Amebaborne "Attilina massiliensis" Keratitis, France.

We report a case of Acanthamoeba castellani keratitis in a person who wore contact lenses. The amebae hosted an ameba-resistant bacterial symbiont, provisionally named "Attilina massiliensis," a yet undescribed α-Proteobacterium.

A Vision Enhancement System to Improve Face Recognition with Central Vision Loss.

SIGNIFICANCE: The overall goal of this work is to validate a low vision aid system that uses gaze as a pointing tool and provides smart magnification. We conclude that smart visual enhancement techniques as well as gaze contingency should improve the efficiency of assistive technology for the visually impaired. PURPOSE: A low vision aid, using gaze-contingent visual enhancement and primarily intended to help reading with central vision loss, was recently designed and tested with simulated scotoma. Here, we present a validation of this system for face recognition in age-related macular degeneration patients. METHODS: Twelve individuals with binocular central vision loss were recruited and tested on a face identification-matching task. Gaze position was measured in real time, thanks to an eye tracker. In the visual enhancement condition, at any time during the screen exploration, the fixated face was segregated from background and considered as a region of interest that could be magnified into a region of augmented vision by the participant, if desired. In the natural exploration condition, participants also performed the matching task but without the visual aid. Response time and accuracy were analyzed with mixed-effects models to (1) compare the performance with and without visual aid and (2) estimate the usability of the system. RESULTS: On average, the percentage of correct response for the natural exploration condition was 41%. This value was significantly increased to 63% with visual enhancement (95% confidence interval, 45 to 78%). For the large majority of our participants (83%), this improvement was accompanied by moderate increase in response time, suggesting a real functional benefit for these individuals. CONCLUSIONS: Without visual enhancement, participants with age-related macular degeneration performed poorly, confirming their struggle for face recognition and the need to use efficient visual aids. Our system significantly improved face identification accuracy by 55%, proving to be helpful under laboratory conditions.

Repertoire of free-living protozoa in contact lens solutions.

BACKGROUND: The repertoire of free-living protozoa in contact lens solutions is poorly known despite the fact that such protozoa may act as direct pathogens and may harbor intra-cellular pathogens. METHODS: Between 2009 and 2014, the contact lens solutions collected from patients presenting at our Ophthalmology Department for clinically suspected keratitis, were cultured on non-nutrient agar examined by microscope for the presence of free-living protozoa. All protozoa were identified by 18S rRNA gene sequencing. RESULTS: A total of 20 of 233 (8.6 %) contact lens solution specimens collected from 16 patients were cultured. Acanthamoeba amoeba in 16 solutions (80 %) collected from 12 patients and Colpoda steini, Cercozoa sp., Protostelium sp. and a eukaryotic more closely related to Vermamoeba sp., were each isolated in one solution. Cercozoa sp., Colpoda sp., Protostelium sp. and Vermamoeba sp. are reported for the first time as contaminating contact lens solutions. CONCLUSION: The repertoire of protozoa in contact lens solutions is larger than previously known.

Aggregatibacter aphrophilus chronic lacrimal canaliculitis: a case report.

BACKGROUND: Chronic canaliculitis is often misdiagnosed as conjunctivitis, delaying proper documentation and management. Aggregatibacter aphrophillus has not been implicated in chronic canaliculitis. CASE PRESENTATION: We report a case of unilateral chronic epiphora associated with chronic lacrimal canaliculitis resistant to prolonged topical antibiotic treatment in a 65-year-old woman without notable medical history. Canaculotomy, curettage with removal of concretions and tubing with silicone stent for six weeks resolved this chronic infection. Culturing lacrimal secretions and concretions yielded Aggregatibacter aphrophilus in pure culture. Histological analyses showed elongated seed clusters surrounded by neutrophils. Fluorescence in Situ Hybridization confirmed the presence of bacteria in two distinctive concretions. CONCLUSION: This first documented case of A. aphrophilus chronic lacrimal canaliculitis illustrates that optimal surgical management of chronic lacrimal canaliculitis allows for both accurate microbiological diagnosis and treatment.

Paracoccus yeei keratitis in a contact lens wearer.

OBJECTIVES: Paracoccus yeei is an environmental bacterium suspected to be responsible for ocular infections. In this study, culture-based and polymerase chain reaction (PCR) sequencing-based investigations of a corneal scraping specimen confirmed P. yeei keratitis in one contact lens wearer. METHODS: A 34-year-old male patient, who was a contact lens wearer, presented with a unilateral corneal ulcer. A corneal scraping was performed to conduct a microbiological investigation. Disease progress was favorable after a 5-week topical treatment, which combined rifampicin, ciprofloxacine, tobramycine, and dexamethasone. The final visual acuity of the right eye was 5/10 with correction, limited by a central corneal scar. RESULTS: Culturing the corneal scraping specimen yielded P. yeei, which was also directly detected by PCR sequencing the bacterial 16S rDNA in the presence of negative controls. The P. yeei isolate was susceptible to ticarcillin, with a minimal inhibitory concentration (MIC) of <4 mg/L of ceftazidime (MIC of 0.5 mg/L), imipenem (MIC < 0.5 mg/L), gentamycin (MIC of 0.5 mg/L), tobramycin (MIC < 0.06 mg/L), rifampicin (MIC < 0.125 mg/L), ciprofloxacin (MIC < 0.5 mg/L), and colimycin (MIC < 2 mg/L). The isolate was resistant to fosfomycine with a MIC 32 > mg/L. CONCLUSIONS: P. yeei is a new cause of keratitis that must be diagnosed by a laboratory analysis of corneal scrapings due to the potentially poor outcome of infection.

Corneal Toxicity in Patients Treated by BELANTAMAB MAFODOTIN: How to Improve and Facilitate Patients Follow-Up Using Refractive Shift?

Purpose: Multiple myeloma (MM) is the second most common neoplastic blood disease worldwide. Belantamab mafodotin is a new antibody conjugate anti-B-cell maturation antigen effective against refractory myelomas. It induces intracorneal microcysts leading to refractive fluctuations. The aim of this study is to assess the value of monitoring refractive fluctuations based on the location of microcystic-like epithelial changes (MECs) to facilitate patient follow-up. Methods: This observational and multicentric study was conducted using data collected from several French centers contacted through secure email through a standardized data collection table. Results: The fluctuation of objective refraction in spherical equivalent confirms a significant myopic shift from peripheral to central forms. A decrease in the best-corrected visual acuity (BCVA), an increase in keratometry, and an increase in central epithelial pachymetry have also been observed when MECs migrate toward the center. Conclusion: The myopization found in our study in patients with central and paracentral MECs is consistent with current literature. Fluctuations in BCVA, keratometry, and epithelial pachymetry are also consistent. This study is the first real-world study and highlights heterogeneity in follow-up, emphasizing the need to establish multidisciplinary follow-up strategies. The analysis of refractive fluctuations appears to be a reproducible and noninvasive screening method that could facilitate patient follow-up without the need for consultation focused on corneal diseases.

Corneal ectasia after intrastromal presbyopic surgery.

PURPOSE: To report histopathologic findings in a case of bilateral corneal ectasia following intrastromal femtosecond laser presbyopia surgery. METHODS: Case report. RESULTS: A 56-year-old patient was referred for bilateral corneal ectasia. He was treated for hyperopia using LASIK twice in both eyes. A bilateral femtosecond laser intrastromal presbyopia correction was secondarily performed. The patient complained of progressive loss of distance visual acuity shortly after. Corneal topography showed a bilateral central corneal protrusion. Rigid contact lenses were successfully fitted on the right eye and, because the patient still complained, a deep anterior lamellar keratoplasty was performed in the left eye. Light and electronic microscopy of the corneal button revealed that the inner intrastromal incision crossed the LASIK interface and led to stromal bed dehiscence. CONCLUSION: This case illustrates that intrastromal refractive surgery should not be recommended in eyes previously treated by lamellar refractive surgery.

Dolosigranulum pigrum keratitis: a three-case series.

BACKGROUND: Dolosigranulum pigrum is a commensal inhabitant of the upper respiratory tract suspected to be responsible for ocular infections but no well-described case of D. pigrum corneal infection has been reported. Herein culture and PCR-sequencing-based investigations of corneal scraping specimens confirmed D. pigrum keratitis in three patients. CASE PRESENTATION: Three elderly patients presented with unilateral keratitis. None was a corneal-contact lens wearer, one had previous cataract surgery and another suffered rheumatoid arthritis sicca syndrome. Culturing the corneal scraping specimen was positive for two cases and PCR-sequencing of bacterial 16S rDNA in the presence of negative controls identified D. pigrum in three cases. The two D. pigrum isolates were in-vitro susceptible to penicillin G, amoxicillin, doxycycline, rifampicin and gentamicin. In all cases, surgical treatment of corneal thinning was necessary, but corneal perforation occurred in two cases despite intensive antimicrobial treatment with ticarcillin, gentamicin and vancomycin or levofloxacin eye drops leading to enucleation in one case. CONCLUSIONS: D. pigrum is the likely cause of corneal infection in three patients, with effective antibiotic treatment in two patients.

Keratoconus and the Impact of Treatment on Patients' Quality of Life: A Qualitative Study.

INTRODUCTION: Keratoconus has a significant impact on patients' quality of life (QoL), from diagnosis to the advanced stages of the disease. The aim of this research was to identify domains of QoL affected by this disease and its treatment. METHODS: Phone interviews were conducted using a semi-structured interview guide, with patients with keratoconus stratified according to their current treatment. A board of keratoconus experts helped identify the guide's main themes. RESULTS: Thirty-five patients (rigid contact lenses, n = 9; cross-linking, n = 9; corneal ring implants, n = 8; and corneal transplantation, n = 9) were interviewed by qualitative researchers. Phone interviews revealed several QoL domains affected by the disease and its treatments: "psychological", "social life", "professional life", "financial costs" and "student life". All domains were impacted, independently of the treatment history. Few differences were found between treatment regimens and keratoconus stages. Qualitative analysis enabled the development of a conceptual framework based on Wilson and Cleary's model for patient outcomes common to all patients. This conceptual model describes the relationship between patients' characteristics, their symptoms, their environment, their functional visual impairment and the impact on their QoL. CONCLUSIONS: These qualitative findings supported the generation of a questionnaire to evaluate the impact of keratoconus and its treatment on patients' QoL. Cognitive debriefings confirmed its content validity. The questionnaire is applicable for all stages of keratoconus and treatments and may help tracking change over time in regular clinical settings. Psychometric validation is yet to be performed before its use in research and clinical practices.

Nocardia transvalensis keratitis: an emerging pathology among travelers returning from Asia.

BACKGROUND: The incidence rate of Nocardia keratitis is increasing, with new species identified thanks to molecular methods. We herein report a case of Nocardia transvalensis keratitis, illustrating this emerging pathology among travellers returning from Asia. CASE PRESENTATION: A 23-year-old man presented with a 10-week history of ocular pain, redness, and blurred vision in his right eye following a projectile foreign body impacting the cornea while motor biking in Thaïland. At presentation, a central epithelial defect with a central whitish stromal infiltrate associated with pinhead satellite infiltrates was observed. Identification with 16S rRNA PCR sequencing and microbiological culture of corneal scraping and revealed N. transvalensis as the causative organism. Treatment was initiated with intensive topical amikacin, oral ketoconazole and oral doxycycline. After a four-week treatment period, the corneal infiltrate decreased so that only a faint subepithelial opacity remained. CONCLUSION: Nocardia organisms should be suspected as the causative agent of any case of keratitis in travelers returning from Asia. With appropriate therapy, Nocardia keratitis resolves, resulting in good visual outcome.

Inhibition of corneal neovascularization after alkali burn: comparison of different doses of bevacizumab in monotherapy or associated with dexamethasone.

BACKGROUND: To compare the effects of different doses of bevacizumab with both saline and dexamethasone on inflammatory angiogenesis in the rat cornea induced by small chemical lesions. METHODS: Corneal chemical cauterization was performed on 24 rats. Animals were divided randomly into six groups and received a daily subconjunctival injection for 7 days of: balanced salt solution 0.1 mL or dexamethasone phosphate 4 mg/day or bevacizumab 2.5 mg/day, 3.75 mg/day, 5.0 mg/day or bevacizumab 5.0 mg/day + dexamethasone phosphate 4 mg/day. Clinical examination under slitlamp was performed daily for 7 days to evaluate corneal opacity and vessel size evolution. Computer assisted quantitative image analysis was used to measure the total corneal area covered by neovascularization. RESULTS: At final examination, the dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups showed a significant lowering in corneal opacity score as compared with control (P = 0.024, P = 0.006 and P = 0.013, respectively). Also, a significant reduction on new vessels size score was observed. Surface of corneal neovascularization was significantly reduced in dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups compared with control (P =0.045, P = 0.047 and P = 0.044, respectively). CONCLUSION: Our study demonstrates the ability of a 5.0 mg/day bevacizumab subconjunctival injection, in monotherapy or associated with dexamethasone, to cause a short-term involution of corneal neovascularization after corneal alkali burn. Combination of both of these treatments may have advantages to monotherapy approaches.

Optic nerve compression by an intraorbital megadolichoectatic ophtalmic artery.

A 47-year-old woman, physically active, presented with a history of progressive isolated right eye visual loss (20/200). Ophtalmological examination with Goldmann's perimetry showed a Marcus Gunn pupil, an optic disc temporal pallor and a central scotoma on the affected eye. CT scan and cerebral angiography demonstrated an abnormally wide and elongated (megadolichoectatic) intraorbital ophthalmic artery responsible for optic nerve compression in the optic canal. Pulse steroid therapy was chosen and allowed recuperation of right eye visual acuity to 20/20. A 3-months' follow-up was decided and to date, 1 year later, she fell back to 20/40 with a normal right eye visual field. The authors compare these clinical and radiological findings with intraorbital aneurysms and discuss the therapeutic options for this extremely rare form of vascular disease.

Complications of cosmetic iris implants: French series of 87 eyes.

PURPOSE: Iris intraocular implants were developed to manage congenital or traumatic iris defects. However, they are also used to change the color of patient eyes. The aim of this retrospective series was to report complications in patients managed in France after cosmetic implantation. SETTING: Ophthalmological institutions and private ophthalmologists in France. DESIGN: Multicenter retrospective observational study. METHODS: Questionnaires were sent to all ophthalmology departments in university hospitals and to private ophthalmologists. This questionnaire listed demographic and clinical data for each implanted eye with a focus on safety, the description of ocular complications (corneal edema, endothelial cell loss, increased intraocular pressure, and intraocular inflammation), and the therapeutic management implemented. RESULTS: Forty-four questionnaires (87 eyes) were collected, and ultimately, 33 questionnaires (65 eyes) were considered complete and analyzed. Two types of implants were identified. Of the 65 eyes analyzed, only 5 eyes (7.7%) did not experience any complication and 60 eyes (92.3%) had at least 1 complication. The most commonly reported complication was corneal decompensation (78.5%). The diagnosis of glaucoma was made in over half (52.3%) of the cases. Explantation was needed in 81.5% of cases. The mean final visual acuity was 0.45 ± 0.08 logarithm of the minimum angle of resolution (logMAR) (0 to 2 logMAR). CONCLUSIONS: Several ocular complications with a decreased mean visual acuity were described in a young healthy population. In addition, patient information on the safety of this procedure appeared insufficient.

A retrospective analysis of characteristic features of responder patients to autologous serum eye drops in routine care.

PURPOSE: Autologous serum eye drops (ASEDs) are used worldwide to treat dry eye disease (DED). However, the biological composition of ASEDs has not been well investigated, and effectiveness predictive factors remain to be identified. The main objective of this study was to compare the response of patients treated with ASEDs biologically characterized and used for DED routine care. METHODS: This retrospective observational study was conducted in a single university hospital, and included 50 patients (87 eyes) with DED refractory to conventional treatment and resulting from various etiologies with Ocular Surface Disease Index (OSDI) ≥ 20. Each patient used eight drops a day per treated eye with 20% diluted ASEDs. Undiluted serum extensive biological characterizations were performed, and symptoms were recorded before the initiation of ASEDs and closer to the sixth month of treatment. Responders were defined as presenting an improvement from baseline ≥14 points in OSDI and/or ≥1 grade in corneal fluorescence staining for all eyes treated. RESULTS: The OSDI and the Oxford scale were significantly reduced from 68.7 ±â€¯23.2 to 54.8 ±â€¯25.7 and 3.2 ±â€¯1.5 to 2.1 ±â€¯1.3 (p ≤ 0.0001), respectively. A total of 68% of the patients were responders. Nonresponding patients had significantly higher epidermal growth factor concentrations in the serum compared to responders (p = 0.017). CONCLUSIONS: ASED administration resulted in significant clinical improvement in the management of DED. Biological differences observed between responders and nonresponders suggested that a better understanding of the biological activity of ASEDs is still required.

Short-term results of penetrating keratoplasty performed with the Femtec femtosecond laser.

PURPOSE: To evaluate the use of the Femtec femtosecond (fs) laser for penetrating keratoplasty (PK) in the treatment of corneal diseases. DESIGN: Prospective, nonrandomized clinical study. METHODS: Nine eyes of nine patients underwent surgery for PK. Five had pseudophakic bullous keratopathy, three had Fuchs dystrophy, and one presented in a keratoconus patient. A Femtec (20/10 PerfectVision; GmbH, Heidelberg, Germany) fs laser was used to create penetrating cuts on donor and recipient corneas. All patients were evaluated for uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), pachymetry, topography, and endothelial cell density (ECD). Scanning electron microscopy (SEM) was performed on corneal tissue after surgery. RESULTS: All eyes were treated successfully without intraoperative complications. The mean follow-up was 6 +/- 3 months. At the last postoperative examination mean BSCVA was 20/69 and there was a significant improvement (P = .08) in both UCVA and BSCVA. Mean astigmatism was 2.9 +/- 1.2 diopters. Mean ECD was 1194 +/- 465 cells/mm(2) with a mean cell loss after surgery of 49.8% +/- 19.8%. SEM displayed smooth rectilinear cut margins and minor remaining tissue bridges. One patient presented a retinal detachment three months after surgery that was successfully treated and two subjects showed an allograft rejection. CONCLUSION: Use of the Femtec fs laser was effective and safe to perform PK. Short-term visual results and refractive results are analogous to conventional PK or other fs laser-assisted PK studies. Longer-term follow-up of additional cases is necessary to precisely quantify the endothelial cell loss after fs surgery.

Corneal endothelial cell loss after cataract extraction by using ultrasound phacoemulsification versus a fluid-based system.

PURPOSE: To compare in vivo corneal endothelial cell loss (ECL) after fluid-based versus ultrasound phacoemulsification. METHODS: In this prospective randomized study, 2 groups of 21 patients underwent phacoemulsification with ultrasound (group 1) or a fluid-based system (group 2). A "divide and conquer" method with capsular bag lens implantation was performed. Cataracts graded up to nuclear opalescence 4.9 in Lens Opacities Classification System III (LOCS III) only were included. Endothelial cell density (ECD), percent hexagonality, endothelial cell area (ECA), coefficient of variation in cell size, and central corneal pachymetry were measured preoperatively, 7 days, 1 month, and 3 months after surgery. Statistical analysis was performed by using a 2-tailed Student t test. RESULTS: Average nuclear opalescence was identical in both groups (P = 0.908). Mean ECD was 1867 +/- 451 and 2031 +/- 400 cells/mm at 3 months postoperatively. Mean ECL was 498 +/- 415 (20.6% +/- 17.1%) and 302 +/- 302 cells/mm (13.3% +/- 13.2%) at 7 days, 589 +/- 342 (24.3% +/- 14%) and 254 +/- 214 cells/mm (11.2% +/- 9.1%) at 1 month, and 555 +/- 340 (22.9% +/- 14%) and 247 +/- 208 cells/mm (10.9% +/- 9.1%) at 3 months in groups 1 and 2, respectively. ECL was significantly lower for group 1 than for group 2 (P < 0.001) after the first postoperative month. A significant increase in ECA was also observed at the first and third (P = 0.012) postoperative months. CONCLUSIONS: Our study showed significantly lower ECL after phacoemulsification for a fluid-based versus an ultrasound system. The fluid-based method was safer than conventional ultrasound in cataract surgery, with a nuclear opalescence graded up to 4.9 in the LOCS III classification.

Corneal Surface Ablation Laser Refractive Surgery for the Correction of Myopia: A Network Meta-analysis.

PURPOSE: To systematically compare the efficacy, predictability, safety, postoperative haze, pain scores, and epithelial healing time of four corneal surface ablation procedures. METHODS: PubMed, Embase, Cochrane Library, and the U.S. trial registry were searched up to June 2018. Randomized controlled trials were selected. Efficacy (uncorrected distance visual acuity of 20/20 or better), predictability (refractive spherical equivalent within ±0.50 diopters [D] of the target), and safety (loss of two or more lines of spectacle corrected distance visual acuity) were set as primary outcome measures. Haze, pain scores, and epithelial healing time were set as secondary outcome measures. RESULTS: Eighteen studies involving 1,423 eyes were included. According to the Grading of Recommendations Assessment, Development, and Evaluation, the quality of outcomes were moderate to high (70.6%). There were no differences in efficacy, predictability, safety, haze, day 1 pain, and epithelial healing time between treatments. Epithelial laser in situ keratomileusis (epi-LASIK) had statistically significantly higher pain scores on day 3 compared to photorefractive keratectomy (PRK) (weighted mean differences [WMD] = 2.2, 95% credible intervals [CrI] = 0.19 to 4.01) and transepithelial PRK (T-PRK) (WMD = 2.7, 95% CrI = 0.51 to 4.84). The surface under the cumulative ranking curve ranking results (best to worst) showed laser epithelial keratomileusis (LASEK) ranked highest for efficacy, predictability, safety, and day 1 pain scores. Epi-LASIK ranked best for grade 1 haze scores. T-PRK ranked best for haze of 0.5 or higher, haze scores day 3 pain scores, and epithelial healing time. CONCLUSIONS: Surface laser refractive surgeries are comparable in terms of efficacy, predictability, safety, and postoperative haze except for day 3 pain scores, with epi-LASIK being more painful compared to PRK and T-PRK. [J Refract Surg. 2018;34(11):726-735.].