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Background: Peripheral ulcerative keratitis (PUK) is a group of inflammatory corneal ulcers with stromal thinning and peripheral localization. Amniotic membranes (AM) are used for their anti-inflammatory and healing properties. A freeze-drying process now allows maintaining the AM viable for a long time at room temperature without altering its physical, biological, and morphologic characteristics. The effectiveness of spongy freeze-dried amniotic membrane (FD-AM) graft with multimodal imaging in the management of severe corneal thinning PUK has not been reported. Case presentation: A 67-year-old Caribbean man histologically diagnosed with ulcerative colitis, was referred to our tertiary eye care center for a deep nasal juxtalimbal ulcer of the left eye. He was treated with topical steroids and antibiotics, methylprednisolone pulses, and oral prednisone. Due to continuous stromal thinning with 100 μm of residual corneal thickness, the decision was made to perform surgery. Conjunctival resection, inlay and overlay spongy FD-AM (Visio Amtrix® S, Tissue Bank of France, FR) were performed to preserve globe integrity. Despite tapering off oral steroids, PUK developed in the fellow eye on the 2 months follow-up. Treatment with human monoclonal antibody against tumor necrosis factor-alpha was initiated to control the active underlying inflammation. Six months following surgery, the ulcer was healed and corneal thickness in front of the former ulceration was measured at 525 μm on anterior segment-optical coherence tomography. Confocal microscopy confirmed the integration of the amniotic membrane between the corneal epithelium and the anterior stroma. Conclusion: Transplantation of FD-AM with a spongy layer was associated with restoration of normal corneal thickness in the PUK area. It seems to be a safe, effective, and easily accessible solution for the surgical management of PUK with impending perforation. [ABSTRACT FROM AUTHOR]

Background/objectives: Post-keratoplasty infectious keratitis (PKIK) is a unique sight-threatening clinical entity which often poses significant therapeutic challenges. This study aimed to examine the clinical presentation, risk factors, management, and clinical outcomes of PKIK. Methods: This was a retrospective study of all patientswho presented to the Queen's Medical Centre, Nottingham, with PKIK between September 2015 and August 2022 (a 7-year period). Relevant data on types of keratoplasty, clinical presentations, causative microorganisms, management, and outcome were analyzed. Results: Forty-nine PKIK cases, including four cases of interface infectious keratitis, were identified during the study period. The most common graft indications for PKP, DALK and EK were failed grafts (9, 37.5%), keratoconus (6, 54.5%) and Fuchs endothelial corneal dystrophy (FECD; 8, 57.1%), respectively. Staphylococcus spp. were the most commonly identified organisms (15, 50.0%). Bullous keratopathy (18, 36.7%), ocular surface disease (18, 36.7%), and broken/loose sutures (15, 30.6%) were the most common risk factors. Concurrent use of topical steroids was identified in 25 (51.0%) cases. Of 31 functioning grafts at presentation, 12 (38.7%) grafts failed at final follow-up with 15 (48.4%) patients retaining a CDVA of =1.0 logMAR. The overall estimated 5-year survival rate post-PKIK was 55.9% (95% CI, 35.9%-75.9%), with DALK having the highest survival rate [63.6% (95% CI, 28.9%-98.3%)], followed by EK [57.1% (95% CI, 20.4%-93.8%)] and PKP [52.7% (95% CI, 25.1%-80.3%)], though no statistical difference was observed (p=0.48). Conclusions: PKIK represents an important cause of IK and graft failure. Bullous keratopathy, OSD and suture-related complications are the commonest risk factors, highlighting the potential benefit of prophylactic topical antibiotics (for unhealthy ocular surface) and early suture removal (where possible) in reducing the risk of PKIK. Graft survival may be higher in lamellar keratoplasty following PKIK but larger studies are required to elucidate this observation. [ABSTRACT FROM AUTHOR]

Next generation sequencing (NGS) studies in healthy equine eyes have shown a more diverse ocular surface microbiota compared to culture-based techniques. This study aimed to compare the bacterial ocular surface microbiota in both eyes of horses with unilateral ulcerative keratitis (UK) with controls free of ocular disease. Conjunctival swabs were obtained from both ulcerated eyes and unaffected eyes of 15 client-owned horses with unilateral UK following informed consent, as well as from one eye of 15 healthy horses. Genomic DNA was extracted from the swabs and sequenced on an Illumina platform using primers that target the V4 region of bacterial 16S rRNA. Data were analyzed using Quantitative Insights Into Molecular Ecology (QIIME2). The ocular surface of ulcerated eyes had significantly decreased species richness compared with unaffected fellow eyes (Chao1 q = 0.045, Observed ASVs p = 0.045) with no differences in evenness of species (Shannon q = 0.135). Bacterial community structure was significantly different between either eye of horses with UK and controls (unweighted UniFrac: control vs. unaffected, p = 0.03; control vs. ulcerated, p = 0.003; unaffected vs. ulcerated, p = 0.016). Relative abundance of the gram-positive taxonomic class, Bacilli, was significantly increased in ulcerated eyes compared with controls (q = 0.004). Relative abundance of the taxonomic family Staphylococcaceae was significantly increased in ulcerated and unaffected eyes compared with controls (q = 0.030). The results suggest the occurrence of dysbiosis in infected eyes and reveal alterations in beta diversity and taxa of unaffected fellow eyes. Further investigations are necessary to better understand the role of the microbiome in the pathophysiology of ocular surface disease. [ABSTRACT FROM AUTHOR]

Objective: To describe a protocol for corneal ulcer monitoring utilizing daily fluorescein staining and evaluation of owner‐acquired anterior segment images. Animal studied: Nine client‐owned small animal patients (eight dogs, one cat) diagnosed with superficial corneal ulcers at the University of Georgia Veterinary Capitalize Hospital. Procedure(s): In addition to routine ulcer therapy, patients were discharged with supplies to perform daily fluorescein staining including a Quikvue® cobalt blue light camera adapter. Fluorescein staining was performed daily, photographs and/or videos were acquired at home by the patient's owner(s), and images were analyzed daily by trained personnel. In‐house examinations were performed weekly and within 24 h after the ulcer had appeared healed on photographs. Results: All (9/9) owners were able to take interpretable photographs. The majority (6/9) of patients had images successfully detailing their ulcer healing progress. One (1/9) patient appeared healed on images, but on subsequent examination had persistent ulceration covered by third eyelid elevation. Two (2/9) patients had persistent ulceration, consistent on both images and examination, but exited the study prematurely prior to ulcer healing. Conclusions: Remote fluorescein staining and image evaluation can be considered as an adjunct for monitoring ulcer healing but should not be used alone or as a substitute for ophthalmic examinations. Ulcers under the third eyelid have potential to be missed on image evaluation alone. [ABSTRACT FROM AUTHOR]

Introduction: The use of contact lenses has progressively increased around the world, thereby increasing the risk of complications. The most serious complication is microbial keratitis (corneal infection) that can progress to a corneal ulcer. Methods: Fourteen multipurpose contact lens solutions were tested on mature biofilms comprising Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens and Candida albicans, using the minimum disinfection times recommended by the manufacturers. The biofilm was induced in the lens case, and 24 h later, the solutions were added. Activity against planktonic and sessile cells was evaluated and quantified as colony forming units per millilitre. The minimum concentration for biofilm eradication was defined as a 99.9% reduction in viable cells. Results: Although most solutions exhibited activity against planktonic cells, only five of the 14 solutions produced a significant reduction in the S. marcescens biofilm. No solution achieved the minimal biofilm eradication of S. aureus, P. aeruginosa and C. albicans. Conclusion: Multipurpose contact lens solutions provide greater bactericidal and/or fungicidal activity on planktonic cells than biofilms. The minimal eradication biofilm concentration was only achieved for S. marcescens. [ABSTRACT FROM AUTHOR]

Purpose: To study the clinical outcomes, time span of healing of various ocular surface disorders with amniotic membrane graft. Methods: A total of 41 patients, presenting to cornea clinic were included in the study and divided into five groups depending on the type of diagnosis: Group 1, with either >2 weeks of Persistent epithelial defect following cataract/retinal/glaucoma surgeries or Shield ulcers, Group 2 with >4 weeks of Non healing corneal ulcers, Group 3 with chemical injuries, Group 4 with Epithelial defects following keratoplasty, and Group 5 is the miscellaneous group. Results: The mean age of the study subjects was 50.0 years. Overall mean duration between clinical presentation and AMT was 23.59 (30.7) days, a median 16 days (IQR; 2 26 days). Failure rate was high in Group 5 (n = 3: 30.0%) and Group 2 (n = 3: 27.3%). Time taken for epithelial closure was slower in groups 1 and 5 patients. The average time taken for reabsorption of AMG was 14.98 days. The complications included repeat AMG was in four eyes (9.75%), and graft displacement was noted in four eyes (9.75%) required resuturing, three eyes required TPK (7.31%), and one eye underwent evisceration (2.43%) following severe corneal melt secondary to neurotropic ulcer. The mean log MAR visual acuity improved from 1.52 to 1.26 at the 3 months. Conclusion: Understanding on timespan for healing of ocular surface disorders with AMG is needed to assess the prognosis of the disease, preoperative counselling for repeat procedures, and the compliance with regard to follow up. [ABSTRACT FROM AUTHOR]

A 4-yr-old, male, captive-born African helmeted turtle (Pelomedusa subrufa) was presented for an ocular disorder of 3 days duration. Physical examination showed edema of all limbs and blepharedema of the left eye. Ophthalmic examination revealed severe blepharoconjunctivitis, a large melting corneal ulcer, and stromal densification that prevented evaluation of the anterior chamber. Examination of the right eye was unremarkable. Ultrasonography of the left eye revealed corneal perforation associated with severe anterior uveitis. Enucleation was performed based on the poor prognosis for the eye and the risk of septicemia. Providencia rettgeri was identified from bacterial culture. Fungal culture was negative. Histopathology of the eyeball revealed a corneal perforation associated with edema and heterophilic infiltration of the corneal stroma. Three weeks after surgery, the enucleation wound had healed. Providencia rettgeri has been reported as a rare cause of keratitis in humans. A systematic literature review showed one case of a melting corneal ulcer in an Asian rhinoceros (Rhinoceros unicornis) associated with this infectious agent. This is the first report of corneal perforation associated with P. rettgeri in a reptile. [ABSTRACT FROM AUTHOR]

During infectious keratitis, the production of collagenolytic and inflammatory substances, along with increased corneal matrix metalloproteinase (MMP) activity, induces the degradation of corneal collagen and may cause postkeratitis complications, such as opacity, thinning, and corneal perforation. MMPs, especially MMP-2 and MMP-9, are overexpressed in infectious keratitis and sustained over time by inflammatory and nonmicrobial mechanisms. The high MMP levels are correlated with excessive corneal destruction in bacterial, herpetic, fungal, and acanthamoeba infections. Nonspecific treatments, such as tetracyclines, particularly doxycycline, or corticosteroids, are used as adjuvants to antimicrobials to alleviate the disproportionate degradation and inflammation of the corneal layers caused by corneal MMPs and decrease the recruitment and infiltration of inflammatory cells. Treatments showing inhibition of specific MMPs (Galardin, ZHAWOC7726), interfering with pro-MMP activation (EDTA, ascorbic acid), or showing anticytokine effect (epigallocatechin-2-gallate, TRAM-34) have been reported. Other treatments show a direct action over corneal collagen structure such as corneal cross-linking or have been associated with reduction of MMP levels such as amniotic membrane grafting. Although the use of these drugs has been shown in studies to be effective in controlling inflammation, especially in experimental ones, robust studies are still needed based on randomized and randomized clinical trials to demonstrate their potential effect as adjuvants in the management of infectious keratitis. [ABSTRACT FROM AUTHOR]

Background: Corneal blindness is a major public health problem worldwide and preventable cause of blindness in India. Corneal blindness is the second most common cause of blindness, after cataract, in developing countries. Aims and Objectives: A clinical study of keratomycosis to compare the efficacy of topical 10% NaCl with 5% natamycin (Group A) versus topical 5% natamycin (Group B) alone as a treatment strategy. Materials and Methods: This prospective, randomized, interventional, and comparative study with parallel design enrolled 100 cases diagnosed with unilateral keratomycosis and fulfilling the inclusion criteria, who presented to the outpatient department of Ophthalmology, Maharani Laxmi Bai Medical College and Hospital, Jhansi, Uttar Pradesh, between April 2021 and June 2022 (15 months). Results: Maximum patients in both the study groups belonged to the age group of 41–50 years showed male preponderance and belonged to the low socioeconomic status. Maximum patients in both the study groups had shown total regression in 66 cases with 41 cases from Group A and 25 cases from Group B, respectively. Regression was not seen in 34 cases with 9 cases belonging to Group A and 25 cases belonging to Group B. Maximum patients in study Group A had shown ulcer regression in 3.56 average weeks duration, while it was in 4.50 average weeks duration in Group B. Conclusion: This comparative and interventional study demonstrates that the study Group A receiving 10% sodium chloride solution with 5% natamycin helps in faster healing of corneal ulcer, rate of progression of ulcer is slowed down, and complications are less in comparison to Group B receiving 5% Natamycin alone owning to the anti-edema property of hypertonic saline. Hence, topical 10% NaCl solution can be used with 5% natamycin, as a cost-effective adjunct in the management of fungal keratitis. [ABSTRACT FROM AUTHOR]

Background: Corneal ulceration is sight-threatening. Accurate determination of the pattern, causative organisms and factors affecting severity and outcome will guide management. Objectives: To determine the pattern and microbiological diagnosis of corneal ulcers seen at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA). Materials and Methods: This was a longitudinal descriptive study of all consenting consecutive corneal ulcer patients managed at AEFUTHA from December 2018 to December 2019. Socio-demographic data, relevant history, clinical and laboratory findings were documented. Data was analysed using Statistical Package for Social Sciences (SPSS) version 22. Findings: There were 18 corneal ulcer patients among the 3853 consecutive new patients seen within the study period (a hospital prevalence rate of 0.47%). All 18 patients were recruited. They were aged 23 to 84 years; mean age was 50.4 ± 15.7. Majority were females 11(61.1%); 50% were farmers; 50% had preceding eye injury; 94% practiced prior self-medication; 72.2% presented ≥ 2 weeks after onset of symptoms. The ulcers were mostly central (61.1%); wide (>5 mm) 77.8% and deep (posterior stromal) 77.8%. Microorganisms isolated from 11(61.1%) specimens were: bacteria 6 (54.5%); fungi 4 (36.4%); acanthamoeba 1 (9.1%). Bacterial isolates were: staphylococcus aureus (5.6%) and pseudomonas aeruginosa (5.6%). Conclusion: Corneal ulcers presenting at AEFUTHA were severe (centrallylocated, wide and deep) with poor visual outcome after treatment. The microbial isolates were bacteria, fungi and acanthamoeba. Late presentation after prior self-medication was common. Public education on early hospital presentation is necessary. Corneal transplant services are also needed for visual rehabilitation. [ABSTRACT FROM AUTHOR]

Corneal injuries in pets cause severe suffering and vision impairment, creating significant challenges in the field of veterinary medicine. It is important to understand that the cornea lacks the inherent capability to regenerate itself through the administration of substances such as hyaluronic acid or antibiotics, which are commonly utilized by veterinarians for managing edema and infections in animals. It has been shown that platelet rich fibrin extract (PRFE) is effective in healing both deep corneal ulcers and superficial keratitis. In this case report, the use of PRFE in dogs and cats which showed promising results. [ABSTRACT FROM AUTHOR]

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In equine ophthalmology, ulcerative keratitis is among the most common conditions and, in general, arises as a consequence of some trauma suffered. Secondarily, subsequent contamination by pathogenic or resident bacteria of the horse's ocular microbiota may have undesirable consequences. Under physiological conditions, the normal microbiota coexists with the immune status of the host, serving as a barrier, ensuring the health of the ocular surface, and inhibiting the proliferation of pathogens. However, in the imbalance of immune barriers, the normal microbiota can become pathogenic and lead to infection, acting as an opportunistic agent. The present study aims to demonstrate the antimicrobial effect of platelet-rich plasma (PRP), its time of action, and its correlation with the concentration of its same components in vitro on Staphylococcus sciuri, a bacterium with high prevalence in the normal ocular microbiota of horses in the municipality of Minas Gerais. For the preparation of the PRP, eight adult Quarter Horse (QH) horses were used. The individual PRP was prepared by the double centrifugation protocol, and then, the PRPs were added to a pool, followed by testing their interaction in culture with Brain Heart Infusion (BHI) broth at different dilutions against five strains collected from different animals. After 3, 6, 12, and 18 hours, the colony formation units (CFU) count on a 5% horse blood agar plate was evaluated for each time point. Our study showed that Staphylococcus sciuri, the resident microorganism of the ocular conjunctival microbiota of horses, is more susceptible when compared to the standard strain "American Type Culture Collection" (ATCC-29213) Staphylococcus aureus, a pathogenic microorganism, which was used for the validation of our study. The antibacterial effect shown in this study was bacteriostatic for up to 6 hours. The most concentrated PRP dilutions, 1 : 1 and 1 : 2, were also most effective, suggesting that the antibacterial effect is volume dependent. [ABSTRACT FROM AUTHOR]

This article concerns a 64-year-old woman who was diagnosed with corneal ulcer, and had subsequently undergoing four failed penetrating keratoplasties in eight years. She was admitted to the hospital for her fifth and sixth penetrating keratoplasty operations. During the nursing period{April 6 to May 15, 2021{Gordon's 11 functional health patterns were used for interviews, physical assessment, direct care, and medical record review. The observed symptoms included health problems related to disturbed sensory perception with specified visual perception, knowledge deficit, and sense of hopelessness. By improving the patient's self-care skills, it's possible to prevent accidental damage caused by visual impairment in one eye. Therefore, the author used health education, knowledge of penetrating keratoplasty operation, focused on self-care skills to help the patient understand the poor disease prognosis. Further, a religious intervention, such as meditation and chanting sutra, was used to help improve disease acceptance and reduce the sense of hopelessness. It is suggested that relevant professional groups appoint corneal transplant case managers to intervene in the course of the disease in a timely manner and carefully track the situation, so as to provide continuous and comprehensive care. The author hopes that the sharing of this nursing experience will provide a reference for similar cases. (Tzu Chi Nursing Journal, 2023; 22:4, 105-114) [ABSTRACT FROM AUTHOR]

There have been multiple reports of eye infections caused by antibiotic-resistant bacteria, with increasing evidence of ineffective treatment outcomes from existing therapies. With respect to corneal infections, the most commonly used antibiotics (fluoroquinolones, aminoglycosides, and cephalosporines) are demonstrating reduced efficacy against bacterial keratitis isolates. While traditional methods are losing efficacy, several novel technologies are under investigation, including light-based anti-infective technology with or without chemical substrates, phage therapy, and probiotics. Many of these methods show non-selective antimicrobial activity with potential development as broad-spectrum antimicrobial agents. Multiple preclinical studies and a limited number of clinical case studies have confirmed the efficacy of some of these novel methods. However, given the rapid evolution of corneal infections, their treatment requires rapid institution to limit the impact on vision and prevent complications such as scarring and corneal perforation. Given their rapid effects on microbial viability, light-based technologies seem particularly promising in this regard. [ABSTRACT FROM AUTHOR]

Introduction: Keratitis is the infection and inflammation of the cornea. Microbial keratitis is a potentially sight-threatening corneal condition. The aim of this study was to find out the prevalence of positive microbiological culture among patients with infective keratitis visiting the Cornea Unit of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with a clinical diagnosis of infective keratitis presenting to the Cornea Unit of a tertiary eye care centre from 16 October 2020 to 16 March 2021 after obtaining ethical approval from the Ethical Review Board. After slit-lamp examination, corneal scrapings were performed under aseptic conditions which were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 428 patients, 337 (78.73%) (73.24-84.33, 95% Confidence Interval) had a positive microbiological culture. A total of 213 (49.76%) of enrolled samples had a prior history of ocular trauma. Aspergillus species 68 (20.17%) and Streptococcus species 33 (9.79%) were the most common organisms isolated from fungal and bacterial corneal ulcers respectively. Conclusions: The prevalence of positive microbiological culture among patients with infective keratitis from this study is similar to the pattern reported from similar settings.

Objective: The aim of this work is to evaluate the safety and efficacy of repeated sessions of photo-activated chromophore for keratitis-cross linking (PACK-CXL) window absorption (WA) for the treatment of resistant bacterial keratitis (BK). Patients and methods: This is a retrospective clinical cohort study. Thirty eyes with clinically suspected and lab-confirmed bacterial keratitis, resistant to appropriate antibiotic therapy- which was modified by sensitivity reports- for 2 weeks with failure of epithelialization for 4 weeks after the standard anti-microbial therapy (SAT) together with one setting of PACK-CXL WA were included. If after the first session of PACK-CXL, there is a start of improvement in the form of reduction of the size of corneal ulcer and stromal infiltrates together with the start of epithelialization on clinical examination and AS-OCT, another session of PACK-CXL WA was performed after one week, and so on, till the complete healing and resolution of bacterial keratitis and confirmation by negative bacterial culture. Identification of the micro-organisms was done by lab study before and after treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT). Results: Thirty eyes of 30 patients were recruited in this study. They were 16 males and 14 females, their mean age was 44.3 ± 5.38 years. The mean ulcer size was 3.96 ± 1.87 (mm3), while the mean size of stromal infiltrates was 4.52 ± 2.24 (mm3). PACK-CXL WA treatment was performed an average of 2.87 times for the 30 eyes. Complete healing and resolution (Successful treatment) was observed in 27 eyes (90%) of cases and failure of epithelialization was observed only in 3 eyes (10%). Complete corneal healing was reported in the second month postoperatively in 90% of eyes. Conclusion and recommendation: PACK-CXL WA may be a promising, non-invasive treatment option for resistant bacterial keratitis. It may have a synergistic effect with standard antimicrobial treatment (SAT). Also, it can overcome the antibiotics resistance that has become rapidly spreading worldwide. Repeated sessions of PACK-CXL WA may be more effective for the treatment of resistant bacterial keratitis till complete epithelialization and resolution of BK than a single session with few complications. However, further prospective and comparative studies to support the results are needed. [ABSTRACT FROM AUTHOR]

Melting corneal ulcers in dogs develop secondary to the imbalance between proteinases and proteinase inhibitors in the healing process of corneal wounds. Common complications of melting corneal ulcers in dogs are descemetocele, staphyloma and uveitis, which can lead loss of vision. Medical records of 342 dogs diagnosed with melting corneal ulcers from May 2013 to November 2022 treated surgically using VetShield® and SoftShield® collagen bandage lenses and third eyelid flap. Dogs included in the study had a clinical diagnosis of melting corneal ulcer without evidence of retinal detachment or lens luxation confirmed by ocular ultrasonography. 204/342 cases (59.65%) of treated dogs regained their vision and corneal transparency; 113/342 cases (33.04%) had corneal fibrosis and pigmentation with improved vision; 17/342 cases (4.97%) had lost vision due to corneal scarring and 8/342 (2.34%) underwent intrascleral prosthesis due to secondary glaucoma as a complication. Placement of bandage collagen lenses and third eyelid flap in melting corneal ulcers in dogs is an easy, straightforward surgical procedure which can be performed by any veterinarian practitioner with good results. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiological factors and clinical significance of canine distichiasis. Animals studied: Two hundred and ninety‐one client‐owned dogs. Methods: Retrospective study of medical records for canine patients diagnosed with distichiasis between 2010 and 2019 in an ophthalmology specialty practice. The breed, sex, skull conformation, coat type, age at the time of diagnosis, reason for presentation, clinical examination findings, and affected eyelid(s) were reviewed. Results: The prevalence of distichiasis was 5.5% (95% confidence interval (CI): 4.9–6.1) in the population of dogs presented to an ophthalmology specialty practice. The breeds with the highest prevalence were English bulldogs (35.2%, 95% CI: 26.7–43.7) and American cocker spaniels (19.4%, 95% CI: 8.3–30.5). The prevalence was significantly higher in brachycephalic dogs (11.9%, 95% CI: 9.8–14.0) than in non‐brachycephalic dogs (4.6%, 95% CI: 4.0–5.3) and in short‐haired dogs (8.2%, 95% CI: 6.8–9.6) than in dogs with other coat types (5.3%, 95% CI: 4.5–6.1). Most dogs were affected bilaterally (63.6%, 95% CI: 58.0–69.1). Among dogs with clinical signs, 39.0% (95% CI: 26.5–51.4) exhibited corneal ulceration, including superficial ulcers (28.8%, 95% CI: 17.3–40.4) and deep stromal ulcers (10.2%, 95% CI: 2.5–17.8). Distichiasis was non‐irritating in 85.0% (95% CI: 80.6–89.4) of affected dogs. Conclusion: This study reports the largest cohort of canine distichiasis to date. In a large proportion of dogs, distichiasis was a non‐irritating condition. However, brachycephalic breeds, especially English bulldogs, were the most frequently and severely affected. [ABSTRACT FROM AUTHOR]

Background: Vernal keratoconjunctivitis (VKC) severely affects the quality of life of affected patients. The development of a shield ulcer is considered one of the most severe late-stage complications, which when untreated leads to irreversible vision loss. In this systematic review, we outlined the results of surgical treatments of corneal shield ulcers in VKC. Methods: We searched 12 literature databases on 3 April 2023 for studies of patients with VKC in which shield ulcers were treated by any surgical treatment. Treatment results were reviewed qualitatively. Assessments of the risk of bias of individual studies were made using the Clinical Appraisal Skills Programme. Results: Ten studies with 398 patients with VKC were eligible for the qualitative review. Two categories of surgical approaches were described: supratarsal corticosteroid injection and debridement with or without amniotic membrane transplantation. Almost all patients experienced resolution or improvement of their shield ulcers, regardless of treatment modality. Time to healing was faster with surgical debridement. A small proportion experienced recurrence and side effects. Conclusions: Surgical treatment for shield ulcers in VKC seems highly effective, but careful post-operative treatment and follow-ups are necessary due to the risk of recurrence and potential side effects. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to report the outcomes of panophthalmitis and to identify factors significantly affecting globe survival in the disease. Methods: This was a retrospective study on patients with panophthalmitis in a tertiary hospital between January 1, 2017, and December 31, 2019. The demographics, treatment details, culture results, and final outcomes were recorded. Logistic regression and Cox proportional hazards (CPH) were calculated to identify variables associated with globe loss. A P < 0.05 was considered significant. Results: Eighty-five eyes of 85 patients (31 culture positive) were eligible for review. The mean age of the participants was 55.21 ± 20.17 years with a male-to-female ratio of 2.04:1. Corneal ulcer (38.82%; n = 33) and open globe injuries (OGIs) (38.82%; n = 33) were the most common etiologies. Pseudomonas aeruginosa (n = 10; 11.76%) was the most common isolate. The mean duration of hospital stay was 7.58 ± 2.32 days. Overall, 44 (51.76%) globes could be salvaged. The need for evisceration (P = 0.901) and hospital stays (P = 0.095) were similar for culture-positive and -negative cohorts. The unadjusted logistic regression and CPH models showed that culture sterility did not affect globe survival [OR = 1.210 (0.501-2.950), P = 0.668; HR = 1.176 (0.617-2.243), P = 0.623]. The adjusted logistic regression and the CPH models showed that corneal ulcers [OR = 10.900 (2.460-48.200), P = 0.002; HR = 5.393 (1.603-18.140), P = 0.006] and OGI [OR = 7.360 (1.650-32.700), P = 0.009; HR = 4.548 (1.321-15.660), P = 0.016] were significantly associated with globe loss. Conclusion: Corneal ulcer or OGI as the primary etiology is detrimental to globe survival in panophthalmitis. [ABSTRACT FROM AUTHOR]

Rosacea is a chronic inflammatory dermatosis typically affecting the facial skin but also the eyes. With its chronic course with fluctuating episodes of flashing, redness, papulopustules, and nodules it poses a severe psychologic burden to the affected individuals. In addition to the facial changes, more than half of the patients have ocular involvement ranging from blepharitis and conjunctival hyperemia to more severe ophthalmic damage, and even blindness. Clinically, the ocular involvement in rosacea includes meibomian gland dysfunction with relapsing hordeola and chalazia, diffuse hyperemic conjunctivitis, photophobia, episcleritis, or kerato-conjunctivitis, and in rare cases, corneal ulcers. These are mainly observed in adult patients but can also occur in children. Depending on the degree of cutaneous or ocular findings, patients with rosacea may present first to the dermatologist or to the ophthalmologist. Both specialists should be aware of the potential oculocutaneous involvement. Any ocular complaints expressed by the patient in the setting of a dermatologist's office should be referred promptly for an ophthalmologic examination. Conversely, signs suggestive of rosacea in the eye should lead the ophthalmologist to consider underlying skin disease. A timely interdisciplinary collaboration is paramount for the earlier diagnosis and treatment, thus preventing permanent eye impairment in this chronic dermatosis. [ABSTRACT FROM AUTHOR]

Introduction: Microbial keratitis is a corneal infection caused by microorganisms and is characterized by a profound corneal epithelial defect that infects the cornea and causes severe and progressive visual loss. In recent years, the incidence of microbial keratitis has increased. One of the critical risk factors for increasing this incidence is using contact lenses. As the number of contact lens users increases, the number of corneal ulcers associated with contact lenses also increases. Case Presentation: A 25-year-old man was admitted to the emergency department with a complaint of gradually blurry vision in his left eye four days after using contact lenses for overnight uses since the previous few days and did not routinely clean contact lenses or replace contact lens cleaning fluid. The visual acuity of the patient's left eye was hand movement with conjunctival and pericorneal injection in the conjunctiva and 6 x 7 mm stromal level infiltrate, blurred margin, and whitish color in the center of the cornea. After 28 days of treatment, an examination showed the patient's left eye improvement. Visual acuity was 3/60, conjunctival injection disappeared, corneal swelling significantly resolved, hypopyon disappeared, and ulcer completely re-epithelialized. Conclusions: Empirical therapy with broad-spectrum antibiotics and other adjunctive therapy has a good outcome in treating contact lens-related corneal ulcers. [ABSTRACT FROM AUTHOR]

In this scoping review, we examine underlying causes of loss to follow-up for chronic (glaucoma) and acute (corneal ulcers) eye conditions using the Penchansky and Thomas access to care framework. We explore barriers by World Health Organization income levels and by studying geographical location. We identified 6,363 abstracts, with 75 articles retrieved and 16 meeting inclusion criteria. One article discussed barriers to follow-up care for people with corneal ulcers, and the other 15 were for people with glaucoma. The most frequent barriers to care were affordability, awareness, and accessibility. The international studies had a greater percentage of studies report acceptability as a barrier to loss to follow-up. Countries with universal healthcare included affordability as a loss to follow-up barrier, emphasizing that cost goes beyond the ability to pay for direct treatment costs. Understanding and addressing barriers to follow-up care can aid the goal of continued care and decrease the risk of poor outcomes and vision loss. • Affordability was the most reported barrier to follow-up care. • Affordability was a barrier regardless of country income level. • Future research should examine barriers to follow-up for corneal ulcer care globally. • All dimensions of barriers to care in the Penchansky and Thomas framework were observed. • Policy changes are needed to address barriers for eye care loss to follow-up. [ABSTRACT FROM AUTHOR]

Purpose: The following is a comparative analysis on the treatment outcomes of corneal perforations using amniotic membrane transplantation (AMT) or penetrating keratoplasty (PK). Methods: This monocentric retrospective study was performed at the Department of Ophthalmology, University Hospital Ulm, Germany. A total of 78 eyes of 78 patients were included. Thirty-nine eyes received an AMT, and 39 patients were treated with a PK. Primary outcome was recurrence of perforation. Secondary outcomes were patient mortality and visual acuity. Results: No statistically significant difference was observed with regard to a recurrence of perforation between the two groups (26% in AMT vs 23% in PK, p > 0.99). The time of recurrences was within the first two years and did not differ statistically (p = 0.97). In addition, a proportional hazards model with cox regression regarding recurrent perforation showed no significant differences (p = 0.5). After AMT, 41% and after KP, 28% of the patients died during follow-up (p = 0.2), respectively. The Charlson Comorbidity Index (p < 0.0001) and the age at the time of surgery (p = 0.0002) were statistically significantly higher in those who were deceased. A mean follow-up of 485 ± 517 days was recorded. Conclusion: Both surgical methods show good results and no statistically significant difference regarding recurrent perforation rate. About a third of the patients died during the follow-up period. The decision regarding the appropriate method should therefore be based on a combination of all factors. [ABSTRACT FROM AUTHOR]

A retrospective study of corneo-conjunctival disorders was conducted on 71 dogs at several private pet clinics in Alexandria in Egypt between 2019 and 2022 to determine the incidence of corneo-conjunctival disorders among different breeds, ages, and sexes of dogs using descriptive statistical tools. The overall incidence of corneo-conjunctival disorders in dogs was (35.50%) of the total ocular disorders encountered with Golden retriever breed being the most affected. Most corneo-conjunctival affections were met with dogs less than 1 year of age with the cornea being the most affected anatomical location. Corneal Ulcer was the most frequently diagnosed clinical condition. It was also seen that males were affected more than females. [ABSTRACT FROM AUTHOR]

To document atypical presenting forms of ocular sarcoidosis at the corneal level. Case report. A 63-year-old woman presented multiple uncommon unilateral primary corneal conditions as manifestation of ocular sarcoidosis, including peripheral ulcerative keratitis, sterile corneal infiltrate (corneal granuloma), and sterile infiltrates related to a corneal foreign body, requiring medical and surgical management to control the inflammatory symptoms and to preserve the integrity of the eyeball. An excisional biopsy of a nodule in the temporal conjunctiva was performed under topical anesthesia. Histological analysis revealed a non-caseating granuloma, confirming the diagnosis of ocular sarcoidosis. When thinking of ocular involvement in patients with ocular sarcoidosis, it is essential to remember that manifestations such as peripheral ulcerative keratitis, sterile corneal infiltrate, and sterile foreign body-related infiltrates may be presentations of this disease. [ABSTRACT FROM AUTHOR]

The cornea is the clear, anterior surface of the eye and is pivotal in maintaining vision. The article comprehensively reviews the diagnostic evaluations and therapeutic strategies for corneal ulcers, a potentially sight-threatening condition. Corneal ulceration results from various etiologies including infectious agents (bacteria, viruses, fungi, and parasites) and non-infectious factors (dry eye, autoimmune conditions, and trauma). Prompt and accurate diagnosis, often employing techniques such as slit-lamp examination, corneal scrapings, and laboratory cultures, is crucial to guide appropriate treatment. Antibiotic therapy remains the cornerstone for bacterial ulcers, with fortified antibiotics or a combination approach often used for severe infections. Viral ulcers, predominantly caused by the herpes simplex virus, are managed with antiviral agents, while fungal ulcers necessitate antifungal medications, often for prolonged periods. Parasitic infections like Acanthamoeba keratitis require dual-therapy with antiseptics and anti-amoebozoal drugs. In cases where the etiology is non-infectious, addressing the underlying cause (e.g., lubricating drops for dry eye or immunosuppressants for autoimmune conditions) is paramount. The article emphasizes the importance of regular monitoring, as some ulcers might require surgical interventions like corneal transplantation, especially if there's impending perforation or scarring affecting vision. Recent advancements, including the use of adjuvant therapies like corneal cross-linking and amniotic membrane transplantation, have shown promise in improving outcomes. In conclusion, the management of corneal ulcers is multi-faceted, requiring a tailored approach based on the underlying cause. Early detection, combined with the right therapeutic modality, is essential in preserving vision and preventing complications. This review serves as an invaluable guide for clinicians to navigate the challenges of diagnosing and managing corneal ulcers.

A corneal ulcer is a break or defect in the surface epithelium of the cornea, accompanied by tissue decay in the nearby area, leading to stromal necrosis. On a pathological level, there are swelling and an influx of cells in the affected region. Corneal ulcers often arise due to bacterial, viral, fungal or parasitic infections. However, non-infectious causes, such as dry eye, inflammatory disorders and trauma, also have a role. Delayed treatment can lead to blindness. Accurate diagnosis and prompt management are essential. Initially, patient history provides clues. A history of contact lens wear is often linked to bacterial or Acanthamoeba infections. Scratches may herald fungal infections, especially in agricultural settings. Viral aetiologies often correlate with dendritic patterns. Next, the slit-lamp examination can highlight corneal defects and infiltrates. Fluorescein staining may enhance the visibility of epithelial defects. Diagnostic procedures may include corneal scraping for microscopy, culture or polymerase chain reaction (PCR). This aids in identifying causative agents and tailoring antimicrobial therapy. Empirical treatment, especially in severe or progressing ulcers, begins before culture results. Bacterial ulcers frequently receive broad-spectrum antibiotics initially. Fungal infections warrant antifungal therapy, often with natamycin. Acanthamoeba keratitis necessitates specific antiamoebic therapy. Refractory or complex cases might demand additional interventions, such as corneal cross-linking or therapeutic keratoplasty. Appropriate patient education, such as contact lens hygiene, can serve as a preventative measure. Overall, understanding the underpinnings and a systematic approach to diagnosis and management are vital in preserving vision and avoiding complications in corneal ulcer patients.

Purpose: To determine the demographic and microbiological profile involved in the causation of corneal ulcers in Eastern India during the COVID era. Method: Patients presenting with corneal ulcers fulfilling the inclusion and exclusion criteria were taken as the case. The study duration was from January 2021 to December 2021. Socio-demographic details and information about risk factors were noted. A detailed corneal examination followed by corneal scraping was performed for microbiological evaluation. Results: In 1 year, 99 infective corneal ulcer patients were evaluated. Farmers (24.2%) were found to be maximally affected by corneal ulcers. The peak in cases was recorded from October to December (38.4%). Ocular trauma was the commonest risk factor (42.4%). The majority (80.8%) of patients were already on some topical antimicrobials. 22.2% of samples showed fungal filaments on KOH mount; 54.5% of these cases turned out to be culture-positive. 17.56% of KOH-negative samples turned out to be culture-positive (fungal). Overall, the culture positivity rate was 28.28% out of which fungal isolates were 89.28% and bacterial isolates were 10.72%. Fusarium species were identified as the most common organism contributing 42.85%, followed by Aspergillus fumigatus (14.28%). 10.72% of cases were culture positive for Pseudomonas aeuroginosa. Conclusion: Trauma with the organic matter was the predominant cause of fungal keratitis. In this study, fungal keratitis was found to be more common. Fusarium was the most common isolate.

Background Corneal wound healing involves several complex pathways that can be targeted by drugs with varying mechanisms of action. Infected corneal ulcers represent a special challenging situation facing ophthalmologists due to resistance to treatment and visual impairing complications. Purpose The aim of this study was to evaluate the efficacy of umbilical cord blood serum (CBS) as an adjunctive therapy for resistant infected corneal ulcers. Patients and methods This prospective cohort study included 40 eyes having infected corneal ulcer resistant to specific medical treatment for 2 weeks. The patients were recruited from the Cornea Unit at Tanta University Hospital, Tanta, Egypt. They were divided into two groups, 20 cases each. Group A cases were treated with umbilical CBS as an adjunctive therapy together with medical treatment based on culture and sensitivity testing, while group B cases continued the conventional medical treatment only till the complete healing was achieved. The results of the two groups were compared regarding the duration of healing and best-corrected visual acuity improvement. Results Visual acuity improvement was achieved with one or more line gain in 14 (70%) cases in group A compared to 6 (30%) cases in group B, with a statistically significant difference (P = 0.008). Healing was achieved in 16 (80%) cases of group A in 2–4 weeks compared to 14 (70%) cases of group B that achieved healing in a longer duration of 3–6 weeks, with a statistically significant difference (P = 0.001). Amniotic membrane transplantation AMT was required in 4 (20%) cases in group A due to thinning compared to 6 (30%) cases in group B. Conclusion Umbilical CBS was safe and effective when applied to the cornea as an adjunctive therapy in cases of resistant infected corneal ulcers where it accelerated healing with better visual outcome results.

Background Corneal ulcer is an inflammatory or more seriously infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma. Aim The aim of this study was to evaluate the clinical profile of corneal ulcers at Sardar Patel Medical College and associated group of hospitals, Bikaner, Rajasthan, India. Patients and methods This is a prospective, longitudinal, observational study that was conducted for two years from October 2020 to October 2022. It involved 100 clinically diagnosed corneal ulcer patients, recruited by consecutive sampling, attending the Outpatient Clinic at the Department of Ophthalmology, who were willing to participate in the study. Clinical evaluation included the sociodemographic aspects and the ulcer characteristics, including its location, shape, depth, presence of satellites, and hypopyon. Corneal scraping was performed in 60 cases with full aseptic measures after the instillation of topical anesthetic and the samples were sent to the Microbiology Department for further processing. Results The maximum proportion (52%) of the study population were 41-60 years old, with 58% of the patients being males, and 75% from rural areas. Most of the ulcers (68%) were central or paracentral in location, with 38% being of ameboid shape and 48% being superficial. Based on etiology, 48% were fungal, 32% were bacterial, 16% viral, 1% parasitic, and 3% noninfective. The most common pathogen was Aspergillus fumigatus followed by Staphylococci and viral infection. Conclusion Corneal ulcers were found most commonly in males aged 40–60 years hailing from rural areas engaged in agriculture. The most common etiological agent was Aspergillus fumigatus followed by Staphylococci.

Objective The aim of this study was to compare the clinical efficacy of platelet-rich plasma (PRP) eye drops to conventional therapy (preservative-free artificial tears and vitamin A gel drops) in the management of dormant corneal ulcer. Patients and methods This prospective study was conducted on 50 eyes of 50 patients with dormant corneal ulcer. The patients were randomized into two equal groups: group I, treated with PRP eye drops plus conventional therapy, and group II, treated with conventional therapy only. Corrected distance visual acuity, healing of corneal surface, and subjective symptoms were evaluated. Results There was a statistically highly significant difference between the pretreatment and the 3-month posttreatment ulcer size in the PRP group (3.76±1.33 and 0.92±1.96 mm, respectively, P

Purpose: To report on the microbiological profile and antibiotic sensitivity patterns of infectious keratitis at a tertiary center in central India. Methods: The suspected case of severe keratitis underwent microbiological culture and identification using the VITEK 2 technique. Antibiotic susceptibility for different sensitivity and resistance patterns was analyzed. Demographics, clinical profile, and socioeconomic history was also documented. Results: Culture was positive in 233/455 (51.2%) patients. Pure bacterial growth was present in 83 (35.62%) patients and pure fungus was present in 146 (62.66%) patients. The most common bacterial cause of infectious keratitis was Pseudomonas followed by Staphylococcus and Bacillus. Pseudomonas showed 65%–75% resistance against levofloxacin, ceftazidime, imipenem, gentamycin, ciprofloxacin, and amikacin. Staphylococcus showed 65%–70% resistance against levofloxacin, erythromycin, and ciprofloxacin, with Streptococcus being 100% resistant to erythromycin. Conclusion: This study highlights the current trend of microbiological profiles of infectious keratitis and their antibiotic susceptibility at a rural setup in central India. Fungal predominance and increased resistance against the commonly used antibiotics were noted.

BackgroundAnterior segment optical coherence tomography (AS OCT) is a helpful tool used to diagnose and manage many corneal conditions, but its use has not been reported in case of peripheral ulcerative keratitis (PUK). The aim of this study is to describe AS OCT findings in cases of PUK.MethodsRetrospective observational case series of six eyes presenting with a PUK and proven systemic vasculitis. Clinical course, slit lamp photographs, and AS OCT findings were the main outcomes.ResultsThe AS OCT findings were found to correlate with the ocular disease's level of activity. In the acute stage, an absence of corneal epithelium, a scrambled appearance of the anterior stroma and a heterogeneous stromal reflectivity were observed. During the reduction of disease level activity, an irregular hyporeflective epithelium, a smoother anterior stroma, and a homogenous hyperreflective stroma were seen. At the healed stage, a filling of the corneal defect by a hyporeflective thick epithelium, the persistence of the hyperreflective underlying stroma, and a demarcation line were observed. The mean total corneal thickness at last follow-up was significantly thicker (509 ± 147 μm) compared with the mean corneal thickness at onset (408 ± 131 μm; P = 0.03).ConclusionsAS OCT provides an assessment of structural changes occurring in PUK, useful for its diagnosis and monitoring.

Infectious keratitis is a sight-threatening condition that is usually an ocular emergency. The visual outcome depends on prompt and accurate clinical management as well as geographic and epidemiological awareness. We conducted a retrospective observational study to define the epidemiological and laboratory profile, as well as the clinical course of bacterial keratitis in a tertiary hospital in São Paulo over 21 years. Information about age, sex, predisposing factors, topical and surgical treatment, visual acuity, ulcers’ classification, bacterioscopy, culture, and antibiotic sensitivity tests were collected. This study included 160 patients. The mean age was 65.1 ± 18.4 years and risk factors were identified in 83.1 % of the patients. Empirical topical fortified cephalosporin with an aminoglycoside or fourth-generation fluoroquinolone was curative for 66.2 % of the cases. The mean treatment duration was 22.5 ± 9 days. The mean variation of visual acuity was -0.25 logMAR, p < 0.001. Culture revealed 64 % of Gram-positive bacteria. All Gram-positive bacteria were sensitive to cephalothin, vancomycin, and quinolones. All Gram-negative bacteria were sensitive to gentamicin, tobramycin, amikacin, and ciprofloxacin. These findings reinforce the importance of prompt empirical treatment of severe corneal ulcers with a fortified cephalosporin and aminoglycoside or a fourth-generation fluoroquinolone as there are equally effective. Collected data was insufficient to evaluate resistance of ocular infections over time in this population.

Background/objectivesPost-keratoplasty infectious keratitis (PKIK) is a unique sight-threatening clinical entity which often poses significant therapeutic challenges. This study aimed to examine the clinical presentation, risk factors, management, and clinical outcomes of PKIK.MethodsThis was a retrospective study of all patients who presented to the Queen’s Medical Centre, Nottingham, with PKIK between September 2015 and August 2022 (a 7-year period). Relevant data on types of keratoplasty, clinical presentations, causative microorganisms, management, and outcome were analyzed.ResultsForty-nine PKIK cases, including four cases of interface infectious keratitis, were identified during the study period. The most common graft indications for PKP, DALK and EK were failed grafts (9, 37.5%), keratoconus (6, 54.5%) and Fuchs endothelial corneal dystrophy (FECD; 8, 57.1%), respectively. Staphylococcus spp. were the most commonly identified organisms (15, 50.0%). Bullous keratopathy (18, 36.7%), ocular surface disease (18, 36.7%), and broken/loose sutures (15, 30.6%) were the most common risk factors. Concurrent use of topical steroids was identified in 25 (51.0%) cases. Of 31 functioning grafts at presentation, 12 (38.7%) grafts failed at final follow-up with 15 (48.4%) patients retaining a CDVA of ≥1.0 logMAR. The overall estimated 5-year survival rate post-PKIK was 55.9% (95% CI, 35.9%-75.9%), with DALK having the highest survival rate [63.6% (95% CI, 28.9%-98.3%)], followed by EK [57.1% (95% CI, 20.4%-93.8%)] and PKP [52.7% (95% CI, 25.1%-80.3%)], though no statistical difference was observed (p=0.48).ConclusionsPKIK represents an important cause of IK and graft failure. Bullous keratopathy, OSD and suture-related complications are the commonest risk factors, highlighting the potential benefit of prophylactic topical antibiotics (for unhealthy ocular surface) and early suture removal (where possible) in reducing the risk of PKIK. Graft survival may be higher in lamellar keratoplasty following PKIK but larger studies are required to elucidate this observation.

Background: The use of amniotic membranes for corneal perforations using different surgical techniques has been widely described in the literature. This case report is a novel variation in the technique that can be useful for incorporating in clinical practice when the need arises. Case Report: A 36-year-old male patient presented to our clinic with a corneal ulcer in his left eye caused by herpetic keratitis, treated with a topical non-steroidal anti-inflammatory (indomethacin 0.1% solution). Examination revealed a paracentral 2-mm wide corneal perforation on the site of the corneal ulcer. The patient was admitted to the hospital. He was treated with intravenous piperacillin-ofloxacine, and an emergency surgical intervention using a lyophilized amniotic membrane was performed using a "plug and patch" technique. Postoperatively, the patient received 48 h of intravenous antibiotics and was discharged on topical antibiotic/corticosteroid eyedrops along with a 10-day course of oral antibiotics (ofloxacin) and antiviral therapy (valaciclovir). Three months after surgery, the anterior chamber was formed, the corneal defect was closed, and visual acuity improved. One year after initial presentation, anterior segment optical coherence tomography showed a large scarred but healed cornea. Conclusions: We report the successful use of combination of a single round-shaped rolled amniotic membrane with a multilayered amniotic membrane transplantation for the treatment of a 2-mm-wide perforated corneal ulcer. This technique allowed for preservation of the globe integrity without the need for a keratoplasty, stopped further tissue loss, and was associated with a rapid visual recovery. [ABSTRACT FROM AUTHOR]

Corneal ulcer is one of the most devastating eye diseases causing permanent damage. There exist limited soft techniques available for detecting this disease. In recent years, deep neural networks (DNN) have significantly solved numerous classification problems. However, many samples are needed to obtain reasonable classification performance using a DNN with a huge amount of layers and weights. Since collecting a data set with a large number of samples is usually a difficult and time-consuming process, very large-scale pre-trained DNNs, such as the AlexNet, the ResNet and the DenseNet, can be adapted to classify a dataset with a small number of samples, through the utility of transfer learning techniques. Although such pre-trained DNNs produce successful results in some cases, their classification performances can be low due to many parameters, weights and the emergence of redundancy features that repeat themselves in many layers in som cases. The proposed technique removes these unnecessary features by systematically selecting images in the layers using a genetic algorithm (GA). The proposed method has been tested on ResNet on a small-scale dataset which classifies corneal ulcers. According to the results, the proposed method significantly increased the classification performance compared to the classical approaches. [ABSTRACT FROM AUTHOR]

Purpose: To report on the microbiological profile and antibiotic sensitivity patterns of infectious keratitis at a tertiary center in central India. Methods: The suspected case of severe keratitis underwent microbiological culture and identification using the VITEK 2 technique. Antibiotic susceptibility for different sensitivity and resistance patterns was analyzed. Demographics, clinical profile, and socioeconomic history was also documented. Results: Culture was positive in 233/455 (51.2%) patients. Pure bacterial growth was present in 83 (35.62%) patients and pure fungus was present in 146 (62.66%) patients. The most common bacterial cause of infectious keratitis was Pseudomonas followed by Staphylococcus and Bacillus. Pseudomonas showed 65%--75% resistance against levofloxacin, ceftazidime, imipenem, gentamycin, ciprofloxacin, and amikacin. Staphylococcus showed 65%--70% resistance against levofloxacin, erythromycin, and ciprofloxacin, with Streptococcus being 100% resistant to erythromycin. Conclusion: This study highlights the current trend of microbiological profiles of infectious keratitis and their antibiotic susceptibility at a rural setup in central India. Fungal predominance and increased resistance against the commonly used antibiotics were noted. [ABSTRACT FROM AUTHOR]

Purpose: To identify the risk factors associated with the development of ocular surface exposure and severe visual impairment (SVI) in patients with facial nerve palsy (FNP). Methods: Ocular data of all consecutive FNP patients (N = 1870) presenting to an eye-care network over the past 10 years were reviewed. Risk factors associated with SVI (best-corrected visual acuity <20/200) and ocular surface exposure at presentation were evaluated using multivariate analysis and odds ratios (OR). Results: The prevalence of SVI was 15%, and 47% had ocular surface exposure at the first presentation. The presence of corneal scar (28% vs. 10.2%, p < .001; OR 3.05), corneal ulcer (12.9% vs. 2.3%, p < .001; OR 4.67), older age at presentation (p < .001; OR 1.02), >10 mm lagophthalmos (p < .001; OR 8.7), male sex, and duration of FNP (p = .021; OR 1) were independent risk factors for developing SVI. Of the 893 eyes with ocular surface exposure, 75 (3.9%) had a corneal ulcer, and 11 (0.6%) were perforated, with the rest having epithelial defects and punctate keratopathy. Patients with neoplastic etiology (15.9% vs. 5.7%; p < .001; OR 2.39), lagophthalmos (49% vs. 29.7%; p < .001; OR 2.25) and poor Bell's phenomenon (9.4% vs. 4.2%; p = .005; OR 1.8) had twofold risk for developing ocular surface exposure. Conclusion: Eyes with lagophthalmos, poor Bell's phenomenon, and FNP of neoplastic etiology have a higher risk of developing ocular surface exposure. Male sex, increasing age, longer duration of FNP, and >10 mm lagophthalmos are associated with SVI in FNP patients; hence, early and timely intervention is necessary. [ABSTRACT FROM AUTHOR]

Purpose: To identify clinical risk factors for enucleation or evisceration in patients with endophthalmitis at an academic institution. Methods: A retrospective review of patients diagnosed with endophthalmitis at Wilmer Eye Institute from 2010 to 2019 was conducted. Clinical characteristics, including demographics, cause for endophthalmitis, microbial culture results, salvaging procedures and surgical intervention were recorded. In patients who underwent enucleation or evisceration, type of surgery and placement of a primary implant were recorded. Chi-squared, Student's t-tests and multivariate analysis were used to identify clinical factors that predicted enucleation or evisceration. Results: Two hundred and fifty three patients treated for endophthalmitis over the study period were identified, of which 25 (9.88%) underwent enucleation or evisceration. Risk factors for enucleation or evisceration included poor presenting visual acuity (OR 7.86, CI: 2.26, 27.3), high presenting intraocular pressure (OR 1.07, CI: 1.03, 1.12), presence of relative afferent pupillary defect (OR 3.69, CI: 1.20, 11.37) and positive vitreous culture for methicillin-resistant staphylococcus aureus (MRSA) (OR 18.3, CI: 1.54, 219.2) on multivariate analysis. Patients undergoing enucleation or evisceration were also more likely to have trauma, corneal ulcer or combined causes for endophthalmitis and underwent fewer salvaging surgical and procedural interventions. There were no significant differences in characteristics of those receiving enucleation versus evisceration in our cohort. Conclusion: Patients with endophthalmitis who underwent enucleation or evisceration had more severe disease on presentation compared to those treated with eye sparing therapy. Presenting clinical characteristics may have a role in triage and management decisions for patients presenting with severe endophthalmitis. [ABSTRACT FROM AUTHOR]

A 10-year-old, spayed female, Maltese dog presented with a 2-day history of severe left eye squint. Slit-lamp biomicroscopy showed a deep corneal defect stained into a doughnut shape together with hypopyon in the anterior chamber. Based on these results, a diagnosis of descemetocele and uveitis in the left eye was made. Deep keratotomy combined with a nictitating membrane flap effectively resolved the descemetocele without complications. The surgical procedures performed on this patient were easy and effective, and could be used as an alternative to graft surgery for descemetocele treatment. [ABSTRACT FROM AUTHOR]

Objectives: Microbial keratitis can cause significant visual morbidity and is a common reason for presentation to eye casualty clinics. Contact lens wear and poor contact lens hygiene significantly increase the risk of corneal infection. This study aimed to determine the level of contact lens hygiene awareness amongst contact lens wearers attending our service and determining whether contact lens type and hygiene attitude are related to severity of disease. Materials and Methods: This prospective questionnaire-based study included 50 consecutive patients attending the eye casualty clinic of a tertiary referral center. Visual acuity was assessed at presentation and 2 weeks after diagnosis. Patients were divided into subgroups according to contact lens type (monthly, bi-weekly, daily, and extended day and night wear) and risk group (low, medium, and high) depending on their contact lens hygiene practices. Results: Thirty-four women and 16 men were included in this study. Twenty-four patients used monthly disposable contact lenses, 16 used daily disposable contact lenses, 6 were using bi-weekly replacement lenses, and 4 patients were using extended wear (day and night) contact lenses. Twenty-five patients were diagnosed with corneal ulcer, 23 of which had some degree of poor contact lens hygiene. Best corrected visual acuity (BCVA) significantly improved after treatment. Mean BCVA was 0.24 LogMAR before treatment and 0.09 LogMAR after treatment (p<0.05). Conclusion: Our study highlights the need to improve contact lens hygiene awareness and influence hygiene practices. Patients with the poorest contact lens hygiene had slower visual recovery and a higher prevalence of corneal ulcer. Contact lens hygiene advice needs to be clear and reinforced over time. [ABSTRACT FROM AUTHOR]

An 11‐month‐old French bulldog was presented for a recurrent fluid‐filled mass located ventral to the right pinna. An infected parotid sialocele was diagnosed using ultrasonography, computed tomographic sialography and cytological analysis of the fluid. The dog also had a superficial corneal ulcer because of iatrogenic right facial nerve paralysis secondary to previous attempts by the referring veterinarian to excise the mass surgically. Vegetal foreign bodies (grass awns barbs) were found at the entrance to the right parotid canal and were removed with iris forceps. Bacteriology was positive for Streptococcus canis. Conservative management was initiated after grass awn removal, and the dog was discharged with oral antibiotics (amoxicillin‐clavulate orally), ophthalmic antibiotic ointment and artificial tears. Clinical signs related to parotid sialocele resolved, and permanent partial temporal tarsorrhaphy was performed 2 months later. At the 3‐year follow‐up, the dog had no signs of recurrence of the parotid sialocele, but facial paralysis was still present. [ABSTRACT FROM AUTHOR]