Corneal Involvement in HIV-infected Individuals.

Corneal involvement in HIV-infected individuals may be broadly classified into two categories, namely, infectious and noninfectious with the vast majority of manifestations occurring in the former. In this article, we shall focus on these two categories and strive to highlight those presentations that should alert the clinician to suspect underlying HIV infection. Infectious group mainly consists of Herpitic group of viral infections. Bacterial causes may be due to Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeroginosa, alpha hemolytic Streptococcus, Micrococcus and Bacillus. Fungalf keratitis in HIV-infected individuals depends on the geographic locations from which patient comes. Microsporidia and Acanthamoeba are common Protozoal causes. Non-infective inflammatory causes include peripheral ulcerative keratitis, keratoconjunctivitis sicca, and squamous cell carcinoma of the conjunctiva. Severity which is abnormally severe or very minimally reactive makes the clinician suspect of immunosuppression.

[Mixed infections and inflammatory ophthalmic diseases: clinical and laboratory observations]. / Mikst-infektsii i vospalitel'naia oftal'mopatologiia: kliniko-laboratornye nabliudeniia.

In recent years, all medical specialists, including ophthalmologists, have been facing the problem of mixed infections. Recurrent inflammation in the anterior and posterior eye segments is often a result of infection by more than one variety of pathogens. MATERIAL AND METHODS: Over the period 2013-2016, 34 patients (14 men and 20 women) with different inflammatory processes in the eye who appeared DNA-positive for mycoplasmas (Mycoplasma hominis, Ureaplasma urealyticum) and/or chlamydiae (Chlamydia trachomatis) (PCR testing of tear fluid and/or urine) were followed up. All patients were examined for intensive production of herpesvirus, adenovirus, and enterovirus DNA in biological fluids. After being consulted by related specialists, all the patients started local and systemic (antibacterial and antiviral) therapy. In the end of the latter, laboratory tests were repeated. RESULTS: Among all the clinical forms, anterior segment inflammation (i.e. of conjunctiva, cornea, and the anterior vascular tract) prevailed - 76%. In most patients, mycoplasmas and/or chlamydiae formed associations with herpesviruses (n=19; 56%). Bacterial DNA alone (mycoplasma and/or chlamydia) was detected in 12 cases (35%). In 4 cases, mycoplasma and/or chlamydia DNA was detected in tear fluid, in 19 patients - in urine, and in 10 patients - in both secreta. Local and systemic causal treatment enabled resolution of the complaints and symptoms and yielded negative results of follow-up laboratory tests. CONCLUSION: More than a half of the patients demonstrated concomitant viral-bacterial infection (22 cases). The presence of bacterial/viral DNA in biological secreta, as revealed by PCR, reflects the systemic nature of the infection process and, thus, necessitates engagement of related specialists (dermatologists, urologists, gynecologists).

Intravitreal Adalimumab in Active Noninfectious Uveitis: A Pilot Study.

PURPOSE: To evaluate the short-term efficacy of intravitreal adalimumab (IVA) for the treatment of eyes with active noninfectious uveitis. METHODS: Consecutive eyes with active noninfectious uveitis were injected with IVA at 0, 2, then every 4 weeks for total of 26 weeks. RESULTS: Six out of 7 patients (12 of 13 eyes) completed 26 weeks of treatment. One patient (1 eye) failed treatment. Seven out of 12 eyes had improvement of ≥2 ETDRS lines. Three out of three eyes had resolution of anterior chamber cells. And 9 of 10 eyes with vitreous haze had zero haze at 26 weeks. Five out of 8 eyes with macular edema had complete resolution. Median fluorescein angiography score improved from 14 to 4 on last follow-up. CONCLUSIONS: IVA was effective in controlling the inflammation, decreasing the macular edema, and improving the best corrected visual acuity in the majority of eyes in this series.

Infectious Keratitis Following Corneal Crosslinking: A Systematic Review of Reported Cases: Management, Visual Outcome, and Treatment Proposed.

AIM: To describe the infectious complications and the group of pathogens involved in the infection following corneal crosslinking, the visual outcome, and the treatment proposed. METHODS: A Medline (National Library of Medicine, Bethesda, MD, USA) search from October 2000 to October 2013 was performed to identify all articles describing infectious keratitis following corneal crosslinking treatment. Nineteen articles were selected. Ten articles reported infectious complications of corneal crosslinking treatment were included. Nine articles were excluded, because seven described sterile keratitis, one article was in German, and one reported general complication without describing the infection complication. RESULTS: A total number of infections reported included 10 eyes. The infectious keratitis was associated with bacteria in five eyes (50%): gram-positive bacteria in three eyes (30%) (staphylococcus epidermidis, S. aureus and streptococcus salivarius plus S. oralis, respectively) and gram-negative bacteria in two eyes (20%) (E. coli; P. aeruginosa); there was herpes virus in two eyes, fungus in two eyes (Fusarium and Microsporidia) (20%), and Acanthamoeba in one eye (10%). CONCLUSIONS: Only 10 cases of infectious keratitis following corneal crosslinking are published. The most virulent pathogens were Pseudomonas aeruginosa and Acanthamoeba. Less virulent organisms were Escherichia coli and S. epidermidis. Two cases of herpes keratitis were described, suggesting the possibility of systemic antiviral prophylaxis before corneal crosslinking treatment. The most common risk factor of infections identified was postoperative incorrect patient behavior.

Comparison of two in situ corneal donation technique: morgue trephination or scleracorneal removal technique.

PURPOSE: To compare the two different 'in situ' methods of corneal trephination technique under morgue condition (morgue trephination technique, MTT) and classic scleracorneal removal technique (SRT). METHODS: A total of 1179 cases were evaluated for cornea donation at Gazi University Faculty of Medicine mortuary between the years 2008 and 2013 and were included to the study. Suitable donor corneas were retrieved with in situ trephination technique under morgue condition (group 1, MTT) or with in situ classic SRT (group 2, SRT). The two different 'in situ' methods were compared in terms of donor corneal biological quality (endothelial cell count, ECC) and functional outcome (presence of infection and primary graft failure). RESULTS: One hundred and fifty-two of 1179 cases were suitable for corneal donation. Two hundred and twenty-nine corneas of 152 cases were transplanted, 108 corneas were obtained with MTT and 121 corneas were obtained with SRT. Pretransplant and post-transplant ECCs were 2402.5 ± 115.6 and 2108.3 ± 108.23 (p = 0.065) in MTT, respectively, and 2512.7 ± 130.4 and 2235.4 ± 201.8 (p = 0.059) in SRT, respectively. The incidence of primary graft failure and infection was not statistically significantly different between two method [2.7% and 1.6% (p = 0.223), 0.9% and 0.8% (p = 0.115)]. CONCLUSION: The two different 'in situ' methods, MTT and SRT, were similar in terms of donor ECC, presence of infection and primary graft failure. Cornea excision performed through the technique described herein may increase the corneal donation rates as result of reduced disfigurement to donor body and offer important contributions during surgery with good anatomic adaptation of tissues.

Deep anterior lamellar keratoplasty using acellular corneal tissue for prevention of allograft rejection in high-risk corneas.

PURPOSE: To determine whether deep anterior lamellar keratoplasty (DALK) using acellular glycerol-cryopreserved corneal tissue (GCCT) could prevent allograft rejection in high-risk corneas. DESIGN: Prospective, randomized, comparative study. SETTINGS: The Eye Hospital, Wenzhou Medical College, Zhejiang, China. STUDY POPULATION: All patients with herpes simplex virus keratitis, bacterial keratitis, fungal keratitis, or ocular burn, who were eligible as per study design, were invited to participate. OBSERVATION PROCEDURES: According to randomized block design, all patients received either GCCT or fresh corneal tissue (FCT) during DALK. Best-corrected visual acuity (BCVA), slit-lamp microscopy, and in vivo confocal microscopy examinations at 1 week and 1, 3, 6, 12, and 24 months after surgery were analyzed. Kaplan-Meier survival analysis was used to evaluate graft survival rate. MAIN OUTCOME MEASURES: Therapeutic success, 2-year rejection-free graft survival rate and 2-year graft survival rate, in vivo confocal microscopy results, BCVA, and endothelial cell density. RESULTS: Postoperative BCVA of 20/40 or better at the last follow-up visit was achieved in 57.6% (19/33) of eyes in the GCCT group and in 54.8% (17/31) of the FCT group. No graft rejection occurred in the GCCT group, while in the FCT group 10 episodes of stromal rejection developed in 7 eyes. Overall, the rejection-free graft survival rate at 2 years was significantly higher in the GCCT group as compared with the FCT group (100.0%, 78.8% respectively, P = .006). CONCLUSIONS: Deep anterior lamellar keratoplasty using acellular glycerol-preserved cornea could prevent allograft rejection and promote graft survival rate in high-risk corneas.

Prototheca wickerhamii infection of a corneal graft.

Algae are generally noninfectious agents in mammals, with few known pathogenic algae. Prototheca is an achlorophylic nonphotosynthetic algae, globally ubiquitous, and readily isolated from rivers, lakes, ponds, and soil. Although canine and bovine protothecosis have been reported more widely, infections in humans are rare, particularly in patients with an intact immune system. The majority of protothecal infections in humans is associated with Prototheca wickerhamii. We report an unusual case of P. wickerhamii infection in an immunocompetent corneal transplant patient.

Toll-like receptors at the ocular surface.

The Toll-like receptor (TLR) family of pathogen recognition molecules has an important role in recognizing microbial pathogens and microbial breakdown products. Activation of TLRs in the corneal epithelium induces CXC chemokine production and recruitment of neutrophils to the corneal stroma. Although essential for pathogen killing, neutrophils can cause extensive tissue damage, leading to visual impairment and blindness. In this review, we examine the role of TLRs in microbial keratitis and in noninfectious corneal inflammation, most commonly associated with contact lens wear. we present recent findings on TLR signaling pathways in the cornea, including MyD88- and TRIF-dependent responses and discuss the role of resident macrophages and dendritic cells. Finally, we examine the potential for targeting the TLR pathway as a potential therapeutic intervention for microbial keratitis and contact lens-associated corneal inflammation.

Infectious and noninfectious keratitis after laser in situ keratomileusis Occurrence, management, and visual outcomes.

PURPOSE: To retrospectively review the occurrence, treatment, and visual outcomes associated with various etiologies of keratitis as a postoperative complication of laser in situ keratomileusis (LASIK) at an academic surgical center. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: The charts of 5618 post-LASIK patients (10 477 eyes) were reviewed for the development of keratitis. Occurrence rates, management regimens, and final best spectacle-corrected visual acuity (BSCVA) were reported for infectious and noninfectious keratitis etiologies. RESULTS: Post-LASIK keratitis was diagnosed in 279 eyes. The keratitis was diagnosed as infectious in 33 eyes (12%) and as noninfectious in 246 eyes (88%). Infectious cases included 5 eyes (15%) with herpes simplex keratitis (HSV), 18 (55%) with adenoviral keratitis, and 10 (30%) with nonviral (including bacterial, fungal, and parasitic) keratitis. Of noninfectious cases, 193 (78%) were classified as diffuse lamellar keratitis (DLK), 36 (15%) as staphylococcal marginal hypersensitivity, and 17 (15%) as localized debris-related keratitis. CONCLUSIONS: The occurrence of post-LASIK keratitis was 2.66%, with DLK being the most common diagnosis overall. The occurrence of noninfectious keratitis (2.34%) was 7.5 times greater than the occurrence of infectious keratitis (0.31%). Adenoviral keratitis had the best visual outcomes overall, with all 18 patients achieving 20/20 BSCVA. In contrast, all 5 eyes with HSV keratitis lost 1 or 2 lines of BSCVA. Excluding adenoviral keratitis, infectious etiologies had significantly worse visual outcomes than noninfectious etiologies at the 20/40 and 20/20 levels (P = .0013 and P<.001, respectively).

Estudo sobre as causas mais freqüentes de perdas oculares / A study on the most frequent causes of ocular losses

As perdas oculares são constrangedoras ao portador por comprometer a face que é parte do corpo humano que possue os órgãos essenciais para o relacionamento humano. Foram avaliados no presente estudo prontuários de 53 pacientes da clínica de prótese buco-maxilo-facial do Centro de Oncologia Bucal da UNESP de Araçatuba, que tiveram a região ocular comprometida, sendo classificadas em ordem de prevalência as causas das perdas oculares. O glaucoma foi responsável por 37 por cento das perdas oculares, seguido por traumas ou acidentes com 32 por cento. Muitas são as causas das perdas oculares, sendo o glaucoma o principal responsável. As próteses oculares foram criadas com o intuito de devolver a função e a estética comprometidas pela ausência de parte ou total do globo ocular

[Ocular troubles and HIV/AIDS]. / Trastornos oculares y el VIH/SIDA.

AIDS: People living with HIV/AIDS are more prone to ocular conditions due to their weakened immune systems. The symptoms of HIV-related ocular conditions, such as cotton wool spots from cytomegalovirus infections, ocular hemorrhage, Kaposi's sarcoma (KS), keratitis, conjunctivitis, ocular toxoplasmosis, lymphoma, and herpes Zoster, are presented. References are provided for people with ocular problems.^ieng

Prognostic factors associated with the visual outcome after vitrectomy for endophthalmitis.

BACKGROUND: Functional results following vitrectomy with intraocular and systemic antibiotic treatment for endophthalmitis are influenced by numerous factors. METHODS: A retrospective study of 65 cases of endophthalmitis treated between October 1988 and May 1994 at the Department of Ophthalmology, University of Cologne, Germany was conducted. All eyes underwent pars plana vitrectomy and intraocular and systemic antibiotic treatment. RESULTS: Vision of 20/400 or better could be obtained in 66% of eyes following extracapsular cataract extraction and intraocular lens implantation (ECCE + IOL), in 62% after severe eye injury, in 36% of eyes after intraocular surgery for other reasons than cataract extraction with lens implantation and in 33% of patients with endogenous endophthalmitis. Vision of 20/50 or better could be achieved in 41% of eyes following ECCE + IOL and additional systemic steroid treatment. In 22% of cases primary silicone endotamponade was performed; 57% of these eyes obtained visual acuity of 20/400 or better. Fifteen patients (23%) suffered diabetes mellitus; 20/400 vision or better could be achieved in 73% of these eyes. Visual acuity of hand movements or better before vitrectomy was associated with 20/400 vision or better in 69% of cases, whereas ambulatory vision could be attained in only 33% of patients with visual acuity of worse than hand movements at the initial presentation. Visual acuity of less than 20/400 was found in all eyes with haemolytic streptococcal infections. CONCLUSION: Prompt treatment of endophthalmitis is crucial. Additional treatment using systemic steroids and, if necessary, silicone oil can improve the functional outcome in some cases.

[Physiopathologic mechanisms behind eye symptoms in primary tumors of the pineal body]. / Patofysiologiske mekanismer bag øjensymptomer ved primaere tumorer i corpus pineale.

Primary tumors of the pineal body can produce dyscoordinative movements of the eye, pupillary dilatation, paralysis of adduction during convergence and nystagmus. Obstruction of the aqueduct can cause hydrocephalus, increased intracranial pressure and papilledema. Diabetes insipidus may be a presenting symptom. Pinealocytes and the photoreceptors of the eye contain several autoantigens. In man, the best known is the S-antigen. This antigen can be detected in the cerebrospinal fluid of patients with primary tumors of the pineal body. The S-antigen, and possibly other related autoantigens, can elicit an autoimmune mediated reaction causing inflammatory eye symptoms. This recently described paraneoplastic neurologic syndrome shares properties in common with other known cancer-associated ophthalmologic syndromes characterised by rapid development of eye symptoms, rapid loss of sight and by eye manifestations prior to evident appearance of symptoms related to primary tumor growth. A primary tumor of the pineal body should be considered in patients where a monosymptomatic uveoretinitis presents without associated provoking factors. Furthermore, analyses of S-antigen in the spinal fluid can be useful in the clinical diagnosis of the same primary tumors.

Endophthalmitis: incidence, therapy and visual outcome in the period 1983-1992 in the Rotterdam Eye Hospital.

From 1983 to 1992, 134 patients were treated for clinically suspected endophthalmitis. 61% of this endophthalmitis population consisted of cases that were referred to our clinic. In this nine year period antibiotic treatment was carried out according to three consecutively used guidelines. These three treatment schemes differed in antibiotic spectrum and mode of antibiotic delivery. In 68 patients we performed vitrectomy on account of clinical deterioration under antibiotic treatment. We did not find significant differences in visual outcome between the three treatment groups. The incidence of endophthalmitis following cataract or vitreous surgery did not change throughout the study period. There was however a dramatic decrease in incidence of post-traumatic endophthalmitis following the introduction of a prophylactic antibiotic treatment scheme consisting of fortified gentamicin and cefazolin eyedrops, and intravenously and subconjunctivally administered gentamicin, cefazolin, and clindamycin. In 55 of 68 cases in which vitrectomy was performed in conjunction with intravitreal antibiotics, a vitreous or anterior chamber specimen was cultured. 36 patients had a positive culture result. In the group with positive culture result 42% had better visual acuity in the post-treatment period than before treatment. In the group with a sterile culture result 79% had better vision after treatment.

Estudo das alteraçoes oculares em hansenianos de controle ambulatorial / ?

We examined 997 leprous outpatients, 528 of wich (53,0 por cento) were of the lepromatous type 199 (20,0 por cento) of the borderline type, 167 (16,8 por cento) of the tuberculoid type and 103 (10,3 por cento) of the indeterminate type. 579 (58,1 por cento) were male and 418 (41,9 por cento) were female, 314 patients (31,5 por cento) showed ocular adnexa lesions and 389 (39,0 por cento) showed ocular lesions. Ocular manifestations were more common in lepromatous leprosy and increased according to the age of the patients and the duration of disease. Evebrow madarosis (211 cases, 21,2 por cento) was the commonest lesion of the adnexa and iris atropy (255 cases, 25,6 por cento), the commonest ocular lesion. Sight threatening lesion, such as lagophtalmos (2 cases, 1,2 por cento), corneal anesthesia (121 cases, 12,1 por cento) and corneal ulcers (2 cases, 0,2 por cento), acute iritis (2 cases, 0,2 por cento) and chronic iritis (6 cases, 0,6 por cento) were rare findings. This low incidence of sight threatning lesions was in part considered to be due to the early systemic treatment