The aim of our minireview is to provide a brief overview of the diagnosis,clinical aspects,treatment options,management,and current literature available regarding herpes simplex keratitis(HSK).This type of corneal vir...The aim of our minireview is to provide a brief overview of the diagnosis,clinical aspects,treatment options,management,and current literature available regarding herpes simplex keratitis(HSK).This type of corneal viral infection is caused by the herpes simplex virus(HSV),which can affect several tissues,including the cornea.One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea.After the initial infection,the HSV can establish a latent infection in the trigeminal ganglion,a nerve cluster near the eye.The virus may remain dormant for extended periods.Periodic reactivation of the virus can occur,leading to recurrent episodes of HSK.Factors triggering reactivation include stress,illness,immunosuppression,or trauma.Recurrent episodes can manifest in different clinical patterns,ranging from mild epithelial involvement to more severe stromal or endothelial disease.The severity and frequency of recurrences vary among individuals.Severe cases of HSK,especially those involving the stroma and leading to scarring,can result in vision impairment or even blindness in extreme cases.The cornea's clarity is crucial for good vision,and scarring can compromise this,potentially leading to visual impairment.The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization.Antiviral medications,such as oral Acyclovir or topical Ganciclovir,may be prescribed for prophylaxis.The immune response to the virus can contribute to corneal damage.Inflammation,caused by the body's attempt to control the infection,may inadvertently harm the corneal tissues.Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation.In summary,the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.展开更多
Fungal keratitis is an important cause of corneal blindness in China, accounting for 45% of infectious keratitis. The main pathogenic bacteria include yeast, filamentous bacteria and nearly 100 kinds of fungi, which a...Fungal keratitis is an important cause of corneal blindness in China, accounting for 45% of infectious keratitis. The main pathogenic bacteria include yeast, filamentous bacteria and nearly 100 kinds of fungi, which are difficult to diagnose, difficult to treat and poor prognosis. When the infected fungal strains have strong virulence and poor drug sensitivity, it is easy to prolong the disease. Once the fungal infection involves the whole limbus and reaches the whole layer of the cornea, it will be followed by intraocular tissue infection such as anterior chamber, lens and vitreous body. When the infection is difficult to control and the visual function is seriously damaged, the enucleation of eye contents has to be performed, which causes irreversible harm to the patient’s appearance and physical and mental health. Therefore, in order to gain greater hope for the vision of patients with fungal keratitis, In recent years, with the continuous progress of clinical medicine and microbiological diagnostics, the treatment methods of fungal keratitis have been constantly updated. This article will briefly review the new progress in drug and surgical treatment of fungal keratitis in recent years to provide patients with better visual prognosis. .展开更多
AIM:To report the etiologies,risk factors,treatments,and outcomes of infectious keratitis(IK)at a major Vietnamese eye hospital.METHODS:This is a retrospective review of all cases of IK at Vietnam National Eye Hospita...AIM:To report the etiologies,risk factors,treatments,and outcomes of infectious keratitis(IK)at a major Vietnamese eye hospital.METHODS:This is a retrospective review of all cases of IK at Vietnam National Eye Hospital(VNEH)in Hanoi,Vietnam.Medical histories,demographics,clinical features,microbiological results,and treatment outcomes were reviewed.RESULTS:IK was diagnosed in 1974 eyes of 1952 patients,with ocular trauma being the greatest risk factor for IK(34.2%),frequently resulting from an agriculturerelated injur y(53.3%).The mean duration between symptom onset and presentation to VNEH was 19.3±14.4 d,and 98.7%of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH.Based on smear results of 1706 samples,the most common organisms identified were bacteria(n=1107,64.9%)and fungi(n=1092,64.0%),with identification of both bacteria and fungi in 614(36.0%)eyes.Fifty-five of 374 bacterial cultures(14.7%)and 426 of 838 fungal cultures(50.8%)were positive,with the most commonly cultured pathogens being Pseudomonas aeruginosa,Streptococcus pneumonia,Fusarium spp.,and Aspergillus spp.Corneal perforation and descemetocele developed in 391(19.8%)and 93(4.7%)eyes,respectively.Medical treatment was successful in resolving IK in 50.4%eyes,while 337(17.1%)eyes underwent penetrating or anterior lamellar keratoplasty.Evisceration was performed in 7.1%of eyes,most commonly in the setting of fungal keratitis.CONCLUSION:Ocular trauma is a major risk factor for IK in Vietnam,which is diagnosed in almost 400 patients each year at VNEH.Given this,and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration,greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.展开更多
AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK)....AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.展开更多
AIM:To evaluate the correlation between Demodex infestation and keratitis,and to assess demodicosis using a simple approach.METHODS:A modified slit lamp illumination(at 40×magnification)was used to observe Demode...AIM:To evaluate the correlation between Demodex infestation and keratitis,and to assess demodicosis using a simple approach.METHODS:A modified slit lamp illumination(at 40×magnification)was used to observe Demodex tails in 40patients with refractory keratitis and 80 healthy controls.Bacterial smear and culture of the conjunctival sac and corneal lesion were performed to identify the pathogen.Tea tree oil ointment(TTOO)was added as a Demodex killing agent for lid scrubs to the treatment when Demodex infestation was confirmed.RESULTS:Demodex tails were found in all patients compared to 42/80 of the controls(P<0.01).Seventeen patients presented blepharitis,while 23 were free of scales and inflammation at the lid margin.The demodicosis was mild,moderate,and severe in 8,19,and 13 patients,respectively,compared to mild in 42 controls(P<0.01).The keratitis was mild,moderate,and severe in 13,19,and 8patients,respectively.The severity of Demodex infestation was not correlated to the severity of keratitis(P=0.126).The growth of Staphylococcus was revealed in nine patients who did not react to antibiotic eye drops prior to the TTOO treatment.Patients’signs and symptoms got resolved after the lid scrub with TTOO.CONCLUSION:Ocular Demodex needs to be checked and treated in refractory keratitis patients with or without blepharitis.A slit-lamp illumination under high magnification favors the judgment of the severity of Demodex infestation.展开更多
AIM:To analyze a series of antimicrobial peptides(AMPs)in corneal tissue from individuals with fungal keratitis(FK)during the active phase of the fungus infection and after healing.METHODS:Patients undergone lamellar ...AIM:To analyze a series of antimicrobial peptides(AMPs)in corneal tissue from individuals with fungal keratitis(FK)during the active phase of the fungus infection and after healing.METHODS:Patients undergone lamellar keratoplasty for the treatment of severe FK or corneal scar had their corneal buttons sampled.Quantitative real-time polymerase chain reaction(PCR)was used to ascertain the gene expression of human beta-defensin(HBD)-1,-2,-3,-9,S100A7,8,9,and LL-37.RESULTS:All AMPs’messenger ribonucleic acid(mRNA)expression was considerably elevated in all samples(n=12).In contrast to controls,where HBD-2,-3,and S100A7 mRNAs were expressed at very low levels,it was discovered that HBD-1,-9,S100A8,S100A9,and LL-37 were constitutively expressed in all healed samples(n=4).HBD-1,-2-3,S100A7,and LL-37 mRNAs were significantly increased in all active FK samples(n=8).The levels of HBD-9,S100A8,and S100A9 mRNAs were moderately upregulated in all active FK samples.Subgroup comparison showed that HBD-2 was significantly increased in Fusarium keratitis samples(n=5),and LL-37 mRNAs were significantly enhanced in Aspergillus keratitis samples(n=3).Whereas there was not significantly increased of HBD-1,-3,-9,S100A7,8,9 mRNA in Aspergillus keratitis samples compared with Fusarium keratitis samples.CONCLUSION:AMPs expression is increased in active FK,but not all AMPs are equally expressed.HBD-2 and LL-37 expression levels are the highest,showing some specificity of AMP expression related to FK.Human AMPs,particularly HBD-2 may play a significant role in Fusarium keratitis and LL-37 might be the key player in Aspergillus keratitis.展开更多
AIM:To characterize changes of corneal nerve morphology and tear indices in patients with neurotrophic keratitis(NK)treated with recombinant human nerve growth factor(rhNGF).METHODS:In a prospective observational stud...AIM:To characterize changes of corneal nerve morphology and tear indices in patients with neurotrophic keratitis(NK)treated with recombinant human nerve growth factor(rhNGF).METHODS:In a prospective observational study,six patients(nine eyes)were locally treated with rhNGF.Visual acuity,corneal fluorescein staining score,the heights of the tear river,lipid layer thickness(LLT),tear ferning(TF)test,conjunctival impression cytology(CIC)examination,the densities of cornea subbasal nerve fibers were determined before and after treatment.RESULTS:Compared with baseline,there was a significant difference in corneal fluorescence staining scores(P<0.01);all patient corneal epithelial defects recovered completely within 8wk,but there was no significant improvement in the height of the tear river(P=0.202).LLT was significantly increased when compared with baseline(P=0.042);however,the function of conjunctival goblet cells and mucin content did not significantly improve using the TF test and CIC examination(P=0.557,P=0.539).After 8wk of treatment,the average corneal subbasal nerve fiber density increased significantly(P<0.01),as did the number of corneal nerve fiber branches(P=0.001).CONCLUSION:RhNGF can increase the density of corneal subbasal nerve fibers,promote the healing of persistent corneal epithelial defects and corneal ulcers in patients with NK,also improving tear function partially.展开更多
Objective: To analyze the epidemiology, clinical diagnosis and treatment of fungal keratitis (FK) in hospitalized patients at the First Affiliated Hospital of Yangtze University in recent years. Methods: A retrospecti...Objective: To analyze the epidemiology, clinical diagnosis and treatment of fungal keratitis (FK) in hospitalized patients at the First Affiliated Hospital of Yangtze University in recent years. Methods: A retrospective investigation was conducted on the data of 137 cases of FK in our hospital from January 2019 to December 2022. The epidemiological characteristics, identification results of fungal strains, clinical treatment, and prognosis of the patients were analyzed. Results: Among the 137 FK patients, 89 were males and 48 were females, and the ratio of male to female was 1.85:1, The age of onset was the largest number of patients in 50-59 years old and 60-69 years old. The disease occurred most in autumn, winter and summer farming season (from September to December, January, May, June). 72 cases (52.6%) had a clear history of corneal injury, and 43 cases (31.4%) had a history of plant injury. Other risk factors include eye surface diseases, ophthalmic surgery, and wearing corneal contact lenses. The top three pathogens were fusarium (38.7%), aspergillus (23.3%), and alternaria (17.5%). 101 eyes showed improvement or cure after treatment with medication, 9 eyes underwent corneal stromal injection, 11 eyes were covered with conjunctival flap covering or amniotic membrane transplantation, 12 eyes were covered with corneal transplantation, and enucleation of ocular contents was performed in 4 eyes;Visual acuity was improved or maintained in 123 patients (about 89.8%). Conclusions: The incidence of FK in our hospital was mostly middle-aged and elderly men, mostly caused by corneal injury in the process of agricultural labor. The pathogens were mainly fusarium and aspergillus. The preferred treatment was medication, with severe cases requiring combined surgical treatment. Most patients can maintain or improve their vision after treatment.展开更多
·AIM:To report a case which keratitis is the first clinical manifestation of COVID-19 that occurred 3 d earlier than the common COVID-19 symptoms.·METHODS:Regular slit lamp examination,corneal scraping test,...·AIM:To report a case which keratitis is the first clinical manifestation of COVID-19 that occurred 3 d earlier than the common COVID-19 symptoms.·METHODS:Regular slit lamp examination,corneal scraping test,and chest computed tomography(CT)were performed for patients with COVID-19 infection.The ophthalmologic treatment included ganciclovir eye drop(50 mglmL,6 times/d).The treatment for diarrhea included Guifu Lizhong pills(TID).The antiviral therapy consisted of oseltamivir(75 mg capsule Q12 H);therapy preventing bacterial infection consisted of azithromycin(250 mg tablet QD)and moxifloxacin(0.4 g tablet Q12 H);and therapy for cough relief and fever prevention consisted of Chinese herbal decoction.·RESULTS:A 35-year-old male suddenly suffered pain,photophobia,and tears in his right eye for one day without systemic COVID-19 symptoms.Patient was diagnosed with keratitis,which was seemingly different from common keratitis.Ganciclovir eye drop was initiated.The corneal scraping test for COVID-19 was positive.The chest CT images were abnormal confirming the diagnosis of COVID-19 infection.The antiviral and antibacterial therapies were initiated.Chinese herbal therapy was used for cough relief and fever prevention.After roughly two weeks,patient recovered from COVID-19.·CONCLUSION:A new type of keratitis,atypical keratitis,is a clinical manifestation of COVID-19,and this clinical manifestation could appear 3 d earlier than fever and cough.The earlier a COVID-19 clinical manifestation is identified,the earlier can a patient be directed to stay at home,and significantly fewer people would be infected.展开更多
AIM: To evaluate the efficacy of topical administration Natamycin, which is produced by China, in an experimental rabbit model of Fusarium solani keratitis, to provide experimental basis for the application of clinica...AIM: To evaluate the efficacy of topical administration Natamycin, which is produced by China, in an experimental rabbit model of Fusarium solani keratitis, to provide experimental basis for the application of clinical safety. · METHODS: Fusarium solani was induced in the right eye of 30 New Zealand rabbits. Forty-eight hours after inoculation, the animals were divided into 3 different treatment groups, 10 rabbit eyes of each group: Group 1 (Natamycin) treated with topical Natamycin, group 2 (Natacyn) treated with topical Natacyn, group 3 (control) treated with topical saline solution. The eyes of each group was examined clinically with slit lamp using ulcer scoring system on day 4, 10, 15, and 21 for status of healing, corneal vascularisation, iritis, hypopyon and macular nebula. The findings were recorded on day 10 and day 21. · RESULTS: Ulcer score on day 10, day 15, day 21: The score of Natamycin group are 1.45±0.16, 1.08±0.11, 0.70±0.40. The score of Natacyn group are 1.35±0.12, 1.10±0.12, 0.65±0.35. the score of control group are 1.30±0.08, 3.63±0.28, 3.80±0.16. Natamycin group and Natacyn group were different from control group(P <0.01). There is no difference between Natamycin group and Natacyn group. Status of healing on day 10 and day 21: The cure rate of the Natamycin group is 90% on day 10, and 100% on day 21. The cure rate of the Natacyn group is 80% on day 10, and 100% on day 21.Natamycin group and Natacyn group were different from control group (P <0.01). There is no difference between Natamycin group and Natacyn group. Corneal vascularisation, iritis, hypopyon and macular nebula on day 10 and day 21: in Natamycin group, the number of the eyes which have Corner vascularisation, iritis, hypopyon and macular nebula are 2,0,0,2. In Natacyn group, the number of the eyes which have Corner vascularisation, iritis, hypopyon and macular nebula are 1,0,0,2. In control group, the number of the eyes which have Corner vascularisation, iritis, hypopyon and macular nebula are 9,9,8,9.Natamycin group and Natacyn group were different from control group (P< 0.01). There is no difference between Natamycin group and Natacyn group. · CONCLUSION: Natamycin was found to be effective in fungal keratitis, similar to Natacyn, and it can stop the corner vascularisation, iritis, hypopyon and macular nebula to happen. Natamyin manufactured in China is effective against fungal keratitis, with esay availability and low toxicity in its use.展开更多
AIM:To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis.· METHODS:A retro...AIM:To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis.· METHODS:A retrospective study was done to 10 patients (10 eyes) who had accepted removal of the necrotic corneal tissue combined with conjunctival flap covering surgery for fungal keratitis,the diagnosis by corneal scraping and smear examination or confocal microscopy check hyphae.Local and systemic antifungal therapy more than one week for all patients,corneal ulcer enlarge or no shrink.Slit lamp microscope examination the diameter of corneal ulcer about 2mm-4mm.Anterior segment optical coherence tomography(AS-OCT)examine the depth of corneal ulcer between 1/3-1/2,infiltrate corneal stroma about 20um-80um,the diameter of corneal ulcer about 3mm-6mm.Type-B ultrasonic exclusion endophthalmitis.Complete removal lesions until transparent of stroma,make conjunctival flap equal or greater than ulcer 1mm nearby conjunctiva.Continued antifungal therapy.The vision,fungal recurrence,conjunctival flap rollback or desquamate were analysed.· RESULTS:Ten patients had success done this surgery,the corneal ulcer was not enlarge and healing afteroperation.7 cases were bridging conjunctival flap and 3cases were single conjunctival flap.Preoperation vision above 0.1 had 8 cases,7 cases had vision above 0.1 one week after surgery,while 1 cases vision droped from 0.3 to 0.05.There was not recurrent for fungal,2 cases conjunctival flap rollback:1 case was bridging and 1case was single flap,no conjunctival flap desquamate.· CONCLUSION:It is safe and effective to perform removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis which werenot sensitive or aggravate for antifungal drugs.展开更多
AIM: To investigate the inflammatory amplification effect of high-mobility group box 1(HMGB1) in Aspergillus fumigatus(A. fumigatus) keratitis and the relationship between lectin-like oxidized low-density lipoprotein ...AIM: To investigate the inflammatory amplification effect of high-mobility group box 1(HMGB1) in Aspergillus fumigatus(A. fumigatus) keratitis and the relationship between lectin-like oxidized low-density lipoprotein receptor 1(LOX-1) and HMGB1 in keratitis immune responses.METHODS: Phosphate buffer saline(PBS), and Boxb were injected into BALB/c mice subconjunctivally before the corneas were infected with A. fumigatus. RAW264.7 macrophages and neutrophils were pretreated with PBS and Boxb to determine the HMGB1 inflammatory amplification effects. Abdominal cavity extracted macrophages were pretreated with Boxb and Poly(I)(a LOX-1 inhibitor) before A. fumigatus hyphae stimulation to prove the the relationship between the two molecules. LOX-1, interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), macrophage inflammatory protein-2(MIP-2) and IL-10 were assessed by polymerase chain reaction and Western blot.RESULTS: Pretreatment with Boxb exacerbated corneal inflammation. In macrophages and neutrophils, A. fumigatus induced LOX-1, IL-1β, TNF-α and MIP-2 expression in Boxb group was higher than those in PBS group. Poly(I) treatments before infection alleviated the proinflammatory effects of Boxb in abdominal cavity extracted macrophages. Pretreatment with Boxb did not influence Dectin-1 mRNA levels in macrophages and neutrophils.CONCLUSION: In fungal keratitis, HMGB1 is a proinflammatory factor in the first line of immune response. HMGB1 mainly stimulates neutrophils and macrophages to produce inflammatory cytokines and chemokines during the immune response. LOX-1 participates in HMGB1 induced inflammatory exacerbation in A. fumigatus keratitis.展开更多
·AIM:To investigate the expression of interleukin-10 (IL-10) and the effect of NS-398(COX-2 inhibitor) on the expression of IL-10 in fungal keratitis in rats,and analyze its effects on anti-fungus immunity.·...·AIM:To investigate the expression of interleukin-10 (IL-10) and the effect of NS-398(COX-2 inhibitor) on the expression of IL-10 in fungal keratitis in rats,and analyze its effects on anti-fungus immunity.·METHODS:Ninety Wister rats were randomly divided into 3 groups.Group A was blank control group (10 eyes).Group B was fungal keratitis group (40 eyes).Group C was fungal keratitis group treated with NS-398 (40 eyes).PAS staining,100g/L potassium hydroxide (KOH) smear and fungal culture confirmed the successful establishment of fungal keratitis model.After the central epithelium was scraped,Fusarium solani colonies were applied and contact lens was put on the right cornea of group B and C,and plane contact lens was put on the left cornea of control eyes.Phosphate buffered saline (PBS) eyedrops were given for group B and NS-398 eyedrops for group C.The expression of IL-10 on corneas of group B and C on the 1st day,3rd days,7th days,and 14th days were detected by immunohistochemistry and semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR).·RESULTS:Histopathologic examination showed neutrophil infiltration and severe tissue necrosis in ulcer cornea.PAS staining confirmed the existence of hyphae and spores in the superficial layer of stroma.In the blank and control groups almost no expression of IL-10 was detected at any observing points.In group B the expression of IL-10 increased at first and decreased thereafter.Its expression also showed significant difference at any observing points (P￡?0.01).Compared with group B,the expression of IL-10 in group C showed no difference on the 1stday,decrease on the 3rd day,but a significant increase on the 7th day and 14th day.·CONCLUSION:IL-10 takes part in the occurrence and development of fungal keratitis.NS-398 can upgrade the expression of IL-10 in fungal keratitis in the later period of the ulcer.Meanwhile,pathologic observation showed a slightly corneal opacity.IL-10 may play an important role in the process of cornea anti-damage repair.·展开更多
AIM: To investigate the ocular surface microbiome profile of patients with fungal keratitis(FK) through bacterial 16 S r DNA sequencing. METHODS: The swab samples were collected from 8 patients with FK(Group 1 from th...AIM: To investigate the ocular surface microbiome profile of patients with fungal keratitis(FK) through bacterial 16 S r DNA sequencing. METHODS: The swab samples were collected from 8 patients with FK(Group 1 from the corneal ulcer, Group 2 from the conjunctival sac of the infected eyes, and Group 3 from the conjunctival sac of the fellow eyes) and 10 healthy eyes(Group 4 from the conjunctival sac). Bacterial 16 S rDNA V4-V5 region sequencing was performed to characterize the bacterial communities on the ocular surfaces of the patients with FK. RESULTS: Our metagenomic data showed that 97% of the sequence reads were categorized into 245 distinct bacterial genera, with 67.75±7.79 genera detected in Group 1, 73.80±13.44 in Group 2, 74.57±14.14 in Group 3, and 89.60±27.49 in Group 4. Compared with the healthy eyes(Group 4), both infected(Groups 1 and 2) and fellow eyes(Group 3) of the patients with FK showed reduced bacterial diversity and altered ocular surface microbiota compositions, with lower abundance of Corynebacterium and Staphylo coccus and higher abundances of Pseudomonas, Achromobacter, Caulobacter and Psychrobacter. CONCLUSION: Our report depicts the altered ocular surface bacterial community structures both in the affected and fellow eyes of patients with FK. These changes may contribute to the pathogenesis of FK or the increased risk for FK.展开更多
AIM:To investigate the effect of amniotic membrane covering(AMC) on the healing of cornea epithelium and visual acuity for fungal keratitis after debridement.METHODS:Twenty fungal keratitis patients were divided into ...AIM:To investigate the effect of amniotic membrane covering(AMC) on the healing of cornea epithelium and visual acuity for fungal keratitis after debridement.METHODS:Twenty fungal keratitis patients were divided into two groups randomly, the AMC group and the control group, ten patients each group. Both debridement of the infected cornea tissue and standard anti-fungus drugs treatments were given to every patients, monolayer amniotic membrane were sutured to the surface of the entire cornea and bulbar conjunctiva with 10-0 nylon suture for patients in the AMC group.The diameter of the ulcer was determined with slit lamp microscope and the depth of the infiltration was determined with anterior segment optical coherence tomography. Uncorrected visual acuity(UCVA) was tested before surgery and three month after healing of the epithelial layer. The healing time of the cornea epithelium, visual acuity(VA) was compared between the two groups using t- test.RESULTS:There was no statistical difference of the diameter of the ulcer, depth of the infiltration, height of the hypopyon and VA between the two groups beforesurgery(P >0.05). The average healing time of the AMC group was 6.89 ±2.98 d, which was statistically shorter than that of the control group(10.23±2.78d)(P <0.05).The average UCVA of the AMC group was 0.138 ±0.083,which was statistically better than that of the control group(0.053±0.068)(P <0.05).CONCLUSION:AMC surgery could promote healing of cornea epithelium after debridement for fungal keratitis and lead to better VA outcome.展开更多
AIM: To observe the curative effect of bandage contact lens in neurogenic keratitis.METHODS: Twenty cases of neurogenic keratitis were studied at the Department of Ophthalmology, the First Affiliated Hospital of China...AIM: To observe the curative effect of bandage contact lens in neurogenic keratitis.METHODS: Twenty cases of neurogenic keratitis were studied at the Department of Ophthalmology, the First Affiliated Hospital of China Medical University, between October 2012 and June 2013. These included 13 males and 7 females, aged from 35 to 88 y. Patients were voluntarily divided into an experimental group(lens wearing group, n =10) and control group(drug therapy,n =10). In experimental group patients wore silicone hydrogel bandage soft contact lens. Both groups used the following eyedrops: 0.5% levofloxacin TID; 0.5%Sodium carboxymethyl cellulose QID; fibroblast growth factor BID; ganciclovir BID [cases complicated with herpes simplex virus(HSV)]; compound tropicamide BID(cases concurrent hypopyon). The healing time of corneal ulcer and complication rates were observed in the two groups.RESULTS: The healing time of corneal ulcer in the experimental group was 10.80±4.44 d versus 46.70±13.88 d in the control group(P <0.05). No complications occurred in the experimental group, except for the lens falling off twice in one case, the patient recovered eight days after rewearing the lens. While in the control group, all cases vascularized, 2 cases were complicated with descemetocele that recovered with amniotic membrane transplantation and 1 case was complicated with corneal perforation that recovered by autologous conjunctival flap covering.CONCLUSION: Bandage contact lens is a safe and effective method of treating neurogenic keratitis andsignificantly shortened the healing time of corneal ulcer.展开更多
●AIM:To observe the expression and role of aryl hydrocarbon receptor(Ah R)in the immune response of mouse cornea infected with Aspergillus fumigatus(A.fumigatus).●METHODS:Murine models of A.fumigatus keratitis were ...●AIM:To observe the expression and role of aryl hydrocarbon receptor(Ah R)in the immune response of mouse cornea infected with Aspergillus fumigatus(A.fumigatus).●METHODS:Murine models of A.fumigatus keratitis were established by scraping the central epithelium of mouse cornea,daubing A.fumigatus on the cornea and covering with a contact lens.The mice were randomly divided into the control group and the A.fumigatus-infected(A.F.)group for 1,3 and 5 d respectively,which corneas were daily monitored by a slit lamp microscope and the clinical scores were also recorded timely after infection.In this study,immunofluorescence staining was used to detect the expression and localization of Ah R in mouse corneas,and the m RNA and protein of Ah R were detected by reverse transcription-polymerase chain reaction(RT-PCR)and Western blot.In addition,mouse peritoneal macrophages were stimulated by A.fumigatus with or without the pretreatment of Ah R antagonist CH223191 and Ah R agonist FICZ,and the tumor necrosis factor alpha(TNF-α),inducible nitric oxide synthase(i NOS),interleukin-10(IL-10)and Arg-1 m RNA were detected by RT-PCR.●RESULTS:According to the results of the slit light photography,it was clearly indicated that the corneal inflammation were the most severe and the clinical score became the highest as well on the 3 rd day after the infection of A.fumigatus.Contrasted with the control group,the expression of Ah R in the corneal epithelial cells infected with A.fumigatus was significantly increased detected by immunofluorescence staining.Ah R mainly expressed in the nucleus and cytoplasm of corneal epithelial cells.Consistent with the transcriptional level of Ah R m RNA,the expression level of Ah R protein reached the peak on the 3 rd day after infection which was detected by Western blot.Furthermore,RT-PCR showed that CH223191 up-regulated the expression of TNF-αand i NOS and down-regulated the expression of IL-10 and Arg-1 in peritoneal macrophages;inversely,FICZ reduced the expression of TNF-αand i NOS while elevated the expression of IL-10 and Arg-1.●CONCLUSION:Ah R is involved in the pathogenesis of A.fumigatus keratitis and induced immune protection in anti-A.fumigatus immune response by inhibiting M1 and increasing M2 phenotype macrophage-related inflammatory factors.展开更多
AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of...AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of surgery in the treatment.METHODS: The clinical records of 27 patients(27 eyes)with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained.RESULTS: There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule,accounting for 56%, 26%, 15% and 2.5%, respectively.Fusarium was identified in 44%(12/27) of the eyes,followed by Aspergillus in 22%(6/27). Posterior segment infection was involved in 78%(21/27) of the patients. The corneal infection was larger than 3 mm×3 mm in 89%(24/27) of the patients, and 22%(6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes(81.5%) underwent penetrating keratoplasty(PKP), and over half of them(54.5%)were operated within 3d from the onset of antifungal therapy. Fourteen eyes(52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes(55.6%) underwent pars plana vitrectomy(PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60%(9/15),lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes(16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes(18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION: Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis.Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy(especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.展开更多
AIM:To explore the effects of lectin-like ox-LDL receptor(LOX-1) on innate immunity against Aspergillus fumigatus(A.fumigatus) in mice cornea.METHODS:The mRNA levels of LOX-1 were tested in normal and A.fumigatus infe...AIM:To explore the effects of lectin-like ox-LDL receptor(LOX-1) on innate immunity against Aspergillus fumigatus(A.fumigatus) in mice cornea.METHODS:The mRNA levels of LOX-1 were tested in normal and A.fumigatus infected corneas of C57BL/6and BALB/c mice.The expression of LOX-1,pro-inflammatory cytokines TNF-α,CXCL1 and IL-6,antiinflammatory cytokines IL-10,and matrix metalloproteinase 9(MMP9) were tested with treatment with LOX-1 neutralizing antibody or control IgG in A.fum/gatus infected corneas of C57BL/6.Macrophages and neutrophils were extracted from susceptible C57BL/6mice,and pretreated with LOX-1 neutralizing antibody or IgG,then stimulated with A.fum/gatus.The mRNA levels of LOX-1,TNF-α,CXCL1,IL-6,IL-10 and MMP9 were evaluated by polymerase chain reaction.RESULTS:The expression of LOX-1 was significantly increased in C57BL/6 mice corneas after A.fum/gatus infection compared with BABL/c mice.After treatment with LOX-1 neutralizing antibody,the expression of LOX-1,TNF-α,CXCL1,IL-6,MMP9 and IL-10 in C57BL/6corneas were significantly decreased compared with treatment with control IgG;the expression of LOX-1,CXCL1,IL-6 and IL-10 were significantly decreased in macrophages,while TNF-α and MMP9 expressions had no change;LOX-1,TNF-α,CXCL1,IL-6,MMP9 and IL-10 expressions were significantly decreased in neutrophils.CONCLUSION:The expression of LOX-1 can affect the expression of pro-inflammatory and anti-inflammatory cytokines in fungal infected corneas,macrophages and neutrophils of C57BL/6.LOX-1 inhibition rebalances the inflammatory response of fungal keratitis in mice.展开更多
AIM:To characterize effect of astaxanthin(ASX)in Aspergillus fumigatus(A.fumigatus)induced keratitis in mouse model.METHODS:In vivo,fungal keratitis mouse model was established in C57BL/6 mice using A.fumigatus,follow...AIM:To characterize effect of astaxanthin(ASX)in Aspergillus fumigatus(A.fumigatus)induced keratitis in mouse model.METHODS:In vivo,fungal keratitis mouse model was established in C57BL/6 mice using A.fumigatus,followed by ASX or dimethyl sulfoxide(DMSO)treatment.Clinical responses were evaluated by clinical score and myeloperoxidase(MPO)assay.Inflammatory cytokines were assessed by reverse-transcription polymerase chain reaction(RT-PCR),Western blot,immunofluorescence,and enzyme-linked immuno sorbent assay(ELISA).RESULTS:In animal model,ASX improved corneal transparency and clinical response,suppressed the expression of inflammatory cytokine like IL-1β,TNF-α,and HMGB-1.Neutrophil levels have been shown to decrease in ASX-treated cornea by immunofluorescence and MPO.TLR2 and TLR4 levels were lower in ASX-treated group than DMSO-treated.CONCLUSION:ASX can suppress inflammatory response and reduce inflammatory cytokine production in mice model with A.fumigatus keratitis.展开更多
文摘The aim of our minireview is to provide a brief overview of the diagnosis,clinical aspects,treatment options,management,and current literature available regarding herpes simplex keratitis(HSK).This type of corneal viral infection is caused by the herpes simplex virus(HSV),which can affect several tissues,including the cornea.One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea.After the initial infection,the HSV can establish a latent infection in the trigeminal ganglion,a nerve cluster near the eye.The virus may remain dormant for extended periods.Periodic reactivation of the virus can occur,leading to recurrent episodes of HSK.Factors triggering reactivation include stress,illness,immunosuppression,or trauma.Recurrent episodes can manifest in different clinical patterns,ranging from mild epithelial involvement to more severe stromal or endothelial disease.The severity and frequency of recurrences vary among individuals.Severe cases of HSK,especially those involving the stroma and leading to scarring,can result in vision impairment or even blindness in extreme cases.The cornea's clarity is crucial for good vision,and scarring can compromise this,potentially leading to visual impairment.The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization.Antiviral medications,such as oral Acyclovir or topical Ganciclovir,may be prescribed for prophylaxis.The immune response to the virus can contribute to corneal damage.Inflammation,caused by the body's attempt to control the infection,may inadvertently harm the corneal tissues.Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation.In summary,the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.
文摘Fungal keratitis is an important cause of corneal blindness in China, accounting for 45% of infectious keratitis. The main pathogenic bacteria include yeast, filamentous bacteria and nearly 100 kinds of fungi, which are difficult to diagnose, difficult to treat and poor prognosis. When the infected fungal strains have strong virulence and poor drug sensitivity, it is easy to prolong the disease. Once the fungal infection involves the whole limbus and reaches the whole layer of the cornea, it will be followed by intraocular tissue infection such as anterior chamber, lens and vitreous body. When the infection is difficult to control and the visual function is seriously damaged, the enucleation of eye contents has to be performed, which causes irreversible harm to the patient’s appearance and physical and mental health. Therefore, in order to gain greater hope for the vision of patients with fungal keratitis, In recent years, with the continuous progress of clinical medicine and microbiological diagnostics, the treatment methods of fungal keratitis have been constantly updated. This article will briefly review the new progress in drug and surgical treatment of fungal keratitis in recent years to provide patients with better visual prognosis. .
文摘AIM:To report the etiologies,risk factors,treatments,and outcomes of infectious keratitis(IK)at a major Vietnamese eye hospital.METHODS:This is a retrospective review of all cases of IK at Vietnam National Eye Hospital(VNEH)in Hanoi,Vietnam.Medical histories,demographics,clinical features,microbiological results,and treatment outcomes were reviewed.RESULTS:IK was diagnosed in 1974 eyes of 1952 patients,with ocular trauma being the greatest risk factor for IK(34.2%),frequently resulting from an agriculturerelated injur y(53.3%).The mean duration between symptom onset and presentation to VNEH was 19.3±14.4 d,and 98.7%of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH.Based on smear results of 1706 samples,the most common organisms identified were bacteria(n=1107,64.9%)and fungi(n=1092,64.0%),with identification of both bacteria and fungi in 614(36.0%)eyes.Fifty-five of 374 bacterial cultures(14.7%)and 426 of 838 fungal cultures(50.8%)were positive,with the most commonly cultured pathogens being Pseudomonas aeruginosa,Streptococcus pneumonia,Fusarium spp.,and Aspergillus spp.Corneal perforation and descemetocele developed in 391(19.8%)and 93(4.7%)eyes,respectively.Medical treatment was successful in resolving IK in 50.4%eyes,while 337(17.1%)eyes underwent penetrating or anterior lamellar keratoplasty.Evisceration was performed in 7.1%of eyes,most commonly in the setting of fungal keratitis.CONCLUSION:Ocular trauma is a major risk factor for IK in Vietnam,which is diagnosed in almost 400 patients each year at VNEH.Given this,and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration,greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.
基金Supported by the National Natural Science Foundation of China(No.82171025No.82070934)+2 种基金the Fundamental Research Funds for the Central Universities(No.HUST:2019kfy XMBZ065)the Key Research and Development Program of Hubei Province(No.2021BCA146)the Clinical Research Foundation of Wuhan Union Hospital(No.2021xhlcyj03)。
文摘AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.
基金Supported by the National Natural Science Foundation of China(No.82271052,No.82271058,No.U20A20386)the Taishan Scholar Program(No.tspd20150215,No.tsqn201909188)。
文摘AIM:To evaluate the correlation between Demodex infestation and keratitis,and to assess demodicosis using a simple approach.METHODS:A modified slit lamp illumination(at 40×magnification)was used to observe Demodex tails in 40patients with refractory keratitis and 80 healthy controls.Bacterial smear and culture of the conjunctival sac and corneal lesion were performed to identify the pathogen.Tea tree oil ointment(TTOO)was added as a Demodex killing agent for lid scrubs to the treatment when Demodex infestation was confirmed.RESULTS:Demodex tails were found in all patients compared to 42/80 of the controls(P<0.01).Seventeen patients presented blepharitis,while 23 were free of scales and inflammation at the lid margin.The demodicosis was mild,moderate,and severe in 8,19,and 13 patients,respectively,compared to mild in 42 controls(P<0.01).The keratitis was mild,moderate,and severe in 13,19,and 8patients,respectively.The severity of Demodex infestation was not correlated to the severity of keratitis(P=0.126).The growth of Staphylococcus was revealed in nine patients who did not react to antibiotic eye drops prior to the TTOO treatment.Patients’signs and symptoms got resolved after the lid scrub with TTOO.CONCLUSION:Ocular Demodex needs to be checked and treated in refractory keratitis patients with or without blepharitis.A slit-lamp illumination under high magnification favors the judgment of the severity of Demodex infestation.
基金Supported by the National Natural Science Foundation of China(No.82171025,No.82070934)the Fundamental Research Funds for the Central Universities(HUST:No.2019kfyXMBZ065)+1 种基金the Key Research and Development Program of Hubei Province(No.2021BCA146)the Clinical Research Foundation of Wuhan Union Hospital(No.2021xhlcyj03).
文摘AIM:To analyze a series of antimicrobial peptides(AMPs)in corneal tissue from individuals with fungal keratitis(FK)during the active phase of the fungus infection and after healing.METHODS:Patients undergone lamellar keratoplasty for the treatment of severe FK or corneal scar had their corneal buttons sampled.Quantitative real-time polymerase chain reaction(PCR)was used to ascertain the gene expression of human beta-defensin(HBD)-1,-2,-3,-9,S100A7,8,9,and LL-37.RESULTS:All AMPs’messenger ribonucleic acid(mRNA)expression was considerably elevated in all samples(n=12).In contrast to controls,where HBD-2,-3,and S100A7 mRNAs were expressed at very low levels,it was discovered that HBD-1,-9,S100A8,S100A9,and LL-37 were constitutively expressed in all healed samples(n=4).HBD-1,-2-3,S100A7,and LL-37 mRNAs were significantly increased in all active FK samples(n=8).The levels of HBD-9,S100A8,and S100A9 mRNAs were moderately upregulated in all active FK samples.Subgroup comparison showed that HBD-2 was significantly increased in Fusarium keratitis samples(n=5),and LL-37 mRNAs were significantly enhanced in Aspergillus keratitis samples(n=3).Whereas there was not significantly increased of HBD-1,-3,-9,S100A7,8,9 mRNA in Aspergillus keratitis samples compared with Fusarium keratitis samples.CONCLUSION:AMPs expression is increased in active FK,but not all AMPs are equally expressed.HBD-2 and LL-37 expression levels are the highest,showing some specificity of AMP expression related to FK.Human AMPs,particularly HBD-2 may play a significant role in Fusarium keratitis and LL-37 might be the key player in Aspergillus keratitis.
基金Supported by the Shaanxi Provincial Department of Science and Technology(No.2021SF-331)。
文摘AIM:To characterize changes of corneal nerve morphology and tear indices in patients with neurotrophic keratitis(NK)treated with recombinant human nerve growth factor(rhNGF).METHODS:In a prospective observational study,six patients(nine eyes)were locally treated with rhNGF.Visual acuity,corneal fluorescein staining score,the heights of the tear river,lipid layer thickness(LLT),tear ferning(TF)test,conjunctival impression cytology(CIC)examination,the densities of cornea subbasal nerve fibers were determined before and after treatment.RESULTS:Compared with baseline,there was a significant difference in corneal fluorescence staining scores(P<0.01);all patient corneal epithelial defects recovered completely within 8wk,but there was no significant improvement in the height of the tear river(P=0.202).LLT was significantly increased when compared with baseline(P=0.042);however,the function of conjunctival goblet cells and mucin content did not significantly improve using the TF test and CIC examination(P=0.557,P=0.539).After 8wk of treatment,the average corneal subbasal nerve fiber density increased significantly(P<0.01),as did the number of corneal nerve fiber branches(P=0.001).CONCLUSION:RhNGF can increase the density of corneal subbasal nerve fibers,promote the healing of persistent corneal epithelial defects and corneal ulcers in patients with NK,also improving tear function partially.
文摘Objective: To analyze the epidemiology, clinical diagnosis and treatment of fungal keratitis (FK) in hospitalized patients at the First Affiliated Hospital of Yangtze University in recent years. Methods: A retrospective investigation was conducted on the data of 137 cases of FK in our hospital from January 2019 to December 2022. The epidemiological characteristics, identification results of fungal strains, clinical treatment, and prognosis of the patients were analyzed. Results: Among the 137 FK patients, 89 were males and 48 were females, and the ratio of male to female was 1.85:1, The age of onset was the largest number of patients in 50-59 years old and 60-69 years old. The disease occurred most in autumn, winter and summer farming season (from September to December, January, May, June). 72 cases (52.6%) had a clear history of corneal injury, and 43 cases (31.4%) had a history of plant injury. Other risk factors include eye surface diseases, ophthalmic surgery, and wearing corneal contact lenses. The top three pathogens were fusarium (38.7%), aspergillus (23.3%), and alternaria (17.5%). 101 eyes showed improvement or cure after treatment with medication, 9 eyes underwent corneal stromal injection, 11 eyes were covered with conjunctival flap covering or amniotic membrane transplantation, 12 eyes were covered with corneal transplantation, and enucleation of ocular contents was performed in 4 eyes;Visual acuity was improved or maintained in 123 patients (about 89.8%). Conclusions: The incidence of FK in our hospital was mostly middle-aged and elderly men, mostly caused by corneal injury in the process of agricultural labor. The pathogens were mainly fusarium and aspergillus. The preferred treatment was medication, with severe cases requiring combined surgical treatment. Most patients can maintain or improve their vision after treatment.
基金Supported by the Tongji-Rockcheck Life Science and Medicine Research Center(No.202014)。
文摘·AIM:To report a case which keratitis is the first clinical manifestation of COVID-19 that occurred 3 d earlier than the common COVID-19 symptoms.·METHODS:Regular slit lamp examination,corneal scraping test,and chest computed tomography(CT)were performed for patients with COVID-19 infection.The ophthalmologic treatment included ganciclovir eye drop(50 mglmL,6 times/d).The treatment for diarrhea included Guifu Lizhong pills(TID).The antiviral therapy consisted of oseltamivir(75 mg capsule Q12 H);therapy preventing bacterial infection consisted of azithromycin(250 mg tablet QD)and moxifloxacin(0.4 g tablet Q12 H);and therapy for cough relief and fever prevention consisted of Chinese herbal decoction.·RESULTS:A 35-year-old male suddenly suffered pain,photophobia,and tears in his right eye for one day without systemic COVID-19 symptoms.Patient was diagnosed with keratitis,which was seemingly different from common keratitis.Ganciclovir eye drop was initiated.The corneal scraping test for COVID-19 was positive.The chest CT images were abnormal confirming the diagnosis of COVID-19 infection.The antiviral and antibacterial therapies were initiated.Chinese herbal therapy was used for cough relief and fever prevention.After roughly two weeks,patient recovered from COVID-19.·CONCLUSION:A new type of keratitis,atypical keratitis,is a clinical manifestation of COVID-19,and this clinical manifestation could appear 3 d earlier than fever and cough.The earlier a COVID-19 clinical manifestation is identified,the earlier can a patient be directed to stay at home,and significantly fewer people would be infected.
基金Supported by Major Project of The Ministry of Science and Technology of China (No. 2007BAI26B07)
文摘AIM: To evaluate the efficacy of topical administration Natamycin, which is produced by China, in an experimental rabbit model of Fusarium solani keratitis, to provide experimental basis for the application of clinical safety. · METHODS: Fusarium solani was induced in the right eye of 30 New Zealand rabbits. Forty-eight hours after inoculation, the animals were divided into 3 different treatment groups, 10 rabbit eyes of each group: Group 1 (Natamycin) treated with topical Natamycin, group 2 (Natacyn) treated with topical Natacyn, group 3 (control) treated with topical saline solution. The eyes of each group was examined clinically with slit lamp using ulcer scoring system on day 4, 10, 15, and 21 for status of healing, corneal vascularisation, iritis, hypopyon and macular nebula. The findings were recorded on day 10 and day 21. · RESULTS: Ulcer score on day 10, day 15, day 21: The score of Natamycin group are 1.45±0.16, 1.08±0.11, 0.70±0.40. The score of Natacyn group are 1.35±0.12, 1.10±0.12, 0.65±0.35. the score of control group are 1.30±0.08, 3.63±0.28, 3.80±0.16. Natamycin group and Natacyn group were different from control group(P <0.01). There is no difference between Natamycin group and Natacyn group. Status of healing on day 10 and day 21: The cure rate of the Natamycin group is 90% on day 10, and 100% on day 21. The cure rate of the Natacyn group is 80% on day 10, and 100% on day 21.Natamycin group and Natacyn group were different from control group (P <0.01). There is no difference between Natamycin group and Natacyn group. Corneal vascularisation, iritis, hypopyon and macular nebula on day 10 and day 21: in Natamycin group, the number of the eyes which have Corner vascularisation, iritis, hypopyon and macular nebula are 2,0,0,2. In Natacyn group, the number of the eyes which have Corner vascularisation, iritis, hypopyon and macular nebula are 1,0,0,2. In control group, the number of the eyes which have Corner vascularisation, iritis, hypopyon and macular nebula are 9,9,8,9.Natamycin group and Natacyn group were different from control group (P< 0.01). There is no difference between Natamycin group and Natacyn group. · CONCLUSION: Natamycin was found to be effective in fungal keratitis, similar to Natacyn, and it can stop the corner vascularisation, iritis, hypopyon and macular nebula to happen. Natamyin manufactured in China is effective against fungal keratitis, with esay availability and low toxicity in its use.
文摘AIM:To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis.· METHODS:A retrospective study was done to 10 patients (10 eyes) who had accepted removal of the necrotic corneal tissue combined with conjunctival flap covering surgery for fungal keratitis,the diagnosis by corneal scraping and smear examination or confocal microscopy check hyphae.Local and systemic antifungal therapy more than one week for all patients,corneal ulcer enlarge or no shrink.Slit lamp microscope examination the diameter of corneal ulcer about 2mm-4mm.Anterior segment optical coherence tomography(AS-OCT)examine the depth of corneal ulcer between 1/3-1/2,infiltrate corneal stroma about 20um-80um,the diameter of corneal ulcer about 3mm-6mm.Type-B ultrasonic exclusion endophthalmitis.Complete removal lesions until transparent of stroma,make conjunctival flap equal or greater than ulcer 1mm nearby conjunctiva.Continued antifungal therapy.The vision,fungal recurrence,conjunctival flap rollback or desquamate were analysed.· RESULTS:Ten patients had success done this surgery,the corneal ulcer was not enlarge and healing afteroperation.7 cases were bridging conjunctival flap and 3cases were single conjunctival flap.Preoperation vision above 0.1 had 8 cases,7 cases had vision above 0.1 one week after surgery,while 1 cases vision droped from 0.3 to 0.05.There was not recurrent for fungal,2 cases conjunctival flap rollback:1 case was bridging and 1case was single flap,no conjunctival flap desquamate.· CONCLUSION:It is safe and effective to perform removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis which werenot sensitive or aggravate for antifungal drugs.
基金Supported by the National Natural Science Foundation of China(No.81470609 No.81500695+5 种基金 No.81700800 No.81870632 No.81800800)Natural Science Foundation of Shandong Province(No.ZR2017BH025 No.ZR2017MH008 No.ZR2013HQ007)
文摘AIM: To investigate the inflammatory amplification effect of high-mobility group box 1(HMGB1) in Aspergillus fumigatus(A. fumigatus) keratitis and the relationship between lectin-like oxidized low-density lipoprotein receptor 1(LOX-1) and HMGB1 in keratitis immune responses.METHODS: Phosphate buffer saline(PBS), and Boxb were injected into BALB/c mice subconjunctivally before the corneas were infected with A. fumigatus. RAW264.7 macrophages and neutrophils were pretreated with PBS and Boxb to determine the HMGB1 inflammatory amplification effects. Abdominal cavity extracted macrophages were pretreated with Boxb and Poly(I)(a LOX-1 inhibitor) before A. fumigatus hyphae stimulation to prove the the relationship between the two molecules. LOX-1, interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), macrophage inflammatory protein-2(MIP-2) and IL-10 were assessed by polymerase chain reaction and Western blot.RESULTS: Pretreatment with Boxb exacerbated corneal inflammation. In macrophages and neutrophils, A. fumigatus induced LOX-1, IL-1β, TNF-α and MIP-2 expression in Boxb group was higher than those in PBS group. Poly(I) treatments before infection alleviated the proinflammatory effects of Boxb in abdominal cavity extracted macrophages. Pretreatment with Boxb did not influence Dectin-1 mRNA levels in macrophages and neutrophils.CONCLUSION: In fungal keratitis, HMGB1 is a proinflammatory factor in the first line of immune response. HMGB1 mainly stimulates neutrophils and macrophages to produce inflammatory cytokines and chemokines during the immune response. LOX-1 participates in HMGB1 induced inflammatory exacerbation in A. fumigatus keratitis.
文摘·AIM:To investigate the expression of interleukin-10 (IL-10) and the effect of NS-398(COX-2 inhibitor) on the expression of IL-10 in fungal keratitis in rats,and analyze its effects on anti-fungus immunity.·METHODS:Ninety Wister rats were randomly divided into 3 groups.Group A was blank control group (10 eyes).Group B was fungal keratitis group (40 eyes).Group C was fungal keratitis group treated with NS-398 (40 eyes).PAS staining,100g/L potassium hydroxide (KOH) smear and fungal culture confirmed the successful establishment of fungal keratitis model.After the central epithelium was scraped,Fusarium solani colonies were applied and contact lens was put on the right cornea of group B and C,and plane contact lens was put on the left cornea of control eyes.Phosphate buffered saline (PBS) eyedrops were given for group B and NS-398 eyedrops for group C.The expression of IL-10 on corneas of group B and C on the 1st day,3rd days,7th days,and 14th days were detected by immunohistochemistry and semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR).·RESULTS:Histopathologic examination showed neutrophil infiltration and severe tissue necrosis in ulcer cornea.PAS staining confirmed the existence of hyphae and spores in the superficial layer of stroma.In the blank and control groups almost no expression of IL-10 was detected at any observing points.In group B the expression of IL-10 increased at first and decreased thereafter.Its expression also showed significant difference at any observing points (P￡?0.01).Compared with group B,the expression of IL-10 in group C showed no difference on the 1stday,decrease on the 3rd day,but a significant increase on the 7th day and 14th day.·CONCLUSION:IL-10 takes part in the occurrence and development of fungal keratitis.NS-398 can upgrade the expression of IL-10 in fungal keratitis in the later period of the ulcer.Meanwhile,pathologic observation showed a slightly corneal opacity.IL-10 may play an important role in the process of cornea anti-damage repair.·
基金Supported by the National Natural Science Foundation of China(No.81670839)the Key Research and Development Plan of Shandong Province(No.2018CXGC1205)
文摘AIM: To investigate the ocular surface microbiome profile of patients with fungal keratitis(FK) through bacterial 16 S r DNA sequencing. METHODS: The swab samples were collected from 8 patients with FK(Group 1 from the corneal ulcer, Group 2 from the conjunctival sac of the infected eyes, and Group 3 from the conjunctival sac of the fellow eyes) and 10 healthy eyes(Group 4 from the conjunctival sac). Bacterial 16 S rDNA V4-V5 region sequencing was performed to characterize the bacterial communities on the ocular surfaces of the patients with FK. RESULTS: Our metagenomic data showed that 97% of the sequence reads were categorized into 245 distinct bacterial genera, with 67.75±7.79 genera detected in Group 1, 73.80±13.44 in Group 2, 74.57±14.14 in Group 3, and 89.60±27.49 in Group 4. Compared with the healthy eyes(Group 4), both infected(Groups 1 and 2) and fellow eyes(Group 3) of the patients with FK showed reduced bacterial diversity and altered ocular surface microbiota compositions, with lower abundance of Corynebacterium and Staphylo coccus and higher abundances of Pseudomonas, Achromobacter, Caulobacter and Psychrobacter. CONCLUSION: Our report depicts the altered ocular surface bacterial community structures both in the affected and fellow eyes of patients with FK. These changes may contribute to the pathogenesis of FK or the increased risk for FK.
基金Supported by National Natural Science Foundation of China(No.81200661)Nature Science Foundation of Hubei Province(No.2010CDB09802)Wuhan Chenguang Plan Grant(No.201150431124)
文摘AIM:To investigate the effect of amniotic membrane covering(AMC) on the healing of cornea epithelium and visual acuity for fungal keratitis after debridement.METHODS:Twenty fungal keratitis patients were divided into two groups randomly, the AMC group and the control group, ten patients each group. Both debridement of the infected cornea tissue and standard anti-fungus drugs treatments were given to every patients, monolayer amniotic membrane were sutured to the surface of the entire cornea and bulbar conjunctiva with 10-0 nylon suture for patients in the AMC group.The diameter of the ulcer was determined with slit lamp microscope and the depth of the infiltration was determined with anterior segment optical coherence tomography. Uncorrected visual acuity(UCVA) was tested before surgery and three month after healing of the epithelial layer. The healing time of the cornea epithelium, visual acuity(VA) was compared between the two groups using t- test.RESULTS:There was no statistical difference of the diameter of the ulcer, depth of the infiltration, height of the hypopyon and VA between the two groups beforesurgery(P >0.05). The average healing time of the AMC group was 6.89 ±2.98 d, which was statistically shorter than that of the control group(10.23±2.78d)(P <0.05).The average UCVA of the AMC group was 0.138 ±0.083,which was statistically better than that of the control group(0.053±0.068)(P <0.05).CONCLUSION:AMC surgery could promote healing of cornea epithelium after debridement for fungal keratitis and lead to better VA outcome.
文摘AIM: To observe the curative effect of bandage contact lens in neurogenic keratitis.METHODS: Twenty cases of neurogenic keratitis were studied at the Department of Ophthalmology, the First Affiliated Hospital of China Medical University, between October 2012 and June 2013. These included 13 males and 7 females, aged from 35 to 88 y. Patients were voluntarily divided into an experimental group(lens wearing group, n =10) and control group(drug therapy,n =10). In experimental group patients wore silicone hydrogel bandage soft contact lens. Both groups used the following eyedrops: 0.5% levofloxacin TID; 0.5%Sodium carboxymethyl cellulose QID; fibroblast growth factor BID; ganciclovir BID [cases complicated with herpes simplex virus(HSV)]; compound tropicamide BID(cases concurrent hypopyon). The healing time of corneal ulcer and complication rates were observed in the two groups.RESULTS: The healing time of corneal ulcer in the experimental group was 10.80±4.44 d versus 46.70±13.88 d in the control group(P <0.05). No complications occurred in the experimental group, except for the lens falling off twice in one case, the patient recovered eight days after rewearing the lens. While in the control group, all cases vascularized, 2 cases were complicated with descemetocele that recovered with amniotic membrane transplantation and 1 case was complicated with corneal perforation that recovered by autologous conjunctival flap covering.CONCLUSION: Bandage contact lens is a safe and effective method of treating neurogenic keratitis andsignificantly shortened the healing time of corneal ulcer.
基金Supported by the National Natural Science Foundation of China(No.81870632)the Youth National Natural Science Foundation of China(No.81700800,No.81800800)the Natural Science Foundation of Shandong Province(No.ZR2019BH004,No.ZR2017MH008,No.ZR2017BH025).
文摘●AIM:To observe the expression and role of aryl hydrocarbon receptor(Ah R)in the immune response of mouse cornea infected with Aspergillus fumigatus(A.fumigatus).●METHODS:Murine models of A.fumigatus keratitis were established by scraping the central epithelium of mouse cornea,daubing A.fumigatus on the cornea and covering with a contact lens.The mice were randomly divided into the control group and the A.fumigatus-infected(A.F.)group for 1,3 and 5 d respectively,which corneas were daily monitored by a slit lamp microscope and the clinical scores were also recorded timely after infection.In this study,immunofluorescence staining was used to detect the expression and localization of Ah R in mouse corneas,and the m RNA and protein of Ah R were detected by reverse transcription-polymerase chain reaction(RT-PCR)and Western blot.In addition,mouse peritoneal macrophages were stimulated by A.fumigatus with or without the pretreatment of Ah R antagonist CH223191 and Ah R agonist FICZ,and the tumor necrosis factor alpha(TNF-α),inducible nitric oxide synthase(i NOS),interleukin-10(IL-10)and Arg-1 m RNA were detected by RT-PCR.●RESULTS:According to the results of the slit light photography,it was clearly indicated that the corneal inflammation were the most severe and the clinical score became the highest as well on the 3 rd day after the infection of A.fumigatus.Contrasted with the control group,the expression of Ah R in the corneal epithelial cells infected with A.fumigatus was significantly increased detected by immunofluorescence staining.Ah R mainly expressed in the nucleus and cytoplasm of corneal epithelial cells.Consistent with the transcriptional level of Ah R m RNA,the expression level of Ah R protein reached the peak on the 3 rd day after infection which was detected by Western blot.Furthermore,RT-PCR showed that CH223191 up-regulated the expression of TNF-αand i NOS and down-regulated the expression of IL-10 and Arg-1 in peritoneal macrophages;inversely,FICZ reduced the expression of TNF-αand i NOS while elevated the expression of IL-10 and Arg-1.●CONCLUSION:Ah R is involved in the pathogenesis of A.fumigatus keratitis and induced immune protection in anti-A.fumigatus immune response by inhibiting M1 and increasing M2 phenotype macrophage-related inflammatory factors.
文摘AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of surgery in the treatment.METHODS: The clinical records of 27 patients(27 eyes)with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained.RESULTS: There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule,accounting for 56%, 26%, 15% and 2.5%, respectively.Fusarium was identified in 44%(12/27) of the eyes,followed by Aspergillus in 22%(6/27). Posterior segment infection was involved in 78%(21/27) of the patients. The corneal infection was larger than 3 mm×3 mm in 89%(24/27) of the patients, and 22%(6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes(81.5%) underwent penetrating keratoplasty(PKP), and over half of them(54.5%)were operated within 3d from the onset of antifungal therapy. Fourteen eyes(52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes(55.6%) underwent pars plana vitrectomy(PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60%(9/15),lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes(16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes(18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION: Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis.Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy(especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.
基金Supported by the National Natural Science Foundation of China(No.81470609No.81170825)+2 种基金Key Project of Natural Science Foundation of Shandong Province(No.ZR2012HZ001)Youth Project of Natural Science Foundation of Shandong Province(No.ZR2013HQ007)Specialized Research Fund for the Doctoral Program of Higher Education(No.20123706110003)
文摘AIM:To explore the effects of lectin-like ox-LDL receptor(LOX-1) on innate immunity against Aspergillus fumigatus(A.fumigatus) in mice cornea.METHODS:The mRNA levels of LOX-1 were tested in normal and A.fumigatus infected corneas of C57BL/6and BALB/c mice.The expression of LOX-1,pro-inflammatory cytokines TNF-α,CXCL1 and IL-6,antiinflammatory cytokines IL-10,and matrix metalloproteinase 9(MMP9) were tested with treatment with LOX-1 neutralizing antibody or control IgG in A.fum/gatus infected corneas of C57BL/6.Macrophages and neutrophils were extracted from susceptible C57BL/6mice,and pretreated with LOX-1 neutralizing antibody or IgG,then stimulated with A.fum/gatus.The mRNA levels of LOX-1,TNF-α,CXCL1,IL-6,IL-10 and MMP9 were evaluated by polymerase chain reaction.RESULTS:The expression of LOX-1 was significantly increased in C57BL/6 mice corneas after A.fum/gatus infection compared with BABL/c mice.After treatment with LOX-1 neutralizing antibody,the expression of LOX-1,TNF-α,CXCL1,IL-6,MMP9 and IL-10 in C57BL/6corneas were significantly decreased compared with treatment with control IgG;the expression of LOX-1,CXCL1,IL-6 and IL-10 were significantly decreased in macrophages,while TNF-α and MMP9 expressions had no change;LOX-1,TNF-α,CXCL1,IL-6,MMP9 and IL-10 expressions were significantly decreased in neutrophils.CONCLUSION:The expression of LOX-1 can affect the expression of pro-inflammatory and anti-inflammatory cytokines in fungal infected corneas,macrophages and neutrophils of C57BL/6.LOX-1 inhibition rebalances the inflammatory response of fungal keratitis in mice.
基金Supported by the National Natural Science Foundation of China(No.81870632)Youth Project of Natural Science Foundation of ghandong Province(No.ZR2019BH004).
文摘AIM:To characterize effect of astaxanthin(ASX)in Aspergillus fumigatus(A.fumigatus)induced keratitis in mouse model.METHODS:In vivo,fungal keratitis mouse model was established in C57BL/6 mice using A.fumigatus,followed by ASX or dimethyl sulfoxide(DMSO)treatment.Clinical responses were evaluated by clinical score and myeloperoxidase(MPO)assay.Inflammatory cytokines were assessed by reverse-transcription polymerase chain reaction(RT-PCR),Western blot,immunofluorescence,and enzyme-linked immuno sorbent assay(ELISA).RESULTS:In animal model,ASX improved corneal transparency and clinical response,suppressed the expression of inflammatory cytokine like IL-1β,TNF-α,and HMGB-1.Neutrophil levels have been shown to decrease in ASX-treated cornea by immunofluorescence and MPO.TLR2 and TLR4 levels were lower in ASX-treated group than DMSO-treated.CONCLUSION:ASX can suppress inflammatory response and reduce inflammatory cytokine production in mice model with A.fumigatus keratitis.
