[Advances in clinical diagnosis and treatment of microsporidial keratitis].

Microsporidia, a unicellular eukaryotic microorganism, poses a risk of infecting the eyes, precipitating microsporidia keratitis (MK). This condition typically manifests in two forms: microsporidian keratoconjunctivitis (MKC) or stromal keratitis (MSK). While MKC often resolves spontaneously, it can progress to MSK, a vision-threatening condition that, in severe instances, may lead to corneal perforation. Epidemiological studies reveal that MK is prevalent in Southeast Asia, particularly during the rainy season. Diagnosis encompasses a range of methods, including corneal scraping for microbiological analysis, PCR testing, and advanced imaging techniques such as AS-OCT and IVCM. Therapeutic approaches vary, with MKC typically managed through local and systemic drug therapy, while MSK may necessitate more aggressive interventions, including corneal transplantation. In China, MK case reports are scarce, and physicians still grapple with a lack of comprehensive understanding regarding its clinical presentation, diagnostic strategies, and treatment options. This deficit can lead to missed or misdiagnoses, as well as overtreatment. Consequently, this review endeavors to comprehensively outline the epidemiology, etiology, clinical features, diagnostic modalities, and therapeutic interventions for MK, thereby offering valuable insights and guidance for clinical practice.

Thygeson Superficial Punctate Keratitis: A Clinical and Immunologic Review.

ABSTRACT: Thygeson superficial punctate keratitis (TSPK) is clinically characterized by exacerbations and remissions of gray-white opacities within the corneal epithelium, most often bilateral but may be asymmetric. Symptoms typically include photophobia, tearing, blurring, and eye irritation. Although disease progression and prognosis are well described, the exact cause is unknown. Hypotheses exist implicating virus-mediated immunity as the cause of TSPK following cases of viral keratitis; however, several polymerase chain reaction studies refute the infectious process concurrently with symptomatic TSPK. This is further supported by the consistent lack of response to antiviral and antibacterial treatment. A subset of dendritic cells known as Langerhans cells (LC) found within the corneal epithelium has been positively correlated with exacerbations of TSPK. Langerhans cells proliferate to protect and mitigate the cornea's inflammatory response, but the inflammatory triggers and relapses associated with TSPK are not well understood. Several topical drugs exist to treat inflammation related to TSPK; however, drug delivery is a major barrier to treatment because of the tear film and epithelial barrier. Drug-eluting contact lenses that target intermediates of inflammation could serve as a more effective treatment modality because of the increased bioavailability of the drugs. This review is an in-depth survey of the literature regarding the relationship between the origin and pathophysiology of LC and TSPK at the immunologic level. We also discuss potential pharmacotherapeutic interventions for TSPK prevention and treatment.

Ocular Lens Expulsion Secondary to Fusarium Endophthalmitis: A Case Report.

BACKGROUND: Endophthalmitis is an uncommon yet devastating compilation of Fusarium keratitis. Cases of Fusarium keratitis are seen commonly in tropical regions of the world; however, they have been increasing in frequency in the United States. CASE REPORT: We present the case of a 36-year-old man who experienced an ocular lens expulsion secondary to Fusarium endophthalmitis. Why Should an Emergency Physician Be Aware of This?:Fusarium keratitis is becoming more common and can progress to endophthalmitis without proper management. This infection can be difficult to recognize and treat, so early action by the emergency physician could be the difference between vision loss and vision-sparing care.

Neurotrophic Keratitis Due to Congenital Corneal Anesthesia with Deafness, Hypotonia, Intellectual Disability, Face Abnormality and Metabolic Disorder: A New Syndrome?

Neurotrophic keratitis is a rare degenerative disease of the cornea that can lead to corneal ulceration, scarring, and significant visual impairment. It most commonly occurs in adults and is rarely diagnosed in children. Congenital corneal anesthesia is an extremely rare condition that requires appropriate ophthalmologists' attention in making diagnosis and treatment decisions. This condition usually presents in infancy or early childhood and is characterized by rare blinking rate, decreased tearing or a corneal ulcer that is unresponsive to treatment. In this case report, we describe a patient with multiple systemic and neurological disorders who presented to the ophthalmology department due to corneal erosion unresponsive to treatment. Brain magnetic resonance imaging confirmed bilateral trigeminal hypoplasia and the diagnosis of neurotrophic keratopathy due to bilateral congenital corneal anesthesia was made. The discrepancy between clinical signs and symptoms or treatment non-response in cases of corneal erosions should alert the ophthalmologists to suspect trigeminal dysfunction. MRI is the gold standard to confirm congenital corneal anesthesia and to differentiate from other possible neurotrophic keratitis causes.

Epidemiology, clinical profile and treatment outcomes of bacterial and fungal keratitis.

PURPOSE: The purpose of the study is to determine the microbiological etiology, epidemiological factors, and clinical profile and treatment outcomes of infective keratitis in Ophthalmology department, Minia University, Egypt. METHODS: Prospective, nonrandomized, observational clinical series of cases, including 150 patients with mean age 30 (range 12 to 85 years), 90 patients (60%) were males and 60 (40%) were females, clinically diagnosed as infective corneal ulcer, attending the Ophthalmology Department-Faculty of Medicine. Minia University, Minia, Egypt. From December 2018 to December 2020. Detailed history taking and all clinical findings were collected. Corneal scrapings were obtained from patients and subjected to staining and culture for bacterial and fungal pathogens; Bacterial and fungal growth were identified by standard laboratory procedures. RESULTS: Corneal trauma by a vegetative matter was the commonest risk factor associated with infective keratitis in 92 cases (61.3%). Smear and culture was positive in 83 cases (58.4%) of 142 corneal scrapings obtained, of which 60 cases were fungal (72.3%), 21 cases were bacterial (25.3%) and two cases were mixed bacterial and fungal (2.4%), Aspergillus species was the commonest fungal species isolated in fungal keratitis. One hundred forty-two cases (94.67%) healed completely with scar. Only six cases (4%) required evisceration due to aggressive presentation from the start and keratoplasty was performed for two cases (1.33%). CONCLUSIONS: Fungal keratitis was the commonest type in cases attending to our department. Adequate diagnosis, management and follow-up helped in achieving high successful curative outcomes. CLINICAL TRIAL NUMBER: Clinical Trials.gov ID: NCT04894630. Time of registration 1 December 2018.

Clinical profile of keratitis treated within 3 months of acute COVID-19 illness at a tertiary care eye centre.

PURPOSE: To report the spectrum of keratitis treated within 3 months of acute COVID-19 infection. METHODS: Retrospective, descriptive case series study of 19 eyes of 16 patients who presented at tertiary eye care centre in Southern India. RESULTS: Median age of the patients was 43(IQR 35-55.5) years. Majority (15/16, 93.75%) were males. Unilateral affliction was predominant (13/16, 81.25% patients). Nine had a history of hospitalization, five had received oxygen supplementation and five had been treated with steroids during COVID-19 illness. The median duration between COVID-19 diagnosis and the ocular symptoms in the eye was 29 (IQR 22-57) days. Microbiological diagnosis consisted of microsporidia in nine eyes of seven patients, fungus in six patients, Pythium in one patient, and herpes zoster ophthalmicus in one patient. One patient had neurotrophic keratitis. Therapeutic penetrating keratoplasty was performed in five patients, glue application in two patients and three were managed with tarsorrhaphy with/without amniotic membrane grafting or tenonplasty. There was medical and surgical cure in all patients. CONCLUSIONS: Microsporidia was the commonest cause of keratitis, followed by fungal infection. Majority of the microsporidia infections were keratoconjunctivitis. The fungal isolates identified were Aspergillus and Mucor species. All patients responded to conventional management guidelines with favourable outcomes.

[Modern capabilities in diagnosis and treatment of neurotrophic keratopathy]. / Sovremennye vozmozhnosti diagnostiki i lecheniya neirotroficheskoi keratopatii.

In recent years, the problem of diagnosing and treating neurotrophic keratopathy (NK) has become relevant in view of its prevalence reaching 1.6-11.0 per 10000 people. While previously it was associated only with neuroparalytic keratitis, at present the violation of sensitive and trophic innervation of the cornea with the development of characteristic keratopathy is observed in many diseases and injuries of the organ of vision. Diagnosis of NK is based on anamnestic information and assessment of clinical and functional parameters: determination of the stability of the tear film, tear production and assessment of staining of the ocular surface with vital dyes. The main role in the diagnosis of NK belongs to corneal sensitivity determined with the Cochet-Bonnet esthesiometer. Treatment of NK is designed to restore or increase corneal sensitivity and involves tear replacement therapy, instillations of preparations derived from patient's own blood, anti-inflammatory, metabolic and antibacterial therapy. However, instillations of human erve growth factor (NGF) - the drug Cenegermin (registered in Europe in 2017 at a dose of 20 µg/ml under the name Oxervate), a recombinant form of human rhNGF from Escherichia coli bacteria - exhibit the highest pathogenetic orientation. Its «target¼ is the affected nerve fibers (specific receptors for their growth factor), which makes it possible to eliminate the violation of reparative processes in neural and epithelial cells. A high and long-term clinical efficacy of a course of six (with an interval of 2 hours) instillations of the drug for 8 weeks in the treatment of children and adults with NK has been established. Among the pathogenetically justified methods of surgical treatment, there is the so-called surgical neurotization of the cornea involving the contralateral supraorbital, supratrochlear, great auricular and other nerves, which has a long-term clinical effect.

The management of neurotrophic keratitis.

PURPOSE OF REVIEW: The management of neurotrophic keratitis (NK) has evolved in the last decade. The present article reviews updated management guidelines of this entity, as well as future innovations in the field. RECENT FINDINGS: The advent of confocal microscopy has allowed for the first time to image corneal nerves. In addition, multiple novel topical treatments such as nerve growth factor have improved the prognosis of this disease, with many other in the pipeline. Finally, corneal nerve restoration is now possible with corneal neurotization procedures. SUMMARY: Many novel treatments based on agents that stimulate nerve regrowth are now available to treat NK. Improvement in neurotization procedures could also address advanced stages of this disease with surgery.

Improvement of Vision and Ocular Surface Symptoms With a Scleral Lens After Microbial Keratitis.

ABSTRACT: A 38-year-old woman, previous daily disposable soft contact lens wearer, reported an episode of microbial keratitis positive for Pseudomonas aeruginosa 11 months before contacting the investigators. After acute treatment, she was left with a degree of opacity in the pupillary area, corneal scar, and an irregular corneal profile, with a best spectacle visual acuity of +0.48 logarithm of the minimum angle of resolution. A scleral lens was able to mask those corneal sequelae and, even considering the corneal opacity, the visual acuity recovered to +0.06 logarithm of the minimum angle of resolution. The patient was fitted with a 16.4-mm scleral lens and attended several appointments over a 12-month follow-up period. After 12 months of scleral lens wear, the improvement of both high-contrast and low-contrast visual acuities remained stable and a clearing of the corneal opacity was observed. The comfort was assessed with the Ocular Surface Disease Index questionnaire, which depicted a comfort enhancement from 75.0 to 47.9 over the short term. The Quality of Vision questionnaire was also administrated and showed an improvement on frequency, severity, and bothersome of the vision-related symptoms over time. Scleral lens may be a good option to improve vision, comfort, and restore the ocular surface function in patients with corneal scars and opacities secondary to microbial keratitis.

Inherited ichthyosis and fungal infection: an update on pathogenesis and treatment strategies.

Inherited ichthyoses are a group of genodermatoses classified as either nonsyndromic or syndromic. Nonsyndromic ichthyoses and keratitis, ichthyosis and deafness (KID) syndrome predispose to fungal infection. The diagnosis and treatment of fungal infections underlying ichthyoses are challenging. In this review, we summarize reported cases of ichthyosis with fungal infection over the past 50 years. Atypical manifestations such as alopecia, papules and brittle nails occurred in patients with ichthyosis combined with fungal infection. Various pathogenic mechanisms have been implicated, including mutations of ichthyosis-related genes leading to disruption of the skin barrier via multiple pathways. Host immune disorders, including atopy and abnormal innate immunity also contribute to susceptibility. Specific fungi may escape the immune response. Extensive and recurrent fungal infections are not uncommon in patients with ichthyosis, making a cure more difficult and increasing the need for systemic antifungal therapy. Traditional and new ichthyosis treatments aiming to improve skin barrier function could help prevent fungal infection. In conclusion, the close relationship between ichthyosis and fungal infection is of vital importance in clinical practice and requires more attention from physicians. More studies are required to investigate the mechanisms and explore useful treatment strategies.

[Consensus of experts on diagnosis and treatment of neurotrophic keratitis in China (2021)].

Neurotrophic keratitis is a degenerative disease of the cornea caused by impairment in the trigeminal nerve, which can lead to dry eyes, corneal epithelial defects and corneal ulcers. The common causes include herpes virus infection, craniocerebral and ophthalmic surgery injury, and diabetes. Due to the reduced or lack of corneal sensitivity, patients' symptoms are mild, while severe corneal stroma melting or even perforation may occur. And the conventional symptomatic treatment is not effective. In view of the current lack of clinical understanding of this disease, there are a large number of problems of misdiagnosis and mistreatment. To improve the level of diagnosis and treatment, the consensus of experts on diagnosis and treatment of neurotrophic keratitis, which can be used as a reference for ophthalmologists in clinical work, is formulated by the Cornea Group of Chinese Ophthalmological Society. (Chin J Ophthalmol, 2021, 57:90-94).

[Clinical features and treatment prognoses of Pythium keratitis].

Objective: To analyze the clinical features and evaluate the prognoses of Pythium keratitis. Methods: It was a retrospective study. The clinical characteristics, confocal microscopic image characteristics, treatment and curative effect of 6 cases of Pythium keratitis identified by DNA sequencing from June 2017 to June 2019 were reviewed retrospectively. Results: Among the 6 patients, there were 4 males and 2 females. All cases were monocular. The age was (58.7±11.3) years (range, 52 to 72 years). Keratopathy under a slit lamp was characterized by a dry ulcer surface, burr signs, satellite foci and pseudopodia around the ulcer. An elevated lesion was observed in 2 patients, and no obvious immune ring structure was observed in all patients. Confocal microscopy did not reveal any specific characteristics of Pythium infection. All patients did not respond well to antifungal drugs and received keratoplasty. Three patients had postoperative recurrence. The recurrence time was 4-6 days after the first operation and 2-3 days after the second operation. Two patients underwent two and three corneal transplants, respectively, after recurrence, but evisceration was required finally. Conclusions: Pythium keratitis is rare and can hardly be distinguished from common fungal infections in clinical manifestations and auxiliary examinations. The disease progresses rapidly, the rates of recurrence and evisceration after keratoplasty are both high, and DNA sequencing is the key to identifying the etiology, which should be paid more attention. (Chin J Ophthalmol, 2021, 57: 589-594).

Moraxella keratitis: epidemiology and outcomes.

We aimed to assess the prevalence, risk factors, and visual outcome of Moraxella keratitis. We retrospectively reviewed the medical charts of patients diagnosed with Moraxella spp. keratitis at the Quinze-Vingts National Ophthalmology Hospital, Paris, France, between January 2016 and December 2018. Definitive microbiological identification was performed on archival strains using matrix-assisted laser desorption ionization time of flight coupled to mass spectrometry. One hundred one culture-proven cases of Moraxella keratitis were identified. The most common isolates were Moraxella lacunata (50%) and Moraxella nonliquefasciens (38%). Systemic predisposing factors, principally diabetes mellitus (13%) were identified in 28% of patients, and 87% of patients had ocular surface conditions, including blepharitis (25%), prior ocular surgery (21%), glaucoma (17%), exposure keratopathy (16%), and trauma (16%). Severely affected inpatients were treated empirically with fortified antibiotics including vancomycin, piperacillin, and gentamicin. The presence of hypopyon and being over the age of 60 years were associated with a poorer final visual acuity (p < 0.05). Adjuvant treatment, mostly amniotic membrane transplantation, was required for 31 eyes. The prognostic factors significantly associated with the need for adjuvant treatment were a larger infiltrate and hypoesthesia. The clinical features including ulcer healing, treatment duration, and infiltrate size were not different between Moraxella species. Keratitis caused by Moraxella spp. are rare in France but may threaten sight. The early identification of patients with a poor ocular surface, particularly those with neurotrophic keratopathy and anesthetic cornea, is crucial to prevent delayed healing of ulcers and the need for adjuvant treatment.

Clinical, etiopathogenic, and therapeutic aspects of KID syndrome.

Keratitis-ichthyosis-deafness (KID syndrome) is a syndromes ichthyoses that is clinically and genetically heterogeneous requiring early and long-term multidisciplinary monitoring of affected individuals. A review of the clinical, etiopathogenic and therapeutic aspects is presented of this rare congenital ectodermal disorder.

Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 2001 to 2014.

PURPOSE: To study the surgical outcome of therapeutic penetrating keratoplasty (TPK) for medically uncontrolled microbial keratitis at a tertiary hospital in Taiwan over a 14-year period. METHODS: This is a retrospective case series study. Patients who underwent TPK at National Taiwan University Hospital in 2001-2014 were included. Patients were divided into 3 diagnostic groups: bacterial keratitis, fungal keratitis, and acanthamoeba keratitis. Each of the following criteria was evaluated: graft clarity at 1 month and 1 year postoperatively, cure of the disease, and anatomical success rate. RESULTS: A total of 107 TPKs were included. TPK eradicated the infection in 57/62 (91.9%) of bacterial keratitis, 33/41 (80.5%) of fungal keratitis, and 9/10 (90.0%) of acanthamoeba keratitis. 22/57 grafts (38.6%) of bacterial keratitis, 22/38 grafts (57.9%) of fungal keratitis, and 5/10 grafts (50.0%) of acanthamoeba keratitis remained clear at 1 year postoperatively. The 1-year graft survival rate did not significantly differ among these 3 groups. The leading causes of graft failure were late endothelial decompensation and graft reinfection. A higher percentage of graft clarity was achieved in grafts <8.5 mm in diameter than in larger grafts (55.4% vs. 31.4%, P = 0.027). Of the 14 patients with endophthalmitis at the time of TPK, the infection was successfully treated in 13 patients except 1 patient required evisceration. CONCLUSION: TPK is valuable in the management of medically uncontrolled microbial keratitis, although the 1-year graft survival rate is unsatisfactory. TPK combined with intravitreal antibiotics and vitrectomy is also a beneficial treatment strategy for patients with endophthalmitis secondary to microbial keratitis.

[Depth Effect of Cold Atmospheric Pressure Plasma in Keratitis Therapy: A Corneal Stroma Tissue Model]. / Tiefenwirkung von kaltem Atmosphärendruckplasma in der Keratitistherapie: ein Hornhautstromagewebemodell.

The incidence of microbial keratitis has been increasing and is now 28 cases/100,000 inhabitants; this may be due to the more frequent use of contact lenses. Keratitis can lead to visual impairment and in severe cases with endophthalmitis to enucleation of the affected eye. As microorganisms are becoming more resistant to antibiotic therapy, there is a need for new therapeutic strategies. Cold atmospheric pressure plasma has already been successfully used to disinfect surfaces. This study investigates the efficacy of cold atmospheric pressure plasma against Escherichia coli in a depth-resolved corneal stroma tissue model.

[A clinical analysis of 46 cases of neurotrophic keratitis].

Objective: To investigate the clinical characteristics and therapeutic effect of neurotrophic keratitis (NK). Methods: A retrospective case series study. A total of 46 patients (48 eyes) with clinically diagnosed NK in Beijing Tongren Hospital from May 2013 to July 2016 were analyzed, including 26 males (26 eyes) and 20 females (22 eyes), aged (51±18) years. The general condition, etiology, clinical features, stage of disease and curative effect of NK patients were summarized. Corneal sensation was measured by Cochet-Bonnet corneal sensor for 25 patients (26 eyes), and the correlation between corneal sensation and clinical staging was analyzed. The χ(2) test was performed on the distribution characteristics of patients with different clinical stages of NK. Correlation analysis of corneal sensation and the disease stage was performed using Spearman correlation analysis. Results: Forty-four cases of monocular disease (96.65%) and 2 cases (4.35%) of bilateral disease were enrolled. Four eyes (8.33%) were from young patients (aged 18-29 years), 23 (47.92%) were from middle-aged patients (aged 30-59 years), and 21 (43.75%) were from elderly patients (aged ≥60 years). The disease was at stage Ⅰ in 8 eyes (16.67%), at stage Ⅱ in 21 eyes (43.75%), and stage Ⅲ in 19 eyes (39.58%). There was no significant difference in clinical staging between the three age groups (χ(2)=2.452, P=0.658). The most common cause of NK was virus infection (17 eyes,35.42%), followed by neurosurgical sequelae (11 eyes, 22.92%) and diabetes in 10 eyes(20.83%). Corneal sensation of 26 eyes ranged from 0-3 cm. There was no significant correlation between clinical stage and corneal sensation (r(2)=0.284, P=0.753). The patients were followed up for an average of 7 months. Thirty-four eyes (70.83%) received conservative treatment, and 8 eyes(16.67%) had surgery. Six patients (6 eyes) were lost for follow-up. Conclusions: NK can occur in all ages, mainly in the elderly. The clinical manifestations are diverse. If time delays in the diagnosis and treatment, it often causes corneal ulcers. There is no significant correlation between corneal sensation and clinical stage. Early diagnosis and targeted treatment are important for protecting patients' visual function.(Chin J Ophthalmol, 2020, 56:274-298).

MSCs helped reduce scarring in the cornea after fungal infection when combined with anti-fungal treatment.

BACKGROUND: Fungal Keratitis (FK) is an infective keratopathy with extremely high blindness rate. The damaging effect of this disease is not only the destruction of corneal tissue during fungal infection, but also the cornea scar formed during the healing period after infection control, which can also seriously affect a patient's vision. The purpose of the study was to observe the effect of umbilical cord mesenchymal stem cells (uMSCs) on corneal scar formation in FK. METHODS: The FK mouse model was made according to a previously reported method. Natamycin eye drops were used for antifungal treatment 24 h after modeling. There are four groups involved in the study, including control group, FK group, vehicleinj FK group and uMSCsinj FK group. Mice in uMSCsinj FK group received repeated subconjunctival injections of uMSCs for 3 times at the 1d, 4d and 7d after FK modeling. At 14d, 21d and 28d after trauma, clinical observation, histological examination, second harmonic generation and molecular assays were performed. RESULTS: The uMSCs topical administration reduced corneal scar formation area and corneal opacity, accompanying with decreased corneal thickness and inflammatory cell infiltration, following down-regulated fibrotic-related factors α-SMA, TGFß1, CTGF, and COLI and finally inhibited phosphorylation of TGFß1/Smad2 signaling pathway during FK corneal fibrosis. CONCLUSION: The results confirmed that uMSCs can improve corneal opacity during the scar formation stage of FK, and exert anti-inflammatory and anti-fibrotic effects.

Microbial Keratitis in Thyroid Eye Disease: Clinical Features, Microbiological Profile, and Treatment Outcome.

PURPOSE: To report the incidence, clinical features, microbiologic profile, and risk indicators in the development of microbial keratitis in Thyroid Eye Disease (TED). METHODS: All patients who were diagnosed to have TED and developed microbial keratitis between the years 2009 to 2017 at the Ophthalmic Plastic Surgery service, LV Prasad Eye Institute were included in this retrospective interventional study. The clinical features, microbiological profile, and treatment outcome of the infection were studied. Possible risk factors leading to the development of microbial keratitis were studied. RESULTS: A total of 1,000 patients of TED were evaluated in the 10-year period. Of the 1,000, 13 patients (14 eyes, 1.4%) were diagnosed with microbial keratitis. The average age at presentation was 44 years (range 1969 years). Of the 13 patients, 10 (77%) were men, 12 (92%) were hyperthyroid, and 12 (92%) were active (average clinical activity score 3) at presentation. Average exophthalmometry value in the involved eye was 24.75mm, and severe eyelid retraction (>2mm scleral show) was noted in 13 of 14 eyes. None of the patients had optic nerve compression. Moderate motility restriction (2 in all gazes) was noted in 6 eyes, and severe motility restriction (4 in all gazes) in 8 eyes. At presentation, 11 (85%) had visual acuity of counting fingers at 1 meter or less, The mean follow up from the time of presentation was 18.3 months (range 566 months). Majority of the eyes (8/14) presented with severe infection (panophthalmitis with microbial keratits = 1, total corneal infiltrate with/without melt = 4, severe thinning/perforation = 4). Microbiological work up of 14 eyes revealed presence of gram-negative bacteria in 5 eyes which included Escherichia coli, Pseudomonas sp., and Acinetobacter sp., and gram-positive bacteria in 4 eyes including Streptococcus pneumoniae, Corynebacterium sp., and Staphylococcus sp. Three eyes revealed a mixed infection of E. coli with Alternaria sp, and E. coli with Corynebacterioum amycolatum while 1 had Corynebacterium pseudodiptheriticum, and S. pneumoniae. Two eyes of the bilateral case showed no growth. Antibiotic susceptibility revealed 6 of the 7 gram-negative isolates were multidrug resistant, whereas the gram-positive isolates were susceptible to most drugs tested. Surgical procedures required were tarsorrhaphy in 7 eyes, tissue adhesive with bandage contact lens in 4, evisceration in 4, levator recession in 2, 3-wall orbital decompression in 2, and penetrating keratoplasty in 1 eye. The visual acuity at presentation was counting fingers or worse in 10/14 eyes. Posttreatment, 10 eyes achieved resolution of infiltrate (with visual improvement in 2), and 4 required evisceration. CONCLUSIONS: In the authors large series of TED, microbial keratitis was noted in 1.3% of patients presenting to a tertiary eye center. Majority presented with advanced diseases and ended with a poor outcome. Gram-negative isolates showed multidrug resistance. An association with early phase of active TED (CAS 3 or more), severe eyelid retraction, and moderate-severe motility restriction is suggested.Microbial Keratitis occurs in 1.3% cases of Thyroid Eye Disease. It is more common in men, and in active disease. The microbiological spectrum and possible clinical risk factors are presented.

Subconjunctival bone marrow-derived mesenchymal stem cell therapy as a novel treatment alternative for equine immune-mediated keratitis: A case series.

Equine immune-mediated keratitis (IMMK) leads to increased corneal opacity and inflammation secondary to an alteration of the local immune system. Bone marrow-derived mesenchymal stem cells (BM-MSC) have been shown to modulate the immune system by downregulating inflammation. Four horses with unilateral IMMK poorly responsive to traditional medical treatments underwent novel, autologous subconjunctival BM-MSC therapy. Bone marrow was harvested and processed as previously described for equine orthopedic disease. Horses received autologous subconjunctival BM-MSC injections approximately every 3-4 weeks for 1-5 treatments total. Horses were maintained on their current medical treatment regimen throughout the BM-MSC treatment period. Three horses had a positive response to therapy as demonstrated by an increase in corneal clarity, a decrease in neovascularization and a reduction in surface irregularity. One horse was nonresponsive to therapy. These experimental results demonstrate the safety and potential efficacy of an innovative solution for IMMK.