Collarette Elimination and Demodex Mite Eradication with Topical Lotilaner Ophthalmic Solution, 0.25.

Purpose: To evaluate the efficacy of topical lotilaner ophthalmic solution, 0.25%, in patients with Demodex blepharitis. Methods: Eighteen adults with Demodex blepharitis, defined as >10 collarettes on the upper lid and/or mite density of ≥1.5 mites per lash (upper and lower), were treated bid for 42 days with the topical lotilaner ophthalmic solution, 0.25%. Contact lens wear, artificial eyelashes, and lid structural abnormalities were among the exclusion criteria. No other antibacterial, antiparasitic, or anti-inflammatory treatment or lid hygiene products were permitted. One eye of each patient was selected for analysis and assessed on day 7, 14, 28, and 42. Collarettes were graded at each visit, and mite density was evaluated by microscopy at each visit except day 7. Outcome measures were collarette elimination (≤2 lashes with collarettes) and mite eradication (0 mites). Drop tolerability, adverse events, visual acuity, and slit-lamp biomicroscopy were assessed. Results: Collarette elimination was achieved in 13/18 participants (72.2%) by day 42. Mean collarette grade (upper lid) declined from 3.56 ± 0.17 to 0.28 ± 0.11. Mite eradication was achieved in 14/18 participants (77.8%) by day 42. Mean mite density decreased from 2.63 ± 0.39 to 0.12 ± 0.08 mites/lash. Participants reported good tolerability. Adverse events were mild and transient and did not result in treatment discontinuation. Conclusion: Six weeks of at-home topical therapy with the lotilaner ophthalmic solution, 0.25%, was effective in eliminating the most common objective signs of Demodex blepharitis, with a collarette elimination rate of 72% and mite eradication in 78% of eyes by day 42. ISRCTN registration #: 24398865.

Keys to Unlock the Enigma of Ocular Toxocariasis: A Systematic Review and Meta-analysis.

PURPOSE: Ocular toxocariasis (OT) is a zoonotic infection caused by larval stages of Toxocara canis and T. cati. The current review and meta-analysis aimed to evaluate the global prevalence of OT. METHODS: Five English (PubMed, Scopus, Science Direct, Web of Science, and Google Scholar) databases were explored and 101 articles met the inclusion criteria. RESULTS: The pooled prevalence (95% confidence interval) of OT was higher in immunological studies (9%. 6-12%) than in studies that applied ophthalmic examination (1%. 1-2%). The lower middle-income level countries had the highest prevalence (6%. 2-12%) as well as the African region (10%. 7-13%). The highest infection rate (4%. 2-7%) was detected in the 1-25 mean age group. CONCLUSION: Regular anthelminthic treatment of cats and dogs, and removal of animal feces from public places must be considered.

Long-term Results of Trimethoprim-Sulfamethoxazole Versus Placebo to Reduce the Risk of Recurrent Toxoplasma gondii Retinochoroiditis.

PURPOSE: To compare the effects of 1 year of treatment with trimethoprim-sulfamethoxazole (TMP-SMZ) vs placebo in reducing the risk of recurrence of toxoplasmic retinochoroiditis during a 6-year follow-up period. DESIGN: Randomized, double-masked clinical trial. METHODS: This cohort included 141 subjects recruited in Campinas, Brazil. The inclusion criterion was unilateral active recurrent toxoplasmic retinochoroiditis. All subjects were treated with 1 dose of TMP-SMZ (160 mg/800 mg) twice daily for 45 days, and all lesions healed after this treatment. After this initial treatment, subjects were randomly assigned to group 1 (1 TMP-SMZ dose every other day for 311 days) or group 2 (1 identical placebo tablet containing starch with no active ingredients every other day for 311 days). Between the second and sixth years of follow-up appointments, none of the subjects received treatment unless a new recurrence episode had occurred. The primary outcomes were recurrent toxoplasmic retinochoroiditis within the first year of follow-up and recurrent toxoplasmic retinochoroiditis in the 6 years of follow-up. RESULTS: The cumulative probability of recurrence 1, 2, 3, 4, 5, and 6 years after the initial infection was, respectively, 13.0% (9/69), 17.4% (12/69), 20.3% (14/69), 23.2% (16/69), 26.1% (18/69), and 27.5% (19/69) in the placebo group and 0%, 0%, 0%, 0%, 0%, and 1.4% (1/72) in the TMP-SMZ group (P < .001; log-rank test). There were 3 cases (3/69; 4.3%) of multiple recurrences in the same individual in the placebo group. No treatment-limiting toxicity or side effects were observed in either group. New recurrences were more frequent among female subjects. CONCLUSIONS: TMP-SMZ may be used safely for prophylaxis of recurrent toxoplasmic retinochoroiditis and may provide long-term benefits.

Thelaziosis due to Thelazia callipaeda in Europe in the 21st century-A review.

Thelazia callipaeda was first described at the beginning of the 20th century in Asia, but this eyeworm is now frequently reported in Europe in the 21st century. To date, thelaziosis has been described in the following European countries (in order of appearance): Italy, France, Germany, Switzerland, Spain, Portugal, Belgium, Bosnia and Herzegovina, Croatia, Serbia, Romania, Greece, Bulgaria, Hungary, Slovakia, the United Kingdom, Turkey and Austria. The infected vertebrate host species include domestic carnivores (dogs and cats), wild carnivores (red foxes, wolves, beech martens, wildcats and golden jackals), lagomorphs (brown hares and wild European rabbits) and humans. In Europe, 11 cases of human thelaziosis have been reported, the majority of which are autochthonous. However, some of them have been imported, a fact which highlights the importance of surveillance policies to restrict cross-border spread of the parasite. The objectives of this article are to review key aspects of the epidemiology of T. callipaeda, summarise animal and human cases in Europe and emphasise the importance of education and awareness among veterinarians, physicians (particularly ophthalmologists) and animal, in order to owners to tackle this zoonosis.

Prevention of canine ocular thelaziosis (Thelazia callipaeda) with a combination of milbemycin oxime and afoxolaner (Nexgard Spectra®) in endemic areas in France and Spain.

In the past decade, canine thelaziosis due to Thelazia callipaeda has been diagnosed in an increasing number of European countries, with endemic areas being identified. A multi-center field trial was conducted in endemic areas in France and Spain to evaluate the efficacy of monthly administrations of the oral milbemycin oxime/afoxolaner combination (NexGard Spectra®) for the prevention of T. callipaeda infection in at-risk dogs. A total of 79 dogs negative for T. callipaeda and with a clinical history of eyeworm infection in the past two years completed the study. Dogs were randomly allocated either to a negative control group (42 dogs) or to the NexGard Spectra® treated group (37 dogs). All dogs were followed up for a 6-month period and assessed monthly for the presence of nematodes on the eyes and for the signs of ocular thelaziosis (e.g., conjunctivitis, keratitis, and ocular discharge). When the presence of nematodes was confirmed, the conjunctival fornix was flushed with a saline solution for parasite recovery and counting, and the dogs were treated appropriately. Recovered parasites were stored in 70% alcohol for subsequent morphological identification. During the course of the study, 57.1% (24/42) of the control dogs were diagnosed positive for Thelazia infection, which illustrates a high incidence rate of parasite infection. Conversely, no eyeworm was recovered from any of the 37 dogs that received NexGard Spectra®. All parasites sampled were confirmed to be T. callipaeda. This clinical field study demonstrated that monthly administrations of NexGard Spectra® provided 100% preventive efficacy against canine thelaziosis.

Fibrous Catalyst-Enhanced Acanthamoeba Disinfection by Hydrogen Peroxide.

SIGNIFICANCE: Hydrogen peroxide (H2O2) disinfection systems are contact-lens-patient problem solvers. The current one-step, criterion-standard version has been widely used since the mid-1980s, without any significant improvement. This work identifies a potential next-generation, one-step H2O2, not based on the solution formulation but rather on a case-based peroxide catalyst. PURPOSE: One-step H2O2 systems are widely used for contact lens disinfection. However, antimicrobial efficacy can be limited because of the rapid neutralization of the peroxide from the catalytic component of the systems. We studied whether the addition of an iron-containing catalyst bound to a nonfunctional propylene:polyacryonitrile fabric matrix could enhance the antimicrobial efficacy of these one-step H2O2 systems. METHODS: Bausch + Lomb PeroxiClear and AOSept Plus (both based on 3% H2O2 with a platinum-neutralizing disc) were the test systems. These were tested with and without the presence of the catalyst fabric using Acanthamoeba cysts as the challenge organism. After 6 hours' disinfection, the number of viable cysts was determined. In other studies, the experiments were also conducted with biofilm formed by Stenotrophomonas maltophilia and Elizabethkingia meningoseptica bacteria. RESULTS: Both control systems gave approximately 1-log10 kill of Acanthamoeba cysts compared with 3.0-log10 kill in the presence of the catalyst (P < .001). In the biofilm studies, no viable bacteria were recovered following disinfection in the presence of the catalyst compared with ≥3.0-log10 kill when it was omitted. In 30 rounds' recurrent usage, the experiments, in which the AOSept Plus system was subjected to 30 rounds of H2O2 neutralization with or without the presence of catalytic fabric, showed no loss in enhanced biocidal efficacy of the material. The catalytic fabric was also shown to not retard or increase the rate of H2O2 neutralization. CONCLUSIONS: We have demonstrated the catalyst significantly increases the efficacy of one-step H2O2 disinfection systems using highly resistant Acanthamoeba cysts and bacterial biofilm. Incorporating the catalyst into the design of these one-step H2O2 disinfection systems could improve the antimicrobial efficacy and provide a greater margin of safety for contact lens users.

Trimethoprim-Sulfamethoxazole Versus Placebo in Reducing the Risk of Toxoplasmic Retinochoroiditis Recurrences: A Three-Year Follow-up.

PURPOSE: To compare the effects of 1 year of treatment with trimethoprim/sulfamethoxazole (TMP-SMZ) vs a placebo in reducing the risk of toxoplasmic retinochoroiditis recurrences during a 3-year follow-up period. DESIGN: Randomized, double-masked clinical trial. METHODS: This cohort included 141 volunteers recruited in Campinas, Brazil. Inclusion criterion was unilateral active recurrent toxoplasmic retinochoroiditis. All volunteers were treated with 1 tablet of TMP-SMZ (160 mg/800 mg) twice daily for 45 days, and all lesions healed after this treatment. After this initial treatment, the volunteers were randomly assigned to Group 1 (1 TMP-SMZ tablet every 2 days for 311 days) or Group 2 (1 identical placebo tablet containing starch with no active ingredients every 2 days for 311 days). At the second- and third-year follow-up appointments, none of the volunteers received treatment unless a new recurrence episode had occurred. The primary outcomes were recurrent toxoplasmic retinochoroiditis within the first year of follow-up and recurrent toxoplasmic retinochoroiditis within the third year of follow-up. RESULTS: The cumulative probability of recurrence at 1, 2, and 3 years of follow-up were, respectively, 13.0% (9/69), 17.4% (12/69), and 20.3% (14/69) in the placebo group and 0% (0/72) in the TMP-SMZ group (P < .001, log-rank test). There was no case of multiple recurrences in the same individual. No treatment-limiting toxicity or side effects were observed in either group. New recurrences were more frequent among female volunteers. CONCLUSIONS: TMP-SMZ may be used safely for prophylaxis of recurrent toxoplasmic retinochoroiditis, with long-term benefits.

Infection by Austrodiplostomum compactum metacercariae in fish from the Nova Avanhandava reservoir, Tietê river, São Paulo State, Brazil / Infecção por metacercárias de Austrodiplostomum compactum em peixes do Reservatório de Nova Avanhandava, rio Tietê, Paulo, Brasil

This study aimed to evaluate the infection by the Austrodiplostomum compactum metacercariae in fishes from the Nova Avanhandava Reservoir, low Tietê river, São Paulo State, Brazil. The parasites were collected from eye (aqueous and vitreous humor), fixed in AFA solution and stained with carmine. The morphometric analysis was performed using a computerized system for analysis of images QWin Lite 2.5 (Leica). Prevalence, mean intensity of infection and abundance of infected fish were calculated. Of the 22 species of fish registered, five were infected by metacercariae: Hoplias malabaricus, Metynnis maculatus, Plagioscion squamosissimus, Satanoperca pappaterra and Schizodon nasutus. Of the 627 fish evaluated, 34% were infected. A higher prevalence was observed in P. squamosissimus and S. pappaterra. Schizodon nasutus and M. maculatus are new hosts reported for A. compactum metacercariae.

Avaliou-se a infecção por metacercárias de Austrodiplostomum compactum em peixes do Reservatório de Nova Avanhandava, baixo rio Tietê, São Paulo, Brasil. Os parasitos foram coletados nos olhos (humor aquoso e vítreo), fixados com solução de AFA e corados com carmim. A análise morfométrica foi realizada por meio de sistema computadorizado de análise de imagem QWin Lite 2.5 (Leica). A prevalência, intensidade média de infecção e a abundância média dos peixes infectados foram calculadas. Das 22 espécies de peixes capturadas, cinco estavam infectadas por metacercárias: Hoplias malabaricus, Metynnis maculatus, Plagioscion squamosissimus, Satanoperca pappaterra e Schizodon nasutus. De um total de 627 peixes avaliados, 34% estavam infectados. Alta prevalência foi observada em P. squamosissimus e S. pappaterra. Schizodon nasutus e M. maculatus são novos hospedeiros registrados para metacercárias de A. compactum.

Priming of host resistance to protect cultured rainbow trout Oncorhynchus mykiss against eye flukes and parasite-induced cataracts.

In the present study, immunologically naive rainbow trout Oncorhynchus mykiss were experimentally exposed to a low-level Diplostomum spathaceum (Trematoda) infection to stimulate acquired resistance and, along with unexposed controls, were subsequently exposed to natural infection for 8 weeks. The priming of the host resistance, designed to simulate a procedure applicable in aquaculture, decreased the number of establishing parasites compared to untreated controls by the end of the experiment. This effect was slow and did not protect the fish against the parasite-induced cataracts. The results suggest that this type of priming of host resistance is probably inefficient in preventing the deleterious effects of D. spathaceum infection in aquaculture conditions.

Microbial keratitis and the role of rub and rinsing.

Recent outbreaks of microbial keratitis in contact lens wearers have involved various pathogens, including Acanthamoeba and Fusarium species. Specific reasons for the marked increase in microbial keratitis, particularly those involving species typically rarely involved in contact lens infection, remain unknown. Possible contributing factors include inadequacies of various multipurpose solutions against certain pathogens; inadequate lens care hygiene, including elimination of the digital rubbing step; poor contact lens storage case hygiene; and the introduction of new soft contact lens materials that may promote adherence of certain pathogens, particularly when a digital rubbing step is eliminated. Although there is some conflict of opinion in the literature regarding the necessity for a mechanical rub during lens cleaning and disinfection, growing evidence supports the reestablishment of a digital rub component to multipurpose solution lens care systems. This article reviews the literature on whether such a process should be recommended to contact lens wearers.

A clinical trial of ivermectin against eyeworms in German Shepherd military working dogs.

OBJECTIVE: To determine if monthly ivermectin was efficacious in reducing the observed incidence of eyeworms over a period of 2 months as compared with normal husbandry practices in a population of Republic of Korea Army military working dogs (MWDs). METHODS: Prospective observation of 114 German Shepherd MWDs in a randomized, double-blind, controlled clinical trial. MWDs were randomly assigned to either a treatment group receiving a monthly dose of 0.2 mg/kg BW ivermectin orally, or to a control group given an equivalent dose volume and frequency of a saline placebo. A quantitative numerical count of eyeworms found in the eyes of MWDs was conducted at 25-day intervals. RESULTS: The prevalence of eyeworms in the treatment group went to zero at 25 days and remained lower at 50 days (5%) than baseline (24%). Prevalence in the controls remained approximately constant over all treatment times (14% to 18%). CONCLUSION: Although ivermectin does not prevent dogs from being infected with eyeworms, the study suggests that ivermectin administered orally at a dose of 0.2 mg/kg every 3 weeks significantly reduces the prevalence of Thelazia species eyeworms in dogs.

Parasite resistance and avoidance behaviour in preventing eye fluke infections in fish.

This paper examines the efficiency of acquired resistance in protecting the fish host, rainbow trout (Oncorhynchus mykiss), against the trematode parasite Diplostomum spathaceum, and the hypothesis that fish recognize areas where infective stages are aggregated and show avoidance behaviour. We found that when fish with a low level of infection were held in restricted cages in natural conditions they became infected and developed cataracts as a result of this infection. This suggests that acquired resistance is insufficient in protecting fish against the parasite or the deleterious effects of infection in conditions where fish could not avoid the parasite. Behavioural experiments in the laboratory showed that fish reacted to the parasite cercariae by avoiding the infection source, which decreased the rate of parasite establishment. We conclude that by using a combination of behavioural avoidance and physiological resistance, fish could defend against the parasite more effectively.

Onchocerciasis in West Africa after 2002: a challenge to take up.

Initially planned for a 20 year life time, the Onchocerciasis Control Programme in West Africa (OCP) will have finally continued its activities for nearly three decades (vector control alone from 1975 to 1989, then vector control and/or therapeutic treatment until 2002). Although onchocerciasis is no longer a problem of public health importance nor an obstacle to socio-economic development in the OCP area, the control of this filariasis is not over because OCP never aimed at eradication, neither of the parasite (Onchocerca volvulus), nor of its vector (Simulium damnosum s.l.). In 2003, the eleven Participating countries of OCP will take over the responsibility of carrying out the residual activities of monitoring and the control of this disease. This mission is of great importance because any recrudescence of the transmission could lead in the long run to the reappearance of the clinical signs of onchocerciasis, if not its most serious manifestations. For epidemiological and operational reasons, and given the disparity in national health policies and infrastructures, the capacities of the countries to take over the residual activities of monitoring and control of onchocerciasis are very unequal. Indeed, the interventions to be carried out are very different from one country to another and the process of integrating the residual activities into the national health systems is not taking place at the same pace. This inequality among the countries vis-a-vis the challenges to be met does not, however, prejudge the epidemiological situation after 2002 whose evolution will also depend on the effectiveness of the provisions made before that date by OCP, then after 2002, by the Regional Office for Africa of the World Health Organization which is currently setting up a sub-regional multidisease surveillance centre.

Contact lenses and bacterial infections.

Research has shown that although rare, contamination of contact lenses with Acanthamoeba and other organisms after cleansing can cause severe ocular morbidity. The author reviews the research data, and offers recommendations for appropriate use of cleansing solutions.

Present challenges in the global prevention of blindness.

Cataract is responsible for 50% of world blindness, with at present an estimated backlog of 13.5 million cases in need of surgery. Low-cost cataract surgery must be made more available in developing countries, making use of alternative approaches for outpatient surgery and optimal management of available resources. Trachoma control needs to be targeted at the worst affected areas in endemic countries, with more emphasis on behavioural, educational and community aspects of the disease. Vitamin A deficiency and xerophthalmia control are becoming matters of maternal and child health care, with early intervention during infancy in view of the mortality issue. There are good prospects for the prevention of blindness from onchocerciasis, through the availability of ivermectin, but large-scale distribution schemes are still needed in most of the African countries concerned. The early detection and management of open-angle glaucoma still poses a major problem in developing countries, and further development of appropriate technology is needed in this field. Another area where more efforts are needed is ocular trauma, which is commonly the cause of unilateral loss of vision. General preventive measures must be enforced and better training provided to health personnel to deal competently with such cases, in order to prevent late complications. Diabetes, finally, is on the increase in many developing countries, giving rise to problems in dealing effectively with the ensuing retinopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Ophthalmomyiasis: a review with special reference to Cochliomyia hominivorax.

Ophthalmomyiasis, infestation of the eye by dipterous fly larvae, may result in sequelae ranging from minor irritation to blindness, disfigurement, and death. Infestation with Cochliomyia hominivorax, a medically significant and economically important species, exemplifies the mechanisms by which larvae can cause tissue damage. Although clinical history may be suggestive of ophthalmomyiasis, the definitive diagnosis requires direct observation of larvae. Treatment of ophthalmomyiasis involves removal or destruction of the larvae, if alive, and appropriate management of any sequelae. Preventive measures may not always be successful.

Thelazia rhodesii (Desmarest, 1828) in cattle of Central Province, Zambia.

Sanga cattle from Central Zambia were examined during the dry and the rainy seasons for the presence of the adult stage of eyeworm Thelazia rhodesii. Prevalences were recorded according to age/sex groups. The occurrence of ocular diseases was also noted. Differences between the total prevalences of infection with the parasite in the dry and rainy seasons were observed: respectively 3.1% and 26.6% of all cattle examined (p less than 0.001), which numbered 223 head in the dry season and 248 in the rainy season. In both seasons, adult males showed the highest prevalence and calves the lowest. In the dry season the parasite was found in two of the 23 males (8.7%) but in none of the 24 calves. During the rains, eight of the 22 adult males (36.4%), and two of 53 calves (3.8%) were parasitized (p less than 0.001). A comparison of the prevalences in the latter season between a group of cows sprayed weekly with a synthetic pyrethroid and an untreated group showed no significant difference between the two groups (p greater than 0.1). No correlation was found between T. rhodesii infection and the occurrence of eye lesions (p greater than 0.1). It is concluded that in traditionally managed Zambian cattle the infection is seasonal, is more frequent in adult male animals and is not associated with eye infections (i.e., pink-eye).