Search Results (125)

We report a case of herpes simplex virus type 1 (HSV-1) anterior uveitis evolving into an acute iris transillumination-like syndrome with secondary pigmentary glaucoma, highlighting diagnostic challenges and treatment considerations. A 61-year-old immunocompetent woman presented with unilateral anterior uveitis characterized by keratic precipitates and mild anterior chamber inflammation. The condition was initially treated with topical and subconjunctival corticosteroids without antiviral therapy. After an initial resolution of symptoms, upon the cessation of treatment, the patient developed features resembling unilateral acute iris transillumination (UAIT) syndrome with elevated intraocular pressure, diffuse pigment dispersion, and progressive iris transillumination defects. Aqueous polymerase chain reaction (PCR) testing confirmed the presence of HSV-1. Despite the initiation of antiviral therapy, the condition progressed to severe pigmentary glaucoma, with unreliable intraocular pressure measurements due to prior LASIK surgery. Cataract extraction, pars plana vitrectomy, and Ahmed valve implantation were performed, with only partial recovery of visual acuity. This case illustrates that HSV-1 uveitis can mimic or transition into a UAIT-like syndrome, possibly due to steroid use without concurrent antiviral treatment, which may exacerbate viral replication and damage to the iris pigment epithelium. Aqueous PCR testing aids in differential diagnosis, but indicative medical history and clinical findings should remain instrumental. Clinicians should maintain a high index of suspicion for herpetic etiology in anterior uveitis cases and initiate prompt antiviral treatment to prevent potentially sight-threatening complications. 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

Poxvirus infections, particularly those caused by the monkeypox virus, have emerged as significant public health threats. Ocular manifestations constitute a severe potential clinical complication associated with these infections, potentially resulting in permanent visual impairment in afflicted patients. This review aimed to examine the clinical spectrum of ocular manifestations associated with mpox and other poxvirus infections and to evaluate current management strategies alongside emerging therapeutic interventions and prevention strategies. A comprehensive literature search was performed across major databases to identify studies reporting ocular involvement in poxviral infections. Ocular involvement in poxviral infections ranges from mild conjunctivitis and eyelid lesions to severe keratitis with potential vision loss. Mpox-related ocular manifestations are more prevalent in unvaccinated and immunocompromised individuals. Although early antiviral intervention and supportive care are critical, clinical outcomes vary considerably across viral clades. Emerging evidence indicates that tecovirimat may reduce lesion severity, although its impact on accelerating recovery remains limited. Moreover, vaccine strategies, particularly the MVA-BN (JYNNEOS) vaccine, appear to decrease ocular complications, despite regional disparities in access and implementation. Ocular complications pose a significant clinical challenge in mpox and related poxviral infections. This review highlights the need for early diagnosis and integrated treatment approaches that combine antiviral therapy, supportive care, and targeted vaccination. Further research is essential to refine treatment protocols and assess the long-term outcomes in diverse patient populations. Full article

Purpose: To determine the incidence, risk factors (including systemic immunosuppression), and outcomes of microbial keratitis in corneal transplants over a 16-year observation period at a tertiary referral hospital in Poland. Methods: This retrospective cohort study included 125 episodes of infectious keratitis in 117 patients who underwent corneal transplantation between 2008 and 2023 at the Department of Ophthalmology, Medical University of Warsaw, Poland. The data collected included demographics, indications for transplantation, infection rates, risk factors, best-corrected visual acuity (BCVA) at presentation and discharge, changes in visual acuity, and treatments received prior to hospital admission. Clinical signs, symptoms, diagnostic tests, and management strategies were also reviewed. Additionally, the outcomes of surgical interventions, such as therapeutic corneal transplantation and evisceration, were examined. Results: Among the 2869 corneal transplants performed over the 16-year period, the incidence of post-keratoplasty microbial keratitis (PKMK) was 4.35%. The most common indication for transplantation in affected patients was an active infection unresponsive to medical therapy (n = 62, 52%). One-third of PKMK cases occurred in patients with repeat transplants. Median visual acuity prior to infection was 1.6 logMAR, worsening to 2.3 logMAR at presentation. Following treatment, visual acuity improved to a median of 1.9 logMAR at discharge, with no significant improvement by the one-year follow-up. At that time, 75.1% of patients remained legally blind (BCVA ≤ 20/200); 21% recovered to pre-infection visual levels, while 46% experienced additional visual loss due to PKMK. Multivariate regression identified corneal perforation and systemic immunosuppression as independent predictors of poorer visual outcomes (p < 0.001 and p = 0.03, respectively. Conclusions: Microbial keratitis in corneal grafts is associated with poor long-term visual outcomes. At one year post-infection, the median BCVA was 1.9 logMAR, with 75.1% of patients remaining legally blind. Nearly half of the cohort experienced additional visual loss compared to their pre-infection status, underscoring the severity of PKMK and the need for vigilant postoperative care. Full article

Among free-living amoebae (FLA), Acanthamoeba polyphaga is an important causal agent of Acanthamoeba keratitis (AK), a severe and potentially sight-threatening condition. The present study evaluated the “in vitro” efficiency of Melaleuca alternifolia Cheel (tea tree) (tea tree oil—TTO) and Eucalyptus globulus Labill. (Eucalyptus essential oil—EEO) essential oils against an Acanthamoeba strain isolated from human keratitis. The Minimum Inhibitory Concentration (MIC) of the EOs and the Fractional Inhibitory Concentration (FIC) Index were used to evaluate the decrease in viable cells of Acanthamoeba over time and at different concentrations of EOs, used alone or in association. A relevant amoebicidal effect emerged during the first hours of exposure for both compounds, and TTO was the most effective. The TTO/EEO association clearly indicated a synergistic effect in all tests, and at 2 days post-treatment, no viable A. polyphaga cells were observed at all tested concentrations. In conclusion, the potential therapeutic use of EOs represents a promising therapeutic strategy for the treatment of AK. Full article

Background: Ocular infections can cause severe complications, including blindness, and distinguishing bacterial from fungal keratitis based on clinical features alone is difficult. This study compared broad-range conventional PCR and real-time PCR methods targeting the 16S rRNA gene with traditional culture for diagnosing bacterial ocular infections. Methods: We analyzed 160 ocular specimens from 111 patients, categorizing them as septic or aseptic. The results of both conventional PCR and real-time PCR methods targeting the 16S rRNA gene were compared with traditional culture outcomes. Results: Real-time PCR demonstrated higher sensitivity than conventional PCR, and receiver operating characteristic analysis determined optimal ΔCT cutoff values of −2.13 and −4.09 for septic and aseptic specimens, respectively. Delays in specimen processing significantly affected real-time PCR accuracy. The 16S rRNA meta-taxonomic analysis using nanopore sequencing only validated the PCR results when the DNA concentration was sufficient. Conclusions: Broad-range real-time PCR proved to be a valuable diagnostic tool, particularly in aseptic specimens, with greater sensitivity and specificity than conventional PCR. The established ΔCT cutoff values improved diagnostic accuracy and showed that standardized specimen collection and processing are crucial for maximizing PCR efficacy. Full article

The increasing resistance of Fusarium species to nearly all first-line antifungal agents in clinical settings has led to its designation as a ‘high-priority’ human pathogen. As a dual pathogen, Fusarium spp. threaten both human health and crop production, impacting food security. Our recent drug profiling of clinical Fusarium isolates reveals resistance to several front-line antifungals, with notable cross-azole resistance observed in both clinical and plant-associated strains. While the overuse of agricultural azoles has been implicated in the selection of azole-resistant fungi such as Aspergillus, a similar mechanism has been assumed for Fusarium in clinical settings. However, direct genetic evidence supporting this hypothesis remains limited. In this review, part of our Special Interest (SI) series, we discuss the spectrum of human diseases caused by Fusarium. While incidence data are better established for human keratitis and onychomycosis, invasive fusariosis remains globally underreported. We propose reasons for this distinct clinical spectrum bias and explore the potential genetic basis of azole resistance. Full article

Dupilumab, a monoclonal antibody targeting the interleukin (IL)-4 receptor alpha subunit and IL-13, has markedly advanced the treatment of atopic conditions such as dermatitis, asthma, and chronic rhinosinusitis. However, its expanding use has brought increased attention to a range of ocular adverse events—conjunctivitis, blepharitis, keratitis, corneal ulcers, and cicatricial conjunctivitis—that remain underrecognized and frequently underestimated in clinical practice. These manifestations often emerge in patients with atopic dermatitis and display varying severity, posing diagnostic and therapeutic challenges. Rather than isolated phenomena, these effects appear to stem from a complex interplay of goblet cell depletion, mucin deficiency, immune dysregulation, and microbiome alterations, including Demodex proliferation. Current management strategies remain largely empirical, lacking standardized protocols, and are often guided by anecdotal evidence. In this review, we critically appraise the existing literature, synthesize emerging pathogenic hypotheses, and highlight the unmet clinical need for evidence-based treatment algorithms. We advocate for a multidisciplinary approach and future research aimed at elucidating mechanisms, refining risk stratification, and minimizing ocular toxicity without compromising the therapeutic benefits of dupilumab. Furthermore, we intend to provide a more practical and straightforward resource for the reader based on the current literature on approaching the topic. 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

Corneal endotheliitis is an inflammatory process, most commonly of viral etiology, that manifests clinically with features including corneal edema, keratic precipitates, and a mild anterior chamber reaction. Several studies have implicated human herpesviruses from the Herpesviridae family as primary causes of corneal endotheliitis, including cytomegalovirus (CMV), varicella zoster virus (VZV), and herpes simplex viruses 1 and 2 (HSV-1 and HSV-2). This review critically evaluates the present literature surrounding herpesvirus infections of the corneal endothelium. Full article

Bacterial keratitis (BK) is a severe ocular infection that can lead to vision loss, with antimicrobial resistance (AMR) posing a growing challenge. This study retrospectively analyzed 1071 bacterial isolates from corneal infections over a 10-year period (2014–2024) at a tertiary ophthalmic center in Beijing, categorizing them into three distinct phases: pre-COVID-19, during COVID-19, and post-COVID-19. The results indicated significant changes in pathogen distribution, including a marked decrease in Gram-positive cocci (from 69.8% pre-COVID-19 to 49.3% in post-COVID-19, p < 0.001), particularly in Staphylococcus epidermidis. In contrast, Gram-positive bacilli, particularly Corynebacterium spp., increased from 4.2% to 16.1% (p < 0.001). The susceptibility to gatifloxacin, moxifloxacin, and ciprofloxacin significantly declined in both Gram-positive cocci and bacilli during the COVID-19 period (all p < 0.01). Gatifloxacin resistance in Staphylococcus rose from pre-COVID-19 (15.2%) to COVID-19 (32.7%), remaining high post-COVID-19 (29.7%). A similar trend was observed in Streptococcus and Corynebacterium, where resistance rose sharply from 12.0% and 22.2% pre-COVID-19 to 42.9% during COVID-19, and remained elevated at 40.0% and 46.4% post-COVID-19, respectively (p < 0.01). These findings emphasize the rapid rise of fluoroquinolone resistance in several bacterial groups, underscoring the urgent need for continuous surveillance and improved antimicrobial stewardship to enhance treatment outcomes. Full article

The free-living amoeba Acanthamoeba castellanii is a unicellular eukaryote distributed in a wide range of soil or aquatic environments, either natural or human-made, such as rivers, lakes, drinking water, or swimming pools. Besides its capacity to transport potential pathogens, such as bacteria or viruses, Acanthamoeba spp. can have intrinsic pathogenic properties by causing severe infections at the ocular and cerebral level, named granulomatous amoebic encephalitis and amoebic keratitis, respectively. During its life cycle, A. castellanii alternates between a vegetative and mobile form, named the trophozoite, and a resistant, latent, and non-mobile form, named the cyst. The cyst wall of Acanthamoeba is double-layered, with an inner endocyst and an outer ectocyst, and is mainly composed of cellulose and proteins. The resistance of cysts to many environmental stresses and disinfection treatments has been assigned to the presence of cellulose. The current review aims to present the importance of this glycopolymer in Acanthamoeba cysts and to further report the pathways involved in encystment and excystment. Full article

Pugs are highly predisposed to corneal disorders, such as brachycephalic ocular syndrome (BOS), due to their disproportionate skull, reduced corneal sensitivity and eyelid anomalies such as distichiasis, entropion and lagophthalmos. The risk of corneal disorders which cause significant suffering is substantial, prompting calls for international efforts to reduce their prevalence. While these debilitating conditions are also likely to be common in pugs in Australia, their prevalence and risk factors have not been reported. The anonymised electronic patient records (EPRs) of 1318 pugs attending 139 primary care veterinary clinics participating in VetCompass Australia (VCA) in 2017 were used to investigate the prevalence of ophthalmological pathologies and associated demographic risk factors. Pugs were diagnosed with overweight/obesity (prevalence: 20.2%, 95% confidence interval {CI}: 18.1–22.4) ophthalmological abnormalities (14.5%, 95% CI: 12.6–16.3), particularly corneal disorders (12.4%, 95% CI: 12–15.7), and other conditions. The most prevalent ophthalmological disorders were corneal ulcers (5.5%, 95% CI: 4.4–6.9), corneal pigmentation (3.6%, 95% CI: 2.8–4.8) and keratoconjunctivitis sicca (KCS) (3.3%, 95% CI: 2.5–4.5). The risk of all corneal disorders increased with age (odds ratio 1.11, 95% CI: 1.07–1.15), and corneal pigmentation, KCS and keratitis were more prevalent in older pugs (a median age of 7.6 years or older), while entropion, neovascularisation and ulcerative keratitis affected younger dogs (a median age of 3 years or under). The underlying BOS conformation defects, exophthalmos, lagophthalmos and distichiasis, and early signs of corneal damage should be identified through detailed examinations during primary care veterinary visits, and affected pugs should be removed from the breeding population and treated to reduce the severity and duration of their suffering. Full article

Purpose: To evaluate visual acuity improvement and identify contributing factors in patients with severe keratitis affecting both virgin and transplanted corneas, treated at a hospital. Methods: A retrospective analysis was conducted on 497 patients with unilateral corneal ulcers treated at a tertiary referral center between 2008 and 2023. Data included distance (BCVA) and near best-corrected visual acuity at initial presentation and at discharge, treatments before hospital admission, demographic details, risk factors, clinical signs and symptoms, ancillary test results, and management strategies. Patients were categorized into two groups: Group A (naïve corneal ulcers, 379 patients) and Group B (post-keratoplasty infectious keratitis, 118 patients). Additional analysis focused on patients with presenting visual acuity of at least 1.0 logMAR (≤5/50 Snellen charts = legal blindness) to predict final visual outcomes. Results: The median BCVA at presentation for the entire cohort was 1.9 logMAR, advancing to 1.5 logMAR at discharge (p < 0.001). At least one line improvement in BCVA was observed in 47% of patients (52% of naïve cornea and 33% of transplanted cornea patients). Significantly worse results were observed in Group B were observed for BCVA at presentation, BCVA improvement, and distance and near vision improvement. Among patients with legal blindness at presentation, vision status improved for 52/379 (14%) in Group A and 6/118 (5%) in Group B during hospital admission (p < 0.001), while 67% of the cohort was discharged with VA equal or worse than 5/50. The average hospital stay was 9 days. Near visual acuity got better in 23% of patients (27% in Group A vs. 9% in Group B). A multivariate regression model showed that older age and worse distance BCVA on admission were independent negative predictors of improvement (p < 0.001, p < 0.001, respectively) while midperiphery ulcers were associated with better visual outcomes. Conclusions: Hospital admission leads to BCVA improvement in 47% of the patients with severe corneal ulcer, though the prognosis is significantly worse for those with post-keratoplasty microbial keratitis. At discharge, 67% of patients remained at the legal blindness level. Older age and lower BCVA at first presentation are associated with worse prognosis, while ulcers located in the corneal midperiphery are linked to better visual outcomes. Full article

Fungal keratitis is a severe ocular infection caused by pathogenic fungi, leading to potential vision loss if untreated. Current antifungal treatments face limitations such as low solubility, poor corneal penetration, and limited therapeutic options. This study aimed to develop a thermosensitive in situ gel incorporating ketoconazole nanoparticles (NPs) to enhance drug solubility, stability, and antifungal activity. Ketoconazole NPs were prepared using the solvent displacement method, achieving a particle size of 198.25 ± 27.51 nm, encapsulation efficiency of 94.08 ± 0.51%, polydispersity index of 0.42 ± 0.08, and a positive zeta potential value of +10.08 ± 0.19 mV. The NPs exhibited sustained zero-order release kinetics. The optimized NPs were incorporated into a poloxamer-based in situ gel, demonstrating a gelation temperature of 34.67 ± 0.58 °C and the shortest gelation time. The formulation provided a 5-fold increase in solubility and a 10-fold improvement in drug release compared to pure ketoconazole. Stability studies confirmed the gel retained its physicochemical and rheological properties for three months under various storage conditions. The in situ gel showed sustained release, effective antifungal activity against Malassezia furfur, and good tolerability, suggesting it as a promising alternative for treating fungal keratitis with improved bioavailability and patient compliance. Full article