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1.
Br J Hosp Med (Lond) ; 81(6): 1-10, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32589541

RESUMO

Ocular complications in critical care patients are common. There has been a surge in intensive care admissions following the COVID-19 outbreak. The management of COVID-19 exposes patients to a number of specific risk factors for developing ocular complications, which include non-invasive ventilation, mechanical ventilation and prone positioning. Consequently, it is likely that there will be an increase in the number of ocular complications secondary to the management of COVID-19 patients in the intensive care unit setting, and these complications could lead to permanent visual loss and blindness. Increased awareness of eye care in the intensive care unit setting is therefore vital to help prevent visual loss and maintain quality of life for patients recovering from COVID-19.


Assuntos
Infecções por Coronavirus/terapia , Oftalmopatias/terapia , Unidades de Terapia Intensiva , Oftalmologia , Pneumonia Viral/terapia , Encaminhamento e Consulta , Doença Aguda , Betacoronavirus , Doenças da Túnica Conjuntiva/prevenção & controle , Doenças da Túnica Conjuntiva/terapia , Conjuntivite/prevenção & controle , Conjuntivite/terapia , Doenças da Córnea/prevenção & controle , Doenças da Córnea/terapia , Lesões da Córnea/prevenção & controle , Lesões da Córnea/terapia , Cuidados Críticos , Estado Terminal , Edema/prevenção & controle , Edema/terapia , Endoftalmite/prevenção & controle , Endoftalmite/terapia , Oftalmopatias/prevenção & controle , Glaucoma/diagnóstico , Glaucoma/terapia , Humanos , Ceratite/prevenção & controle , Ceratite/terapia , Lubrificantes/uso terapêutico , Pomadas/uso terapêutico , Pandemias , Transtornos da Visão/diagnóstico , Transtornos da Visão/terapia
3.
Medicine (Baltimore) ; 99(22): e20420, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481438

RESUMO

BACKGROUND: Fungal keratitis is one of the leading causes of ocular morbidity. The prognosis of fungal keratitis is poorer than many other forms of keratitis but the research of which relatively lags behind. We conducted a bibliometric and visualized analysis in order to characterize the overall status, general trends and current foci of keratomycosis research field. METHODS: Literature database ranged from 1959 to 2019 was obtained from web of science core collection and analyzed by Citespace and VOSviewer software. RESULTS: A total of 1906 papers of fungal keratitis were retrieved and derived a 27,917 references document set. The number of publications increased rapidly in past 30 years. Cornea was the journal published most papers of keratomycosis. The leading countries were United States of America (USA), India and Peoples Republic of China (PRC), from where came the most productive and most cited institutions and authors. Co-cited reference analysis revealed the most cited manuscripts were concerned about epidemiology or spectrum. Lens-associated Fusarium, amphotericin B, voriconazole, corneal cross-linking, predisposing factor are some of the high frequency topics in clustered co-cited reference analysis and co-occurrence keywords analysis. Burst detection analysis of keywords showed ocular drug delivery was the new research foci. CONCLUSION: From this study, we received an overall view to the current status, trends and hot spots of fungal keratitis research field. Visualized bibliometric analysis is an efficient way for literature learning and useful for future researchers.


Assuntos
Bibliometria , Pesquisa Biomédica/tendências , Infecções Oculares Fúngicas , Ceratite , Visualização de Dados , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/epidemiologia , Humanos , Internacionalidade , Ceratite/tratamento farmacológico , Ceratite/epidemiologia , Comunicação Acadêmica/tendências
4.
Cochrane Database Syst Rev ; 6: CD013001, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32557558

RESUMO

BACKGROUND: Infectious keratitis is an infection of the cornea that can be caused by bacteria, viruses, fungi, protozoa, or parasites. It may be associated with ocular surgery, trauma, contact lens wear, or conditions that cause deficiency or loss of corneal sensation, or suppression of the immune system, such as diabetes, chronic use of topical steroids, or immunomodulatory therapies. Photoactivated chromophore for collagen cross-linking (PACK-CXL) of the cornea is a therapy that has been successful in treating eye conditions such as keratoconus and corneal ectasia. More recently, PACK-CXL has been explored as a treatment option for infectious keratitis. OBJECTIVES: To determine the comparative effectiveness and safety of PACK-CXL with standard therapy versus standard therapy alone for the treatment of bacterial keratitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 7); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Science Information database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 8 July 2019. SELECTION CRITERIA: We included randomized controlled trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs) of PACK-CXL for bacterial keratitis. We included quasi-RCTs and CCTs as we anticipated that there would not be many RCTs eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors working independently selected studies for inclusion in the review, assessed trials for risk of bias, and extracted data. The primary outcome was proportion of participants with complete healing at four to eight weeks. Secondary outcomes included visual acuity, morphology, adverse events, and treatment failure at four to eight weeks. MAIN RESULTS: We included three trials (two RCTs and one quasi-RCT) in this review for a total of 59 participants (59 eyes) with bacterial keratitis. Trials were all single-center and were conducted in Egypt, Iran, and Thailand between 2010 and 2014. It is very uncertain whether PACK-CXL with standard antibiotic therapy is more effective than standard antibiotic therapy alone for re-epithelialization and complete healing (risk ratio (RR) 1.53, 95% confidence interval (CI) 0.88 to 2.66; participants = 15). We judged the certainty of the evidence to be very low due to the small sample size and high risk of selection and performance bias. The high risk of selection bias reflects the overall review. Masking of participants was not possible for the surgical arm. No participant had a best-corrected visual acuity of 20/100 or better at eight weeks (very low certainty evidence). There is also no evidence that use of PACK-CXL with standard therapy results in fewer instances of treatment failure than standard therapy alone (RR 0.50, 95% CI 0.05 to 4.98; participants = 32). We judged the certainty of evidence to be low due to the small sample size and high risk of selection bias. There were no adverse events reported at 14 days (low certainty evidence). Data on other outcomes, such as visual acuity and morphological characteristics, could not be compared because of variable time points and specific metrics. AUTHORS' CONCLUSIONS: The current evidence on the effectiveness of PACK-CXL for bacterial keratitis is of low certainty and clinically heterogenous in regard to outcomes. There are five ongoing RCTs enrolling 1136 participants that may provide better answers in the next update of this review. Any future research should include subgroup analyses based on etiology. A core outcomes set would benefit healthcare decision-makers in comparing and understanding study data.


Assuntos
Colágeno/efeitos da radiação , Infecções Oculares Bacterianas/radioterapia , Ceratite/radioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/uso terapêutico , Terapia Ultravioleta/métodos , Antibacterianos/uso terapêutico , Infecções Oculares Bacterianas/tratamento farmacológico , Humanos , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia Ultravioleta/efeitos adversos , Acuidade Visual
6.
Ann Clin Microbiol Antimicrob ; 19(1): 11, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228660

RESUMO

BACKGROUND: Fungal keratitis (FK) has been shown to be a climate-sensitive disease. The differentiation between FK from bacterial keratitis (BK) was difficult. The purpose of this study was to compare the bacteriology and mycology between tropical and subtropical Taiwan and to investigate the independent risk factors for identification of fungi from bacteria. METHODS: Two hundred ninety-seven patients with clinical suspected microbial keratitis were prospectively enrolled. A fungal to bacteria rate (FBR), the number of fungi divided by bacteria identified, was determined to estimate the prevalence of fungi and bacteria. Clinical presentation, profiles of microorganisms, and predisposing risk factors were determined. Univariate and multivariate logistic regression analysis were used to investigate the independent risk factors. RESULTS: A total of 82 fungi and 143 bacteria were laboratory confirmed. The identification rate of fungus was higher in tropical Taiwan (p = 0.010). Among the fungi and bacteria confirmed, the FBR was 0.29 (22.4% vs. 77.6%) in subtropical Taiwan, and 0.70 (41.3% vs. 58.7%) in tropical Taiwan. Samples obtained in tropical area (p = 0.019), ocular trauma (p = 0.019), and plant exposure (p = 0.003) were independent risk factors for identification of fungus from bacteria. The predominant fungus isolated from corneal scraping were Fusarium solani (25%) and Trichosporon faecale (25%) in subtropical Taiwan; in tropical Taiwan was Fusarium spp. (50%). CONCLUSIONS: The identification rate of fungus was higher in tropical Taiwan than subtropical Taiwan. Awareness of the local epidemiology is crucial for early diagnosis of fungal keratitis in tropical area.


Assuntos
Úlcera da Córnea/microbiologia , Infecções Oculares Fúngicas/diagnóstico , Ceratite , Adulto , Bactérias/isolamento & purificação , Estudos de Coortes , Infecções Oculares Bacterianas/diagnóstico , Feminino , Fungos/isolamento & purificação , Fusarium/isolamento & purificação , Humanos , Ceratite/diagnóstico , Ceratite/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Taiwan/epidemiologia , Trichosporon/isolamento & purificação , Clima Tropical/efeitos adversos
9.
Zhonghua Yan Ke Za Zhi ; 56(4): 286-293, 2020 Apr 11.
Artigo em Chinês | MEDLINE | ID: mdl-32306621

RESUMO

Objective: To discuss clinical features and treatments of fungal keratitis, and to provide statistical data for clinical therapy and increase the therapeutic effects. Methods: This is a retrospective case series study. An analysis was performed by collecting patients' demography features, risk factors, onset time, lab results, clinical features and treatment from 1 414 cases of fungal keratitis from January 2006 to October 2016 in Qingdao Eye Hospital, Shandong Eye Institute. Results: In the 1 414 cases (1 414 patients), 1 174 patients (83.0%) came from different areas in Shandong Province, and the rest mainly from provinces on the north of Yangtze River. The age was 40 to 60 years in 874 cases (61.4%). The onset time was often in autumn and winter. The average duration between the onset and treatment was 1 to 74 days; 942 patients (67.1%) visited our hospital in 8-30 days after the appearance of the symptoms. Corneal trauma was the most common risk factor, especially injury by plants (367 cases, 26.4%). The positive rate of direct microscopic examination of potassium hydroxide wet mounts was 96.4%. The positive rate of confocal microscopy was 89.8%. Fungi were detected in corneal ulcer scrapings and (or) diseased corneal tissues obtained during surgery from 973 patients (68.8%). Most of the fungi were Fusarium (595 cases, 61.1%), followed by Alternaria (184 cases, 18.9%) and Aspergillus (119 cases, 12.2%). There were 603 cases (42.7%) of superficial and middle stromal infiltration, 614 cases (43.4%) of deep stromal infiltration and 197 cases (13.9%) of full-thickness corneal infiltration. Diameters of the corneal ulcer lesion were mostly between 4 and 6 mm (725 cases, 51.6%), followed by<3 mm (372 cases, 26.4%) and>6 mm (302 cases, 22.0%). Hypopyon was combined in 498 cases (35.2%), corneal perforation in 34 cases (2.4%), and endophthalmitis in 58 cases (4.1%). Surgery was performed in 1 198 cases (84.8%), including penetrating keratoplasty in 416 cases (29.4%), lamellar keratoplasty in 199 cases (14.1%), and corneal ulcer debridement in 532 cases (37.6%), with an effective rate of 98.1% (408 cases), 97.0% (193 cases) and 92.8% (494 cases), respectively. Two hundred and fifteen cases (15.2%) were treated with medical therapy alone, of which 147 cases (68.4%) were cured. Fifty-six patients (3.9%) finally lost their eye balls, including 54 cases of evisceration and 2 cases of ophthalmectomy. Conclusions: Fusarium is the main causative agent of fungal keratitis in Shandong Province. Direct microscopic examination of potassium hydroxide wet mounts is a simple, rapid and effective test method. Early diagnosis can be made if the result of corneal ulcer scraping examination is positive. Antifungal drug treatments can be done in early onset time. If the drug efficacy is poor or the patient's condition gets worse, immediate surgery is the key to controlling fungal keratitis. (Chin J Ophthalmol, 2020, 56:286-293).


Assuntos
Úlcera da Córnea/microbiologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/terapia , Ceratite/microbiologia , Adulto , Antifúngicos/uso terapêutico , China , Fusarium/isolamento & purificação , Humanos , Ceratoplastia Penetrante , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Zhonghua Yan Ke Za Zhi ; 56(4): 294-298, 2020 Apr 11.
Artigo em Chinês | MEDLINE | ID: mdl-32306622

RESUMO

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).


Assuntos
Ceratite/diagnóstico , Ceratite/terapia , Adolescente , Adulto , Idoso , Córnea/patologia , Úlcera da Córnea/etiologia , Feminino , Humanos , Ceratite/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
11.
PLoS One ; 15(4): e0229421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32320433

RESUMO

Oxidative stress may cause ocular surface damage during the development of dry eye. Mammalian cells have defense systems against oxidative stress. A central regulator of the stress response is nuclear factor-erythroid 2-related factor 2 (NFE2L2). NFE2L2 is activated by the novel triterpenoid RS9 (a biotransformation compound of RTA 402). The purpose of this study was to assess the efficacy of RS9 against dry eye using in vitro and in vivo models. Bioactivity was estimated by the induction of mRNAs for two NFE2L2-targeted genes: NQO1 (prevents radical species) and GCLC (glutathione synthesis), using a corneal epithelial cell line (HCE-T). Protection against oxidation and cell damage was tested in vitro by culturing cells under hyperosmotic stress or by the addition of menadione, a generator of reactive oxygen species (ROS). Dry eye in vivo was induced by the injection of scopolamine into rats. Then, 930 nM of RS9 was applied to both eyes for 2 weeks. Oxidative stress was measured by the accumulation of 8-hydroxy-2'-deoxyguanosine (8-OHdG). Corneal wound healing was measured by scoring for superficial punctate keratitis (SPK). Corneal epithelial cell densities were evaluated histologically. RS9 and RTA 402 induced the expression of NQO1 and GCLC mRNAs in HCE-T cells. And both compounds suppressed hyperosmotic-ROS generation and menadione induced cellular damage. However RS9 had a stronger protective effect than RTA 402. Ocular instillation of RS9 also significantly upregulated the expression of Nqo1 mRNA in the corneal epithelium. Accumulation of 8-OHdG, increase of SPK scores and decrement of basal cell density were observed in corneal epithelium from scopolamine-injected rats. These changes were significantly ameliorated by the topical administration of RS9. RS9 induced Nfe2l2 activation and Nfe2l2-targeted genes, reduced oxidation, and ameliorated symptoms of dry eye using in vitro and in vivo models. Thus, RS9 might be a potent candidate agent against dry eye disease.


Assuntos
Lesões da Córnea/tratamento farmacológico , Síndromes do Olho Seco/tratamento farmacológico , Ceratite/tratamento farmacológico , Fator 2 Relacionado a NF-E2/genética , Triterpenos/farmacologia , 8-Hidroxi-2'-Desoxiguanosina/genética , Animais , Lesões da Córnea/induzido quimicamente , Lesões da Córnea/genética , Lesões da Córnea/patologia , Modelos Animais de Doenças , Síndromes do Olho Seco/induzido quimicamente , Síndromes do Olho Seco/genética , Síndromes do Olho Seco/patologia , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/patologia , Epitélio Anterior/efeitos dos fármacos , Epitélio Anterior/patologia , Regulação da Expressão Gênica/efeitos dos fármacos , Glutamato-Cisteína Ligase/genética , Humanos , Ceratite/induzido quimicamente , Ceratite/genética , NAD(P)H Desidrogenase (Quinona)/genética , Estresse Oxidativo/efeitos dos fármacos , RNA Mensageiro/efeitos dos fármacos , Ratos , Espécies Reativas de Oxigênio/metabolismo , Escopolamina/toxicidade , Cicatrização/efeitos dos fármacos , Cicatrização/genética
12.
Medicine (Baltimore) ; 99(10): e19257, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150061

RESUMO

RATIONALE: Traumatic flap dislocation might occur anytime after laser in situ keratomileusis (LASIK), but it is rarely concomitantly complicated with epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis altogether. Here we report a case of traumatic LASIK flap inversion with epithelial ingrowth, Propionibacterium acnes infection, and diffuse lamellar keratitis. PATIENT CONCERNS: A 42-year-old man receiving bilateral LASIK surgery 10 years ago complained of right eye pain for 6 days after twig injury. Temporal flap inversion with epithelial ingrowth and dense infiltration at the interface were noted. DIAGNOSES: Traumatic LASIK flap inversion with epithelial ingrowth, Propionibacterium acnes infection and diffuse lamellar keratitis. INTERVENTIONS: Removal of corneal epithelium around the flap inversion site, flap lifting, scraping of epithelial ingrowth, removal of the dense infiltrate, alcohol soaking, interface irrigation with antibiotics, and flap reposition were performed. Diffuse lamellar keratitis was noted postoperatively. Culture of the infiltrate revealed P acnes. The infiltrate subsided and the cornea cleared up under topical antibiotics and steroid. OUTCOMES: The visual acuity returned to 20/20. No recurrent epithelial ingrowth or infiltrate was noted during the follow-up. LESSONS: This is the first report of Propionibacterium acnes keratitis after traumatic flap inversion. Although epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis all developed after the flap inversion, early recognition and proper intervention lead to a good result without sequels.


Assuntos
Lesões da Córnea/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Ceratite/diagnóstico , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Propionibacterium acnes/isolamento & purificação , Adulto , Lesões da Córnea/complicações , Lesões da Córnea/etiologia , Lesões da Córnea/microbiologia , Diagnóstico Diferencial , Epitélio Anterior/patologia , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Ceratite/complicações , Ceratite/etiologia , Ceratite/microbiologia , Masculino
13.
Invest Ophthalmol Vis Sci ; 61(2): 25, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32084267

RESUMO

Purpose: To determine the role of autophagy in the innate immune response to fungal keratitis (FK) caused by Aspergillus fumigatus infection. Methods: Corneal samples obtained from patients and mice with FK were visualized via transmission electron microscopy (TEM). Autophagy-related proteins LC3B-II, Beclin-1, LAMP-1, and p62 in A. fumigatus-infected corneas of C57BL/6 mice were tested by Western blot. After treatment with autophagy inhibitors 3-methyladenine (3-MA), chloroquine (CQ), or inducer rapamycin, autophagy-related proteins were detected by Western blot. Corneas were photographed with slit lamp microscopy and pathological changes were observed by hematoxylin and eosin staining. Polymorphonuclear neutrophilic leukocytes (PMNs) were assessed by immunofluorescent staining and observed under TEM. The levels of CXCL-1, IL-1ß, HMGB1, IL-18, TNF-α, and IL-10 were tested by reverse transcription polymerase chain reaction and Western blot. The quantification of fungal loads was detected and photographed. Results: The accumulation of autophagosomes in corneas of patients and mice with FK was observed with TEM. The expression of LC3B-II, Beclin-1, and LAMP-1 was elevated in corneas after fungal infection, whereas p62 was reduced. Treatment with 3-MA or CQ upregulated clinical scores, pathological changes, and the expression of CXCL-1, IL-1ß, HMGB1, IL-18, and TNF-α except IL-10. The morphology of PMNs was changed and PMN recruitment was increased in mice corneas treated with 3-MA or CQ, whereas rapamycin reduced the inflammatory response to keratitis. These results were statistically significant. Conclusions: A. fumigatus infection increases the expression of autophagy in corneas. Autophagy plays an anti-inflammatory role in the innate immune response to A. fumigatus keratitis.


Assuntos
Aspergilose/imunologia , Aspergillus fumigatus/imunologia , Autofagia/imunologia , Infecções Oculares Fúngicas/imunologia , Imunidade Inata/imunologia , Ceratite/imunologia , Animais , Antifúngicos/farmacologia , Aspergilose/metabolismo , Aspergilose/patologia , Autofagia/efeitos dos fármacos , Biomarcadores/análise , Córnea/metabolismo , Córnea/patologia , Infecções Oculares Fúngicas/metabolismo , Infecções Oculares Fúngicas/patologia , Ceratite/metabolismo , Ceratite/patologia , Camundongos , Camundongos Endogâmicos C57BL
14.
J Med Microbiol ; 69(3): 414-418, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32011230

RESUMO

Introduction. Ocular microsporidiosis is a significant emerging infectious disease reported in immunocompromised patients and immunocompetent persons throughout the world.Aim. To identify the pathogens responsible for human keratitis, via corneal scrapings.Methodology. Thirty-three hospitalized patients with epithelial keratitis were examined using staining and DNA sequencing. DNA was extracted from corneal samples and the small-subunit ribosomal RNA gene was amplified by polymerase chain reaction (PCR) and sequenced.Results. Twenty-one samples were positive by staining while PCR generated amplicons in 18 cases. Of the 18 sequences, 16 were identical with, or very similar to, those of Vittaforma corneae (99-100 % similarity) and the remaining two sequences were similar to that of unidentified Microsporidium species deposited in the GenBank.Conclusion. This study has reconfirmed that V. corneae causes epithelial keratitis in humans and that a newly detected Microsporidium species is also involved in microsporidial keratitis as one of the emerging pathogens in Thailand. Ophthalomologists should be aware of microsporidial keratitis in people from Thailand and those from neighbouring countries.


Assuntos
Ceratite/microbiologia , Microsporídios não Classificados/genética , Microsporidiose/microbiologia , Adolescente , Adulto , Idoso , Córnea/microbiologia , Feminino , Humanos , Ceratite/epidemiologia , Masculino , Microsporídios não Classificados/isolamento & purificação , Microsporidiose/epidemiologia , Pessoa de Meia-Idade , Epidemiologia Molecular , Tailândia/epidemiologia , Vittaforma/genética , Vittaforma/isolamento & purificação , Adulto Jovem
16.
Am J Ophthalmol ; 213: 217-225, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32059980

RESUMO

PURPOSE: To apply in vivo corneal confocal microscopy (IVCM) to study the pathogenesis of keratitis (keratoendotheliitis) fugax hereditaria, an autosomal dominant cryopyrin-associated periodic keratitis, associated with the c.61G>C pathogenic variant in the NLRP3 gene, in its acute and chronic phase, and to report histopathologic findings after penetrating keratoplasty. DESIGN: This was an observational case series. METHODS: The study population included 6 patients during an acute attack, 18 patients in the chronic phase, and 1 patient who underwent penetrating keratoplasty. Interventions included Sanger sequencing for the NLRP3 variant c.61C>G, a clinical examination, corneal photography, IVCM, light microscopy, and immunohistochemistry. Our primary outcome measures included IVCM and histopathologic findings. RESULTS: During the acute attack, hyperreflective cellular structures consistent with inflammatory cells transiently occupied the anterior to middle layers of the corneal stroma. Other corneal layers were unremarkable. With recurring attacks, central oval stromal opacities accumulated. IVCM revealed that they contained long, hyperreflective, needle-shaped structures in the extracellular matrix. Using light microscopy, the anterior half of the stroma displayed thin and finely vacuolated lamellae, and keratocytes throughout the stroma were immunopositive for syndecan. CONCLUSIONS: The acute attacks and chronic stromal deposits mainly involve the anterior to middle layers of the corneal stroma, and the disease is primarily a keratitis rather than a keratoendotheliitis. IVCM shows that inflammatory cells invade only the stroma during an acute attack. IVCM and light microscopic findings suggest that the central corneal opacities represent gradual deposition of extracellular lipids. The disease could make a good in vivo model to study activation of the NLRP3 inflammasome in cryopyrin-associated periodic syndromes.


Assuntos
Substância Própria/patologia , Ceratite/congênito , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Doença Aguda , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Ceratite/genética , Ceratite/patologia , Ceratite/cirurgia , Ceratoplastia Penetrante , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Linhagem , Adulto Jovem
17.
Gene ; 737: 144450, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32057930

RESUMO

Fungal keratitis is a corneal disease with a high blindness rate caused by pathogenic fungal infections. The pathogenesis of fungal keratitis and the immune response after fungal infection are still unclear. Notably, the pathological features of fungal keratitis in tree shrews are similar to those in humans. In the present study, mRNA profiling of tree shrew corneas with fungal keratitis was performed. GO and KEGG enrichment analyses were performed on the differentially expressed mRNAs, and the GO biological process ontology was used to analyze functional trends in the differentially expressed mRNAs. In total, 151 downregulated and 71 upregulated mRNAs were shared among the 7-day, 14-day and 30-day infection groups. These differentially expressed mRNAs were significantly enriched in the GO category immune response (GO: 0002376) and the KEGG pathways cytokine receptor binding (KEGG ID: tup04060) and cell adhesion (KEGG ID: tup04514). The downregulated mRNAs were significantly enriched in the corneal epithelial cell adhesion function. Fifty-eight initially upregulated mRNAs gradually decreased in expression, and these mRNAs were significantly enriched in the functions lipopolysaccharide (LPS) and antibacterial polypeptide recognition, cell differentiation, and cell rearrangement. Zeta chain of T-cell receptor associated protein kinase 70 (ZAP70), lymphocyte cytosolic protein 2 (LCP2), C-C motif chemokine and its receptor showed high degrees of connectivity in the protein-protein interaction (PPI) network. We speculate that the decrease in symptoms of tree shrew fungal keratitis may be related to the upregulation of genes involved in immune regulation and macrophage colony stimulation. This study showed that the C-C motif chemokine and its receptor may play a key role in regulating tree shrew fungal keratitis, providing a theoretical basis for studying the pathogenesis of human fungal keratitis.


Assuntos
Infecções Oculares Fúngicas/genética , Fusarium/patogenicidade , Ceratite/genética , RNA Mensageiro/genética , Tupaiidae/genética , Animais , Infecções Oculares Fúngicas/microbiologia , Ceratite/microbiologia
20.
Klin Monbl Augenheilkd ; 237(1): 35-40, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31968364

RESUMO

BACKGROUND: Primary localised orbital amyloidosis (PLOA) is a very rare disease. In contrast to the isolated manifestation, systemic involvement can be associated with potentially life-threatening consequences. However, the isolated involvement of the orbit can also lead to serious complications. MATERIAL AND METHODS: Two cases of PLOA are described and the necessary ophthalmic, internistic and immunohistochemical diagnostic testing are explained. RESULTS: The first case describes a 71-year-old woman with PLOA. In the clinic, a yellow-orange bumpy prominence in the nasal lower quadrant without further ophthalmological abnormalities was found. Extensive diagnostic testing found no systemic manifestation. The patient herself was free of complaints. In the follow-up over 4 years, patient showed slow progression without ocular complications. The second case is a 72-year-old male patient with similar clinical signs but localisation in the temporal superior quadrant. During the clinical course, multiple ophthalmological complications developed (ptosis, protrusio bulbi, diplopia, secondary glaucoma, perforated corneal ulcer in neurotrophic keratopathy). Perforating keratoplasty had to be performed. Fractioned radiotherapy led to stabilisation of the disease. The follow-up period was 4 years. CONCLUSION: PLOA can lead to visual and organ threatening complications. Accurate diagnosis is required for further diagnostic and therapeutic procedures and to counteract potential local and systemic complications. Interindividual differences in the course have to be considered.


Assuntos
Amiloidose , Blefaroptose , Exoftalmia , Ceratite , Idoso , Amiloidose/diagnóstico , Amiloidose/cirurgia , Blefaroptose/diagnóstico , Blefaroptose/cirurgia , Exoftalmia/diagnóstico , Exoftalmia/cirurgia , Feminino , Humanos , Ceratite/diagnóstico , Ceratite/cirurgia , Masculino , Órbita
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