Determinants of Clinical Outcomes After Infectious Scleritis.

PURPOSE: The aims of this study were to describe the clinical course of microbial infectious scleritis and identify factors associated with poor visual outcomes. METHODS: Data from 26 eyes of 26 patients with culture-proven bacterial or fungal scleritis presenting at a single tertiary center from January 1, 2007, to July 1, 2021, were reviewed. Thirty-six variables were analyzed for associations with poor vision [best-corrected visual acuity (BCVA) <20/200] or loss of vision (no light perception vision or requirement for enucleation or evisceration) at final visit. RESULTS: The mean age at initial presentation was 67.1 ± 14.0 (range: 34-92) years with a mean follow-up of 2.1 ± 2.2 (0.05-8.45) years. The mean presenting logarithm of minimal angle of resolution (logMAR) BCVA was 1.3 ± 1.0 (∼20/400) and mean final logMAR BCVA was 1.6 ± 1.2 (∼20/800). Fourteen eyes (53.8%) exhibited poor vision and 7 (26.9%) had loss of vision at final follow-up. History of necrotizing scleritis and poor presenting vision were associated with poor final vision (OR = 19.1; P = 0.017 and OR = 7.5; P = 0.047, respectively), whereas fungal scleritis was associated with loss of vision (odds ratio [OR] = 30.3, P = 0.013). Subconjunctival antimicrobial treatment was inversely associated with loss of vision (OR = 0.06, P = 0.023). There was no difference in vision between medical and combined medical-surgical management, although infection resolution time was shorter for combined intervention (16.8 ± 10.6 vs. 53.7 ± 33.8 days; P = 0.005). CONCLUSIONS: Infectious scleritis is often successfully treated, but loss of vision or eye removal is common. Poor baseline vision, history of necrotizing scleritis, and fungal etiology were prognostic for worse clinical outcomes. Surgical intervention was associated with quicker resolution compared with medical treatment alone.

Ophthalmic findings of Mycoplasma-induced rash and mucositis (MIRM) distinct from Stevens-Johnson syndrome.

PURPOSE: To identify ophthalmic manifestations of Mycoplasma-induced rash and mucositis (MIRM). METHODS: The medical records of patients with MIRM treated by the inpatient ophthalmology consult service at a single institution over a period of 4 years were reviewed retrospectively. Eye and skin findings, treatment, hospital course, and follow-up findings were documented and reviewed. RESULTS: MIRM was identified in 10 patients, 10-20 years of age (mean, 13.) All presented with oral mucosal findings and a prodrome. On initial examination, conjunctival epithelial defects were present in 2 patients; pseudomembranes, in 3. Five patients experienced progressive ophthalmic manifestations during hospitalization, including a new cornea epithelial defect in 1 patient and a new conjunctival epithelial defect in 3 patients. All were treated with topical steroids and antibiotics. Post-discharge follow-up obtained for 7 patients documented good visual outcomes and lack of significant ocular sequelae without requiring invasive intervention. CONCLUSIONS: MIRM, previously referred to as mycoplasma-associated Stevens-Johnson syndrome (SJS) among other names, is now understood to be distinct from SJS in the dermatology community. Our MIRM patients present with mild eye findings and required no surgery, similar to the mild course published in the dermatology literature. Patients with MIRM may have a more benign course than those with SJS.

Experience of a non-pediatric-trained ophthalmic hospitalist at a children's hospital.

The relatively novel role of ophthalmic hospitalist at our institution includes evaluation and management of all inpatient and emergency department ophthalmology consultations. This report reviews the management of consultations at a children's hospital by the non-pediatric-trained ophthalmologist in this role. Within the study period of 2 months, 61 pediatric patients were evaluated by the ophthalmic hospitalist service. The pediatric ophthalmology department was consulted in 15 cases (25%), 10 of which were for discussion alone. This model of care illustrates an effective way to provide an ophthalmology consult service at a children's hospital in conjunction with pediatric ophthalmology subspecialists for management.

Management of ocular manifestations of autosomal recessive congenital ichthyosis 4B, harlequin type, in the perinatal period.

Autosomal recessive congenital ichthyosis (ARCI4B [OMIM #242500]), also known as harlequin ichthyosis, presents at birth with extreme hyperkeratosis and thick-fissured plaques, leading to tightness of the skin around the eyes, mouth, ears, chest, abdomen, and extremities. Ocular manifestations include cicatricial ectropion and exposure keratitis. We present 2 infants with ARCI4B and cicatricial ectropion who were managed with aggressive nonsurgical therapy. Both infants avoided severe ocular sequelae and maintained corneal clarity, highlighting that management of exposure keratopathy with frequent ophthalmic ointment application can prevent severe ocular surface pathology in ARCI4B.

An Automated Test of Rat Forelimb Supination Quantifies Motor Function Loss and Recovery After Corticospinal Injury.

BACKGROUND: Rodents are the primary animal model of corticospinal injury and repair, yet current behavioral tests do not show the large deficits after injury observed in humans. Forearm supination is critical for hand function and is highly impaired by corticospinal injury in both humans and rats. Current tests of rodent forelimb function do not measure this movement. OBJECTIVE: To determine if quantification of forelimb supination in rats reveals large-scale functional loss and partial recovery after corticospinal injury. METHODS: We developed a knob supination device that quantifies supination using automated and objective methods. Rats in a reaching box have to grasp and turn a knob in supination in order to receive a food reward. Performance on this task and the single pellet reaching task were measured before and after 2 manipulations of the pyramidal tract: a cut lesion of 1 pyramid and inactivation of motor cortex using 2 different drug doses. RESULTS: A cut lesion of the corticospinal tract produced a large deficit in supination. In contrast, there was no change in pellet retrieval success. Supination function recovered partially over 6 weeks after injury, and a large deficit remained. Motor cortex inactivation produced a dose-dependent loss of knob supination; the effect on pellet reaching was more subtle. CONCLUSIONS: The knob supination task reveals in rodents 3 signature hand function changes observed in humans with corticospinal injury: (1) large-scale loss with injury, (2) partial recovery in the weeks after injury, and (3) loss proportional to degree of dysfunction.