Infectious crystalline keratopathy in dogs and cats: clinical, in vivo confocal microscopic, histopathologic, and microbiologic features of eight cases.

OBJECTIVE: To describe clinical, in vivo confocal microscopic, histopathologic, and microbiologic features of canine and feline cases of infectious crystalline keratopathy (ICK). ANIMALS STUDIED: Six dogs and two cats with naturally acquired ICK. PROCEDURES: Medical records of dogs and cats with a clinical diagnosis of ICK were reviewed. Signalment, medical history, clinical findings, and diagnostic evaluations were retrieved, including corneal cytology, histopathology, in vivo confocal microscopy, and microbiology results. RESULTS: All animals presented with fine, needle-like, and branching white crystalline anterior stromal opacities emanating from corneal facets or corneal epithelial defects. Mild conjunctival hyperemia and anterior uveitis were frequently present. Concurrent ocular and systemic diseases were common, including keratoconjunctivitis sicca, corneal sequestrum, diabetes mellitus, hyperadrenocorticism, and malignant neoplasia. Bacteria, with minimal or absent leukocytes, were identified by cytology and histopathology. Histopathologically, the crystalline corneal opacities corresponded with dense accumulations of bacteria present in the interlamellar stromal spaces and forming cord-like projections within the stroma. In vivo confocal microscopy demonstrated deposits of reflective crystalline or amorphous structures within the stroma with a paucity of associated inflammatory changes. The most frequently cultured bacteria were alpha-hemolytic Streptococcus and Staphylococcus species. Resolution of clinical lesions was achieved in most cases with long-term medical or surgical therapy; however, the initiation of medical treatment was associated with an acute, dramatic onset of severe keratitis and anterior uveitis in some animals. CONCLUSIONS: Infectious crystalline keratopathy in dogs and cats shares many features with this condition in human patients. Prolonged medical therapy, or surgical intervention, is required for resolution.

Endoscopy-assisted vitrectomy for treatment of severe endophthalmitis with retinal detachment.

UNLABELLED: To decrease evisceration of eyes, endoscopy-assisted pars plana vitrectomy is a choice for patients with severe endophthalmitis accompanied with retinal detachment and corneal edema. PURPOSE: To evaluate surgical outcomes using an intraocular videoendoscope for vitrectomy in patients with severe endophthalmitis with retinal detachment. METHODS: From December 2006 to August 2009, the medical records of 21 patients undergoing endoscopy-assisted vitrectomy for endophthalmitis with retinal detachment were studied. Only patients with ≥18 months follow-up were included. RESULTS: Intraocular infections were under control in 19 of the 21 patients. Postoperatively, the visual acuity of three of the patients ranged from 2/100 to 20/100 (14.3 %), two of the patients left with finger counting (9.5 %), eight had hand motion (38.1 %), six had light perception (28.6 %), and the other two had their eyes eviscerated (9.5 %) because of recurrent and uncontrollable infection. CONCLUSIONS: In patients with severe endophthalmitis accompanied with retinal detachment and marked corneal opacity, it is appropriate to conduct endoscopy-assisted pars plana vitrectomy to decrease evisceration of eyes.

Prevalence and associations of blinding trachoma in indigenous Australians within central Australia: the Central Australian Ocular Health Study.

PURPOSE: To determine the prevalence and associations of blinding trachoma within the indigenous Australian population living in central Australia. METHODS: A total of 1884 individuals aged 20 years or older, living among 30 remote communities within the statistical local area of 'Central Australia', were recruited for this study. This equated to 36% of those aged 20 years or older and 67% of those aged 40 years or older within this district. Participants were recruited as they presented to the eye clinic at each remote community. Anterior segment examination was performed and the rates of trachomatous trichiasis (TT) and trachomatous corneal opacification (CO) were documented. The prevalence of TT and CO in one or both eyes was presented. RESULTS: There were 6.1% (95% CI 5.0-7.2) (8.3% of those aged 40 years or older) who had TT and 3.3% (95% CI 2.5-4.1) (4.4% of those aged 40 years or older) who had CO. Both TT and CO were associated with advancing age and female sex. Prevalence varied widely between communities, from 0% to 33% for TT and 0% to 27% for CO. CONCLUSION: Our study has shown that blinding trachoma remains endemic among indigenous Australians in central Australia. However, compared with previous estimates, the prevalence of TT and CO appears to be decreasing.

Antibiotic therapy for trachoma.

Trachoma, a major cause of blindness in some of the world's poorest countries, results from repeated or chronic eye infections with Chlamydia trachomatis.

Microplasma Jet Arrays as a Therapeutic Choice for Fungal Keratitis.

The clinical impact of microplasma jets on rabbit eyes infected by Candida albicans has been investigated. Arrays of such jets produce low-temperature plasma micro-columns suitable for ophthalmic therapeutics and fungal infections, in particular, and the technology is capable of being scaled to surface areas of at least 10 cm2. Keratitis was induced in the right central corneas of rabbits, whereas the left eyes served as a normal group. The rabbits were divided into the plasma non-treated group (control) and plasma treatment group. Histologic analyses of both groups showed marked reductions in the thickness, angiogenesis, and opacity of all rabbit corneas following plasma treatment. Indeed, for treatment times beyond 14 days, infected eyes exhibited no significant differences from the normal group. Healing of rabbit eyes infected by Candida albicans apparently proceeds by disrupting corneal epithelial proliferation, and by reducing fibrotic changes in the stroma. This study demonstrates that low-temperature plasma jets are remarkably effective in healing Candida albicans-infected corneas, thereby providing a promising medical treatment option for keratitis.

[Ocular onchocerciasis: a key role for Wolbachia]. / Okuläre Onchozerkose: Wolbachien haben eine Schlüsselrolle.

Onchocerciasis is caused by the parasitic worm Onchocerca volvulus, which releases millions of offspring (microfilariae). Microfilariae migrate through the skin and can enter the anterior or posterior regions of the eye. While alive, the microfilariae appear to cause little or no inflammation, being in the anterior chamber. However, when they die, either by natural attrition or after chemotherapy, the host response to degenerating worms can result in ocular inflammation (keratitis, uveitis, chorioretinitis, neuritis of the optic nerve) that causes progressive loss of vision and ultimately leads to blindness. With the use of a mouse model of corneal inflammation to study the pathogenesis of ocular onchocerciasis by injecting worm extracts directly into the corneal stroma, it was found that worms treated with the antibiotic doxycycline, which destroys Wolbachia, induced lower corneal stromal thickness and stromal haze (indicators of corneal oedema and opacity) and neutrophil infiltration compared with both untreated worms and worms that do not harbour Wolbachia. These data indicate that endosymbiotic Wolbachia bacteria in filarial parasites have a key role in the pathogenesis of river blindness. Worms recovered from patients treated for 6 weeks with doxycycline contained fewer Wolbachia bacteria and had abnormal embryogenesis, indicating a role for Wolbachia in the survival or fecundity of the worms. Antibiotic treatment may also reduce the severity of the inflammatory response in the cornea.

Incidence of ocular complications in patients with multibacillary leprosy after completion of a 2 year course of multidrug therapy.

AIM: To evaluate the incidence of and risk factors for ocular complications in multibacillary (MB) leprosy patients following completion of 2 year, fixed duration, multidrug therapy (MDT). METHODS: Biannual eye examinations were conducted prospectively on a cohort of MB patients who had completed MDT and followed up for 5 years. The incidence of ocular pathology was calculated as the number of events per person year of event free follow up of patients who did not have the specific finding before completion of MDT. RESULTS: 278 patients had one or more follow up visits after completion of MDT. The incidence of lagophthalmos was 0.24%/patient year (95% CI 0.10% to 0.37%); corneal opacity, 5.35%/patient year (95% CI 4.27% to 6.70%); uveal involvement, 3.78%/patient year (95% CI 2.96% to 4.83%); and cataract that reduced vision to 6/18 or less, 2.4%/patient year (95% CI 1.77% to 3.26%). Overall, 5.65%/patient year (95% CI 4.51% to 7.09%) developed leprosy related ocular disease and 3.86%/patient year (95% CI 3.00% to 4.95%) developed leprosy related, potentially blinding ocular pathology during the period following MDT. Age and other disability also predicted incident eye disease. CONCLUSIONS: Every year, approximately 5.6% of patients with MB who have completed MDT can be expected to develop new ocular complications of leprosy, which often (3.9%) are potentially vision threatening. Because many of these complications cannot be detected without slit lamp examination, periodic monitoring, particularly of older patients and those with other disability, is recommended, in order to detect and treat ocular complications satisfactorily.

Pseudomonas eye infections in cyclophosphamide-treated mice.

Swiss-Webster mice challenged intracorneally with varying doses of P. aeruginosa exhibit eye infection within 24 hr. as detected by corneal opacity. The infection remains localized and spontaneously heals within 4 to 6 weeks. However, when mice are pretreated with a single i.p. injection of cyclophosphamide 4 days prior to either intracorneal or anterior-chamber challenge with various bacterial cell suspensions (10(1) to 10(8)), 83% of the anterior chamber and 54% of the intracorneally challenged mice (most at higher dilutions of the bacteria) died of Pseudomonas septicemia within 48 hr. Corneal damage was histochemically and ultrastructurally observed in surviving animals by 24 to 48 hr. following challenge by either route.

Infectious crystalline keratopathy with ring opacity.

A 41-year-old physician was treated for 3 months with antiviral medications, antibiotics, and steroids for presumed herpetic keratitis. When seen by us, an annular infiltrate was observed, along with crystalline-like opacities in the superficial one third of the stroma. Cultures of scrapings and of subsequent biopsies were positive for Streptococcus mitis of the viridans group; histopathology demonstrated large aggregates of cocci between the stroma lamellae. Tapering of topical corticosteroids and treatment with topical penicillin resulted in resolution of the infiltrates. The clinical appearance and findings in this patient suggest that infectious crystalline keratitis can produce an annular infiltrate. Injection of the organism into rabbit corneas produced a crystalline infiltrate, but no annular opacity was observed. Corticosteroids altered the clinical and histopathologic appearance of the lesions in rabbits.

Infectious crystalline keratopathy in a neonatal infant.

Bilateral white crystalline opacities of the central corneas were found at autopsy in the eyes of a 17-day-old girl with Turner's Syndrome. Corticosteroid therapy had not been used. Histopathologic and electron microscopic evaluation revealed clusters of gram-negative rods between relatively intact stromal lamellae. Inflammation was mild and restricted to the limbus and peripheral cornea. This case represents an unusual presentation of an infectious crystalline keratopathy.

Infectious crystalline keratopathy following trabeculectomy and low-dose topical steroids.

A case of infectious crystalline keratopathy in a patient who had undergone trabeculectomy without 5-fluorouracil is described. Chronic low-dose topical steroids were employed. Crystalline keratopathy occurring in this setting has not been previously described. A 73-year-old diabetic women presented with feathery crystal-like corneal infiltrates. These were cultured and treated with antibiotics based on the sensitivities. The cultures showed a nutritional variant of Streptococcus that was difficult to grow on routine culture plates. It was sensitive to vancomycin. Resolution of the infection occurred with topical treatment. Infectious crystalline keratopathy is a rare but classical corneal infection. The microbiological characteristics that give rise to its clinical appearance and laboratory characteristics are discussed. A rationale for diagnosis and treatment is suggested.

Encephalomyelitis, reproductive failure and corneal opacity (blue eye) in pigs, associated with a paramyxovirus infection.

A new clinicopathological disorder associated with a paramyxovirus infection in pigs is described. Central nervous system manifestations and corneal opacity are the main features in piglets two to 21 days old. Older pigs seem to be more resistant and only corneal opacity is commonly observed. In pregnant sows the virus appears to be responsible for reproductive disturbances such as stillbirth, mummification and a return to oestrus. The changes are mainly microscopic and characterised by a non-suppurative encephalomyelitis, interstitial pneumonia and anterior uveitis with corneal oedema. Experimental infection of one-day-old piglets with the virus reproduced clinical signs similar to those described in naturally infected piglets. The virus was recovered from the tonsils, lung and brain of the experimentally infected piglets between the fourth and 20th day after infection.

Visual outcome of extracapsular cataract extraction and intraocular lens replacement in leprosy patients.

The study was carried out in Meshed, Islamic Republic of Iran, from 1998 to 2000 to explore the visual outcome of eye surgery with extracapsular cataract extraction and intraocular lens replacement on 18 leprosy patients (20 eyes). The most common complications of leprosy were madarosis (90%) and partial or total corneal opacity (90%). Visual acuity before surgery ranged from 'light perception' to 1/10, and this improved after surgery to 5/10-8/10 for 55% of patients. Postoperative infection leading to endophthalmitis occurred in only 1 patient and was treated with drugs; this patient's visual acuity remained at 10 cm finger count. Posterior synechia due to chronic uveitis in leprosy was diagnosed in 70% of eyes, obstructed iris in 25%, keratic precipitates in 25% and moderate iris atrophia in 10%.

Trachoma prevalence in women living in rural northern India: rapid assessment findings.

PURPOSE: Rapid assessment of cicatricial trachoma in adult females aged over 15 years in a previously hyperendemic rural area in Haryana, North India. METHODS: Ten disadvantaged villages each with a population of 3000-5000 were chosen by cluster random sampling. One thousand females, 500 between 15-30 years and the rest over 30 years in the underdeveloped parts of the villages, identified by observation and consultation, were examined for signs of trachomatous scarring (TS), trachomatous trichiasis (TT) and trachomatous corneal opacity (TCO). Examinations of both eyes were performed with the aid of a binocular loupe (2.5x magnification) for signs of trachoma, its complications and other ocular morbidities. RESULTS: Bilateral examination was carried out in all participants. About two-thirds (n = 650; 65%) of subjects did not have any signs of trachoma. The percentages of trachoma stages TS, TT and TCO were found to be 26.4%, 5.4% and 3.2% respectively. Trichiasis was observed in 54 subjects, all in the age group >30 years, and highest in the age group 66-75 years (22.8%). Females in the age group >30 years had significantly higher cicatricial trachoma compared to females <30 years (p < 0.001). Overall 59.3% of affected females had not received any treatment. Epilation and entropion surgery had been performed in 30.3% and 10.4% of affected females, respectively. CONCLUSION: The results of our rapid assessment suggest that the presence of cicatricial trachoma remains an important health issue in females over 15 years of age.

Ocular leprosy in institutionalized Nigerian patients.

OBJECTIVE: This study was aimed at presenting the profile of ocular lesions observed in the in-mates on multidrug treatment, of a leprosy rehabilitation centre in Nigeria. DESIGN: Cross-sectional. METHOD: One hundred patients were selected by systematic random sampling. Sixty-nine had ocular involvement and were the subjects of this study. The age range was 15 to 80 years with a mean age of 51 years. There were 57 males (82.6%) and 12 females (17.4%). The range of duration of treatment was two months to 30 years, with a mean of 15 years. Examination of the anterior and posterior segments of the globe and its adnexa was carried out using Penlight, magnifying loupe and direct ophthalmoscope. Visual acuity was recorded using the Snellen charts. RESULTS: Lepromatous leprosy patients had the greatest incidence of ocular lesions. Ocular lesions were more in patients who have had leprosy for ≥ 15 years. Madarosis (72.5%) and lagophthalmos (29.0%) were the commonest lesions. Corneal involvement was seen in 36.2%. Conjunctivitis in 14.5% . Trichiasis in 10.1% and ectropion in 8.7% . 17.4% were legally blind (VA≤3/60) in the better eye, and 17.4% had cataract in at least one eye. There was no statistically significant difference in the incidence of ocular lesions among males and females, and between patients with Lepromatous and Tuberculoid leprosy. CONCLUSION: Ocular complications are common and sight threatening in leprosy patients. Regular screening and outreach by eye care providers should be incorporated into leprosy care programmes.

Corneal autograft and allograft in a 10-month-old premature boy with acquired bilateral corneal opacities.

PURPOSE: To report a case in which corneal autograft and allograft were performed in a 10.5-month-old, ex 24-week, premature boy with bilateral corneal opacities from infectious keratitis. METHODS: Case report based upon chart review. RESULTS: At 3 years, the corneal autograft is clear without vascular ingrowth. After transplantation, the clarity of the autograft improved markedly and unexpectedly from its pretransplantation appearance. The child fixes and follows and has central steady maintained fixation at near with a spectacle correction of +11.00 diopters. The allografted cornea is opaque with 360 degrees of vascular ingrowth. This eye is phthisical with no response to light. CONCLUSIONS: In circumstances in which a viable cornea is available from the patient's worse prognosis eye, a corneal autograft is a potential treatment option.

A murine model of contact lens-associated fusarium keratitis.

PURPOSE: Fusarium solani and F. oxysporum were the causative organisms of the 2005/2006 outbreak of contact lens-associated fungal keratitis in the United States. The present study was an investigation of the ability of F. oxysporum grown as a biofilm on silicone hydrogel contact lenses to induce keratitis. METHODS: A clinical isolate of F. oxysporum was grown as a biofilm on lotrafilcon A contact lenses, and a 2-mm diameter punch was placed on the abraded corneal epithelium of either untreated or cyclophosphamide-treated C57BL/6 mice or of IL-1R1(-/-), MyD88(-/-), TLR2(-/-), or TLR4(-/-) mice. After 2 hours, the lens was removed, and corneal opacification, colony forming units (CFUs), and histopathology were evaluated. RESULTS: C57BL/6 mice developed severe corneal opacification within 24 hours and resolved after four days. In contrast, corneal opacification progressed in cyclophosphamide-treated mice, and was associated with unimpaired fungal growth in the cornea, and with hyphae penetrating into the anterior chamber. The phenotype of MyD88(-/-) and IL-1R(-/-) mice was similar to that of cyclophosphamide-treated animals, with significantly impaired cellular infiltration and fungal clearance. Although TLR4(-/-) mice developed a cellular infiltrate and corneal opacification similar to C57BL/6 mice, the CFU count was significantly and consistently higher. CONCLUSIONS: Fusarium grown as a biofilm on silicone hydrogel contact lenses can induce keratitis on injured corneas, with disease severity and fungal killing dependent on the innate immune response, including IL-1R1, MyD88, and TLR4.

[Clinical evidence of trachoma in Colombian Amerindians of the Vaupés Province]. / Evidencia clínica de tracoma en indígenas colombianos del departamento de Vaupés.

INTRODUCTION: Trachoma is the leading cause of infectious blindness in the world. In 2008 there were 1,300,000 persons with blindness caused by trachoma and 8 million with trichiasis, which might eventually lead to blindness. In Latin America it has been documented in Brazil, Guatemala and México. OBJECTIVE: To inform the presence of trachoma for the first time in Colombia, amongst Amerindians of the Department of Vaupés. MATERIALS AND METHODS: In 2003 and 2006 the Amerindian Makú communities of San Joaquín and Santa Catalina, located 5 km from the border with Brazil, were visited. From 2007 to 2009, San Gerardo, San Gabriel and Nuevo Pueblo, at a 35 km distance from San Joaquín were visited. RESULTS: In 2006 114 people were examined in Santa Catalina and San Joaquin; 21 patients were clinically diagnosed with trachoma (18.4%), 15 (13.2%) of them children under 15 years old. All trachoma phases were observed. Three women had corneal opacity with poor vision. In the remaining three communities, three women with advanced trachoma with corneal opacity and blindness were detected. The poor quality of living conditions without fresh water and adequate sanitary disposal systems, and the abundance of flies identified as Hippelates sp., are risk factors for the transmission of the disease. DISCUSSION: Trachoma exists in Colombia, and it is frequent among the studied communities. Its focalized distribution makes it amenable to elimination. It is advisable to search for trachoma in other indigenous communities in Vaupés with similar living conditions.

Trichiasis surgery in The Gambia: a 4-year prospective study.

PURPOSE: Trachoma is the leading infectious cause of blindness. Conjunctival Chlamydia trachomatis infection causes scarring, entropion, trichiasis, and blinding corneal opacification. Worldwide, there are 8 million people with trichiasis. Although trichiasis surgery can reduce the risk of blindness, retrospective data suggest that long-term recurrence rates may be high. A 4-year prospective investigation of recurrent trichiasis was conducted in The Gambia. METHODS: Patients with trichiasis were examined at baseline, 6 months, 1 year, and 4 years after posterior lamellar tarsal rotation surgery. Conjunctival swabs for bacteriology and PCR for C. trachomatis were collected at baseline, 6 months, and 1 year. RESULTS: Three hundred fifty-six Gambian patients were enrolled at baseline and 266 were reassessed at 4 years (94% of surviving patients). The recurrence rates were 32%, 40%, and 41% at 6 months, 1 year, and 4 years, respectively. At 4 years, 30% of patients had bilateral trichiasis and 21% had bilateral corneal opacity. Recurrence was associated with severe conjunctival inflammation and severe trichiasis (>10 lashes) at baseline. CONCLUSIONS: Trichiasis recurrence rates were high, and most cases recurred within 6 months of surgery. The results suggest that there are important aspects of surgical technique and quality that should to be addressed. Persistent inflammation is strongly associated with recurrence at 4 years.