Search

Background: Canine non-infectious deep ulcerative keratitis is considered a severe ocular disorder that possibly can progress to perforation. Immediate treatment should be directed to stimulate corneal wound healing, control infection, and minimize self-trauma while eliminating the underlying causes. Aim: This retrospective study was aimed to compare the difference in non-infectious deep corneal wound healing time between cases treated with medical therapy alone and those treated with medical therapy combined with a nictitating membrane flap. Methods: The medical records at the Ophthalmology Clinic, Small Animal Teaching Hospital, Faculty of Veterinary Science, Chulalongkorn University between January 2018 and March 2020 were retrospectively reviewed. Sixty-six eyes (from 65 dogs) diagnosed with non-infectious deep ulcerative keratitis from the medical treatment group (n = 34) and the combined treatment group (n = 32) were included. The combined treatment group was prescribed the same conservative medical administrations plus a surgical nictitating membrane flap for 14 days. Results: Healing time was defined as the duration of time from the day that the dog had been diagnosed with deep ulcerative keratitis by a fluorescein staining test to the day that the corneal fluorescein stain was negative. Overall, the mean age of dogs with deep ulcerative keratitis was 10.49 ± 4.7 years. The disease was commonly evident in females more than males. Shih Tzu was the most prevalent dog breed. The corneal healing time between dogs receiving medical therapy alone and those receiving combined treatment was not statistically significant (p = 0.386). Healing times were not significantly different between sex and breed (p = 0.41). The median corneal healing time for dogs older than 10 years in the combined treatments group (29.5 days; ranging from 20 to 46 days) was longer than for those receiving medical therapy alone (21 days; ranging from 9.5 to 30.5 days). Conclusion: Supportive therapy including a nictitating membrane flap is suggested in dogs prone to deep corneal ulcers not involving infection. Even though the healing time is not statistically significant, a nictitating membrane flap acts as a tissue bandage to reduce friction over the cornea, and it also alleviates the healing process by moistening the ocular surface. [ABSTRACT FROM AUTHOR]

Mooren's ulcer (MU) is a chronic and painful ulcerative keratitis that is difficult to diagnose, especially when concealed beneath the pterygium, which is a common, benign, wedge-shaped, fleshy tissue growth of the conjunctiva extending onto the cornea. The coexistence of MU and pterygium is extremely rare. A 41-year-old man presented with a 2-month history of unprovoked redness, pain, and blurred vision in the right eye. Corneal epithelial defects around the pterygium head were noted upon slit-lamp examination and fluorescein staining. The patient was initially misdiagnosed with a corneal epithelial defect and pterygium. The initial treatments with anti-inflammatory and corneal epithelial growth promotion tear agents failed. Anterior segment optical coherence tomography (AS-OCT) showed corneal stromal lysis thinning, and in vivo confocal microscopy (IVCM) revealed marked inflammatory cell infiltration and stromal degeneration. We suspected the pathology was an immune-related or tumor-related corneal ulcer. The MU concealed beneath the pterygium was diagnosed by histopathological examination of a biopsy specimen that presented typical localized loss of the corneal epithelium and Bowman's layer, stromal degeneration, and inflammatory cell infiltration. Finally, we performed lamellar keratoplasty (LKP) combined with pterygium excision surgery. The patient recovered with no complications or recurrence during the 1-year follow-up period. Few cases of MU concealed beneath the pterygium have been reported. It is beneficial to rule out the pathological changes concealed beneath the pterygium, combined with multiple means of examination such as slit-lamp examination, AS-OCT, and IVCM. A histopathological examination should be performed to establish a diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to examine microbiological profile with their antibiotic sensitivity in cases of bacterial keratitis in north and central India to ensure appropriate use of antibiotics.Methods: The microbiology laboratory records of 228 patients with culture-proven bacterial keratitis from 1st January to 31st December 2019 were analyzed. Cultured bacterial isolates were subjected to antimicrobial susceptibility testing to antibiotics commonly used in the treatment of corneal ulcer. Chi-squared or Fisher's exact test were applied to check the significance of difference between the susceptibility levels of antibiotics.Results: The prevalence of Staphylococcus aureus and Pseudomonas aeruginosa-induced keratitis was higher in northern India, whereas that by Streptococcus pneumoniae was more prevalent in central India. In central India, 100% of S. pneumoniae isolates were found to be sensitive to ceftriaxone compared to 79% in northern India (P = 0.017). In comparison to 67% of isolates from north India, 15% of S. aureus isolates from central India were found to be sensitive to ofloxacin (P = 0.009). Similarly, 23% of isolates from central India were found sensitive to amikacin compared to 65% of isolates from north India (P = 0.012). P. aeruginosa isolates from central India were found to be sensitive to ceftazidime in 63% of cases compared to 21% of isolates from north India (P = 0.034).Conclusion: Prevalence of bacteria and their susceptibility to antibiotics are not uniform across geography. Vancomycin remained the most effective drug in all gram-positive coccal infections. S. aureus susceptibility to amikacin was significantly greater in north India. P. aeruginosa showed less susceptibility as compared to previous reports. [ABSTRACT FROM AUTHOR]

Purpose: To study the antifungal susceptibility of common corneal pathogenic fungi to antifungal agents in the North Indian population.Methods: Prospective study of the antifungal sensitivity testing (natamycin, amphotericin B, voriconazole, itraconazole, fluconazole, posaconazole, caspofungin, micafungin) of fungal isolates from 50 cases of culture positive fungal keratitis by using E test method. Details noted included demographic data, visual acuity, clinical details, grade of keratitis, healing time, and success in medical management.Results: Of 50 patients with fungal keratitis (mean age: 40.28 ± 16.77 years), 12 eyes healed within 3 weeks, 14 had a delayed healing response, and 24 had chronic keratitis. Among the 15 cases of Fusarium isolates, 93.3% were sensitive to natamycin, while 40% to amphotericin B; 66.6% to voriconazole, 13.4% to itraconazole and fluconazole each. 80% of Fusarium cases (n = 12) showed susceptibility to posaconazole. Among Aspergillus flavus isolates, 53.4% (n = 8) were sensitive to natamycin, with only 40% (n = 7) showing sensitivity to amphotericin B and good susceptibility to azoles. MIC against susceptible Fusarium spp. for natamycin was 3-16 μg/mL, amphotericin B: 1-8 μg/mL, voriconazole: 0.5-1.5 μg/mL, itraconazole: 0.5-12 μg/mL, posaconazole: 0.094-1.5 μg/mL. MIC against Aspergillus flavus was natamycin: 8-32 μg/mL, amphotericin B: 0.5-16 μg/mL, voriconazole: 0.025-4 μg/mL, itraconazole: 0.125-8 μg/mL, posaconazole: 0.047-0.25 μg/mL; against Aspergillus niger isolates, to natamycin was 6 μg/mL (n=1), amphotericin B 8-12 μg/mL (n = 3), voriconazole: 0.125-0.19 μg/mL (n = 3), itraconazole: 0.38-0.75 μg/mL, posaconazole: 0.064-0.19 μg/mL and against Aspergillus fumigatus (n = 1), was natamycin4 μg/mL, amphotericin B - 8 μg/mL, voriconazole 0.25 μg/mL, itraconazole 1 μg/mL, and posaconazole 0.19 μg/mL. MIC against susceptible Acremonium spp. for natamycin was 1.5-16 μg/mL, amphotericin B: 0.5-8 μg/mL, voriconazole: 0.19-3 μg/mL, itraconazole: 0.125 μg/mL, posaconazole: 0.125-0.5 μg/mL and against susceptible Curvularia was natamycin 0.75-4 μg/mL, amphotericin B 0.5-1 μg/mL, voriconazole 0.125-0.19 μg/mL, itraconazole 0.047-0.094 μg/mL, posaconazole 0.047-0.094 μg/mL. MIC against Mucor spp.+ Rhizopus spp. (n = 1) was natamycin: 8 μg/mL, amphotericin B: 0.75 μg/mL, posaconazole: 1.5 μg/mL. MIC against of Alternaria (n = 1) was voriconazole: 0.19 μg/mL, posaconazole: 0.094 μg/mL. MIC against Penicillium (n=1) was natamycin: 8 μg/mL, voriconazole: 0.25 μg/mL, itraconazole: 0.5 μg/mL, and Posaconazole: 0.125 μg/mL.Conclusion: Our observations highlight the variations in susceptibility to antifungal agents. Posaconazole seems to be effective with low MIC against common corneal pathogenic fungal isolates. [ABSTRACT FROM AUTHOR]

A corneal ulcers are one of the most common eye diseases. They come from various infections, such as bacteria, viruses, or parasites. They may lead to ocular morbidity and visual disability. Therefore, early detection can reduce the probability of reaching the visually impaired. One of the most common techniques exploited for corneal ulcer screening is slit-lamp images. This paper proposes two highly accurate automated systems to localize the corneal ulcer region. The designed approaches are image processing techniques with Hough transform and deep learning approaches. The two methods are validated and tested on the publicly available SUSTech-SYSU database. The accuracy is evaluated and compared between both systems. Both systems achieve an accuracy of more than 90%. However, the deep learning approach is more accurate than the traditional image processing techniques. It reaches 98.9% accuracy and Dice similarity 99.3%. However, the first method does not require parameters to optimize an explicit training model. The two approaches can perform well in the medical field. Moreover, the first model has more leverage than the deep learning model because the last one needs a large training dataset to build reliable software in clinics. Both proposed methods help physicians in corneal ulcer level assessment and improve treatment efficiency. [ABSTRACT FROM AUTHOR]

Neurotrophic keratopathy (NK), or neurotrophic keratitis, is a degenerative condition that results from decreased innervation to the cornea. The cornea is innervated by the ophthalmic branch of the trigeminal nerve. Neurotrophic keratopathy is most commonly caused by herpes keratitis however, any condition that disrupts the normal corneal innervation can cause NK. Neurotrophic keratopathy is a clinical diagnosis and is classified into three stages based on the disease severity. Stage 1 has mild epithelial defects, such as punctate keratopathy, stage 2 disease has persistent epithelial defects, and stage 3 is defined by the presence of ulcers. Current treatment modalities consist of medical and surgical options. Stage 1 is treated with lubrication through artificial tears, eyelid taping, and punctal plug/cautery. Stage 2 treatment can involve therapeutic contact lenses, topical autologous or allogenic serum, tarsorrhaphy, botulinum toxin injections, and possibly anti-inflammatory medications. Stage 3 disease may require human nerve growth factor, amniotic membrane transplantation, conjunctival flap, or corneal neurotization. New therapies, such as matrix regenerating therapy, plasma rich in growth factors, Thymosin β4, Substance P/Insulin like growth factor-1, and nicergoline represent exciting future options. Neurotrophic keratopathy is a rare degenerative disease defined by decreased innervation to the cornea that is associated with significant morbidity. Treatment options range from lubrication alone to various medical and surgical treatments. Matrix regenerating therapy, plasma rich in growth factors, Thymosin β4, Substance P/Insulin like growth factor-1, and nicergoline are exciting novel therapies that will influence how neurotrophic keratopathy is treated in the future. [ABSTRACT FROM AUTHOR]

Copyright of Nouveau Praticien Vétérinaire Canine & Féline is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Amniotic membrane (AM) is widely used in ophthalmic surgery. There are three major techniques for amniotic membrane transplantation (AMT): ‘onlay’ (‘patch’) technique, ‘inlay’ (‘multilayer transplantation’) and ‘sandwitch’ technique (a combination of the two techniques mentioned before), but there is no universal technique for placing the amnion on the ocular surface for AMT. In conventional multilayer AMT, the membrane is fixed layer by layer with numerous interrupted sutures, which contributes to a severe corneal inflammatory response and the formation of intense corneal opacity. Purpose: To improve the multilayer amniotic membrane transplantation technique. Material and Methods: The method proposed by us consists in forming a two layer or three layer amniotic graft and anchoring it to the surrounding cornea by a row of interrupted 10-0 sutures. Twenty eight patients with corneal ulcers of different causes underwent amniotic membrane transplantation. There were 17 men (60.7%) and 11 women (39.3%). Mean patient age (standard deviation) was 51.3 (0.81) years. Corneal ulcers were categorized based on the etiology as herpetic (7/28, 25%), neurotrophic (10/28, 35.7%), bacterial (3/28, 10.7%), fungous (2/28, 7.2%), autoimmune (3/28, 10.7%) and those caused by rosacea (3/28, 10.7%). Results: After AMT by the proposed technique, there was a reduction in corneal stromal edema at discharge (χ2 = 29.7; p = 0.0005). In addition, corneal stromal infiltration resorbed at 1 month after surgery compared to at discharge (χ2 = 9.16; p = 0.0025). AMT by the proposed technique facilitated the formation of mild focal corneal opacity in 26 patients (92.8%). Conclusion: Our improved AMT technique reduces the number of sutures on the cornea, enables filling the corneal stromal defect and contributes to decreased inflammatory response and early epithelialization of the corneal surface.

Corneal ulcers are one of the most common ocular disorders in veterinary ophthalmology and several factors can negatively influence the efficacy of the currently available therapeutic options, leading to a loss of corneal transparency and, thus, vision. Twenty-five dogs with clinical signs of corneal ulcers were randomised to receive either corneal phototherapy (16 dogs; study group) or topical standard medical therapy (9 dogs; control group). The riboflavin/UV-A corneal phototherapy (PACK-CXL) consisted in the application of a riboflavin ophthalmic solution (Visioflavin®; Vision Engineering Italy srl, Rome, Italy) onto the cornea for 20 min followed by 30 mW/cm2 UV-A irradiance for 3 min using a point-of-care UV-A device (Vetuvir®; Vision Engineering Italy srl, Rome, Italy). The complete healing of the ulcerative lesion was defined as the complete restoration of the corneal epithelial integrity with negative fluorescein staining. The corneal phototherapy achieved complete corneal healing in all the dogs by 20.5 ± 7.8 days. In the control group, only two dogs achieved complete healing by 21.5 ± 15.6 days. This intervention may represent a valid option to hasten corneal wound healing and a clinical resolution of ulcerative keratitis in dogs.

Neurotrophic keratitis (also called neurotrophic keratopathy) (NTK) is a degenerative disease of the cornea, accompanied with neurogenic inflammation. It caused by a sensitive innervation loss of the trigeminal nerve and characterized by reduced sensitivity of the cornea and a retardation of its healing process. NTC-causing damage to the trigeminal nerve can occur at different levels-from the nucleus to the terminals located in the cornea, and can be caused by ocular and systemic diseases both. The most common causes include herpetic keratitis, diabetes, chemical burns and iatrogenic injuries during ophthalmic operations, intracranial neoplasms, disorders of cerebral circulation and neurosurgical interventions. Corneal changes include epitheliopathy (grade I), persistent erosion (grade II), ulcer and its complications (grade III). The determining diagnostic sign of NTK is a decrease or loss of corneal sensitivity. The morphological characteristics of the corneal nerves can be studied using confocal microscopy.

AIM: To observe the preliminary therapeutic effect of low-temperature plasma ablation combined with drugs in the treatment of infectious corneal ulcer. METHODS: Retrospective case study. A total of 30 eyes were selected from 30 patients with infectious corneal ulcer who were admitted to the ophthalmology department of the First Affiliated Hospital of Chongqing Medical University from December 2018 to March 2020. All patients had positive etiological examination and ulcer or infiltration depth ≤1/2 of corneal thickness. Local low-temperature plasma ablation combined with eye drops was applied to the cases whose corneal ulcer did not improve significantly or corneal infiltration continued to worsen after 3-7d of conventional anti-infection treatment. Postoperative follow-up was 3-6mo to observe the clinical effect.RESULTS: After low-temperature plasma ablation combined with eye drops treatment, the infection in 12 eyes of 12 patients with bacterial corneal ulcer was controlled in 11 eyes of 11 patients and ulcer healed gradually. Keratoplasty was performed in 1 eye due to aggravated infiltration. Among 18 eyes of 18 cases with fungal corneal ulcer receiving low-temperature plasma ablation and combined local antifungal treatment, 13 eyes of 13 cases gradually healed; 2 eyes of 2 patients showed lichen-like changes after the first ablation, but the lesion area was significantly smaller than before and gradually improved after re-ablation treatment; there was no effect in 3 eyes of 3 cases and keratoplasty was finally performed. All the patients were followed up for 3-6mo, 26 eyes of 26 patients were cured and the infection had no recurrence with remaining corneal pannus or leukoplakia. Confocal microscopy did not detect mycelium in cured patients with fungal infection.CONCLUSION: In this preliminary observation, low-temperature plasma ablation combined with drug therapy can effectively control infection, promote healing and improve visual acuity for infective corneal ulcer with infiltration less than 1/2 corneal thickness, and no obvious complications were observed.

A 5-year-old girl had a 2-week history of protruding bilateral eye with blurred vision. The patient had a history of low-grade fever. Bilateral proptosis with a markedly severe protrusion of the conjunctival palpebral and infraorbital tissues was observed. A more pronounced proptosis occurred on the left eye. Lagophthalmos and corneal defects were found in the left eye. Laboratory tests revealed anemia, hyperleukocytosis, and thrombocytopenia. A confirmed diagnosis of acute myeloid leukemia-M2 was established from bone marrow aspiration. The patient was treated with standard multiagent chemotherapy and topical antibiotic eyedrops. Proptosis had resolved in 4 months with residual corneal cicatrix in the left eye.

The aim of this study was to report transmission electron microscopic findings of a case with whole corneal descemetocele following infective corneal ulcer for the first time in literature. A 72-year-old male patient presented with infective corneal ulcer. After resolution of the infection, corneoscleral transplantation was performed. The excised very thin corneal membrane was processed for transmission electron microscopic examination. Transmission electron microscopic examination of the specimen revealed many layered structures that consisted of two different types of cells. The first type consisted of lighter staining polygonal cells, while the second consisted of elongated cells with relatively dense staining. All cells were connected with a large number of gap or adherens junctions with intercalation of the cell membranes of adjacent cells. A haphazard distribution of cytoplasmic microfilaments were also observed in all of the cell types. There was no evidence of the presence of endothelial cells throughout the specimen. There was also no evidence of Descemet membrane presence except for a small part adjacent to iris tissue that contained some melanosomes. Although we clinically diagnosed descemetocele, Descemet membrane was not present at the electron microscopic level, and thus, the expression “descemetocele” is inappropriate. [ABSTRACT FROM AUTHOR]

The author of this letter agrees with the proposal to minimize the use of eponyms in science. They have been working towards this goal as the editor-in-chief of the Journal of Veterinary Diagnostic Investigation and editor of Jubb, Kennedy & Palmer's Pathology of Domestic Animals. They have made changes in articles and upcoming editions to replace eponyms with more descriptive terms. They have also anglicized Latin terminology to demystify scientific communication. The author believes that the use of eponyms should be discontinued and that instructors and literature sources should carefully consider their use. [Extracted from the article]

In the present study, the results of the new generation platelet-rich fibrin (PRF) membrane graft application in deep corneal ulcers accompanying descemetocele in cats in ocular surface reconstruction surgery were evaluated, and a retrospective non-comparative study covering the period between May 2019 and August 2021 was conducted. Patients underwent routine surgical procedures for corneal ulcers, and then a new-generation autologous PRF membrane graft was transplanted to the ulcer site. Nineteen eyes were analyzed (14 males, five females). Corneal integrity and vision were achieved in all cases aft er treatment. No signs of infection and infl ammation were noted aft er membrane transplantation. Th e PRF membrane was transplanted to the defected area with sutures generating highly eff ective results in eliminating the defect"s urgency, supporting the cornea, and accelerating the corneal healing. Corneal integration of the PRF membrane was successful in all cases without postoperative separation or stretching. In conclusion, the PRF membrane graft ing was safely and eff ectively utilized in the surgical treatment of deep corneal ulcers in cats with a success rate of 89.4% in descemetocele cases.

Nada Al-Yousuf,1,2 Hasan Alsetri,3 Eman Farid,4,5 Sara M George4 1Department of Ophthalmology, King Abdullah Medical City, Manama, Kingdom of Bahrain; 2Department of Surgery, College of Medicine, Manama, Kingdom of Bahrain; 3Department of Chemistry and Biochemistry, University of California Los Angeles, Los Angeles, CA, USA; 4Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain; 5Department of Microbiology, Immunology & Infectious diseases, College of medicine, Arabian Gulf University, Manama, Kingdom of BahrainCorrespondence: Nada Al-YousufDepartment of Ophthalmology, King Abdullah Medical City, 61, King Abdulaziz Avenue, Manama, Kingdom of Bahrain, Tel +973 77310071, Fax +973 77310001, Email nyousuf10@gmail.comPurpose: To describe the method used locally in amniotic membrane preparation and preservation for ocular surface reconstruction. To report the indications, surgical techniques, outcome and complications of amniotic membrane transplant using the locally prepared tissue. To examine the safety and efficacy of this less commonly studied method in amniotic membrane banking technique.Patients and Methods: Dimethylsulphoxide (DMSO) was used for the preparation and preservation of the amniotic membrane. A retrospective study was done from 2005 to 2017 to examine the indications of amniotic membrane transplant. The surgical techniques used for different indications are described. Surgical outcome and complications are reported.Results: The prepared tissue was used for the surgical management of a variety of disorders related to the ocular surface. Over the 12 years period from 2005 to 2017, a total of 135 cases were done. The most common indications for amniotic membrane transplant were pterygium surgery (41%), non-healing corneal ulcer (24%), others (13%), corneal perforation (10%), chemical burn (7%), bullous keratopathy (3%) and conjunctival-corneal scarring (2%). The most common surgical procedures used were inlay, overlay and combination (sandwich) techniques. Success rates for this ocular structure restoration procedure were the highest when treating corneal ulcers (81%), followed by pseudophakic bullous keratopathy (75%), then corneal perforations (70%). The recurrence rate for pterygium with amniotic membrane transplant was 14%. The most common complication was repeat amniotic membrane transplant. There were no complications related to the banking technique.Conclusion: This method of preparation and preservation of amniotic membranes is safe and effective for ocular surface disorders. Amniotic membrane transplants have high success rates when treating, corneal ulcers, corneal perforations, pseudophakic bullous keratopathy and epidermolysis bullosa.Keywords: pterygium, bullous keratopathy, corneal perforation, corneal ulcer, descemetocele, epidermolysis bullosa, ocular surface

Purpose: To study the microbiological profile of clinically diagnosed infectious keratitis cases in tertiary care hospitals in Solan, HP (India). Design: The study design involves prospective cross-sectional study. Materials and Methods: It was a prospective cross-sectional study that included clinically diagnosed corneal ulcer patients from September 1, 2018 to September 1, 2019. The demographic data, predisposing risk factors, clinical details, previous treatment history, investigations, treatment, and visual outcomes were analyzed. Results: A total of 36 patients were included in the study, and no significant difference between the number of males and females was noted (P = 0.74). The most common etiology of ulcer was corneal trauma in 25 (69%) patients. Injury with vegetative material was the most common mode of injury (18 of 25, 72%), followed by injury during construction work (3 of 25, 12%). Twelve of 36 (33%) cases were fungal, 6 (16%) were found to be bacterial and 2 (5%) cases had mixed organisms. The most common organism isolated was Fusarium spp. in 8 (40%) cases. The most common bacterial isolate was Staphylococcus aureus in 4 (20%) cases, followed by one each of Streptococcus pneumonia (5%) and Pseudomonas spp. (5%). Thirteen patients (36%) reached outpatient department between 7 and 14 days and 15 (42%) patients 2 weeks after the start of symptoms with no significant difference in the two genders (P = 0.97). Conclusion: Majority of infectious corneal ulcers in our region are fungal due to injuries during predominantly agriculture-based lifestyles and need urgent management.

Purpose The aim of this study was to evaluate the safety and efficacy of double stromal lenticules, extracted by femtolaser small incision lenticule extraction (SMILE) surgery, as a surgical adjuvant for sealing of impending corneal perforation. Patients and methods The study included 20 eyes of 20 patients with impending corneal perforation. Double corneal stromal lenticules obtained through SMILE surgery, with a central thickness of 65 μm for each lenticule, were fixed over the corneal impending perforation site by 10-0 nylon interrupted stitches. The patients were monitored for a minimum of 6 months and were assessed using slit-lamp biomicroscopy, fluorescein stain, tonometry, and best spectacle-corrected visual acuity measurements. Postoperative complications were recorded throughout the follow-up period. Results The mean age of the patients was 51.25±1.49 years. The mean thickness of the used double SMILE lenticules was 108.85±10.77 μm (range, 90–120 μm). The preoperative best spectacle-corrected visual acuity was counting fingers at 30 cm in four patients, whereas the other 16 patients had a visual acuity of hand movement. Postoperatively, the corneal perforations were successfully sealed in 16 (80%) patients, and 15 (75%) patients exhibited a statistically significant improvement in visual acuity (P=0.02). During the follow-up period of 6 months, there was evidence of one case of infection and two cases of sliding graft. There was no significant association between the patients’ data and the reported complications except the association between complications and hand movement visual acuity. Conclusion The use of double corneal lenticules was a safe and effective surgical adjuvant for corneal perforation closure. It is a simple and inexpensive temporary measure to improve the corneal condition for further definitive interventions.

Purpose: To assess Photo Activated Chromophore for Infective Keratitis-Cross Linking (PACK-CXL) and its efficacy as a treatment modality in managing microbial keratitis. Methods: Single Centre prospective interventional study in infectious keratitis. A total of eleven patients were taken who had corneal thickness (CT) more than 400μm. PACK-CXL was performed according to Dresden's protocol. The response was assessed by slit lamp examination, BCVA and AS-OCT at the time of complete healing. Results: The mean visual acuity at presentation was 1.207logMAR (0.3-3) which improved to mean value of 0.53logMAR (0.3-1). Mean time taken for complete epithelization was 17.45 days (14- 30 days) and that for complete healing was 33.72 days (21- 60 days). Mean CT at the baseline was 650.5± 108μm which reduced on consecutive follow up visits. There was reduction in the symptoms in nine patients except in two. One case reported increase in symptoms with worsening increase in endoexudates and hypopyon, and the other developed drug toxicity due to topical medications. Conclusion: Patients who underwent PACK-CXL showed good and early healing, good remodelling of cornea and improved visual acuity. The recalcitrant cases became responders to the same medications after PACK-CXL. Thus, PACK-CXL works well for both fungal and bacterial keratitis.

Aim: To explore the factors associated with culture positivity and worsening of corneal ulcers in patients presenting to a tertiary care teaching hospital in south Kerala. Methods: We did a retrospective review of hospital-based case records from June 2018 to May 2019 and included all cases of infective corneal ulcer admitted during the period of study with corneal stromal infiltrate on slit-lamp examination. Results of gram stain, potassium hydroxide stain, and culture result were noted. The treatment history (moxifloxacin (0. 3%) or fortified cephalosporin and gentamicin or natamycin) was recorded. The data were exported to the statistical software SPSS V27.0 for further analysis. Results: The data of 125 culture-positive and 250 culture-negative ulcers were studied. Most patients were aged >55 years (n = 201, 53.6%) and 35–55 years (n = 120, 32.0%). The association of culture negativity with nontraumatic risk factors was significant (P = 0.01) but not with the size of the ulcer, progress score, or worsening clinical status of the ulcer. More persons with pretreatment (15.2%) showed worsening of the clinical status compared to those who did not (6.3%) (P = 0.005). 63% of the culture-positive cases had not taken any pretreatment. Compared to noncentral ulcers there was a marked deterioration of central ulcers (16.7%) (P = 0.005). Conclusion: Pretreatment and centrally located ulcers were significantly associated with a worsening clinical condition in this study. Culture-positive corneal ulcers showed a tendency toward improvement, but we could not find an association between the detection of the organism and its favorable response to treatment.

Purpose: to study the effectiveness of the use of thrombofibrin clot of platelet-rich plasma (PRP) in patients with corneal ulcers. Material and methods. A clinical study, conducted by the Department of Traumatology and Reconstructive Surgery of Helmholtz National Medical Research Center of Eye Diseases, involved 20 patients, aged from 22 to 82, with corneal ulcers of inflammatory and burn genesis more than 100 microns deep. All patients got coated with a thrombofibrin PRP clot from autologous blood. Prior to the study, all patients received standard treatment for 2 weeks to 3 months, including multiple amniotic membrane coating, with no effect. The thrombofibrin clot was produced by the Scientific Department of Biotechnology and Transfusiology of the N.V. Sklifosovsky Research Institute for Emergency Medicine. The ready clot was placed on the surface of the cornea and covered with an amniotic membrane. The membrane was fixed to the episclera along the border of the limb with a circular suture, whereupon autologous serum was injected along the limb in 4 quadrants, to be followed by temporary lateral blepharography. Results. On the 2nd day following the procedure, the patients noted a decrease in lacrimation and pain in the operated eye. As shown by optical coherence tomography, the average depth of the corneal ulcer at the beginning of the study in all patients was 129 ± 28.5 microns. On the 5th day, the depth lowered to an average of 71 ± 32.6 microns, and on the 10th day, to 23.3 ± 15.1 microns. In 7 patients (35%), complete healing of the defect was observed on the 15th day, while in 9 patients (45%) it was stated between the 16th and the 20th day. Thus, the average time of healing of the ulcer with complete epithelization occurred was 15 days. In four patients with the consequences of severe burns (20%), the ulcer did not heal due to extensive damage to the limbal zone. Conclusion. The use of a thrombofibrin PRP clot in combination with amniotic membrane transplantation allows achieving a stable and fairly rapid healing of corneal ulcers of various origins. However, this method is ineffective in patients with limbal cell insufficiency, severe burns and extensive damage to the limbal zone. In such cases, it is advisable to use more radical surgical methods, such as buccal or limbal cell transplantation, or allolimbal transplantation.

IntroductionCorneal opacity is a leading cause of blindness worldwide. In resource-limited settings, untreated traumatic corneal abrasions may result in infection and ultimately, opacity. Although antimicrobial treatment of corneal ulcers may successfully cure infections, the scarring that accompanies the resolution of infection can still result in visual impairment. Prevention may be the optimal approach for reducing corneal blindness. Studies have employed community health workers to provide prompt administration of antimicrobials after corneal abrasions to prevent infections, but these studies were not designed to determine the effectiveness of such a programme.Methods and analysisThe Village-Integrated Eye Worker trial (VIEW) is a cluster-randomised trial designed to assess the effectiveness of a community health worker intervention to prevent corneal ulcers. Twenty-four Village Development Committees (VDCs) in Nepal were randomised to receive a corneal ulcer prevention programme or to no intervention. Female Community Health Volunteers (FCHVs) in intervention VDCs are trained to diagnose corneal abrasions, provide antimicrobials and to refer participants when needed. An annual census is conducted over 3 years in all study VDCs to assess the incidence of corneal ulceration via corneal photography (primary outcome). Masked outcome assessors grade corneal photographs to determine the presence or absence of incident corneal opacities. The primary analysis is negative binomial regression to compare the incidence of corneal ulceration by study arm.Ethics and disseminationThe University of California San Francisco Committee on Human Research, Nepal Netra Jyoti Sangh and the Nepal Health Research Council have given ethical approval for the trial. The results of this trial will be presented at local and international meetings and submitted to peer-reviewed journals for publication.Trial registration numberNCT01969786; Pre-results.

OBJECTIVE:To compare oral voriconazole vs placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. DESIGN:Non-prespecified, secondary case-control analysis from a multicenter, double-masked, randomized placebo-controlled clinical trial. METHODS:Study Participants: Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 or worse who eventuated to therapeutic penetrating keratoplasty (TPK). INTERVENTION:Study participants were randomized to oral voriconazole vs oral placebo; all received topical antifungal drops. MAIN OUTCOME MEASURES:TPK button culture positivity. RESULTS:A total of 95 of 194 (49.5%) study participants enrolled at Madurai, Coimbatore, or Pondicherry, India eventuated to TPK in an average of 20.9 days (standard deviation 15.2 days, range 2-71 days). TPK button cultures were available for 67 of 95 (71%) of the TPKs performed and were positive for filamentous fungus in 45 of 67 (67%) cases. For each 1-day increase in the time to TPK there was 0.94-fold decreased odds of fungal culture positivity (95% confidence interval [CI] 0.90-0.98, P = .005). Those randomized to oral voriconazole had 1.26-fold increased odds of TPK button culture positivity after controlling for time to TPK and baseline organism, but this was not statistically significant (95% CI 0.32-4.87; P = .74). Those who underwent TPK for lack of response to medical therapy were 10.64-fold more likely to be culture positive than if the indication for surgery was perforation and this was statistically significant (95% CI 2.16-51.70; P = .003). CONCLUSIONS:There appears to be no benefit to adding oral voriconazole to topical antifungal agents in the treatment of severe filamentous fungal ulcers. Infection rather than inflammation appears to be the reason for the worsening clinical picture in many of these patients.

PURPOSE:To identify fungal keratitis patients who are at risk of a poor outcome and may benefit from closer follow-up or more aggressive treatment. DESIGN:Secondary analysis of randomized clinical trial data. METHODS:We compared the clinical outcomes of patients who had positive 6-day fungal cultures with those who did not, using backward stepwise regression with covariates for all baseline clinical characteristics. SUBJECTS:Patients presenting with a smear-positive filamentous fungal ulcer and visual acuity of 20/400 or worse, and who subsequently had a 6-day fungal culture performed at the Aravind Eye Care system (India), Lumbini Eye Hospital (Nepal), or Bharatpur Eye Hospital (Nepal). MAIN OUTCOME MEASURES:The primary outcome is rate of corneal perforation and/or the need for therapeutic penetrating keratoplasty. Secondary outcomes include 3-month best spectacle-corrected visual acuity (BSCVA), 3-month infiltrate and/or scar size, and rate of re-epithelialization. RESULTS:Patients who tested positive at their 6-day culture had twice the hazard of experiencing a corneal perforation or the need for therapeutic penetrating keratoplasty (P = .002) than those who tested negative, even after controlling for baseline ulcer characteristics. These patients also had on average 0.26 logMAR lines worse BSCVA at 3 months (P = .001). Culture positivity at day 6 was not a statistically significant predictor of 3-month infiltrate/scar-size (-0.24 mm1; P = .45) or time to re-epithelialization (hazard ratio = .81; P = .31). CONCLUSIONS:Here we identify a uniquely valuable clinical tool, day 6 culture results, for the treatment of severe fungal keratitis. Risk stratification based on repeat culture positivity is an objective way to assess response to medical therapy and identify patients who are at high risk of a poor clinical outcome. This establishes a new standard of care for severe fungal keratitis management.

PurposeUnderstanding the spectrum of pathogens in a given geographic region is important when deciding on empiric antibiotic therapy. In this study, we evaluate the spectrum of bacterial organisms cultured from corneal samples and their antibiotic sensitivities to guide initial treatment of keratitis.MethodsWe performed a retrospective case review of cultures from suspected infectious keratitis cases at the Francis I. Proctor Foundation, University of California, San Francisco, from 1996 through 2015. Logistic regression models were used to assess the risk of culturing methicillin-resistant Staphylococcus aureus (MRSA) from ulcers over time and the association between the year cultured and moxifloxacin resistance.ResultsA total of 522 of 2203 (23.7%) cultures grew bacterial organisms believed to be the etiology of infection, with available antibiotic sensitivity data. Of these, 338 (65.3%) grew gram-positive organisms with the most common being methicillin-sensitive Staphylococcus aureus (20.1%, N = 105). One hundred eighty (34.7%) grew gram-negative species with Pseudomonas aeruginosa as the most prevalent organism (10.9%, N = 57). There was 1.13 increased odds of culturing MRSA for each 1-year increase in the culture date (P = 0.01) and 1.26 increased odds of culturing an organism resistant to moxifloxacin with each 1-year increase in the culture date after controlling for the infectious organism (P < 0.001).ConclusionsGram-positive organisms are the most commonly identified etiology of microbial keratitis in this series. Approximately 35% of cultured organisms had variable susceptibility to moxifloxacin, and resistance seems to be increasing over time. The risk of culturing MRSA increased over time.

This case report describes ocular and nasal leech infestation (hirudiniasis) in a dog. The patient presented for a suspected ocular foreign body. The patient was sedated to allow proper examination, which revealed a leech foreign body attached to the bulbar conjunctiva adjacent to the inferotemporal limbus of the left eye. A 3.5% hypertonic saline solution was applied topically to the eye in four sequential drops, until the leech detached itself and was removed with a cotton bud. The affected eye was found to have a small corneal ulcer, a small area of scleral haemorrhage, and prominent lymphoid follicles within the third eyelid. Approximately 5 min after the leech was removed, another leech emerged from the left nostril. The patient was sent home on chloramphenicol ointment for treatment of the corneal ulcer, was rechecked 4 days later by an American Board of Veterinary Ophthalmology resident (PM) and found to have a normal ocular exam. This case report highlights that topical hypertonic saline solution (3.5%) can be an effective and easily prepared treatment for ocular and nasal hirudiniasis in veterinary patients. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of Pseudomonas aeruginosa microbial keratitis in a patient wearing the same soft contact lenses in both eyes. Methods: 14-year-old girl with soft contact lenses she was diagnosed with a corneal ulcer in her right eye. Scrapings were positive for P. aeruginosa, started on fortified topical antibiotics, came one day after treatment then did not show up in her follow-ups. Two weeks later, she came after using the same contact lens in her left eye, diagnosed with a corneal ulcer, scraping of the corneal ulcer and contact lens were again positive for P. aeruginosa, she was admitted due to her poor compliance, treated with fortified topical antibiotics. Results: The microbial keratitis healed with successful treatment. Conclusions: Sight-threatening microbial keratitis can occur after using the same soft contact lenses in both eyes two week apart, showing how fertile is the contact lens for the growth of bacteria. [ABSTRACT FROM AUTHOR]

Corneal ulcer is the most common symptom of corneal disease, which is one of the main causes of corneal blindness. The accurate classification of corneal ulcer has important clinical importance for the diagnosis and treatment of the disease. To achieve this, we propose a deep learning method based on multi-scale information fusion and label smoothing strategy. Firstly, the proposed method utilizes the densely connected network (DenseNet121) as backbone for feature extraction. Secondly, to fully integrate the shallow local information and the deep global information and improve the classification accuracy, we develop a multi-scale information fusion network (MIF-Net), which uses multi-scale information for joint learning. Finally, to reduce the influence of the inter-class similarity and intra-class diversity on the feature representation, the learning strategy of label smoothing is introduced. Compared with other state-of-the-art classification networks, the proposed MIF-Net with label smoothing achieves high classification performance, which reaches 87.07 and 83.84% for weighted-average recall (W_R) on the general ulcer pattern and specific ulcer pattern, respectively. The proposed method holds promise for corneal ulcer classification in fluorescein staining slit lamp images, which can assist ophthalmologists in the objective and accurate diagnosis of corneal ulcer. [ABSTRACT FROM AUTHOR]

Background: Immunotherapy has been widely used to treat Colorectal cancer but has also observe some immune-related adverse effects. With proper treatment, most irAE can be solved and the effect of immunotherapy will not be affected by temporary immunosuppression. However, there are few reports about corneal irAE, and the current understanding of irAE is incomplete. Here we report a metastatic colorectal cancer case of immunerelated keratitis caused by nivolumab and to explore the occurrence of immune-related keratitis. Case description: Here we report the case of a 49-year-old man with mCRC who had no previous ocular disease but developed immune-related ulcerative keratitis after treatment with nivolumab. We summarize a large amount of literature to discuss the mechanism of immune-related keratitis. In addition, we conclude a method that may be used to detect the occurrence of immune keratitis, by monitoring MMPs and maspin in patients treated with nivolumab. We believe immune-related keratitis may be a rare complication of nivolumab in the treatment of mCRC. The effect of simple anti-infective therapy and repair-promoting drugs was not obvious, but the effect of glucocorticoid combined with autologous serum was significant. Conclusion: The mechanism of immune-related keratitis is that nivolumab destroys the immune microenvironment and ACAID, and affects corneal healing. Patients who use nivolumab can prevent immune keratitis by testing MMPs and maspin. The occurrence of immune keratitis may be a good indicator of the efficacy of ICI, and further study can be done in the follow-up. [ABSTRACT FROM AUTHOR]

Background: Herpes simplex keratitis (HSK) is a rare and sight-threatening complication following refractive surgery. SmartSurfACE surgery is the result of combining transepithelial photorefractive keratectomy (trans-PRK) with Smart Pulse Technology (SPT) to diminish surface irregularities of the residual stromal bed after surgery with less pain, faster re-epithelialization, and better postoperative visual acuity. In this article, we report the first case of HSK following SmartSurf ACE without history of herpetic eye disease.Case Presentation: A 21-year-old woman underwent bilateral SmartSurfACE without history of clinical herpetic infection, active eye disease, or systemic disease. Mild superficial punctate keratitis occurred on the tenth postoperative day. The condition was not improved by ophthalmic drugs of anti-inflammation or epithelial healings. Dendritic corneal ulcer appeared within one month, which is the commonly recognized clinical manifestation of herpes simplex keratitis. The patient was managed with topical and systemic antiviral agents. After nine days of antiviral therapy, the lesion healed up, remaining mild stromal scarring in both eyes ultimately.Conclusion: Herpes simplex keratitis is a rare but sight-threatening complication following refractive surgery. For the ocular irritation symptoms of postoperative patients, we should consider the possibility of HSK and give timely treatment. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid vasculitis (RV) is a rare but potentially devastating complication of rheumatoid arthritis (RA). It typically occurs in patients with extra-articular manifestations. Here we reported a case of PUK with nodular episcleritis and pulmonary nodules that occurred in the same patient without joint involvement. Case presentation: A 43-year-old Chinese woman, exhibited a partial crescent-shaped marginal corneal ulcer in the right eye at admission and the ulcer developed rapidly into nearly 360-degree ulcers in both eyes within one week. Nodular episcleritis was observed in the right eye. Conjunctival biopsy revealed vasculitis. Her rheumatoid factor (RF) and anti-cyclic citrullinated protein antibody were positive, while anti-neutrophilic cytoplasmic antibody (c-ANCA) and anti-protease 3 were negative. Pulmonary nodules were found, without joint involvement. The ocular condition did not relieve under the topical and systemic use of corticosteroids, or under other immunosuppressive agents until the infliximab therapy. PUK recurrence was observed after the discontinuation of infliximab. Conclusions: Rapidly deteriorated PUK with nodular episcleritis and pulmonary nodules occurred in the same patient is a special case of RA without joint involvement. This case reinforces the concept that RV may be the initial sign of RA. Infliximab can be used to prevent further progress of RA-related PUK in some refractory cases. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical outcomes and efficacy of diamond burr debridement (DBD) treatment for corneal ulceration in cats. Procedure(s): Medical records of cats that received DBD at two private practices between 2015 and 2021 were retrospectively reviewed. DBD was performed using a battery‐powered, handheld motorized burr and a bandage contact lens was placed in 18/21 eyes. Corneal ulceration was considered resolved if the cornea was fluorescein negative with a stable epithelial surface. Recurrence was defined as return of corneal ulceration. Descriptive statistics and a Fisher's exact test were conducted on the study population. Results: Twenty‐one eyes from 20 cats with superficial corneal ulcers refractory to medical treatment underwent DBD. Domestic and Burmese were the most commonly encountered breeds and the median age of affected cats was 8.83 years (range 0.5–20 years). Corneal ulceration was present for a median of 14 days prior to DBD. Healing was achieved in 81% of eyes; with four eyes failing to heal and requiring further intervention. Corneal sequestrum was reported in one case that failed to heal. Of the healed cases, three cases recurred (17.6%) at a mean of 116.3 days (range 79–135 days). Burmese were overrepresented (p <.001) in cases that failed to heal or recurred (6/7 eyes; 85.7%). The median postoperative follow‐up time was 93 days (range 6–1613 days). Conclusions: Diamond burr debridement is a safe, non‐invasive treatment for corneal ulceration in cats but, compared with published results, it had a lower success rate than superficial lamellar keratectomy. [ABSTRACT FROM AUTHOR]

Infectious keratitis is a severe infection of the eye, which requires urgent care in order to prevent permanent complications. Typical cases are usually diagnosed clinically, whereas severe cases also require additional tools, such as direct microscopy, corneal cultures, molecular techniques, or ophthalmic imaging. The initial treatment is empirical, based on the suspected etiology, and is later adjusted as needed. It ranges from topical administration of active substances to oral drugs, or to complex surgeries in advanced situations. A novel alternative is represented by Photoactivated Chromophore Corneal Collagen Cross-Linking (PACK-CXL), which is widely known as a minimally invasive therapy for corneal degenerations. The purpose of this review is to identify the main diagnostic and prognostic factors which further outline the indications and contraindications of PACK-CXL in infectious keratitis. Given the predominantly positive outcomes in the medical literature, we ponder whether this is a promising treatment modality, which should be further evaluated in a systematic, evidence-based manner in order to develop a clear treatment protocol for successful future results, especially in carefully selected cases. [ABSTRACT FROM AUTHOR]

Background: To evaluate use of homologous platelet rich plasma (PRP) drop and leucocyte-platelet rich fibrin (L-PRF) clot/membrane as regenerative therapy for healing of corneal ulcer in dogs and its subsequent comparison with conventional therapy. Methods: In this randomized study, 30 dogs were divided into three groups of 10 animals each. It was ensured each group had grade I, II and III ulcers. Group I received medicinal treatment with antimicrobial and non-steroidal anti-inflammatory eye drop. In group II PRP drops and in group III L-PRF membrane was used to evaluate corneal ulcer healing. Homologous platelet concentrates were prepared in laboratory and used for assessment of healing on various grades of corneal ulcer on basis on reduction in size and depth of ulcer, presence of stromal infiltration, scleral involvement, corneal opacity and vascularization. Result: Post treatment, the size of corneal ulcer started to reduce gradually from day 7 onwards. Significant (p≤0.05) reduction was observed from day 10 in group I after instillation of drops Moxifloxacin and Flurbiprofen and in group II after instillation of PRP. It was measured as 5.35±0.63 and 5.20±0.98 mm at day 0, which reduced significantly (p≤0.05) to 3.90±0.50 and 3.10±0.98 mm at day 10 in group I and group II respectively. In group III there was significant reduction in size of ulcer from day 0 to day 7 measuring 7.80±1.05 and 0.20±0.11 mm respectively. Thereafter, from day 10 onwards complete sealing of ulcer was observed in all the cases. Post treatment there was no significant reduction in corneal opacity from day 0 to day 30 in group I dogs and corneal opacity persisted specially in grade II and grade III ulcers. There was significant reduction (p≤0.05) in opacity from 2.90±0.35 to 2.10±0.38 and 3.00±0.37 to 2.40±0.34 in group II and group III dogs from day 0 to day 10 respectively. In group I, II and III there was significant (p≤0.05) reduction in vascularization from 1.50±0.30 to 1.20±0.13, 1.30±0.37 to 0.60±0.22 and 1.40±0.31 to 0.40±0.31 from day 0 to day 15 respectively. There was a significant reduction in vascularization on day 15 in group II and group III compared to group I animals. [ABSTRACT FROM AUTHOR]

Background: The prevalence of fungal keratitis has risen in recent years significantly. To avoid additional complications, diagnosing and treating fungal keratitis is crucial. This study aims to measure the efficacy of a calcofluor white (CFW) stain for the quick diagnosis of fungal keratitis and to contrast the positive rates, sensitivity, and specificity with a 10% potassium hydroxide (KOH)-based smear and culture technique. Methods: From individuals with clinically suspected corneal ulcers, 30 corneal scrapings had been collected. Data on demographics had been analyzed. Results: Of the 30 patients, 40% were women and 60% were men. There was a 1.5:1 man-to-woman ratio. The age of patients ranged from 29 to 71 years (mean 46.67 ± 10.90). The age presentation of those between the ages of 41 and 50 years was the most frequent (36.7%). The majority of cases were farmers (43.3%). Trauma was the most common predisposing factor (46.6%). Twenty-four (80%) cases were culture positive. Eleven (36.7%) were fungal, 13 (43.3%) were bacterial and 6 (20%) showed no growth. Fusarium was the most common fungal isolate (36.4%), followed by Aspergillus (27.3%). While Staphylococcus aureus was the most common bacterial isolate (46.2%), followed by Pseudomonas (38.4%). The sensitivity of KOH wet mount and CFW stain was 72.7% and 90.9%, respectively. The specificity of both KOH wet mount and CFW stain was 100%. Conclusion: The early diagnosis of fungal keratitis can be made rapidly by direct microscopic examination of fungal elements using CFW stain. When diagnosing fungal keratitis, CFW has higher sensitivity to KOH. [ABSTRACT FROM AUTHOR]

The article discusses a study intended to assist clinicians to determine the likely cause of a corneal ulcer and to understand the management of corneal ulcers, including the timing of referral to an ophthalmologist. It is noted the most vision-threatening causes of corneal ulceration are trauma and infection. It is noted that neurotrophia, exposure, inflammation and rarely autoimmune conditions are usually less acutely vision threatening.

Simple Summary: Infected corneal ulcers are a common and painful disease, usually caused by bacteria in dogs. Short-nosed dog breeds are predisposed to corneal ulcers. Treatment aims to eliminate bacteria, stop the enzymatic tissue melting process in the cornea, and allow for normal healing to resume. Success of treatment largely depends on the effectivity of the applied medications, possibly including antibiotics. In the context of globally growing antibiotic resistance, non-antibiotic-based treatment alternatives are desirable. Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) reduces enzymatic tissue melting and damages multiple targets within microorganisms, resulting in corneal stabilization and non-antibiotic-based elimination of bacteria. A confirmatory clinical study providing unbiased evidence of PACK-CXL effectiveness in dogs is currently lacking. We therefore aim to conduct such a study and determine whether PACK-CXL is a viable alternative to conventional state-of-the-art medical therapy for corneal ulcer treatment in dogs. Here we present the randomized controlled clinical trial study protocol. Registering trials favors sound statistical analysis and prevents publication bias. The trial results will be published after successful trial conclusion. Infectious keratitis is a common and painful disease, usually caused by bacteria in dogs. Brachycephalic breeds are at increased risk. Despite medical therapy, enzymatic corneal melting can lead to ulcer perforation and globe loss. Treatment alternatives are needed due to an increase in antibiotic resistance and growing popularity of brachycephalic dogs. Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) reduces enzymatic collagenolysis and damages multiple targets within microorganisms, resulting in corneal tissue stabilization and elimination of bacteria, irrespective of their antibiotic resistance status. A randomized controlled trial providing evidence of PACK-CXL effectiveness in dogs is lacking. We aim to determine whether PACK-CXL is a viable alternative to conventional medical therapy for canine infectious keratitis. Two hundred-and-seventy client-owned dogs with presumed infectious keratitis will be allocated to two equally sized treatment groups (PACK-CXL or medical therapy) in a masked, randomized, controlled, multicenter trial in eleven clinics. The primary outcome measure is treatment success defined as complete epithelial closure within 28 days. The sample size is based on a group sequential design with two interim analyses, which will be overseen by a Data Safety and Monitoring Board. Ethical approvals have been obtained. The study protocol is preregistered at preclinicaltrials.eu. Publishing trial protocols improves study reproducibility and reduces publication bias. [ABSTRACT FROM AUTHOR]

This study was done to know the etiology of infective corneal ulcer in Delhi NCR and to highlight the risk factors, specific pathogens responsible for ulcer. 60 subjects with ulcer were selected . A detailed ocular examination was carried out using slitlamp. 2 % fluorescein staining, Gram and Giemsa stain was done. Material obtained by scraping was inoculated directly on blood agar, chocolate agar, sabouraud dextrose agar and KOH mount. The result concluded that Out of 60 subjects, median age was 40 years, 80% were male, 20% female, 51.6% were laborers, 20% were agriculturalist, 18.3% were students, and 8.3% were housewives. Out of all participants, 50% had viral ulcer, 25% had fungal ulcer, 23.3% had bacterial ulcer and 1.6% had protozoal keratitis. The incidence of infective corneal ulcers are more common between 3&4th decade above 60years with male predominance, more common in laborers. viral ulcers were found to be maximum among all types of ulcers. [ABSTRACT FROM AUTHOR]

Peripheral ulcerative keratitis (PUK) is an inflammatory, necrotic condition in the peripheral cornea which may end in corneal perforation and visual morbidity if not treated adequately. PUK can occur due to infectious or non-infectious causes. Early cases need medical therapy, both locally and systemically (for some cases). However, advanced PUK may necessitate surgical removal of inciting cause of the pathology and maintaining tectonic stability. Such surgical treatment, including corneal transplantations, may be used in an emergency setting or for visual rehabilitation following preliminary stabilization of the affected cornea. The outcome of these surgeries need to be analyzed to understand the long-term visual prognosis of such eyes. This is an attempt to analyze surgical modalities in the management of PUK and their outcomes. [ABSTRACT FROM AUTHOR]

To determine if smartphone photography could be a useful adjunct to blindness prevalence surveys by providing an accurate diagnosis of corneal opacity. 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. 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). 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. [ABSTRACT FROM AUTHOR]

To describe the effectiveness and safety of nicergoline in patients with epithelial corneal defect or corneal ulcer due to neurotrophic keratitis (NK). A prospective case series review was performed in 14 patients with NK who started treatment with nicergoline as an off-label prescription from January to November 2020. Patients with a epithelial defect or corneal ulcer due to NK were treated with oral nicergoline. Complete corneal healing was observed in 10 (71.4%) of the 14 patients after 25.6 ± 26.60 days (range 7–90) with nicergoline. In three (21.5%) patients wound healing was not achieved, and one patient (7.1%) was lost to follow-up. The mean time between diagnosis and the starting of nicergoline was 10.92 ± 8.85 days (0–28). No adverse effects of nicergoline were observed. Nicergoline as an adjunctive treatment for NK showed a potential use in the healing of epithelial defect in real-life clinical practice. [ABSTRACT FROM AUTHOR]

To describe the clinical picture and outcome of a case of Pythium keratitis, presenting as peripheral ulcerative keratitis (PUK). A 54- year- old male presented to the clinic with a PUK in the right eye. Systemic investigations were performed to rule out associated collagen vascular disorders. Microbiological examination of corneal scrapings was performed to rule out secondary infection which revealed gram positive cocci on Gram stain. There was no growth of any organism on culture. Topical vancomycin 5% and ciprofloxacin 0.3% were started initially. On regular follow-up, there was worsening of clinical signs. Topical and oral corticosteroids were further added. Due to progressive worsening of infiltrate size and corneal perforation, therapeutic penetrating keratoplasty was performed. Pythium insidiosum (confirmed by DNA sequencing and zoospore formation) was grown from excised corneal button and the histopathology revealed filaments suggestive of Pythium species. This case describes the uncommon manifestation of Pythium insidiosum keratitis presenting as peripheral ulcerative keratitis. [ABSTRACT FROM AUTHOR]

To describe a case of cocaine-induced midline destructive lesions (CIMDL) associated with ocular autoimmune disease.Methods: Observational case report. A 45-year-old man with history of chronic osteolytic sinusitis due to cocaine abuse presented with sudden vision loss in right eye. Ophthalmic examination revealed fixed right mydriasis with extraocular movements limitation and optic disc swelling. Computed tomography showed an orbital infiltrating mass. The diagnosis of orbital-apex syndrome secondary to CIMDL was established. Steroids and antibiotics therapy were started without vision improvement. At 6-months follow-up, a corneal ulcer with characteristics of peripheral ulcerative keratitis (PUK) was evidenced, coinciding with an upper respiratory bacterial infection. CIMDL and PUK share common pathogenic pathways, with implication of autoimmune factors and exposure to infective antigens. We hypothesized that chronic cocaine use, along with persistent bacterial infection, could have triggered an inflammatory reaction, which contributed to CIMDL development and the appearance of PUK. [ABSTRACT FROM AUTHOR]

In this study, clinical, parasitological and histopathological findings of thirteen kelp gulls (Larus dominicanus) found infected with eyeflukes in Brazil are presented. Parasites detected in the ventral conjunctival fornix were identified as Philophthalmus lachrymosus [mean intensity of infection: 16 (5-36) worms/bird]. Eleven birds (85%) presented signs of systemic disease, such as emaciation, dehydration and depressed consciousness. Conjunctival hyperemia was observed in 22 eyes (85%). Keratitis, corneal ulcers, corneal abscess and chemosis were also detected in some eyes (4-8%). Histopathologic lesions, likely due to the parasite attachment to the conjunctiva, were found in the eyes of one infected bird that died from unrelated causes. Philophthalmosis by P. lachrymosus is here reported as a clinically relevant eye disease in kelp gulls. [ABSTRACT FROM AUTHOR]

Purpose. The aim of this study is to report the clinical characteristics, visual outcomes, and antibiotic susceptibilities of patients with Pseudomonas aeruginosa endophthalmitis. Methods. The medical records of patients with culture-proven Pseudomonas aeruginosa endophthalmitis treated from June 2013 to December 2019 were reviewed. Results. This study included 36 eyes of 36 patients. The clinical settings included ocular trauma (15/36), corneal ulcer (9/36), postoperative endophthalmitis (5/36), endogenous (3/36), and unknown (4/36). Sixteen patients underwent evisceration, 13 patients underwent pars plana vitrectomy (PPV), 2 patients were treated with only intravitreal antibiotics, and 5 patients did not undergo surgery. Only one patient achieved a visual acuity of 20/400, and the others had all counting fingers or below. The cultured Pseudomonas aeruginosa was 100% sensitive to gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin and, approximately 95% sensitive to meropenem, imipenem, and aztreonam. Conclusion. The visual outcomes of Pseudomonas aeruginosa endophthalmitis were very poor, and the evisceration rate remained high. Pseudomonas aeruginosa has good susceptibility to gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin. [ABSTRACT FROM AUTHOR]

Background: To present a case with a history of laser in situ keratomileusis (LASIK) developing diffuse lamellar keratitis (DLK) after diamond burr superficial keratectomy (DBSK) for recurrent corneal erosion (RCE).Case Presentation: A 25-year-old man presented with multiple episodes of RCE one year after femtosecond-assisted LASIK for myopia correction. Because conservative treatments failed to halt the repetitive attack of RCE, he underwent epithelial debridement and DBSK. However, severe foreign body sensation and blurred vision developed on postoperative day one. The next day, slit lamp biomicroscopy revealed DLK manifested as diffuse granular infiltrates at the flap interface. After topical corticosteroid treatment, the inflammation resolved gradually, and his vision recovered to 20/20.Conclusions: Diffuse lamellar keratitis is a rare post-LASIK complication that can be triggered by DBSK, which causes impairment of the corneal epithelial integrity and subsequent inflammation at the flap interface. For post-LASIK patients with RCE, alternative treatments, such as anterior stromal puncture, may be considered to avoid extensive disruption of corneal epithelium and DLK development depending on the size and the location of the lesions. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to compare corneal culture results using the ESwab™ and Amies charcoal swab. Animals studied: One hundred fourteen canine and fifteen feline eyes. Procedures: Retrospective analysis of Dick White Referrals bacterial and fungal corneal culture data was conducted. Results were included from canine and feline patients, which presented with suspected infectious keratitis that had samples taken using an Amies charcoal swab followed by an ESwab™ in the same eye. In respect to positive and negative cultures, a McNemar test was conducted comparing instances of disagreement between swab types, and the Kappa coefficient (κ) was calculated to assess the level of agreement between swab types. Results: The ESwab™ produced more positive corneal cultures (71/129 [55.0%]) than the Amies charcoal swab (41/129 [31.8%]). 2/129 eyes produced positive fungal cultures. Considering 37/129 eyes in which both swab types detected a positive corneal culture, the same bacterial species were cultured from each swab type in 34/37 (91.9%) eyes, and an additional bacterial species was cultured by the ESwab™ in 3/37 (8.1%) eyes. In 34/38 (89.5%), instances of disagreement between swab types, the ESwab™ showed a positive culture, and the Amies charcoal swab showed a negative culture from the same eye, and this difference was significant (p < 0.0001). There was a moderate level of agreement between results from both swab types (κ = 0.432). Conclusions: ESwab™ sampling alone may be superior to Amies charcoal swabs for detecting presence of bacteria in suspected infectious keratitis in cats and dogs. [ABSTRACT FROM AUTHOR]

Purpose: To examine the relationship between Minimum Inhibitory Concentration (MICs) and response to therapy of 6 Fusarium spp. and 5 Aspergillus fumigatus isolated from equine ulcerative keratitis cases. Procedure: Fungi were identified by morphology and Internal Transcribed Spacer (ITS) polymerase chain reaction (PCR) with sequencing and evaluated at the University of Texas Fungal Testing Laboratory for susceptibility to three azole antifungals (miconazole, voriconazole, posaconazole), natamycin, and two echinocandins (anidulafungin, caspofungin). A Mann–Whitney rank sum test was used for the comparison of time to heal between infections of different fungal genera and in vitro susceptibility to the drug administered. Results: Fusarium spp. were resistant to azole antifungals in 6/6 cases (100%). Fusarium spp. were susceptible to echinocandins and natamycin in all cases. A. fumigatus was resistant to anidulafungin in 1/5 cases (20%) and posaconazole in 1/5 cases (20%) The remainder of A. fumigatus isolates were susceptible to all antifungal agents tested. Fusarium isolates were treated with antifungals to which they were not susceptible; however, all cases of A. fumigatus were treated with antifungals to which they were susceptible. All Fusarium cases and A. fumigatus cases experienced clinical resolution, regardless of surgical intervention. There was no statistical correlation between fungal genus and time to heal (p <.082). Conclusions: The in vitro susceptibility indicated that all cases of Fusarium spp. were resistant to azole antifungal drugs which were used as treatment. Clinical outcomes, however, showed that all cases healed despite resistance to antifungals. [ABSTRACT FROM AUTHOR]