM used, the deeper the ulcer was, the less likely it was to heal at 3 months (P = 0.02). Conclusions This is the first study that provides positive insight into the effectiveness of FD-AM compared with C-AM when used as overlay transplantation for treating corneal ulcers.

Summary. The neuro-trophic condition of the cornea affects the healing process of corneal defects in patients with keratitis, causing the severity, duration and consequences of the disease. The aim was to identify the features of the dynamics of the II degree of severity bacterial keratitis in patients with diabetes mellitus (DM) at different stages of the severity of diabetic polyneuropathy (DPN). Materials and methods. The results of treatment of 19 patients with bacterial keratitis of the II degree of severity and type 1 DM were analyzed. II degree of severity of bacterial keratitis was determined according to our proposed scheme at a sum of points 15-21. All patients were treated with instillations of the antibiotic ofloxacin, antiseptics, antioxidants, reparants, artificial tears, mydriatics, systemic anti-inflammatory therapy. Patients were divided into two groups according to the severity of DPN: with symptomatic (first group) and stage with impaired DPN (second group). In addition to standard, ophthalmic examination methods included bacteriological examination, fluorescein test, OCT of the anterior segment of the eye, non-contact corneal esthesiometry. Results and discussion. In most patients of the second group, corneal sensitivity and depth of edema of the corneal tissues surrounding the ulcer, the size of the ulcer defect and the depth of corneal infiltration, the degree of pericorneal injection, the depth of the corneal ulcer defect from the 1st, 7th, 10th and 14th days of observation, respectively, were higher than in patients of the first group (p

Purpose:to assess the effect of ultraviolet (UVA) crosslinking of Bioplast plastic material (silicon-dried human cornea) on its biomechanical stability and effectiveness for keratoplasty in corneal ulcers. Material and methods. To determine the maximum rehydration time, 12 Bioplast samples were incubated in physiological solution (NaCl 0.9 %) for 12 hours and monitored for thickness using optical coherence tomography (OCT Spectralis, Heidelberg Engineering). After the epithelium was scarified rehydrated corneas were treated withof 0.1% riboflavin solution for 30 minutes, and after it 8 rehydrated samples (experimental group) were treated with UVA for 30minutes (wavelength 370 nm, power 3 mW/cm2) using a UV-X device system (IROC AG, Switzerland). In the control group (4 rehydrated samples), no UVA crosslinking was performed. The elastic-strength indicators of the experimental and control group samples were assessed by applying uniaxial tension using a deformation machine (Autograph AGS-H, Japan). To examine the patients (presented in clinical examples)before and after keratoplasty with Bioplast subjected to UVA crosslinking, a set of standard ophthalmic tests was used. Results.Rehydration of Bioplast was the most intensive in the first three hours of incubation, during which time tissue thickness increased uniformly by 50–55 μm/hour to 700–710 μm, while further incubation showed no significant additional effect on the fluid content in the cornea. After UVA crosslinking, the strength indices and the elastic modulus of the rehydrated Bioplast samples significantly increased in comparison with the control group. Clinical examples demonstrate the effectiveness of modified Bioplast for organ-preserving penetrating keratoplasty in case of perforatedcorneal ulcer. Conclusion. UVA crosslinking of rehydrated Bioplast increases its biomechanical stability. The data of laboratory studies and the first clinical tests demonstrate that modified Bioplast may be an effective replacement of native donor cornea in urgent keratoplasty of perforated ulcers.

Corneal infections are one of the leading causes of ocular morbidity and blindness world-wide. If normal defence mechanisms of the eye are compromised, almost any microorganism can invade the cornea. It is important to know the exact aetiology of corneal ulcer to institute appropriate therapy in time, least serious consequences may follow. To isolate and identify the fungi from corneal scrapings of suspected keratitis patients. A prospective study of Fungal keratitis was conducted at Al-Azhar Medical College & Super Speciality Hospital in Thodupuzha, Kerala a tertiary care hospital with a capacity of 650 beds. The duration of the study was two years from January 2018 to January 2020. Patients with suspected fungal corneal ulcers presenting in the Out-Patient Department (OPD) of Ophthalmology were investigated for fungal etiology in the Department of Microbiology were included in this study. Each patient was examined with slit lamp. Data collected from history given by patient and patient examination. Using standard techniques. The specimens collected were then smeared on two slides, which were stained with Gram stain (for bacterial keratitis) and 10% potassium hydroxide preparation (for fungal keratitis) studied under light microscope.Of the 866 patients with corneal ulcer investigated, 83 cases with fungal and 36 with bacterial aetiology was identified. Males were more commonly affected and were mostly in the age group of 31-40 year. It was seen that trauma was the most common predisposing factor especially in the agriculturists and the farmers. Among the identified fungi, most were hyaline. Of the 83 positive specimens, the most frequent agent isolated was Fusarium species in 31 (37.3%) cases. 23 (27.7%) was the second most common followed by , ., . Candida albicans were 5 (6%) followed by 1 (1.2%).Fungal Keratitis is a serious problem usually following corneal trauma, it requires rapid detection and identification of fugal agents for treatment to prevent disastrous consequences.

Aim: To assess and compare clinico-microbiological efficacy of Moxifloxacin (0.5%) plus Vancomycin (2.5%) combined therapy to Fortified Vancomycin (5%) in bacterial keratitis. Materials and Methods: The present study was conducted on patients who visited eye OPD, J.N.M.C.H and Gandhi Eye Hospital, Aligarh. Patients with bacterial keratitis were diagnosed and included in the study. Right eyes were instilled moxifloxacin plus vancomycin combination therapy and Left eyes were instilled fortified vancomycin. Microbiological results were recorded on first visit and on follow up visits during course of treatment. Results: Total of 32 patients were included in the study. At first visit, only 8 cases were positive for bacterial culture with coagulase negative Staphylococcus (CoNS) being the most common organisms. All the smears became negative in first follow-up (7th day) in both the groups. No significant difference were found in clinical and microbiological study outcome betweenthe two-study groups. Conclusions: We conclude that both the drugs, i.e. moxifloxacin (0.5%) plus vancomycin (2.5%) combined therapy and fortified vancomycin (5%) had good efficiency clinically and in microbial elimination in cases of bacterial keratitis with equivalent outcome. Keywords: Keratitis, Corneal ulcer, Bacterial keratitis, Efficacy.

Aim: To evaluate the clinical efficacy of a selective, partial, pedicle conjunctival flap in the treatment of deep corneal ulcers with or without perforation, resistant to medical treatment. Method: This interventional self-controlled retrospective study included 31 eyes of 31 patients with deep corneal ulcers who underwent conjunctival flap surgery in a tertiary eye care unit between 2017 and 2019. Of these, 9 eyes exhibited corneal perforation. The follow-up period was 12 months. The primary outcome measures were restoring ocular surface integrity and secondary outcome measures were improvement in visual acuity and postoperative complications encountered. Results: Out of the total of 31 patients, 17 patients (55%) were males and 14 patients (45%) were females. The mean age was 56.03 ± 15.46 years. The mean disease duration was 64.10 ± 35.01 days, the mean diameter of the ulcer was 3.61 ± 1.02 mm and the mean depth of the ulcer was 70.65 ± 20.28% of the thickness of the cornea. The etiology was extensive and the corneal ulcers were categorized as infectious (12), noninfectious (16), and unknown (3). An anatomic cure was obtained in 29 (94%) of 31 eyes. Conjunctival flap surgery was unsuccessful in 2 eyes that required evisceration. The postoperative visual acuity (BCVA) improved in 13 (42%) of the 31 eyes, decreased in 9 eyes (29%) and remained unchanged in 9 eyes (29%). The most frequent complications after conjunctival flap surgery were pseudopterygium, cataract and corneal opacity and less frequent complications were glaucoma, astigmatism, flap retraction, corneal perforation and endophthalmitis. Conclusions: Conjunctival flap surgery can successfully treat refractory deep corneal ulcers. It can restore ocular surface integrity and provide metabolic and mechanical support for corneal healing. Also, it can avoid emergency penetrating keratoplasty or create appropriate conditions for a future optic keratoplasty.

Background: Keratitis is a potentially serious corneal infection and a major cause of visual impairment worldwide. Most common form of which is infectious variety; pathogens may be bacteria, viruses, fungi and parasites which varies with age and predisposing factors. Topical antimicrobials and cycloplegic agents are the mainstay of treatment. Pattern of causative organisms and drug sensitivity changes from time to time and differs from one to another geographic location. Objective: To assess and evaluate the pattern of diagnosed patient of keratitis presented in a tertiary hospital. Material and methods: This cross-sectional study was conducted on 500 diagnosed patients of keratitis in the department of cornea of National Institute of Ophthalmology & Hospital, a well-known tertiary care hospital with 500 beds for a period of 6 months. Patients were selected based on specific selection criteria. Detail history was taken, and thorough ocular examination was done in every patient. Corneal scrapings were taken for Gram’s stain and 10% potassium hydroxide wet mount preparation. All the relevant data was recorded in a predesigned data collection sheet. Results: The mean age of the study subjects was 38.49 years. Male (43.2%) and female (56.8%) ratio was almost equal. The prevalence was highest among lower economic class (56.8%) as usual, and lowest among affluent class (3.8%) but not sparing them. In terms of regional distribution, majority (42.6%) of the patients came from rural area, whereas 37% from urban non-slum area and 20.8% from urban slum area. The problem was mostly observed among day-laborers (24.8%) with gradually declining trend among students (20.6%), housewives (20%), service holders (14.2%), businessmen (3.2%) and unemployed (2.2%), surprisingly! Presentation of the cases were mostly in between 2nd-3rdweek (55%), while 30% patients were presented within 1st week & 15% after 4 weeks of diagnosis. Among the cases, it was found that 28.8% patients had corneal injury, which were caused by vegetative trauma in 16% cases, 4% dust or sand trauma, 2.8% animal injury, 2.2% stick injury, 1% nail injury and 2.8% patients had history of other injury like stone, wooden materials, flying insects, dirty wire etc. Ocular diseases predispose to corneal ulcer were present in 9% patients. These were chronic dacriocistitis, entropion and trichiasis. 1.2% patients were diabetic, and 1% patients had history of inadvertent use of steroids. On the contrary, there were no specific predisposing factors in 71.2% cases. Among the cases, 96.6% experienced photophobia, 90% had foreign body sensation, 88.4% had reduced vision, 85.4% had eye pain, 78.8% suffered from watering, 73.6% had discharge, 48.8% had burning sensation, 12.2% had decreased corneal sensation and 11.2% patients noticed white spot in cornea in first stage. Slit lamp bio-microscopic examination of the patients shows 90% patients had conjunctival injection, 70% had epithelial defect, 28.6% patients had stromal infiltration, 18.4% patients had hypopyon, 14% patients had feathery pattern, 8.8% patients had suppuration, anterior chamber reaction was present in 4.4% cases and 2.2% patients had satellite lesion. The evaluation of etiology on the basis of clinical appearance reveals 61.4% of cases were presented with viral keratitis, 23.0% fungal corneal ulcer, 11.4% with bacterial corneal ulcer, 2.2% with marginal keratitis, 0.8% with exposure keratitis, 0.8% with filamentary keratitis and 0.4% cases with Acanthamoebic keratitis at the time of presentation. While assessing the depth of keratitis of the study subjects, 73.2% found superficial while 26.8% found deep. Assessment of area of corneal involvement in terms of punctate epithelial defect showed that in 46.8 % cases less than 3mm of cornea was involved, 3 to 6 mm of the cornea involved in 19.6 % cases and in 11.8 % corneal involvement was found in more than 6 mm area. Corneal scraping done in 118 (23.6%) out of 500 patients. Among them, Fungi were found in 11.2% cases, mixed organism in 4%, Bacteria in 5.6% and Acanthamoeba found in o.4% cases while 2.4% remains unidentified. Conclusion: Analysis of the study findings shows diversity in the pattern, presentation, predisposing factors of different form of keratitis which may be helpful as basis of further study on this problem.

Objectives To report the surgical technique and postoperative outcome of corneal repair with autologous buccal mucous membrane grafts in dogs and cats with descemetoceles, deep corneal ulcers, and perforated corneal ulcers with or without iris prolapse. Animal studied Twelve cats (13 eyes) and fourteen dogs (14 eyes) were treated. Procedures Grafts were harvested from the unpigmented superior labial mucosa using a biopsy punch. The corneal lesion was carefully debrided and cleaned. The graft was secured to the healthy cornea with a combination of simple interrupted and continuous 9-0 polyglycolic acid sutures. In 25/27 treated eyes, an overlying pedicle conjunctival graft was also performed. A temporary nictitating membrane flap was used in all cases. The pedicle conjunctival graft was trimmed about 10-20 days postoperatively. The median follow-up period was 549.2 days (range 14-2691 days). Results No surgical intra-operative complications were observed. The ulcers healed and the integrity of the globe was restored in 24/27 treated eyes. Different grades of corneal fibrosis and/or vascularization and/or pigmentation were observed in all cases at the long-term follow-up. In two cases, enucleation was performed due to postoperative complications and one animal developed phthisis bulbi. A total of 22/27 treated eyes appeared to have regained effective visual function at the last clinical evaluation. Conclusions Autologous buccal mucous membrane grafts appear to successfully manage severe corneal ulcers in dogs and cats, providing a useful and economical alternative to other corneal grafts.

Introduction: Collagen cross-linking (CXL) is a well-established treatment for the management of keratoconus. Considering corneal stiffening and antimicrobial effects of CXL, this procedure has bee...

We report an atypical presentation of Beauveria bassiana keratitis which unusually presented in a 85-year-old patient with a corneal ulcer with an anterior segment inflammation and hypopyon. Despite negative culture and unspecific results from panfungal PCR-based sequencing, the patient was treated for a presumed fungal infection. Following clinical deterioration an emergency surgical intervention with apposition of a corneal patch was performed. Infection resolution was achieved following the introduction of systemic voriconazole to the topical one.

Purpose To report 7 patients (14 eyes) with bilateral Pseudomonas aeruginosa keratitis (PAK). Methods Case records of patients with bilateral PAK were reviewed at a single academic medical center from April 2009 to December 2020. Results Seven patients aged 29 to 94 years presented with bilateral P. aeruginosa corneal ulcers. All patients were soft contact lens wearers except one elderly patient with a complex ocular history. Three patients wore specialty contact lens, including one cosmetic contact lens wearer, one multifocal contact lens wearer, and one extended-wear contact lens wearer. The remaining three patients were not overnight contact lens wearer but regularly showered in contact lens or used tap water for contact lens case cleaning. All patients presented with asymmetric disease, with visual acuity ranging from 20/20 to light perception. Ulcers were located centrally in 5 eyes (35.7%), diffusely over the entire cornea in 5 eyes (35.7%), temporally in 2 eyes (14.2%), and nasally in 1 eye (7.14%), and in 1 eye (8.3%), the ulcer location was not recorded. Corneal thinning was noted in 7 eyes (50%). Hypopyon was also noted in 7 eyes (50%). Two patients required procedures because of progressive stromal necrosis. All other patients were treated nonsurgically, with antibiotic drops, which resulted in ulcer resolution. Final visual acuity on last recorded follow-up ranged from 20/20 to no light perception. Conclusions This is the largest case series of bilateral PAK, which occurred primarily in contact lens wearer. This case series reiterates the risk of contact lens infection related to poor hygiene.

Aim: To study the microbiological and epidemiological profile of patients with suppurative corneal ulcer presenting in a rural referral center situated in a Sub-Himalayan territory of north India. The study was conducted to evaluate the epidemiology and frequency of mycotic keratitis among the patients of suppurative corneal ulcer and to identify various fungal species as etiological agents. Methods: Corneal scrapings from 56 patients of suppurative corneal ulcers were subjected to direct microscopy and culture. Results: Of the 56 cases of suppurative corneal ulcer investigated, fungal etiology was identified in 18 (32%) cases. Most of the patients (82.1%) worked in agriculture. Trivial trauma with vegetative matter was the most common predisposing factor. Fusarium and Acremonium species were the most common fungi isolated, followed by Aspergillus. Four cases of rare mycotic keratitis caused by Paecilomyces lilacinus, Scedosporium apiospermum, Monilia sitophila, and Ulocladium species were detected. Four cases were smear positive (10% KOH wet mount) but culture negative. Analysis of KOH wet mount was done using culture as gold standard. The sensitivity and specificity of KOH wet mount was 71.43% and 90.48%, respectively. Conclusion: Direct microscopy and culture has a greater diagnostic value in the management of suppurative corneal ulcer. The authors have observed changes in the pattern of organisms identified as cause of fungal keratitis in the region. Rare species of fungi may also be detected if corneal scrapings are collected for direct microscopy and culture from all the cases of suppurative corneal ulcers greater than 2 mm.

Objectives To identify bacterial microorganisms associated with canine keratomalacia, review their antimicrobial sensitivity, and evaluate clinical outcomes compared to results of microbial culture. Methods Retrospective analysis of clinical records of dogs diagnosed with a melting corneal ulcer presented to a referral hospital in Hertfordshire, UK between 2014 and 2018. Results One hundred and ten melting corneal ulcers were sampled in 106 dogs. The most common pure bacterial isolate was Pseudomonas aeruginosa (n = 26) followed by β-hemolytic Streptococcus (n = 12). Melting corneal ulcers that cultured coagulase-positive Staphylococcus, coliform bacteria, Pasteurella multocida, Enterococcus, and Streptococcus viridans presented in smaller numbers and were analyzed together (n = 16). Multiple cultures were identified in nine cases (n = 9). Forty-seven cultures yielded no bacterial growth (n = 47). The susceptibility to fluoroquinolones remained high with the exception of β-hemolytic Streptococci. There was no significant difference in the ulcer severity at presentation in regard to the cultured bacteria. Overall, 63 eyes (57%) received surgical grafting in addition to medical treatment. In 14 cases (13%), the progression of corneal melting despite medical ± surgical treatment resulted in enucleation. Fifty-seven percent (8/14) of the enucleated eyes cultured pure Pseudomonas aeruginosa isolates. In contrast, all β-hemolytic Streptococcus-associated ulcers healed. Conclusions The most common bacterial species associated with canine keratomalacia were Pseudomonas aeruginosa and β-hemolytic Streptococcus. Because of the variation in antibacterial sensitivity between these two species, bacterial culture and sensitivity testing should be performed in all dogs presenting with keratomalacia. Melting corneal ulcers associated with pure Pseudomonas infection were significantly more likely to result in globe loss than melting corneal ulcers associated with other cultures.

Corneal ulcer is considered one of the most common ocular surface diseases, it may lead to blepharospasm, photophobia, lacrimation, conjunctival hyperemia, and corneal oedema. Conventional treatments are sometimes not effective in solving the pathological condition therefore blood derivatives which are rich in growth factors were used to accelerate wound healing as well as its ability to induce regeneration of affected tissues. Blood derivatives include autologous serum (AS), eye drops platelets rich plasma (E-PRP). A 6 mm induced corneal wound were performed at the center of the cornea at one eye at a 240 M depth in 20 mongrel dogs. Dogs divided into three groups, E-PRP group (8 dogs) and AS group (8 dogs) and a control group (4 dogs) received normal saline eye drops. All dogs were received 4-time treatment per day until negative fluorescein stain test is obtained. Histological study was performed for 3 dogs (one from each group) two months from the beginning of the experiment. Clinically the E-PRP group showed faster healing time with a significant difference (3.62±0.23 day) from AS group (4.75±0.25 day) and control group (6.75±0.30 day). Histologically, E-PRP group showed more arrangement of the epithelial layers compared with AS group and control group. Aim of our study: to compare the efficacy of AS and E-PRP in the healing of induced corneal wound in dogs. In conclusion, E-PRP and AS showed a significant faster epithelial healing from control group. As well as E-PRP showed also a significant improvement over AS in heling time and quality of regenerated epithelial tissue.

Granulomatosis with polyangiitis (GPA) is a granulomatous-necrotic systemic vasculitis with a lesion of predominantly the upper and lower respiratory tracts at the onset of the disease (vasculitis, accompanied by granulomatous inflammation), and subsequently renal (glomerulonephritis). In addition, GPA may manifest as inflammation of small arteries and veins. Despite many years of study of this disease, the etiology of GPA remains unknown. The present case is about a 47-year-old female, who had been suffering from necrotizing scleritis, corneal ulcer, and secondary glaucoma in both eyes for 3 months, and she was treated with anti-inflammatory and antimicrobial therapy that showed no effect; the patient’s general condition became worse. In the second week of treatment, multiple abscess ruptures exposed the sclera. Sampling of the affected conjunctival tissue and positive HLA B8 haplotype and ANCA (PR3-ANCA) testings make it clear that GPA was the main reason of necrotizing scleritis with inflammation. The targeted treatment of the underlying disease allows to stabilize an inflammation of corneal and scleral lesions.

We describe the case of Gefitinib-related bilateral corneal perforation. An 86-year-old female patient had bilateral painless and progressive vision loss due to neurotrophic corneal ulcer, following a 2-month treatment with Gefitinib, a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor for metastatic adenocarcinoma of the lung with confirmed EGFR gene mutation. She had no signs of ocular infection, inflammation, or lid problems to account for the development of corneal damage. Neurotrophic ulcer evolved into a frank perforation in one eye and an impending perforation on the other eye. EGFR inhibitors have been associated with dry eye, epithelial erosions, ulcerative keratitis, and corneal edema. However, to the best of our knowledge, this is the first case of bilateral severe corneal ulcer due to Gefitinib. The patient went on to have bilateral corneal graft surgery. This case aims to raise awareness among ophthalmologists and oncologists of the association between EGFR inhibitors, corneal neurotrophic ulcers, and possible evolution in corneal perforation.

Several studies demonstrate the effectiveness of eye drops Platelet Rich Plasma (E-PRP) as a promoter of the healing of different ophthalmological disorders in human, due to the high concentration of growth factors as EGF, PDGF-BB and Fibronectin which represent the key to obtain the desired regenerative effects on the ocular surface. There is different protocol for PRP eye drops preparation for use in human corneal disorders. This study was to evaluate an easy and affordable technique for preparation of canine autologous E-PRP according to standard measure used before for human corneal disorders to be used in canine corneal ulcers in comparison with control group, all treatments were applied four times daily. Twelve healthy dogs were divided into two groups first group included eight dogs which received autologous E-PRP compared with second group which included four dogs and received saline eye drops as control. Complete blood count is performed to whole blood and E-PRP to validate last one content of platelets which must equal more 1.5 those in whole blood. E-PRP contain platelets 2.41-fold than those in whole blood with one step centrifugation technique. Autologous canine E-PRP mean healing time was 3.62±0.23 days while with control group mean healing time was 6.75±0.30 days. In conclusion, As the E-PRP is now widely documented in human ophthalmology, it had been proven as a great result in veterinary practice when prepare autologous E-PRP by single step centrifugation to be used for canine corneal wound and healing rate was better than control group by significant difference. which make it novel option for treatment for canine corneal ulcer.

BACKGROUND There is no in vivo evidence for the effectiveness of adjuvant intrastromal and combination of intrastromal and intracameral voriconazole (VCZ) for treating Aspergillus fumigatus keratitis. This study aimed to compare the efficacy of both agents against it. METHODS A randomized, masked, controlled experimental study was conducted on 11 albino New Zealand white rabbits in which moderate fungal keratitis was induced by inoculating spores of A. fumigatus to the cornea. The rabbits were allocated into 3 groups: 50 μg/0.1 ml intrastromal VCZ injection, 50 μg/0.1 ml intrastromal VCZ and intracameral VCZ injections, and topical VCZ (control). The treatment was given 5 days after inoculation. Epithelial defect, infiltrate size, corneal ulcer depth, and hypopyon were evaluated clinically. Histopathological and mycological examinations were also done 14 days after treatment. RESULTS All rabbits in the adjuvant treatment groups demonstrated a tendency of a better clinical response with decreasing size of epithelial defect (p = 0.679) and infiltrate (p = 0.755) than in the control group. Direct microscopy, corneal culture, and chop corneal tissue culture were still positive in most of the rabbits from all groups. Histopathological examination showed an increase of inflammatory cells after treatment in all groups, especially in rabbits which were inoculated with A. fumigatus spores in both eyes. CONCLUSIONS An adjuvant combination of intrastromal and intracameral VCZ showed a tendency of better clinical response for A. fumigatus-induced moderate fungal keratitis in rabbits.

Streptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.

Fungal keratitis is a sight threatening condition which is widespread in tropical and subtropical countries. This study aimed to evaluate the efficacy of a combination of topical and intracameral injections of amphotericin B in the treatment of severe fungal keratitis. Patients and methods. This prospective, comparative study included 40 patients of culture proved fungal keratitis recruited from outpatient clinic of Mansoura ophthalmic center, faculty of medicine Mansoura University, Egypt, in the period from January 2017 to December 2018. Pregnant and lactating women, Children < 12 years of age, One-eyed patients, Patients with concurrent sclera involvement and Patients with impending perforations, elevated intraocular pressure were excluded from the study. The patients were randomly divided into 2 groups: Group A: underwent only topical amphotericin B. Group B: underwent combined topical & intracameral injection of antimicrobials. Patients were followed up at 1 day, 1 week, weekly till the end of the first month after injection then every 2 weeks for another month after then monthly till the 6th month. Results. Both groups were sex and age matched. Trauma was the most common risk factor recorded. Aspergillus was the commonest causative agent (85%) in group A, the size of corneal ulcer improved from 32.44 ± 19.37 to 29.71 ± 17.16 at 1st week to 18.81 ± 10.04 in the 1st month, in group B the ulcer size decreased from 30.24 ± 16.09 to 21.81 ± 11.04 (p

Purpose. To study the microbiological profile of corneal ulcers depending on demographic and clinical characteristics of patients.Materials and methods. 97 patients (114 eyes) (65 men and 32 women) diagnosed with corneal ulcer were tested. 80 patients had unilateral and 17 bilateral ulcers. The patients’ age varied from 15 to 87 years (24.7 % aged 50–59, 27.8 % aged 60–69, and 19.7 % aged 70 or older). All patients were examined for the microbiological profile of corneal scrapings to determine the microbial flora of the corneal ulcer. The significance of gender, age and clinical differences found in the structure of the microbiological profile was evaluated by the the χ² criterion.Results. Gram-positive microorganisms were among the most frequently detected: Staphylococcus epidermidis in 25.3 % of cases, Streptococcus pneumoniae in 21.7 % of cases, Streptococcus viridians in 16.3 % of cases, and Staphylococcus aureus in 7,8 % of cases. Gram-negative microbial flora (Pseudomonas aeruginosa) was revealed in 22.3 % of cases, while fungi were identified in 6.6 % of cases.Conclusion. The microbiological profile of corneal ulcer depends on the patient’s age, localization, size and depth of the lesion, as well as the presence of complication. Severe and complicated forms of corneal ulcer (sized ˃5 mm, depth of the lesion exceeding two thirds of corneal thickness) are often associated with the detection of more than one type of microorganism.

BACKGROUND Significant causes of corneal blindness worldwide are ocular trauma and corneal ulceration that are often under reported. They may be responsible for 1.5 - 2.0 million new cases of monocular blindness every year. Corneal ulceration in developing countries has only recently been recognised as a silent epidemic. Infectious keratitis is one of the leading causes of blindness but in most cases these infections represent preventable or treatable ophthalmic diseases. Important predisposing factors related to corneal ulcers are trauma, chronic ocular surface disease, contact lens usage, ocular surgery, corneal anaesthetics abuse, diabetes mellitus, vitamin deficiency and immuno-deficiencies. This work is proposed to study the prevalence, clinical and lab diagnosis and management of suppurative corneal ulcer. We wanted to study the socio-demographic profile, microbiological investigation and treatment outcome of patients with corneal ulcer. METHODS This is a prospective study conducted among patients presenting with corneal ulcer at a tertiary level Government Medical College, Ajmer, Rajasthan. RESULTS Trauma comes out as a major predisposing factor for the development of corneal ulcer. 18.1 % of the study subjects had bacterial corneal ulcer and 37.7 % had fungal ulcer. More than half of the patients showed good prognosis on follow up. There was good response in most of patients, 51.2 % improved in first week which increased to 57.4 % at the time of second follow up. The most common bacterial species responsible for corneal ulcer was found to be staphylococcus followed by pseudomonas. CONCLUSIONS Bacteria and fungi are a frequent cause of ulcerative keratitis. Microbiological work up is an essential tool in the diagnosis of these infections which should not be under-rated. Timely administration of species-specific treatment certainly results in early resolution of keratitis followed by satisfactory visual outcome. Late or inappropriate treatment worsens the condition resulting in corneal perforation and increased morbidity. KEYWORDS Prospective, Corneal Ulcer, Bacterial, Fungal, Infectious

Myotonic dystrophy is a systemic disorder associated with progressive muscle weakness of the extremities and multi-organ dysfunction. This condition commonly affects the levator palpebrae superioris muscle, which leads to ptosis and eventually affects patients' activities of daily living. The effects of ptosis on activities of daily living are usually overlooked; therefore, the importance of treatment is underestimated, and surgical procedures are considered infeasible in patients with pre-existent levator palpebrae superioris muscle weakness. This case report describes the case of a middle-aged man with myotonic dystrophy type 1, who presented with ptosis, which significantly restricted his participation in rehabilitation and activities of daily living secondary to a limited visual field. He was evaluated by an ophthalmologist; however, surgery was contraindicated in view of the high risk of complications, such as exposure keratitis and corneal ulcer. Double eyelid tapes were used as a non-surgical intervention, which significantly increased the palpebral fissure height and improved the visual field, with a higher modified functional index score. Double eyelid tapes may serve as an effective, safe, and reliable therapeutic option for severe ptosis in patients with myotonic dystrophy.

Background: Ascorbic acid has been suggested to be effective against chemical burns. It was first tested in rabbits before being implemented in human subjects. It was proven to be useful in treatments for different conditions, such as corneal chemical and thermal burns. Herein, we aimed to review the effects of ascorbic acid in the healing of chemical and thermal corneal burns. Methods: We performed an electronic search of English literature in MEDLINE, clinicaltrials.gov, and Google Scholar, without time constraints. Articles were selected based on inclusion and exclusion criteria, using they keywords “Corneal Burn,” AND “Corneal Ulcer,” AND “Vitamin C.” This yielded 17 English language articles focused on the effect of vitamin C on chemical or thermal corneal burn-induced ulcers. Results: The 17 eligible studies that fulfilled the inclusion criteria included three retrospective, nonrandomized, comparative studies on human subjects and 14 in vivo, laboratory-based studies on rabbits (12 studies), rats (one study), as well as guinea-pigs (one study). Most studies showed benefits in using vitamin C as a prophylactic treatment to delay or stop corneal ulcer formation after chemical or thermal corneal burn. Conclusions: Vitamin C is a very basic, inexpensive prescription and can be used to treat corneal ulcers following a variety of corneal burns. This review highlights the necessity for conducting randomized controlled trials to investigate the prophylactic role of vitamin C and to determine its minimum required dose for the management of corneal ulcers after different types of corneal burns.

Clinical relevance: Keratitis is common and studies of blindness throughout the world have found that corneal disease is the second most common cause of blindness.Background: Microbial keratitis a ...

Corneal ulcer is a severe pathology of the anterior segment of the eye, the outcome of which can be the loss of the eye as an organ, the formation of gross corneal opacity and irreversible vision loss. Currently, there is evidence of the successful use of preformed physical factors in the treatment of patients with corneal ulcers. The article presents information about the effectiveness of magnetic therapy, pulsed electrotherapy, ultrasound and laser therapy, hyperbaric oxygenation and a number of other physiotherapy methods in this pathology. Standard pathogenetic therapy is an integral part of the treatment process of corneal ulcers, but the use of physiotherapy techniques in addition to standard therapy allows you to achieve a better clinical effect, which makes it possible to consider the actual problem of medical rehabilitation of patients with corneal ulcers.