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Introduction: Infectious inflammation of the periorbital and orbital soft tissue can be classified as preseptal (periorbital) or postseptal (orbital) cellulitis. Eyelid abscess, an accumulation of pus in the palpebral tissue, can occur in isolation or in association with preseptal cellulitis. Preseptal cellulitis is nearly three times more common than orbital cellulitis. Case Presentation: The patient, in this case, was admitted with a complaint of swollen left eyelid ten days before being admitted. Swollen eyelid with the inability to open the left eye was accompanied by pus discharge five days before coming to the hospital. Current complaints include eyelid pain, swelling, and discharge of thick yellow fluid. Massive abscess with active pus and crust was present in the left superior and inferior eyelid and frontotemporal area. A head CT scan revealed a soft tissue mass in the left sub galea soft tissue, left frontal region, left orbit, and left temporal region. Multi-department consultations and several workups were done to reveal the etiology and plan the appropriate management of this condition. Conclusion: A comprehensive assessment must be done to distinguish preseptal and orbital cellulitis. Ophthalmology examination and imaging are crucial to detect any extension of the palpebral abscess beyond the orbital septum. Examining an immunocompromised state and focal infection is crucial in determining proper treatment.

Background: Fungal keratitis is one of the most difficult forms of microbial keratitis to treat successfully. Aspergillus flavus is a type of filamentous fungus that often causes suppurative keratitis. Complications that often arise from fungal keratitis are corneal perforation and blindness due to scar tissue formation. Methods: Aspergillus flavus was injected into the corneas of 28 Sprague Dawley rats intrastromal and divided into 4 groups, with each group consisting of 7 rats, fungal injection into the cornea as a fungal injection without therapy, natamycin therapy, cryotherapy, and combination therapy. Therapy was given five days after the fungal injection into the cornea and the formation of keratitis and corneal central thinning. After four days of therapy, the eyes were enucleated to determine the effect of cryotherapy on MMP-8 and TIMP-1 expression in the cornea with an immunohistochemistry (IHC) staining examination. The differences in MMP-8 and TIMP-1 expressions between groups were analyzed using the Kruskal Wallis test and Mann-Whitney post hoc test with a significant p

Purpose: To investigate the relationship between blood parameters and platelet-rich fibrin (PRF) membrane size for ocular graft. Methods: Total of 12 New Zealand white rabbits, 6.5 ml of blood samples was taken for each rabbit, including 5 ml for platelet-rich fibrin membrane production using L-PRF protocol (centrifugation at 2700 rpm for 12 minutes) 1.5 ml for evaluation of blood parameters. Measurement of blood parameters consists of fibrinogen, haemoglobin, hematocrit, red blood cell (RBC), white blood cell (WBC) and platelet. Measurement of the platelet-rich fibrin membrane area was done using a calibrated photograph and ImageJ software. The Pearson correlation coefficient (r) was used to evaluate each scattergram statistically. Results: Linear regression analysis found a significant positive effect on the PRF membrane area on the fibrinogen (r = 0.802, p = 0.02), WBC (r = 0.625, p = 0.03) and platelet (r = 0.839, p = 0.001). However, there was no apparent correlation to haemoglobin (r = 0.514, p = 0.087), RBC (r = 0.548, p = 0.065) and hematocrit (r = 0.454, p = 0.138). Conclusions: The area of the PRF membrane has a positively significant relation to the fibrinogen, WBC and platelets. The data in this study can be used to estimate the size of the PRF membrane as an ocular graft.

Introduction: High recurrence of a fibrotic disease, pterygium, following the surgical procedure is perceived as the primary challenge of its management. As the standard procedure, adjuvant therapy of using mitomycin C could dramatically reduce the recurrence of pterygium but could cause multiple serious complications. Our study aimed to investigate curcumin and fibrin glue as alternative candidates for adjuvant therapy in pterygium surgery. Methods: Human pterygium fibroblast (HPF) was isolated from the patient and cultured in-vitro. The HPF culture was then exposed with mitomycin C (0.4 mg/mL), curcumin (200 μmol/L), and fibrin glue, respectively, for 48 hours. The outcomes were determined by the proliferation of HPF and the expression of transforming growth factor-beta (TGF-β) which were obtained from 2,5-diphenyl-2H-tetrazolium bromide assay and immunofluorescence staining analysis with TGF-β antibody. Results: The experiment revealed that mitomycin C, curcumin, and fibrin glue could significantly inhibit the proliferation of HPF (p

Introduction: Ocular blast injury related to fireworks most often causing corneal erosion (29%), conjunctival erosion (11%), and conjunctival foreign body (10%) with children are more often than adults (65.9%:34.1%), and males far more often than female (71.9%:28.1%). Knowing proper management is very important to achieve the best result. Case presentation: We describe an ocular blast injury that experienced broad erosion and multiple foreign bodies on the corneal and pericorneal surface in the left eye and visual acuity decreased. The foreign body was scattered, and the fluorescein test was positive. We did proper foreign body extraction, irrigation, and ocular bandage. It was treated with chloramphenicol 0.5% eye ointment and homatropine eye drop. In two months, the patient’s left eye had clear cornea with a small scar formation near the visual axis. The visual acuity was 6/7 and BCVA was 6/6 with S-0.5 C-0.5 A 50° correction. Conclusions: Patients with ocular blast injury limited to superficial cornea erosion and and conjunctival erosion have a reasonable probability of achieving the best visual acuity. Foreign body extraction, proper irrigation, and topical medication show promising results. Scar formation near the visual axis can disrupt visual acuity however can be corrected in this case it can be corrected with glasses. Furthermore, public promotion and regulation to control firework using are very important.

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

Introduction: Ocular symptoms are uncommon manifestations of coronavirus disease 2019 (COVID-19) infection. Earlier study reported that dry eye, blurred vision, foreign body sensation, tearing, itching, conjunctival secretion, conjunctival congestion, ocular pain, and photophobia are among the ocular symptoms that could be found in COVID-19 patients. However, there are only a few reports available regarding corneal involvement in this disease. Here we report a case of keratoconjunctivitis as the only symptom of COVID-19 infection. Case description: A 27-year-old man who worked as an obstetrics and gynecology resident came to the outpatient clinic with the chief complaints of eye discomfort, foreign body sensation, conjunctival hyperemia, lacrimation, and photophobia in his right eye for the past 3 weeks. Fluorescence test showed a small corneal lesion. The patient was then diagnosed with keratoconjunctivitis. A week after the treatment, all symptoms were resolved. A month later, the patient came to the emergency room with the same eye complaints but with a more severe pain. The fluorescence test showed wider corneal lesion compared to last month. The result from the corneal swab is negative for bacterial or fungal infection, indicating a viral infection. Afterwards, reverse transcriptase polymerase chain reaction test from nasopharyngeal swab was performed and revealed that the patient was positive for COVID-19. Conclusions: This case report showed that keratoconjunctivitis may occur as the only manifestation of COVID-19 infection. Thus, patient presented with unexplainable eye symptoms should be evaluated for COVID-19 infection.

Introduction: Injuries from mobile phone blasts have been on the rise in recent years. Lithium-ion batteries are the most common type found in cellphones and devices. In 2016 around 100 of the 2.5 million phone cell units have been recorded to have exploded. Mobile battery burst is a significantly underappreciated cause of serious ocular morbidity and could be a combination of mechanical, thermal, and chemical effects. Knowing proper management is very important to achieve the best result. Case presentation: We describe an ocular blast injury due to mobile phone battery explosion when plugged in to charge that experienced spasm and burned cilia, limbal ischemia, broad corneal haziness on both eyes, and visual acuity decreased. The fluorescein test was positive. We did proper irrigation and debris extraction around the ocular surface and periorbital tissue. It was treated with quinolone antibiotics eyedrop, atropine sulfate eyedrop, prednisolone eyedrop, and NSAID orally. In four days, the patient’s eye showed good clinical improvement with decreased corneal haziness with minimal epithelial defect. The visual acuity was improved on both eyes. Conclusions: Lithium-ion batteries are used in almost all smartphones and electronics. Lithium explosions can result in chemical and thermal burns on the ocular surface. Ocular alkali chemical injury combined with thermal and mechanical is an emergency case. The vision can be saved if the ocular surface burns are treated promptly and properly. These cases are required to raise public awareness about the potential risks of smartphone use, adopt safe practices as recommendations from the manufacturers, and avoid counterfeit products and such accidents.

Background: To investigate the effects of limbal mesenchymal stem cell (L-MSCs) secretome on the cornea surface for balancing TNF-? and IL-10 in animal models of pseudomonas aeruginosa keratitis. Method: Animal models have performed a 2 mm long incision with a scratching technique on the central cornea. Then induction of keratitis is inoculated with 1.0 x104 CFU of Pseudomonas aeruginosa 5 ?L of PBS on the cornea surface. The study subjects consisted of 2 groups. The first group was given the antibiotic Levofloxacin 0.5% 1 drop every 6 hours for 5 days. The second group was given Levofloxacin 0.5% 1 drop after that the next 5 minutes given L-MSCs secretome 1 drop every 6 hours for 5 days. After treatment the rat were enucleated and corneal tissue was given immunohistochemical staining of cytokines TNF-? and IL-10 for analyzed. Result: After 5 days of L-MSCs secretome therapy, results expression of TNF-? was not decreased with treatment L-MSCs. The results expression of IL-10 was not increased with treatment L-MSCs. Conclusion: Therapy of L-MSCs secretome was not effected to expression of TNF-? and IL-10, but clinically improved keratitis condition.

Supplemental material, sj-pdf-1-ejo-10.1177_11206721211006583 for Recurrent keratoconjunctivitis as the sole manifestation of COVID-19 infection: A case report by Satria Audi Hutama, Firas Farisi Alkaff, Ryan Enast Intan, Citra Dewi Maharani, Luki Indriaswati and Ismi Zuhria in European Journal of Ophthalmology

Corneal perforation may be associated with prolapse of ocular tissue. We present a rare case reportan11 months-old female presented prolapsed of right eye. She was earlier diagnosedwithright corneal ulcer anddescemetocele. Physicalexamination revealed perforatedcornea.On ultrasound examination showedvitreous hazzinessand membranous opacity assumed due to inflammation. Based on examinationswe suspectedmalignancy process and performed enucleation withautogenous Dermis Fat Graft (DFG) which harvested onthigh region.Histopathology examination revealed chronic inflammation process.Hence, determining the causative factors of the prolapsed eye is the key for better management and prognosis.