Search Results (50)

Background: Fungal keratitis remains a serious threat to vision, often progressing despite medical therapy and requiring surgical intervention. Therapeutic deep anterior lamellar keratoplasty (DALK) and therapeutic penetrating keratoplasty (TPK), are frequently required but carry risks of infection recurrence and graft rejection. As timely identification of the etiological agent is essential for improving the outcomes in infectious keratitis, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) are instrumental in providing insights that can guide better therapeutic decision-making and improving outcomes in fungal keratitis. Case Description: We report the cases of two previously healthy patients (case one, 56-year-old woman; case two, 38-year-old man), who have presented in our service with unilateral infectious keratitis after ocular trauma with vegetable matter during outdoor activities, with a visual acuity of counting fingers and hand motion, respectively. Slit-lamp examination revealed unilateral extensive corneal infiltrates suggestive for fungal etiology in both cases. In vivo confocal microscopy (HRT-3, Heidelberg Retina Tomograph 3/Rostock Cornea Module, Heidelberg Engineering, Heidelberg, Germany) identified lesions suggestive for Candida Albicans and Acanthamoeba coinfection in case one and filamentous fungal keratitis in case two. Anterior segment optical coherence tomography (MS-39, CSO, Italy) was used to monitor the extent and morphology of the infiltrates. The patients underwent therapeutic DALK and TPK, respectively, with good results at the one-year follow-up. Conclusions: Our cases illustrate the advantages of incorporating IVCM and AS-OCT as complementary imaging techniques into clinical practice. IVCM and AS-OCT in fungal keratitis could lead to an earlier diagnosis, more accurate dynamic treatment response evaluation, and the identification of high-risk features for aggressive fungi for a more tailored medical and surgical management. Full article

Background/Purpose: To compare the microbiologic and histopathologic features of Acanthamoeba isolates recovered from patients with Acanthamoeba keratitis (AK) who underwent a therapeutic penetrating keratoplasty (TPK), optical penetrating keratoplasty (OPK), or deep anterior lamellar keratoplasty (DALK) after Rose Bengal Photodynamic Antimicrobial Therapy (RB-PDAT). Methods: Surgical specimens were stained with hematoxylin, eosin, and Periodic Acid-Schiff stains as per institutional protocol at the University of Miami, Bascom Palmer Eye Institute. Analysis of Acanthamoeba cyst depth, number of cysts, and average corneal thickness was established by light microscopy. Results: Seventeen patients with AK underwent surgical intervention and RB-PDAT. Eight patients underwent a TPK and nine patients underwent an OPK/DALK. In the TPK group, average cyst depth was 42.0 ± 52.5 μm from Descemet’s layer and mean corneal button thickness was 661.7 ± 106.5 μm. Comparatively, in the OPK/DALK group, average cyst depth from Descemet’s layer was 261.7 ± 222.7 μm with a mean corneal button thickness of 474.2 ± 126.6 μm. Conclusions: Acanthamoeba cysts were found to penetrate deeper within the cornea amongst patients that underwent an emergent TPK compared to patients that underwent an elective OPK/DALK. This may suggest an association between Acanthamoeba cyst depth and infection severity and provides valuable clinical insights towards understanding factors such as infection recurrence and resistance to treatment. Full article

This report presents two cases of herpes simplex keratitis recurrence after COVID-19 mRNA vaccination in patients on herpetic prophylaxis due to recurrent herpetic keratitis. A 58-year-old man with a history of a previous penetrating keratoplasty presented with blurred vision and evidence of corneal endothelitis 48 h after the first dose of the m-RNA vaccination, and a 24-year-old male student came with a dendritic ulcer 72 h post first vaccination dose. The original prophylactic treatment of 400 mg of acyclovir twice daily was increased to five times per day for a week for both patients. The grafted patient additionally received an increase in Dexamethasone 0.1% from twice daily to four times a day. Improvement was noted within two days and documented at the weekly review, during which both patients returned to their prophylactic antiviral regime without further recurrence. At the time of their second dose of vaccination, both patients followed the same regime with an increase in treatment as per the first dose of vaccination without recurrence. Our findings suggest that patients with recurrent herpetic disease receiving prophylactic treatment need close monitoring when experiencing even subtle symptoms of recurrence and may benefit from an increase in their dose to therapeutic levels during the first days after the COVID-19 mRNA vaccination. Full article

Objectives: The aim was to present the complicated diagnostic and therapeutic process of atypical, painless keratitis caused by a cosmopolitan protozoan of the genus Acanthamoeba. Methods: This Case Report describes a medical case involving a 48-year-old woman who occasionally wears soft contact lenses and was referred to our hospital for treatment due to deteriorating visual acuity in her left eye. The diagnostic process included the isolation of amoebae from corneal scrapings and the morphological and molecular identification of the etiological agent of the infection. Results: After examination, painless atypical keratitis was diagnosed, initially considered recurrent herpetic keratitis. However, antiviral treatment did not bring about any improvement. Further observation revealed a dense, central, annular infiltrate on the periphery of the cornea. Despite treatment, the corneal infiltrate did not improve and the patient required therapeutic penetrating keratoplasty. Ultimately, the patient underwent combined surgery: corneal transplantation with cataract phacoemulsification and intraocular lens implantation. The postoperative course was uneventful. Conclusions: Acanthamoeba keratitis should be included in the differential diagnosis of keratitis, even in the absence of its characteristic feature of severe ocular pain, especially in contact lens wearers and patients who have had herpetic keratitis. Infection of the cornea with the Herpes simplex type 1 virus causes nerve degeneration, which probably translates into a painless course of Acanthamoeba castellanii infection. Full article

Objectives: Microbial keratitis is a precursor to corneal scarring, the fifth-leading cause of blindness and visual impairment worldwide. Despite its significance, there is a paucity of data quantifying the recurrence rates of keratitis and the subsequent corneal damage. This study aims to address this gap by providing a comprehensive analysis of the frequency and origin of keratitis recurrences and its impact on visual deterioration. Methods: We retrospectively analyzed a cohort of 1303 patients diagnosed with microbial keratitis at the Independent Public University Eye Hospital in Warsaw, Poland, between January 2018 and December 2023. All adult patients with at least one documented episode of infectious keratitis were included in the study. Patients were divided into two cohorts: Group 1: patients with recurrent keratitis (n = 233) and Group 2: patients with the first episode of keratitis (n = 1070). Results: The recurrence rate of keratitis was 17.88% (233 of 1303 patients), regardless of etiology. Visual acuity on admission did not differ significantly between the recurrent and naïve groups. However, among patients with at least three episodes, visual acuity was worse (median logMAR for 1 vs. 2 vs. 3 recurrences were the following: 0.30 (0.08–0.67) vs. 0.60 (0.12–1.30) vs. 0.44 (0.20–0.92), accordingly, p = 0.049). Univariate logistic regression identified contact lens usage as a significant risk factor for recurrence (OR 2.37, 95% CI: 1.84–3.08, p < 0.001), also including its inappropriate use (OR 2.25, 95% CI: 1.42–3.66, p = 0.001). In terms of etiology, bacteria were the most common identified cause of keratitis in both the recurrent and naïve groups, accounting for 38.36% (90 cases) in Group 1 and 47% (503 cases) in Group 2. Viruses were the second most prevalent etiology, representing 31.33% (73 cases) in Group 1 and 19.91% (213 cases) in Group 2. Furthermore, a multivariate logistic regression model indicated that advanced age, delayed treatment, fungal etiology, and post-corneal transplant status were strongly associated with worse visual outcomes. Conclusions: Although each recurrence contributes to cumulative vision loss, the majority of patients with recurrent keratitis present with a useful visual acuity (0.3 to 0.60 logMAR). Our study identified older age, fungal etiology, delayed treatment, and post-keratoplasty keratitis as the most significant risk factors for visual deterioration. These findings underscore the need for targeted interventions in populations at higher risk of adverse visual outcomes. Full article

Background and Clinical Significance: Acanthamoeba keratitis (AK) is a rare but serious corneal infection that can lead to severe visual impairment or blindness if not promptly treated. The condition is primarily associated with contact lens use but can also occur due to ocular trauma or environmental contamination. The most frequently used treatment options include biguanides and diamidines, though dosing protocols remain empirical and vary widely among clinicians. Recent research has explored a new standardized protocol with 0.08% polihexanide (polyhexamethylene biguanide, PHMB) as a monotherapy for AK, offering improved efficacy and better corneal penetration. Case Presentation: This case report describes a 35-year-old female contact lens wearer who presented with redness, pain, photophobia, and vision loss in her right eye. Upon referral, a slit-lamp examination revealed stromal infiltrates and perineural involvement, with in vivo confocal microscopy (IVCM) confirming Acanthamoeba cysts. The patient was treated with a new standardized intensive regimen of polihexanide 0.08% monotherapy, leading to rapid clinical improvement. Corneal infiltrates were significantly reduced, and the best-corrected visual acuity (BCVA) improved from 0.4 logMAR to 0.15 logMAR. Resolution with only discrete stromal haze was achieved over the following months, without recurrence. Conclusions: This case highlights the potential of polihexanide 0.08% monotherapy as an effective treatment for AK in a new standardized treatment protocol. Full article

(1) Introduction: The main way of spreading the herpes simplex virus 1 (HSV-1) is through direct contact, as the virus enters the host via mucous membranes. Ocular infection can occur as a primary infection or as a recurrent one. The movement of HSV-1 along the ophthalmic branch of the fifth cranial nerve from its latency phase in the trigeminal ganglion and its activation represent a process influenced by various symbiotic factors, such as environmental conditions and the host’s genetic characteristics. The aim of this study was to assess the frequency of IL28 (rs12980275) and (rs8099917) in recurrent ocular HSV infections. (2) Materials and methods: The study included 60 patients aged over 18, of both sexes, all of whom had a history of herpes simplex labialis (HSL). Patients were tested for HSV-1-specific IgG antibodies, and seropositive individuals were genotyped for single nucleotide polymorphisms (SNPs) rs12980275 and rs8099917. A total of 57 seropositive patients were included in the study. (3) Results: A statistically significant association was found between recurrent HSV keratitis (HSK) and heterozygous GT rs8099917 and homozygous TT rs8099917, as well as heterozygous AG rs12980275 and homozygous AA rs12980275 (p < 0.01). Interestingly, patients with homozygous GG polymorphism for both genotypes GG rs8099917 and GG rs12980275 did not develop recurrent HSV keratitis. (4) Conclusion: The most frequent SNP variations in patients with recurrent HSV disease were heterozygous AG rs12980275 (61.40%) and heterozygous GT rs8099917 (52.63%). Patients with recurrent HSV keratitis lacked the homozygous GG polymorphism in both GG rs8099917 and GG rs12980275 genotypes, suggesting that HSV-seropositive individuals expressing these genotypes may have lower predisposition to develop recurrent stromal HSV keratitis. Full article

Background: Herpes simplex keratitis (HSK) is a disease characterized by the recurrent infection of the cornea, mainly due to infection caused by herpes simplex virus type 1. The suppression of recurrence can suppress progressive corneal scarring, ulcers, and perforation. Cornea contains vitamin D receptors (VDRs). VDR agonists show antimicrobial activity. Case presentation: In this case report, I describe two female patients aged 76 and 85 years old in whom the administration of a VDR agonist led to the suppression of the recurrence of HSK. The former patient had repeated HSK recurrence for over 10 years after the initial infection. The latter patient developed HSK immediately after vitrectomy, and her cornea remained susceptible to infection, resulting in recurrence. Both patients were trying to suppress recurrence by applying acyclovir ophthalmic ointment, but their medication adherence was declining. So, they switched to oral treatment with 0.5 μg of the VDR agonist per day, and since then, there has been no recurrence of HSK. Oral treatment with the VDR agonist is still ongoing. Conclusions: This report highlights the cases where ways were examined to improve medication adherence in elderly patients who had a risk of HSK recurrence. Both patients responded to VDR agonist treatment and were able to suppress recurrence. Full article

Purpose: This study evaluates the effectiveness of therapeutic keratoplasty for Fusarium fungal keratitis and explores the diagnosis and management challenges of this infectious corneal disease. Methods: We retrospectively analyzed therapeutic keratoplasty cases at a tertiary hospital for Fusarium keratitis when standard treatments failed. Results: Five cases of Fusarium keratitis, unresponsive to typical antifungal treatments, required keratoplasty due to fast progression and diagnostic difficulties. Post-surgery, all patients had infection resolution without recurrence, but some complications like anterior chamber leakage, graft rejection, and ocular hypertension were managed effectively. Final visual acuity ranged from 0.9 to finger counting. Conclusions: Fusarium keratitis, often resistant to conventional therapies, may necessitate keratoplasty for resolution. This intervention is crucial for positive outcomes, emphasizing the need for prompt and effective management to prevent severe surgical measures and preserve ocular health. Full article

In this study, we reported two patients with clinical pictures compatible with the diagnosis of bilateral Fuchs’ superficial marginal keratitis (FSMK) treated with surgical treatment and anti-inflammatory drugs. The cases suffered from bilateral photophopia, blurred vision, and pseudopterygium with normal intraocular pressure (IOP). Pseudopterygia extended from temporal and nasal sides and had a gray line between the corneal normal epithelium with no lipid deposits. The first case had a bilateral high mixed astigmatic error and the second had dry eye symptoms. No abnormalities, including systemic inflammatory disease, were found in the laboratory investigations. The first case had bilateral pseudopterygium excision, mitomycin C (MMC) application, and pedicled conjunctival flap transplantation. The patient was followed regularly, and her condition was stable without any recurrence or deterioration in the ocular findings. The second case had conjunctival resection + amniotic membrane transplantation + MMC application six times on the right eye and three times on the left eye during 4 years and suffered recurrences after each operation. Her visual acuity severely decreased with the elevated IOP of both eyes. The patient refused to do any further surgical intervention. Despite its rarity, FSMK should be considered when peripheral corneal infiltration, corneal thinning, and pseudopterygia are observed in both eyes. Full article

Corneal crosslinking (CXL) is a medical procedure used to treat keratoconus. CXL works by strengthening the collagen fibers of the cornea through the application of riboflavin (vitamin B2) and ultraviolet (UV) light, which helps to stabilize the cornea and prevent further deterioration. There is a recognized risk that CXL can trigger the reactivation of dormant herpes simplex virus (HSV), leading to herpetic keratitis even in patients with no history of herpetic disease. We examined the medical history of 52 patients who underwent CXL procedures due to previously diagnosed keratoconus. We reviewed the patient’s medical histories to assess whether there was a herpes labialis infection and/or herpetic keratitis. Altogether, 52 eyes (from 52 patients) were analyzed. Of those, four (7.69%) patients were diagnosed with epithelial herpetic keratitis on the 5–8th day after surgery. All four patients had a history of herpes labialis and no prior HSV keratitis infection. Two patients developed herpetic keratitis despite prophylactic therapy with acyclovir 5 days before surgery. A positive history of HSV lip infection before CXL was present in 18/52 (34.62%). During a one-year follow-up period, no patient experienced a recurrence. Close follow-up is crucial for diagnosing herpetic keratitis after corneal crosslinking. The use of prophylactic antiviral therapy in patients who are asymptomatic and have a history of recurrent herpes labialis does not guarantee the prevention of infection. Full article

Background: Mooren’s ulcer (MU) is a rare and debilitating form of peripheral ulcerative keratitis (PUK), characterized by a crescent-shaped ulcer with a distinctive overhanging edge at the corneal periphery. If left untreated, MU can lead to severe complications such as corneal perforation and blindness. Despite various treatment approaches, including anti-inflammatory and cytotoxic drugs, as well as surgical interventions, there is no clear evidence of the most effective treatment due to the lack of randomized controlled trials. AS-OCT is a non-invasive imaging technique that provides high-resolution cross-sectional images of the anterior segment, allowing for accurate evaluation of corneal ulcer characteristics, including depth, extent, and disease progression. Methods: We present the case of a 20-year-old male patient with MU managed using a stepladder approach, which included local and systemic corticosteroids, limbal conjunctival resection, and Cyclosporine A 1% eye drops. The patient underwent consecutive AS-OCT examinations and strict follow-up to tailor systemic and topical therapy. Results: Complete healing of the corneal ulcer with resolution of the inflammatory process was achieved. There was no recurrence of the disease at the 7-month follow-up. AS-OCT demonstrated progressive reorganization and thickening of the stromal tissue until the complete recovery of stromal thickness. Conclusions: The AS-OCT imaging modality allowed for the accurate evaluation of corneal ulcer characteristics, facilitating informed decision-making regarding the use of systemic immunosuppression, surgical interventions, and local immunomodulation and providing detailed and precise assessment of disease progression. This approach enabled a tailored and effective treatment strategy for the patient and played a critical role in guiding the therapeutic approach. Full article

Background: Early therapeutic penetrating keratoplasty (TKP) for Acanthamoeba keratitis (AK) is thought to have a worse visual prognosis than the delayed optical penetrating keratoplasty (OKP) after successful conservative treatment of AK. This has led to a tendency to prolong conservative therapy and delay penetrating keratoplasty in patients with AK. This retrospective series presents the results of patients with AK that underwent early penetrating keratoplasty after reducing the corneal amoeba load through intensive conservative therapy, so-called “low load keratoplasty” (LLKP). Patients and methods: The medical records of our department were screened for patients with AK, confirmed by histological examination and/or PCR and/or in vivo confocal microscopy, which underwent ab LLKP and had a follow-up time of at least one year between 2009 and 2023. Demographic data, best corrected visual acuity (BCVA) and intraocular pressure at first and last visit, secondary glaucoma (SG), and recurrence and graft survival rates were assessed. Results: 28 eyes of 28 patients were included. The average time from initiation of therapy to penetrating keratoplasty (PKP) was 68 ± 113 days. The mean follow-up time after LLKP was 53 ± 42 months. BCVA (logMAR) improved from 1.9 ± 1 pre-operatively to 0.5 ± 0.6 at last visit (p < 0.001). A total of 14% of patients were under medical therapy for SG at the last visit, and two of them underwent glaucoma surgery. The recurrence rate was 4%. The Kaplan–Meier graft survival rate of the first graft at four years was 70%. The second graft survival rate at four years was 87.5%. Conclusion: LLKP appears to achieve a good visual prognosis with an earlier visual and psychological habilitation, as well as low recurrence and SG rates. These results should encourage us to reconsider the optimal timing of PKP in therapy-resistant AK. Full article

Herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2) are widespread human pathogens that establish chronic latent infections leading to recurrent episodes. Current treatments are limited, necessitating the development of novel antiviral strategies. This study aimed to assess the antiviral efficacy of novel topical formulations containing interferon alpha-2b (IFN α-2b) against HSV-1 and HSV-2. The formulations, Oftalmoferon^® forte (eye drops) and Interferon Vaginal Tablets, demonstrated potent antiviral effects against HSV-1 and HSV-2 in Vero cells, respectively, with concentration-dependent inhibition of viral replication. Subsequently, their efficacy was tested in animal models: HSV-1 keratitis in the rabbit eye model and HSV-2 genital herpes in mice. Oftalmoferon^® forte effectively treated HSV-1 keratitis, reducing clinical symptoms and ulcerations compared to virus control. Interferon Vaginal Tablets showed promising results in controlling HSV-2 genital herpes in mice, improving survival rates, reducing clinical signs, weight loss and viral replication. The novel IFN α-2b formulations exhibited significant antiviral activity against HSV infections in cell culture and animal models. These findings suggest the potential of these formulations as alternative treatments for HSV infections, particularly in cases resistant to current therapies. Further studies are warranted to optimize treatment regimens and assess clinical efficacy in humans. Full article

This study aims to report the efficacy of a combined intrastromal injection in optimizing the outcome of severe mycotic keratitis. Herein, we report a case series of 20 consecutive patients with positive fungal cultures not responding to topical antifungal treatment. Patients received cycles of intrastromal injections of voriconazole (50 µg/0.1 mL) and amphotericin B (2.5 µg/0.1 mL); all patients continued their topical antifungal therapy. The organisms isolated were Fusarium (n = 5), Aspergillus (n = 4), Candida (n = 4), Rhodotorula (n = 2), Penicillium (n = 2), Alternaria (n = 1), Bipolaris (n = 1), and Curvularia (n = 1). The size of the infiltrate varied from 6.5 to 1.5 mm. At presentation, the best corrected visual acuity (BCVA, namely, the best visual acuity achieved with glasses, if needed) was less than 20/400 in all patients, improving to better than 20/400 in eleven patients. Seven patients required surgical intervention; four of them underwent penetrating keratoplasty (PK) à chaud one month after the first intrastromal injection. Patients who underwent surgery achieved a BCVA of 20/40 or better. Combined intrastromal injections before therapeutic penetrating keratoplasty (TPK) effectively reduced ulcer size and graft diameter, preventing infection recurrence. Our results highlight the efficacy of combined intrastromal injections in optimizing outcomes for severe mycotic keratitis undergoing TPK. Full article