Search Results (113)

Background/Objectives: Polymerase chain reaction (PCR) testing of ocular fluids is an essential diagnostic method for identifying infectious causes of uveitis. However, multiplex PCR kits specifically developed for ophthalmic use are not commercially available in many regions, including Korea. Given the biochemical similarity between cerebrospinal fluid (CSF) and aqueous humor, this study evaluated the diagnostic utility of a commercially available CSF multiplex PCR panel for detecting herpesviruses in patients with suspected viral uveitis. Methods: We retrospectively reviewed the medical records of patients whose aqueous humor samples were analyzed using a multiplex PCR assay originally designed for CSF testing (Seeplex Meningitis-V1 ACE Detection kit, Seegene, Seoul, Republic of Korea). The samples were obtained between May 2019 and June 2023 at two tertiary referral hospitals. The assay targeted herpes simplex virus types 1 and 2 (HSV-1, HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein–Barr virus (EBV), and human herpesvirus 6 (HHV-6). Patients were classified into three groups: (I) anterior uveitis with suspected herpesviral infection, (II) acute retinal necrosis (ARN), and (III) CMV retinitis. Baseline characteristics, PCR positivity rates, and virus prevalence were compared among the groups. Results: Among 149 eyes tested, 86 were included in the final analysis. The overall positivity rate was 38.4%. PCR positivity was 19.7% (12/61) in Group I, 93.8% (15/16) in Group II, and 66.7% (6/9) in Group III. CMV was the most common pathogen in Groups I (66.7%) and III (100%), while VZV was predominant in Group II (80%). No HHV-6 infection was detected. Conclusions: The positivity rate in anterior uveitis (Group I) was lower than previously reported, likely due to the limited sample volume relative to the assay’s requirement. Nevertheless, the assay demonstrated diagnostic reliability comparable to previous reports for ARN and CMV retinitis. Therefore, the CSF-based multiplex PCR panel serves as a feasible and cost-effective diagnostic option for sight-threatening posterior segment infections, facilitating prompt diagnosis and treatment, although further optimization is warranted for anterior uveitis. Full article

Purpureocillium lilacinum is an emerging pathogen that can cause severe ocular infections. This study aimed to investigate the risk factors, clinical manifestations, antifungal susceptibilities, and outcomes of ocular infections caused by P. lilacinum at a large ophthalmic center in Southern China. This retrospective study reviewed the medical records of 34 patients with culture-proven P. lilacinum oculomycosis treated at the Zhongshan Ophthalmic Center from January 2020 to December 2024. The study included 34 patients (17 males, 17 females). The most common risk factor was ocular trauma (38.2%). In vitro susceptibility testing revealed high resistance to fluconazole and caspofungin, but general susceptibility to voriconazole (median MIC 0.25 mg/L). Despite 97.1% of patients receiving voriconazole therapy, outcomes were generally poor, with 54.5% of patients experiencing a poor outcome (vision worse than counting fingers). A significantly shorter time to microbiological diagnosis was associated with a favorable outcome (median 26 days vs. 65 days, p = 0.007). In conclusion, the visual outcomes of this infection remain generally poor, with the major clinical challenge being the delay in diagnosis. Therefore, prompt microbiological investigation is recommended for patients with suspected intraocular infection. Voriconazole remains the first-line therapeutic choice, the therapeutic potential of newer triazoles warrants further investigation. Full article

Background: Central retinal artery occlusion (CRAO) is an ophthalmic emergency attributed to a vessel occlusion with an embolus or a thrombus and may occur during the hypercoagulable state, inflammation, or vasculitis. CRAO may occur in children; however its incidence is very rare. Most pediatric cases have detectable etiologies. Case Presentation: We describe the case of an otherwise-healthy six-year-old female, who presented with the sudden and complete vision loss of the left eye lasting over twelve hours after a six-day chickenpox exanthema, followed by a high fever. All the ophthalmological, laboratory, and instrumental investigations led to the diagnosis of a left CRAO. Laboratory testing was unremarkable except for the transient elevation of D dimers (1363 µg/L), IgM anticardiolipin antibodies (238.5 CU), and IgG anti-beta-2 glycoprotein-1 antibodies (76.1 CU) on admission. Thrombolytic treatment was not exerted because of late presentation to the hospital. Treatment with steroids, antiviral medications, antibiotics, and anticoagulants was obtained, but the visual outcome was poor during the hospitalization and at the last follow-up. We could not ascribe features of this case to any etiological condition apart from the documented ongoing chickenpox infection. Conclusions: This is the first case report of CRAO in a child with transient aPL elevation and acute chickenpox infection. Full article

Background: Hypochlorous acid (HOCl) is an integral component of the human innate immune system. It possesses antimicrobial properties and is available in solution, dermal spray, and scar gel forms. Objectives/Methods: This review presents data from studies on the clinical use of HOCl in various specialties, including dermatology, surgery, dentistry, ophthalmology, and rhinology. Results: Due to its anti-inflammatory/antimicrobial/immunomodulatory and healing properties, HOCl is advantageous in treating various skin disorders: ulcus cruris (and wound care), diabetic ulcers, atopic dermatitis, seborrheic dermatitis, pruritus, acne vulgaris, etc. Also, the application of a HOCl spray/gel after surgical procedures may prevent infection, reduce inflammation, and accelerate healing. HOCl is also effective and safe for the prevention and treatment of hypertrophic and keloid scars. Growing evidence shows a broader role for HOCl in limiting cancer cell survival and slowing tumor growth. It is also important in treating various viral infections like SARS-CoV-2 (coronavirus), influenza, and herpes, thereby helping to prevent the spread of aerosols. In addition, since HOCl is an endogenous compound naturally present in mammals with a high safety profile, it may be an effective bacterial disinfectant in dental waterlines. In ophthalmology, adjuvant treatment with HOCl ophthalmic spray can reduce the duration of antibiotic/corticosteroid use, even in severe blepharitis. To fully harness the protective/therapeutic properties of HOCl, future advancements will rely on the development of new chemical compounds and sophisticated pharmaceutical formulations. Conclusions: The majority of clinical studies have confirmed that HOC1 is useful in therapy, although the results are not entirely consistent. Further research is essential to optimize HOCl dosing and to develop controlled-release systems aimed at maximizing its anti-inflammatory and photoprotective effects while minimizing tissue irritation and damage. Full article

Background: In vivo confocal microscopy (IVCM) provides high-resolution corneal imaging that may enhance preoperative and postoperative assessment in refractive surgery. This pilot study aimed to evaluate the diagnostic utility of IVCM in identifying subclinical corneal abnormalities that could influence surgical qualification and outcomes. Methods: A total of 7 patients (3 males, 4 females; mean age 48.8 ± 14.5 years) undergoing qualification or follow-up for refractive surgery were prospectively examined between May 2021 and March 2025. Each participant underwent a comprehensive ophthalmic evaluation, including slit-lamp biomicroscopy, corneal topography, anterior segment optical coherence tomography (AS-OCT), and IVCM using the Heidelberg Retina Tomograph II with Rostock Cornea Module. Patients with prior ocular surgery, active infection, or systemic corneal disease were excluded. Results: IVCM revealed subtle epithelial, stromal, and endothelial abnormalities undetectable by conventional methods. Findings such as Thygeson’s keratitis, pre-Descemet’s dystrophy, and subclinical herpes simplex keratitis led to modifications of surgical plans or disqualification in selected cases. The technique also aided postoperative evaluation of epithelial–stromal interface disorders. Conclusions: IVCM proved to be a valuable adjunct in detecting subclinical corneal pathology, refining patient selection, and improving safety in refractive surgery. Larger multicenter studies are warranted to validate its clinical role and define standardized indications for preoperative screening. Full article

Ophthalmic lens coatings are increasingly designed to combine optical, mechanical, and biological functions. This systematic review, registered in PROSPERO and conducted according to PRISMA 2020 guidelines, synthesized 54 experimental, preclinical, and clinical studies on coatings for spectacle lenses, contact lenses, and intraocular lenses. Spectacle lens studies consistently showed that anti-reflective and blue-light filtering coatings reduce glare perception, improve contrast sensitivity, and provide UV protection, while laboratory tests demonstrated significant reductions in impact resistance, with fracture energy of CR-39 lenses decreasing by up to 63% when coated. Contact lens research revealed that plasma and polymeric coatings reduce water contact angles from >100° to <20°, enhancing wettability, while antimicrobial strategies such as melamine binding or nanoparticle-based films achieved >80% reductions in bacterial adhesion. Drug-eluting approaches sustained antibiotic or antioxidant release for periods ranging from 24 h to 6 days, with improved ocular bioavailability compared with drops. Intraocular lens studies demonstrated that heparin surface modifications reduced postoperative flare and anterior chamber cells, and phosphorylcholine or alkylphosphocholine coatings suppressed lens epithelial cell proliferation. Drug-loaded coatings with methotrexate, gefitinib, or amikacin significantly inhibited posterior capsule opacification and infection in ex vivo and animal models. Collectively, coatings improve visual comfort, photoprotection, wettability, and biocompatibility, but clinical translation requires solutions to mechanical trade-offs, long-term stability, and regulatory challenges. Full article

Background: Despite repeated re-emergence of Sudan ebolavirus (SUDV), its long-term human toll remains under-characterised. We assessed multisystem clinical, biochemical, and psychosocial outcomes ~25 years after the 2000 Gulu outbreak. Methods: We conducted a cross-sectional evaluation of 45 survivors of laboratory-confirmed SUDV and 30 age- and gender-matched community controls from the same region. Symptoms were assessed as current at the study visit using a structured checklist; for each symptom present, we recorded severity and duration from onset to the visit date. Standardised clinical examinations, haematological and biochemical assessments, anxiety and depression screening, and structured interviews on social support and stigma were performed. Group comparisons were assessed with Wilcoxon rank-sum and χ²/Fisher’s exact tests; correlations were assessed with Spearman’s ρ. Findings: Core physiological indices (vital signs, BMI, blood pressure, and body temperature) and mental health were comparable between survivors and controls. Nevertheless, survivors reported ongoing symptoms, including joint pain and visual impairment each in 36% (16/45), fatigue in 18% (8/45), and neurological symptoms in 13% (6/45). Subclinical laboratory deviations centred on hepatic and platelet biology: elevated total bilirubin occurred in 14% of survivors versus 6.7% of controls; thrombocytopenia or platelet morphological abnormalities in 12% versus 3.3%; haemoglobin abnormalities in 6% versus 0%. Among survivors, albumin and mean platelet volume declined with age (both p ≤ 0.03). Psychological morbidity was low (normal anxiety 82% (37/45; and normal depression 80% (36/45). Yet a social paradox emerged, despite universal post-outbreak support, 98% (44/45) described enduring stigma. To minimise differential recall bias, symptom inventories were not collected from controls; consequently, between-group comparisons for symptom prevalence were not performed, and symptom inferences are restricted to survivors and framed descriptively. Interpretation: A quarter-century after infection, SUDV survivors show preserved systemic physiology but carry chronic musculoskeletal, sensory, and neurological sequelae, alongside a discrete subclinical profile implicating hepatic function and platelet biology. Psychological resilience coexists with near-universal, persistent stigma, indicating that material support did not achieve full psychosocial reintegration. Given the lack of virological and deep immune profiling, proposed pathogenetic mechanisms, such as antigen persistence or immune-mediated injury, remain speculative and hypotheses-generating only. These findings argue for survivor-centred long-term care, embedded with epidemic preparedness frameworks that integrate musculoskeletal rehabilitation, ophthalmic and neurological services with comprehensive mental health care, and sustained anti-stigma community engagement. This dissociation, including short-lived support alongside enduring stigma, indicates that humanitarian relief alone does not secure durable psychosocial reintegration and should be complemented by long-horizon, survivor-centred services and community engagement. Funding: This study was supported by the Coalition for Epidemic Preparedness Innovations (CEPI) under the Universal Protocol for Standardising Assays and Advancing Vaccine Immunogenicity Assessments for Emerging and Re-emerging Viral Threats, implemented through the Uganda Virus Research Institute (UVRI) as part of CEPI’s Centralised Laboratory Network (CLN). Full article

Empirical antibiotic treatment is common in acute conjunctivitis despite most cases being non-infectious or viral infections. Operational research (OR) at an eye hospital in Ghana (January–December 2021) identified appropriate antibiotic prescription in 71% of cases. Research dissemination and the sensitisation of key stakeholders followed, including communication of findings and implications to hospital prescribers. We conducted this OR covering January–December 2024 to test the hypothesis that the appropriateness of antibiotic prescriptions will improve, and to investigate the types of antibiotics prescribed and their AWaRe classification. There were 220 acute conjunctivitis cases in 2024, comparable to 2021 (201 cases). Antibiotics were prescribed in 67% of cases in 2024 and 55% in 2021 (aOR 2.51, 95% CI: 1.51–4.19, p < 0.001). Antibiotic prescription appropriateness was higher in 2024 than in 2021: 87% and 71%, respectively (95% CI for change: 5.99–25.99%, p = 0.001). In 2021, only ACCESS and WATCH antibiotics were prescribed. However, 15% of prescriptions in 2024 were RESERVE antibiotics, and multiple antibiotic prescriptions increased from 10% to 22%. This research demonstrates that regular operational research and interventions have the potential to improve antibiotic prescribing in ophthalmic practice in Ghana. It is imperative that the recommendations made by the initial researchers are fully implemented to protect the efficacy of available antibiotics. Full article

Background/Objectives: Corneal re-epithelialization is a critical process following surgical procedures such as photorefractive keratectomy (PRK), phototherapeutic keratectomy (PTK), and corneal UV cross-linking (CXL), as well as cases of corneal abrasion. Delayed epithelial healing can lead to increased discomfort, a higher risk of infection, and suboptimal visual outcomes. This retrospective case series aims to evaluate the efficacy of a novel ophthalmic solution containing cross-linked carboxymethyl cellulose (CX-CMC) and silk proteins in promoting corneal re-epithelialization and improving post-surgical recovery. Patients and methods: A total of 15 patients who underwent PRK, PTK, or CXL or who presented with corneal abrasions were included in the study. Along with standard post-surgical treatment, patients received CX-CMC and silk protein-based eye drops (CORDEV, Ophtagon, Rome, Italy) six times a day. Corneal epithelial thickness was assessed using topography at follow-up visits. Results: Corneal re-epithelialization was observed in all subjects within 24 to 48 h post-procedure. The mean corneal epithelial thickness at 48 h was 73.21 µm, which falls within the typical range of a proliferating corneal epithelium. Conclusions: The CX-CMC and silk protein-based formulation accelerated corneal healing, achieving rapid epithelial recovery. This novel ophthalmic solution offers a promising alternative to conventional post-surgical treatments, potentially improving patient outcomes by reducing healing time, minimising discomfort, and lowering the risk of complications associated with delayed re-epithelialization. Full article

Introduction: Highly Pathogenic Avian Influenza (HPAI) A(H5N1) represents a growing public health challenge, given broadening zoonotic vectors, with a previously reported human mortality rate of roughly 50%. Late March 2024 marked the start of a new outbreak of HPAI A(H5N1) in the United States. While offering unique public health challenges, this outbreak also provides insight into clinical presentation and ocular involvement implications, transmission vectors, and the implementation of successful surveillance strategies. Objectives: This review seeks to highlight current and historical outbreak trends, transmission and ocular tropism significance, and strategies to mitigate viral spread. Methods: A comprehensive narrative literature review was completed using PubMed database as well as local, federal, and international public health press releases. Discussion: The 2024 US outbreak of H5N1 demonstrates the unique adaptability of the virus. Traditionally transmitted to humans via infected poultry, this outbreak marks the first confirmed case of dairy cow-transmitted human infection. Unlike many past H5N1outbreaks, the majority of patients in the current US outbreak have presented with conjunctivitis either alone or alongside systemic symptoms. This ocular-specific disease manifestation offers new clinical and screening implications. Awareness of ophthalmic involvement among physicians and public health organizations can help guide screening candidates and identify potential infections. Full article

Chimpanzees (Pan troglodytes) rescued from the illegal wildlife trade often suffer from chronic, traumatic injuries that require specialized and prolonged medical treatment in wildlife rehabilitation centers. We present the case report of a two-year-old male chimpanzee admitted at the Tchimpounga Chimpanzee Rehabilitation Center in the Republic of Congo with a chronic periorbital abscess, likely caused by a machete wound sustained during the poaching of his mother. Despite receiving extended antimicrobial therapy, his condition was never fully controlled and progressed to a chronic orbital infection, causing him discomfort and producing chronic purulent discharge. Enucleation was performed under general anesthesia using ketamine and medetomidine, with surgical approach adapted to the distinctive orbital anatomy of chimpanzees. During the procedure, ligation of the optic nerve and ophthalmic vessels was required due to the confined orbital apex and extensive vascularization, ensuring adequate haemostasias and procedural safety. The chimpanzee made an uneventful postoperative recovery, resuming normal feeding and social behavior within 48 h, with complete wound healing occurring within two weeks. This case report highlights the importance of prompt surgical intervention when conservative medical management fails to resolve refractory ocular infections in chimpanzees. It also emphasizes the importance of specific anesthetic protocols, refined surgical techniques and tailored postoperative care in wildlife rehabilitation centers. Documenting and sharing detailed case reports such as this contributes to the limited veterinary literature on great ape surgery and supports evidence-based clinical decision-making to improve the welfare and treatment outcomes of rescued chimpanzees. Full article

Aim: We aimed to investigate the incidence, treatment patterns, and associated risk factors of type 1 retinopathy of prematurity (ROP) in the only tertiary-level Neonatal Intensive Care Unit (NICU) in Cyprus. Methods: This retrospective study included all infants screened for ROP between January and December 2023. Data were collected from standardized NICU discharge summaries and included gestational age (GA), birth weight (BW), multiple birth, systemic infection, blood transfusion, oxygen therapy, surgical interventions, and ROP outcomes. Infants were categorized into non-ROP, non-type 1 ROP, and type 1 ROP groups. Statistical analysis was performed to identify differences in risk factor distribution. Results: Among 183 infants, 33 (18.0%) developed ROP, with 11 (6.0%) requiring treatment for type 1 ROP. All infants with type 1 ROP were born at ≤28 weeks GA and weighed <1501 g. Type 1 ROP was significantly associated with lower GA, lower BW, systemic infection, surgery, and prolonged oxygen support (p < 0.05). Six infants were treated with laser and three with intravitreal bevacizumab. No recurrence was observed in the anti-VEGF group during 18 months of follow-up. Two infants with aggressive ROP died before treatment. Conclusions: Type 1 ROP in Cyprus occurred exclusively in extremely preterm infants, associated with the cumulative effect of multiple risk factors. Laser remained the primary treatment, while anti-VEGF was used selectively with favorable outcomes. This study emphasizes the importance of tailoring ROP screening and treatment strategies based on individual neonatal risk profiles, supporting a personalized approach to neonatal ophthalmic care. Full article

The varicella-zoster virus is a human herpesvirus that causes varicella as the primary infection and HZ as the reactivation of a latent infection. Ten to twenty percent of cases of herpes zoster ophthalmicus (HZO) involve the ophthalmic branch of the fifth cranial nerve. Any area of the eye may be affected by the condition. HZ has a lifetime risk of more than 30%. Complications from herpes zoster can significantly lower quality of life. The goal of HZ vaccinations is to stop HZ activation and PHN formation. Despite the uncommon possibility of side effects such as eye problems, the majority of vaccines on the market now are safe. The purpose of this review is to discuss VZV infection and analyze and summarize the ocular complications following VZV vaccination. Full article

Microbial biofilms present a formidable challenge in ophthalmology. Their intrinsic resistance to antibiotics and evasion of host immune defenses significantly complicate treatments for ocular infections such as conjunctivitis, keratitis, blepharitis, and endophthalmitis. These infections are often caused by pathogens, including Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans, particularly in patients using contact lenses or intraocular implants—devices that serve as surfaces for biofilm formation. The global rise in antimicrobial resistance has intensified the search for alternative treatment modalities. In this regard, plant-derived antimicrobials have emerged as promising candidates demonstrating broad-spectrum antimicrobial and antibiofilm activity through different mechanisms from those of conventional antibiotics. These mechanisms include inhibiting quorum sensing, disrupting established biofilm matrices, and interfering with microbial adhesion and communication. However, the clinical translation of phytochemicals faces significant barriers, including variability in chemical composition due to environmental and genetic factors, difficulties in standardization and reproducibility, poor water solubility and ocular bioavailability, and a lack of robust clinical trials evaluating their efficacy and safety in ophthalmic settings. Furthermore, regulatory uncertainties and the absence of unified guidelines for approving plant-derived formulations further hinder their integration into evidence-based ophthalmic practice. This review synthesizes the current knowledge on the pathogenesis and treatment of biofilm-associated ocular infections, critically evaluating plant-based antimicrobials as emerging therapeutic agents. Notably, resveratrol, curcumin, abietic acid, and selected essential oils demonstrated notable antibiofilm activity against S. aureus, P. aeruginosa, and C. albicans. These findings support the potential of phytochemicals as adjunctive or alternative agents in managing biofilm-associated ocular infections. By highlighting both their therapeutic promise and translational limitations, this review contributes to the ongoing discourse on sustainable, innovative approaches to managing antibiotic-resistant ocular infections. Full article

In the present study, we developed a moxifloxacin (MXF)-encapsulated liposome-enriched alginate nanocomposite hydrogel coating. MXF was encapsulated in soy lecithin (SL:MXF:2:1) via the probe sonication method with an average efficiency of 80%. Two different manufacturing methods, including a micropipetting and a T-shaped microfluidic junction (TMJ) device technique, were used to incorporate the MXF-encapsulated liposomes into hydrogel matrices and layered as a coating on polymeric substrate material. Drug encapsulation and its incorporation into the hydrogel matrix significantly enhanced its stability and facilitated a prolonged drug release profile. A relatively rapid drug release was observed in the MXF-encapsulated liposome-loaded polymeric particulate layer developed via the micropipetting than the TMJ device technique. The findings confirmed sustained drug release behavior due to a hydrogel particulate structural uniformity conferred by the micromachine device, TMJ. Thus, these nanocomposite hydrogel coatings achieved can serve as a promising candidate for the treatment of ophthalmic or mucosal membrane infections. Full article