Chlorhexidine in the treatment of microsporidial stromal keratitis and the effect of host immunity: A case series and literature review.

Microsporidial stromal keratitis is an increasingly well-known vision-threatening disease. A large proportion of cases are initially misdiagnosed as herpes simplex keratitis and treated with topical steroids. In most of such cases, medical treatment failed, and corneal transplantation was required. This study reported the results of 0.02% topical chlorhexidine used to treat three cases of microsporidial stromal keratitis and reviewed the literature on the outcomes of microsporidial stromal keratitis treatment. In the first case, histopathology of a specimen from penetrating keratoplasty (PK) revealed severe chronic inflammation involving the entire stromal layer but no microorganism activity after the application of topical chlorhexidine for 10 months. The second case exhibited complete resolution of keratitis after topical chlorhexidine. The patient in the third case did not respond to medical treatment, and therapeutic PK was performed. Histopathological examination revealed numerous microsporidial spores that had colonized in the mid and deep stroma, where few inflammatory cells were observed. These findings explain the variable microsporidial susceptibility to chlorhexidine, suggesting the crucial role of host immunity. In cases of host immunity, topical chlorhexidine may represent a promising option for the treatment of microsporidial stromal keratitis.

Diagnostic utility of neuroretinal rim thickness, measured in clock-hour sectors with HD optical coherence tomography, in preperimetric glaucoma.

BACKGROUND: We evaluated the usefulness of neuroretinal rim (NRR) thicknesses, measured in clock-hour sectors with Cirrus HD optical coherence tomography, for diagnosing preperimetric glaucoma (PPG). METHODS: This prospective study included 39 eyes of 39 patients with PPG and 39 eyes of 39 controls that were matched to patients for age and refractive error. We measured the circumpapillary retinal nerve fiber layer (cpRNFL) thickness, macular ganglion cell-inner plexiform layer (GCIPL) thickness, and optic nerve head (ONH) parameters with optical coherence tomography. The clock-hour NRR thicknesses were derived from a 360° circumferential rim thickness curve. We analyzed the area under the receiver operating characteristics curve (AUROC), cutoff values, and sensitivities at specificities of 90% and 95%. RESULTS: The largest area under the receiver operating characteristics curves were observed for the NRR thickness at 6 o'clock (0.823), the inferior RNFL thickness (0.821), the average RNFL thickness (0.819), and the NRR thickness at 7 o'clock (0.818). The performance of the NRR thickness at 6 o'clock was comparable to the best performances of the cpRNFL, GCIPL, and ONH parameters (all p > 0.05). CONCLUSION: The ability of the clock-hour NRR thickness assessment to diagnose PPG was comparable to the diagnostic abilities of cpRNFL, GCIPL, and ONH parameters. The best indicator of PPG was the NRR thickness parameter that was at 6 o'clock. This finding could play a role in detecting early structural changes in PPG.

Epidemiology of Behcet's Disease in Taiwan: A Population-Based Study.

PURPOSE: To study the incidence and epidemiology of Behcet's disease in Taiwan. METHODS: This retrospective cohort study was conducted using the nationwide reimbursement database in Taiwan. One million registered beneficiaries of the Taiwan National Health Insurance system in 2000 were randomly selected. All medical claims of these persons were collected. The definition of having Behcet's disease was based on diagnostic codes. Persons who had incomplete registry data or diagnoses prior to 2001 were excluded. Annual incidence between 2001 and 2011 was calculated and risk factors for incidence were explored using the Cox proportional regression model. Characteristics of patients with Behcet's disease with and without uveitis were compared. RESULTS: A total of 236 newly diagnosed patients with Behcet's disease were found between 2001 and 2011. The average incidence was 2.40 cases per 100,000 person-years (ranging from 1.29 to 3.53). Female patients and those aged between 40 and 65 years were at the highest risk of Behcet's disease. Only 18.2% of the patients had also suffered from uveitis. The subspecialties of doctors making initial diagnoses and the number of prescribed immunomodulatory agents differed significantly between the patients with and without uveitis (p < 0.001 and <0.05, respectively). CONCLUSION: Incidence of Behcet's disease was not high in Taiwan and relatively few of the patients developed uveitis. Patients of working age or who were female were more likely to have Behcet's disease. However, age of onset and clinical severity differed between patients with and without uveitis.