[Efforts to improve the level of clinical diagnosis and treatment of infectious fundus diseases].

In recent years, the incidence of tuberculosis, HIV, syphilis and other infectious diseases has a "rising" trend. The incidence of infectious fundus diseases is also increasing, and missed diagnosis and misdiagnosis are becoming more common. How to diagnose infectious fundus diseases accurately, avoid missed diagnosis and misdiagnosis, carry out standardized treatment in time, carry out research on infectious fundus diseases related to systemic infectious diseases, and save the visual function of patients are the problems we are facing. This article discusses the related issues. (Chin J Ophthalmol, 2019, 55: 241-245).

Orbital infections: a complete cycle 7-year audit and a management guideline.

OBJECTIVES: Orbital infections are regularly encountered and are managed by various healthcare disciplines. Sepsis of the orbit and adjacent tissues can be associated with considerable acute complication and long-term sequelae. Therefore, prompt recognition and management of this condition are crucial. This article presents the outcomes of a 7-year complete cycle audit project and describes the development of the new local guideline on the management of orbital infections in our tertiary centre. METHODS: (1) A retrospective 5-year audit cycle on patients with orbital infections. (2) A review of available evidence on the management of orbital infections. (3) A new local multidisciplinary guideline on the management of orbital infections. (4) A retrospective 2-year second audit cycle to assess the clinical outcomes. RESULTS: Various disciplines intersect in the management of orbital infections. Standardising the management of this condition proved to be achievable through the developed guideline. However, room for improvement in practice exists in areas such as the promptness in referring patients to specialist care, the multidisciplinary assessment of patients on admission, and the improvement of scanning requests of patients.

Recent Updates on Treatment of Ocular Microbial Infections by Stem Cell Therapy: A Review.

Ocular microbial infection has emerged as a major public health crisis during the past two decades. A variety of causative agents can cause ocular microbial infections; which are characterized by persistent and destructive inflammation of the ocular tissue; progressive visual disturbance; and may result in loss of visual function in patients if early and effective treatments are not received. The conventional therapeutic approaches to treat vision impairment and blindness resulting from microbial infections involve antimicrobial therapy to eliminate the offending pathogens or in severe cases; by surgical methods and retinal prosthesis replacing of the infected area. In cases where there is concurrent inflammation, once infection is controlled, anti-inflammatory agents are indicated to reduce ocular damage from inflammation which ensues. Despite advances in medical research; progress in the control of ocular microbial infections remains slow. The varying level of ocular tissue recovery in individuals and the incomplete visual functional restoration indicate the chief limitations of current strategies. The development of a more extensive therapy is needed to help in healing to regain vision in patients. Stem cells are multipotent stromal cells that can give rise to a vast variety of cell types following proper differentiation protocol. Stem cell therapy shows promise in reducing inflammation and repairing tissue damage on the eye caused by microbial infections by its ability to modulate immune response and promote tissue regeneration. This article reviews a selected list of common infectious agents affecting the eye; which include fungi; viruses; parasites and bacteria with the aim of discussing the current antimicrobial treatments and the associated therapeutic challenges. We also provide recent updates of the advances in stem cells studies on sepsis therapy as a suggestion of optimum treatment regime for ocular microbial infections.

[Alternative Methods of Local Therapy for Complicated Periocular Infections - Two Case Reports]. / Alternative Methoden der Lokaltherapie bei komplizierten periokulären Infektionen ­ 2 Fallberichte.

Background Wounds of the eyelid can usually be cured with common surgical measures and the use of local antibiotics. Here we present two cases to demonstrate that biological debridement and negative pressure vacuum therapy (NPWT), two second line therapies, are effective and possibly superior alternatives to conventional, antibiotic-based approaches. Methodology and Result A persistent infectious wound of the upper eyelid after surgical debridement of necrotising fasciitis and an upper eyelid abscess with multiple purulent entry points, which was refractory to a five-week antibiotic regimen, were treated with biological debridement and NPWT. The combination of these two therapies leads to an optimal outcome. Conclusion Our cases demonstrate that, in ophthalmology, uncommon methods such as biological debridement and NPWT are quite practicable and are valuable therapeutic options.

[Corneal collagen cross-linking in the treatment of infectious keratitis and corneal ulcers]. / Krosslinking rogovichnogo kollagena v lechenii infektsionnykh keratitov i gnoinykh iazv rogovitsy.

In recent years, collagen cross-linking (CXL) of the cornea has acquired a new usage - in the treatment of infectious keratitis and corneal ulcers. This review was aimed at compiling the previously published data and assessing the effectiveness of the method.

Infections after refractive surgery.

PURPOSE OF REVIEW: The purpose of the review is to provide a summary of the recent literature concerning infections after refractive surgery pertinent to each procedure category. RECENT FINDINGS: New data from a large retrospective study suggest that the incidence of post-laser assisted in-situ keratomileusis infectious keratitis is declining. Additionally, recent case studies have reported viral, fungal, and Acanthamoeba pathogens. Corneal collagen cross-linking is emerging as an alternative therapeutic option for early stage post-LASIK infectious keratitis. Postoperative bandage contact lens used in patients undergoing surface ablation procedures may confer a higher risk of infection because of greater colonization rates in those individuals, such as healthcare providers, with relatively high risk of exposure to potential pathogens. In the setting of post-penetrating keratoplasty astigmatism, femtosecond laser astigmatic keratotomy procedures pose a risk of infectious keratitis and even endophthalmitis. Lastly, recent case reports of endophthalmitis after refractive lens procedures highlight the importance of postoperative monitoring for this sight threatening, albeit rare, complication. SUMMARY: The risks and management of infections after surgical refractive procedures vary widely depending on the specific technique employed. As technology and treatment options continue to evolve with further research, we anticipate continued success in the management of postoperative infections after refractive surgery.

Cornea and ocular surface disease: application of cutting-edge optometric research.

: Clinician-scientists bridge the gap between basic research and patient care. At the 2012 Annual Meeting, a symposium highlighting the application of cutting-edge optometric research within the anterior segment was held to present and discuss some of the recent basic scientific advances that will both shape and guide the development of future clinical care practices. This article summarizes this work, bringing together four experts, all clinician-scientists in the field of cornea and ocular surface. Collectively, this work provides new insights to clinicians and researchers alike, as well as brings forth a greater appreciation of the impact of ongoing optometric bench research in advancing clinical care.

Understanding Health Care Disparities Based on Medicare Use for Inflammatory and Infectious Eye Diseases.

Purpose: Inflammatory and infectious eye diseases are an important cause of visual impairment in patients older than 65 years of age. Health care disparities for eye care are present for general eye care. However, there is lack of national data on health disparities regarding eye care use for inflammatory and infectious eye diseases. Our study examines the effect of gender and race on eye care in patients with inflammatory and infectious eye diseases who are equal or greater than 65 years of age. Methods: We have used Medicare data to examine the effect gender and race on use of eye care services in patients with inflammatory and infectious eye diseases for 2014 to 2018. Medicare is a national insurance program administered by the government of United States to insure people age 65 years or older. Owing to its high enrollment, those in Medicare are representative of the U.S. population aged 65 and older. Results: We found that females have higher use for Medicare for inflammatory and infectious eye diseases across all races from 2014 to 2018. On examining the effect of race, African Americans have lower use as compared with Whites. People of Asian descent have the highest use, followed by Hispanic people. Conclusions: Health care disparities exist for eye care use for inflammatory and infectious eye diseases for patients 65 years of age and older. Future studies are required to address these disparities to provide equitable eye care. Translational Relevance: Identification of eye care disparities is the first step to addressing these disparities.

Scleral buckle removal in the vitrectomy era: a 20-year clinical experience.

PURPOSE: To describe the effect of scleral buckle (SB) removal on preoperative symptoms and signs prompting removal and to assess the risk of recurrent retinal detachment (RD) after SB removal. METHODS: A retrospective study of 36 patients who underwent SB removal between August 1988 and December 2007 was performed. Indications for SB removal, presence or absence of pain or diplopia, and recurrence of RD were recorded. Composite RD rates were estimated from previously published studies and stratified into those occurring during the previtrectomy era versus later (1980 to present). RESULTS: Mean follow-up time was 75.5 months after SB removal. Thirty-two of 33 patients (97%) who had preoperative pain had symptom relief. Twelve of 12 patients who had clinical infection had resolution. Of the four patients with diplopia, two experienced complete resolution and two reported substantial improvement but required prisms to obtain single vision. Four of 34 patients (12%) whose retinas were attached at the time of SB removal developed recurrent RD but were successfully repaired without significant visual loss from the RD. CONCLUSION: Scleral buckle removal is effective in eliminating SB-related pain and infection. Symptomatic diplopia can sometimes improve after SB removal. The rates of RD after SB removal observed in this study (12%) and in others performed in the era of vitrectomy were notably lower than those of previous reports.

Targeting toll-like receptor signaling as a novel approach to prevent ocular infectious diseases.

Toll-like receptors (TLRs) play a key role in the innate immune response to invading pathogens. Thus, their discovery has opened up a wide range of therapeutic possibilities for various infectious and inflammatory diseases. In the last several years, extensive research efforts have provided a considerable wealth of information on the expression and function of TLRs in the eye, with significant implications for better understanding of pathogenesis of infectious eye diseases affecting the cornea, uvea, and the retina. In this review, by using bacterial keratitis and endophthalmitis as examples, we discuss the possibilities of targeting TLR signaling for the prevention or treatment of ocular infectious diseases.

Infectious Keratitis: An Update on Role of Epigenetics.

Epigenetic mechanisms modulate gene expression and function without altering the base sequence of DNA. These reversible, heritable, and environment-influenced mechanisms generate various cell types during development and orchestrate the cellular responses to external stimuli by regulating the expression of genome. Also, the epigenetic modifications influence common pathological and physiological responses including inflammation, ischemia, neoplasia, aging and neurodegeneration etc. In recent past, the field of epigenetics has gained momentum and become an increasingly important area of biomedical research As far as eye is concerned, epigenetic mechanisms may play an important role in many complex diseases such as corneal dystrophy, cataract, glaucoma, diabetic retinopathy, ocular neoplasia, uveitis, and age-related macular degeneration. Focusing on the epigenetic mechanisms in ocular diseases may provide new understanding and insights into the pathogenesis of complex eye diseases and thus can aid in the development of novel treatments for these diseases. In the present review, we summarize the clinical perspective of infectious keratitis, role of epigenetics in infectious keratitis, therapeutic potential of epigenetic modifiers and the future perspective.

Ocular Delivery of Predatory Bacteria with Cryomicroneedles Against Eye Infection.

The development of potent antibiotic alternatives with rapid bactericidal properties is of great importance in addressing the current antibiotic crisis. One representative example is the topical delivery of predatory bacteria to treat ocular bacterial infections. However, there is a lack of suitable methods for the delivery of predatory bacteria into ocular tissue. This work introduces cryomicroneedles (cryoMN) for the ocular delivery of predatory Bdellovibrio bacteriovorus (B. bacteriovorus) bacteria. The cryoMN patches are prepared by freezing B. bacteriovorus containing a cryoprotectant medium in a microneedle template. The viability of B. bacteriovorus in cryoMNs remains above 80% as found in long-term storage studies, and they successfully impede the growth of gram-negative bacteria in vitro or in a rodent eye infection model. The infection is significantly relieved by nearly six times through 2.5 days of treatment without substantial effects on the cornea thickness and morphology. This approach represents the safe and efficient delivery of new class of antimicrobial armamentarium to otherwise impermeable ocular surface and opens up new avenues for the treatment of ocular surface disorders.

Diagnosis and management of red eye in primary care.

Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare. Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. Allergies or irritants also may cause conjunctivitis. The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

Gene editing and elimination of latent herpes simplex virus in vivo.

We evaluate gene editing of HSV in a well-established mouse model, using adeno-associated virus (AAV)-delivered meganucleases, as a potentially curative approach to treat latent HSV infection. Here we show that AAV-delivered meganucleases, but not CRISPR/Cas9, mediate highly efficient gene editing of HSV, eliminating over 90% of latent virus from superior cervical ganglia. Single-cell RNA sequencing demonstrates that both HSV and individual AAV serotypes are non-randomly distributed among neuronal subsets in ganglia, implying that improved delivery to all neuronal subsets may lead to even more complete elimination of HSV. As predicted, delivery of meganucleases using a triple AAV serotype combination results in the greatest decrease in ganglionic HSV loads. The levels of HSV elimination observed in these studies, if translated to humans, would likely significantly reduce HSV reactivation, shedding, and lesions. Further optimization of meganuclease delivery and activity is likely possible, and may offer a pathway to a cure for HSV infection.

[Ocular foreign bodies: Epidemiological, clinical and therapeutic aspects in Lubumbashi: About 98 cases]. / Corps étrangers oculaires : aspects épidémiologiques, clinique et thérapeutique à Lubumbashi : à propos de 98 cas.

PURPOSE: The purpose of this study was to determine the epidemiological, clinical and therapeutic features of ocular foreign bodies in our practice setting. METHODS: We conducted a cross-sectional descriptive study with retrospective data collection at the Sainte Ivonne ophthalmology center in Lubumbashi. We studied 98 medical records of patients seen from January through December 2016 for an ocular foreign body. The parameters used for this study were: age, gender, profession, circumstances of the injury, nature of the foreign body, complications, location, entry site, management and prognosis. RESULTS: The frequency of ocular foreign bodies was 2.4%. We saw predominantly young subjects; the mean age was 33.18±17.98 years. Males predominated, with a frequency of 78.57% of the cases, for a gender ratio of 3.7 men to women. The circumstances of the injuries were primarily work-related (36.46% of cases). The type of foreign body was most commonly wood (41.8% of cases). The FB was corneal in 81.7% of cases, conjunctival (bulbar and tarsal) in 13.3% of cases, and limbal in 5% of cases. Treatment consisted of either simple removal (86.61% of cases) or removal with suturing for deeper foreign bodies (13.27% of cases). The functional results obtained were encouraging; 90.82% of patients recovered well with preservation of visual acuity. The majority of the complications consisted of superficial punctate keratopathy in 27.53% of cases and corneal ulcer in 26.53% of cases. The results of our study are consistent with those in the literature in terms of the frequent corneal location of FB's. CONCLUSION: Ocular foreign bodies represent a situation of non-negligable severity and thus require proper early management in order to prevent progression to visual loss or blindness.

Incidence and outcome of endophthalmitis over a 13-year period.

OBJECTIVE: The aim of the study was to assess the functional results and long-term visual prognosis in patients treated for acute endophthalmitis (AE). DESIGN: Observational clinical series. PARTICIPANTS: Evaluation of 120 eyes of 114 patients with AE treated between 1991 and 2004. METHODS: This retrospective institutional analysis included 120 eyes of 114 patients (52 male, 68 female) with AE and a minimum follow-up of half a year. The patients had a mean follow-up of 23 months (6-135 months) and a mean age of 61 years (8 months-94 years) at the time of treatment. Treatment included intraocular injection of antibiotics alone (n = 18, 15%) and vitrectomy combined with intraocular and topical postoperative antibiotics (n = 85, 70%). RESULTS: The most frequent complications were vitreous or retinal hemorrhages (n = 17, 14%), retinal detachment (n = 17, 14%), choroidal detachment (n = 3, 3%), secondary glaucoma (n = 7, 6%), and recurrent endophthalmitis (n = 3, 3%). Four eyes had to be enucleated because of recurrent and uncontrollable infection. Positive microbiological results were achieved in 67 of 88 specimens (76%). The most common isolate was Staphylococcus. At the end of follow-up, visual acuity was reduced (more than 2 lines) in 18 eyes (15%), stable in 22 (18%), and improved (more than 2 lines) in 72 eyes (60%). CONCLUSIONS: AE is a rare but severe disease with a potentially deleterious outcome in affected eyes. In our series, 78% of all eyes had stable or improved postoperative visual acuity following various treatment regimens, depending on the severity of each case.

The impact of infectious ocular emergencies on hospital resources.

BACKGROUND: Infectious ocular emergencies cannot be pre-planned, need a more labour-intensive treatment and are often associated with prolonged hospitalisation. The aim of this study is to assess the impact of infectious ocular emergencies on hospital resources and identify changing trends over the last 10 years. PATIENTS AND METHODS: In a retrospective chart review 13,587 inpatient records from 1998 to 2007 were analyzed for the reason for emergency hospitalization, treatment data, length of hospitalizations and economical impact. RESULTS: 341 cases of severe infectious ocular emergencies with the need for emergency hospitalization were identified. The annual incidence of such emergencies increased continuously and has more than doubled during the last 10 years (51 vs. 24 annual cases). Within the same period the average hospitalization time of all non-infectious patients decreased from 5.41 to 4.95 days while inpatient stay due to infectious ocular emergencies decreased from 10.13 to 8.18 days. The average nursing effort was 4.26 hours per day in the infectious group, while electively admitted patients had an average requirement for nursing time of only 2.92 hours per day. CONCLUSION: The increase in infectious-related hospitalizations, their unpredictability and the need for a more intensive treatment regime have an increasing impact on hospital resources.