Journal of Ophthalmic Inflammation and Infection最新文献

{"title":"Clinical presentations, complications, and outcomes of benoxinate topical ophthalmic anesthetic abuse: a retrospective cohort study.","authors":"Suzan Ibrahim Sakr, Amira Ahmed Nayel, Dina Hazem ElHennawi, Fatma Ibrahim Saad, Alaa Atef Ghaith","doi":"10.1186/s12348-026-00636-4","DOIUrl":"10.1186/s12348-026-00636-4","url":null,"abstract":"<p><strong>Background: </strong>Topical anesthetic abuse is a concerning ophthalmic morbidity that may lead to irreversible visual loss. The primary goal of this study was to compare the clinical presentations, complications, healing duration and visual acuity changes between topical ophthalmic anesthetic users and non-users after superficial corneal trauma. The secondary goal was to correlate different variables related to the use of topical ophthalmic anesthetics with the final clinical outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study reviewed files of patients with a positive history of superficial corneal trauma at Alexandria Ophthalmology Hospital Cornea Clinic, Alexandria, Egypt, between January 2021 and January 2026. Patients were divided according to the use of benoxinate eye drops into two groups (benoxinate users and benoxinate non-users). Data extracted included the patient's job, the cause of the initial injury, the use of topical ophthalmic anesthetic (duration, frequency, and continuation after presentation), clinical picture, complications, healing duration, and visual outcomes.</p><p><strong>Results: </strong>A total of 181 eyes in 147 patients was included, 84 eyes in benoxinate users and 97 eyes in benoxinate non-users. Welders (76.2%), and males (89.3%) predominated in the benoxinate group (p < 0.001). The mean duration of benoxinate use was 11.67 (2-50) days. Clinical manifestations, particularly corneal melting (15 eyes, 17.9%), eyelid contact dermatitis (9 eyes, 10.7%), ring infiltration (26 eyes, 31.0%), complications as corneal vascularization (7 eyes, 8.3%), and perforation (17 eyes, 20.2%) were significantly higher in benoxinate users. Mean difference in visual acuity before and after treatment was significantly lower in benoxinate users (0.18 ± 0.25) than in benoxinate non-users (0.34 ± 0.23), (p < 0.001). Mean healing duration was markedly longer in benoxinate users (41.05 (4- 100)) days compared with the benoxinate non-users (7.93 (3-21)) days (p < 0.001). Adherent leukoma was observed only in patients who continue using benoxinate after starting treatment (15 eyes, 48.4%).</p><p><strong>Conclusions: </strong>Abusing topical ophthalmic anesthetics is associated with severe, permanent, and sight-threatening outcomes. Frequent and prolonged use of topical ophthalmic anesthetics aggravates ocular complications, and delays healing.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"16 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salmonella associated endogenous endophthalmitis: a case study and review of literature.","authors":"Karande Sayali A, Jadhav Lakdawala Sonal, Jay Sheth","doi":"10.1186/s12348-026-00632-8","DOIUrl":"https://doi.org/10.1186/s12348-026-00632-8","url":null,"abstract":"<p><strong>Purpose: </strong>To report a rare case of bilateral endogenous endophthalmitis caused by Salmonella Paratyphi A in an immunocompetent patient and to review the relevant literature.</p><p><strong>Method: </strong>Brief report.</p><p><strong>Results: </strong>A 23-year-old woman presented with acute bilateral vision loss over one day. She had previously received systemic corticosteroids for a presumed Vogt-Koyanagi-Harada syndrome and was administered oral steroids. At presentation, examination revealed conjunctival congestion, Descemet's folds, fibrinous anterior chamber reaction, and hypopyon in the left eye, with obscured; fundus details. B-scan ultrasonography demonstrated a thickened retinochoroidal complex with shallow choroidal detachments and anechoic vitreous cavities. Blood culture grew Salmonella Paratyphi A and vitreous cytology showed abundant monocytes. She received intravitreal vancomycin (1 mg/0.1 ml) and ceftazidime (2.25 mg/0.1 ml), IV ceftriaxone 2 g/day guided by susceptibility, topical prednisolone acetate 1% and atropine 1%, and a tapering course of oral steroids. Following resolution of anterior segment inflammation, she underwent pars plana vitrectomy with lensectomy and silicone oil endotamponade in both eyes. Postoperatively, best-corrected visual acuity improved to 20/250 (OD) and 20/200 (OS).</p><p><strong>Conclusion: </strong>While Salmonella-associated endogenous endophthalmitis is typically associated with poor visual outcomes, this bilateral Paratyphi A case demonstrates that prompt recognition and aggressive combined medical and surgical management can achieve meaningful visual recovery.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"16 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Putative mechanisms of ocular inflammation in syphilis.","authors":"Liam M Ashander, João M Furtado, Keryn A Williams, Giles Best, Melissa H Brown, Justine R Smith","doi":"10.1186/s12348-026-00638-2","DOIUrl":"10.1186/s12348-026-00638-2","url":null,"abstract":"<p><strong>Background: </strong>Ocular syphilis is re-emerging globally as a cause of uveitis, with the potential for substantial vision loss. Multimodal ophthalmic imaging and advanced laboratory research can yield important information about the basic mechanisms of this infectious eye disease.</p><p><strong>Review: </strong>Inflammation of the retina is a frequent manifestation of ocular syphilis. Observations from multimodal ophthalmic imaging suggest the retinal pigment epithelium and retinal vasculature are often involved. Molecular profiling of biopsies from patients with syphilis involving the eye and brain indicates multiple leucocyte subsets infiltrate the posterior eye, and highlights the role of monocytes and macrophages in promoting inflammation. Aqueous and cerebrospinal fluid samples from patients with ocular syphilis contain high levels of inflammatory mediators, including C-C motif chemokine ligand (CCL) 2, C-X-C motif chemokine ligand (CXCL) 8, interleukin (IL)-6, IL-12, and tumour necrosis factor (TNF). Macrophages and dendritic cells exposed to the causative bacterium, Treponema pallidum, increase the production of pro-inflammatory cytokines, such as IL-1β, IL-6, and TNF. Toll-like receptor activation and nuclear factor of kappa light chain enhancer of B-cells (NFκB) signalling in non-ocular human cells play prominent roles in upregulating inflammatory molecules, and altering interactions between leucocytes and epithelial or endothelial cells; similar cellular and molecular changes at the outer and inner blood-retinal barriers could contribute to retinal inflammation in ocular syphilis. Experimental evidence also indicates that T. pallidum alters intercellular junctions and transmigrates endothelial cell monolayers, potentially mediating retinal invasion.</p><p><strong>Conclusions: </strong>Evidence from multimodal ophthalmic imaging, molecular profiling in patients, and non-ocular cell infection models provides essential insights into the pathogenesis of ocular syphilis. This knowledge will target future research towards elucidating the drivers of retinal inflammation in ocular syphilis.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"16 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current landscape of drug induced retinal vasculitis.","authors":"Sivaraman Bala Murugan, Aneena Anna Thomas, Rakshita Deepak Kene, Aditya Rajan, Anup Kelgaonkar, Vedhanayagi Rajesh, Anjana Somanath, Padmamalini Mahendradas, Gokulvasanth Deivasenathipathi, Parthopratim Dutta Majumder","doi":"10.1186/s12348-026-00619-5","DOIUrl":"https://doi.org/10.1186/s12348-026-00619-5","url":null,"abstract":"<p><p>Drug-induced retinal vasculitis (DIRV), a complex diagnostic entity, masquerades as infectious or primary autoimmune diseases. Delineating them is a daunting task. This update aims to consolidate clinical evidence focussing on characteristic \"vascular signatures\" using advanced multimodal imaging tools. Type III (immune complex-mediated) and Type IV (T-cell-mediated) hypersensitivity pathways were involved in diverse range of drugs causing DRIV. The critical therapeutic strategies are highlighted to prevent permanent ischemic damage. Advances in the recent metagenomic markers are added to aid the clinician from a practical standpoint to aid in preventive and personalised ophthalmic care.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"16 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic bias in medical consensus: how flawed panels and lack of evidence can distort definitions and guidelines: the case of Vogt-Koyanagi-Harada disease : Perspective.","authors":"Carl P Herbort, Ioannis Papasavvas, Ahmed M Abu El-Asrar, Abdulrahman F AlBloushi, De-Kuang Hwang, Vania Lages, Wen-Jung Lo, Kazuich Maruyama, Piergiorgio Neri, Masaru Takeuchi, Yoshihiko Usui","doi":"10.1186/s12348-026-00617-7","DOIUrl":"10.1186/s12348-026-00617-7","url":null,"abstract":"<p><strong>Background: </strong>The creation of diagnostic criteria for a disease is always challenging in medicine. Consensus meetings and expert's opinions are sometimes responsible for establishing useful and precise diagnostic criteria but, unfortunately, not all the consensus meetings are based on evidence-based conclusions.</p><p><strong>Methods: </strong>A perspective analysis of the historical evolution of diagnostic criteria for Vogt-Koyanagi-Harada.</p><p><strong>Results: </strong>We examine the historical evolution of diagnostic criteria for Vogt-Koyanagi-Harada disease, an autoimmune condition targeting melanocyte-containing tissues, primarily affecting the choroid and potentially involving the skin, ears, and meninges. Early diagnostic criteria proposed in the late twentieth century were considered inadequate, leading to an international consensus conference in 1999 and the publication of revised diagnostic criteria in 2001. However, these criteria contained major conceptual flaws, notably the combination of acute and chronic clinical features that rarely occur simultaneously. In addition, important diagnostic tools such as indocyanine green angiography were largely excluded due to prevailing local practices and skepticism regarding their use. These limitations hindered accurate diagnosis and delayed recognition of VKH as a disease with distinct acute-onset and chronic forms requiring different diagnostic frameworks and management strategies. Subsequent studies corrected some deficiencies but often generated complex criteria difficult to apply in routine practice.</p><p><strong>Conclusion: </strong>We would like to emphasize the risks of poorly structured consensus processes and propose safeguards to ensure scientifically rigorous and clinically useful recommendations.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fungal keratitis caused by a dematiaceous Pleosporales member following ocular trauma with a wooden fragment: a case report.","authors":"Masayuki Inuzuka, Kiyofumi Mochizuki, Takashi Yaguchi, Katsuhiko Kamei, Hirokazu Sakaguchi, Toshio Hisatomi","doi":"10.1186/s12348-026-00620-y","DOIUrl":"10.1186/s12348-026-00620-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fungal keratitis is a vision-threatening infection. Keratitis caused by dematiaceous fungi belonging to or related to the order Pleosporales is rare and diagnostically challenging because culture growth may be slow, morphology may be nonsporulating, and species-level identification may require molecular methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;A 44-year-old male forestry worker developed right ocular pain and a corneal ulcer after ocular trauma with a wooden fragment. He was referred to our hospital approximately one month after the injury; this first visit was defined as Day 0 (202X/11/27). At presentation, best-corrected visual acuity was 1.0 in the right eye. Slit-lamp examination showed a localized gray-white stromal infiltrate at the temporal peripheral cornea in the 9-10 o'clock position, with irregular margins and an overlying fluorescein-positive epithelial defect, but without hypopyon. The ocular media were sufficiently clear for detailed fundus examination, and dilated fundus examination showed no clinical evidence of posterior segment involvement or endophthalmitis. B-scan ultrasonography was therefore not performed. Direct microscopy using 10% potassium hydroxide wet mount and Fungiflora Y staining, corneal culture, and a 12-strip/24-target multiplex real-time polymerase chain reaction panel were all negative at Day 0. After temporary cessation of antifungal therapy because of severe drug-induced hepatotoxicity during systemic voriconazole and acetazolamide therapy (aspartate aminotransferase 540 U/L, alanine aminotransferase 1041 U/L), the lesion enlarged. Repeat scraping culture yielded a filamentous fungus on Day 58. The isolate formed black, slightly velvety colonies and dark hyphae, but did not produce diagnostic conidia or spores under the conditions used. Sequencing of the ribosomal DNA internal transcribed spacer region by Sanger sequencing, followed by BLAST comparison, suggested that the isolate belonged to the order Pleosporales, although species-level identification was not achieved. Treatment consisted of stepwise combination therapy, including topical voriconazole, amphotericin B, and natamycin, initial systemic voriconazole, subsequent topical amphotericin B, systemic and topical micafungin, and oral terbinafine. After active infection had clinically stabilized, 20% autologous serum eye drops were added to support epithelial healing. At the final follow-up on Day 268, best-corrected visual acuity was 1.2, with a quiet anterior segment and a stable corneal scar.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This case highlights the importance of repeated microbiological sampling and molecular identification in traumatic fungal keratitis when initial tests are negative. It also illustrates the need for cautious, individualized treatment when azole therapy is interrupted because of systemic toxicity. Because species-level identification and antifungal susceptibility testing were not achieved","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ophthalmic manifestation of bilateral ocular toxocariasis: a case-series.","authors":"Junxiang Gu, Zhujian Wang, Min Zhou, Gezhi Xu, Qian Chen, Qing Chang","doi":"10.1186/s12348-026-00618-6","DOIUrl":"10.1186/s12348-026-00618-6","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the clinical features of bilateral ocular toxocariasis (OT).</p><p><strong>Methods: </strong>In this case-series, the ocular characteristics and treatments of the patients diagnosed with bilateral OT from 2015 to 2024 were reviewed and analyzed. The influences of clinical manifestations on prognosis were evaluated.</p><p><strong>Results: </strong>Ten patients aged 21 ± 15 years were included. In all the patients, the onset of the two eyes was asynchronous. The first-affected eyes (FAEs) had worse visual acuity than the second-affected eyes (SAEs) (paired t test, P = 0.024). Peripheral granulomas were observed in 16 eyes (FAE/SAE: 9/7), followed by posterior granulomas in 3 eyes (all FAEs). The peripheral granulomas in FAEs were longer than those in paired SAEs (6.38 ± 1.69 mm versus 5.29 ± 1.77 mm, P = 0.045). Cyclitic membrane, vitreous strand, epiretinal membrane, tractional retinal detachment and ciliary body detachment were observed in 10 (FAE/SAE: 5/5), 6 (FAE/SAE: 3/3), 12 (FAE/SAE: 7/5), 5 (FAE/SAE: 2/3) and 1(FAE) eye at baseline, respectively. The incidences of these lesions didn't vary greatly from baseline to the latest visits except for an increased incidence of tractional retinal detachment (25% to 60%, P = 0.016). Cataract, posterior synechia, band keratopathy and ocular hypertension occurred in 14 (FAE/SAE: 8/6), 9 (FAE/SAE: 6/3), 5 (FAE/SAE: 3/2) and 7 eyes (FAE/SAE: 4/3), respectively. Peripheral granulomas might be correlated with poor visual recovery in this series (Stepwise linear regression, P = 0.003).</p><p><strong>Conclusion: </strong>Bilateral OT cases tended to have an asynchronous onset and asymmetric severity between the two eyes. Such feature could help to maintain the diagnosis of OT and prompt further test of anti-T. canis antibody for confirmation despite bilateral involvement.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular toxoplasmosis in Latin American and European patients: clinical characteristics, visual outcomes, and recurrence patterns.","authors":"Arman Shamani-Aminian, Alfredo Adán, Víctor Llorenç","doi":"10.1186/s12348-026-00615-9","DOIUrl":"10.1186/s12348-026-00615-9","url":null,"abstract":"<p><strong>Background: </strong>Ocular toxoplasmosis is the most common cause of posterior uveitis worldwide and a major cause of visual impairment. Previous studies suggest that the disease may follow a more aggressive clinical course in patients from Latin America; however, direct comparative evidence between geographic populations remains limited. This study aimed to characterize the clinical, serological, and imaging features of a multiethnic cohort of patients with ocular toxoplasmosis and to assess differences according to geographic origin.</p><p><strong>Methods: </strong>A retrospective chart review was performed including 144 patients diagnosed with ocular toxoplasmosis at a tertiary referral center in Barcelona, Spain. Clinical characteristics, recurrence patterns, visual outcomes, and serological findings were analyzed. Outcomes were compared between Latin American (n = 73) and European (n = 71) patients.</p><p><strong>Results: </strong>Latin American origin (OR 8.21; p < 0.001) and older age at disease onset (OR 1.04; p = 0.009) were independently associated with atypical disease presentation. Latin American origin (β = +0.20 LogMAR; p = 0.02), congenital disease (β = +0.52 LogMAR; p < 0.001), and retinal zone I involvement (β = +0.57 LogMAR; p < 0.001) were independently associated with worse visual acuity outcomes. Latin American origin (OR 4.85; p = 0.002) and longer time since disease onset (OR 1.05; p = 0.04) were independently associated with multiple recurrences, whereas congenital disease (OR 0.03; p = 0.01) was associated with lower recurrence risk. Serum IgG levels were significantly higher in Latin American patients (p = 0.002), who also more frequently required systemic corticosteroids along with antiparasitic treatment.</p><p><strong>Conclusions: </strong>Patients of Latin American origin showed a higher prevalence of atypical disease, increased recurrence rates, and poorer visual outcomes compared with European patients. These findings support the hypothesis of a more severe disease phenotype in this population and highlight the importance of closer monitoring and individualized management strategies in patients at higher risk of severe ocular toxoplasmosis.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe corneal melting with necrotic sloughing in Acanthamoeba keratitis mimicking corneal endotheliitis.","authors":"Yukihiko Nakajima, Hiroko Takano, Yuka Kondo, Ryo Taguchi, Machiko Shimmura-Tomita, Toshikatsu Kaburaki, Suguru Nakagawa","doi":"10.1186/s12348-026-00614-w","DOIUrl":"10.1186/s12348-026-00614-w","url":null,"abstract":"<p><strong>Background: </strong>Acanthamoeba keratitis (AK) is a sight-threatening corneal infection that may initially lack typical epithelial or perineural findings and mimic other infectious or inflammatory anterior segment disorders. Endotheliitis-like presentations of AK with stromal edema, keratic precipitates, Descemet membrane folds, and anterior chamber inflammation have been reported, but progression to severe stromal necrosis with spontaneous sloughing of necrotic corneal tissue is rarely documented.</p><p><strong>Case presentation: </strong>A 48-year-old contact lens wearer presented with right eye pain, redness, and decreased vision. Initial examination at a local clinic revealed anterior chamber inflammation without epithelial defects, radial keratoneuritis, or a ring infiltrate, and topical betamethasone was started before referral. At referral (0 weeks; 12 days after symptom onset), slit-lamp examination revealed diffuse stromal edema, fine keratic precipitates, Descemet membrane folds, and anterior chamber inflammation, closely mimicking viral corneal endotheliitis. Aqueous humor polymerase chain reaction for human herpesviruses 1-8 was negative. Because viral endotheliitis or noninfectious anterior uveitis was considered, topical corticosteroids and systemic prednisolone were administered (initially 30 mg/day and was gradually tapered). During follow-up, the clinical appearance evolved toward AK, and anti-infective therapy was revised. Corneal scraping was performed, but direct microscopy and bacterial and fungal cultures were negative. PCR testing of a corneal scraping specimen for Acanthamoeba, bacteria, and fungi was negative. Despite treatment, stromal necrosis progressed to severe corneal melting. At 34 weeks after referral, necrotic corneal tissue spontaneously sloughed as a sequestrum and was submitted for pathological evaluation. Hematoxylin and eosin and periodic acid-Schiff staining revealed necrotic corneal stromal tissue with inflammatory cell infiltration and multiple double-walled cystic structures consistent with Acanthamoeba cysts, confirming AK.</p><p><strong>Conclusions: </strong>This case illustrates a diagnostically challenging form of AK that initially mimicked corneal endotheliitis, yielded negative scraping-based microbiological tests, and was ultimately confirmed by histopathologic examination of spontaneously sloughed necrotic stromal tissue. Severe AK rarely manifests as necrotic stromal sequestration and spontaneous sloughing, in addition to the more commonly recognized destructive outcomes such as corneal thinning, perforation, or keratoplasty-requiring disease. Repeated diagnostic reassessment is important in contact lens wearers with atypical endotheliitis-like keratitis, particularly when the disease progresses despite antiviral or anti-inflammatory therapy.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed-onset cytomegalovirus retinitis after 0.2 µg/day fluocinolone acetonide implantation: a case series.","authors":"Anamika Patel, Ilaria Testi, Carlos Pavesio","doi":"10.1186/s12348-026-00609-7","DOIUrl":"10.1186/s12348-026-00609-7","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the clinical features and outcomes of cytomegalovirus retinitis (CMVR) presenting after intravitreal fluocinolone acetonide (FAc) implantation.</p><p><strong>Methods: </strong>Single centre, retrospective observational case series involving three patients who developed CMVR several months after FAc implantation at the uveitis department at Moorfields Eye Hospital, London, UK. Clinical history, immune status, ocular findings, imaging, and management were reviewed.</p><p><strong>Results: </strong>The first patient with pulmonary sarcoidosis and no systemic treatment presented 14 months post-implant with granular retinitis and severe occlusive retinal vasculitis. He developed renal toxicity to valganciclovir, necessitating intravitreal foscarnet and FAc implant removal. The second patient with presumed ocular sarcoidosis on multiple immunosuppressive agents developed fulminant necrotising CMVR eight months after FAc implantation and responded well to systemic valganciclovir with adjunctive intravitreal foscarnet therapy. The third patient, an elderly man with previous CMV retinitis in the context of follicular lymphoma, experienced reactivation at the margin of an old scar several months after FAc implantation and was stabilised with intravenous and intravitreal foscarnet. Although two patients had bilateral implants, the retinitis remained unilateral. Across cases, presentations ranged from granular retinitis with vasculitis to fulminant necrosis and late reactivation.</p><p><strong>Conclusion: </strong>Delayed-onset CMVR can occur in eyes treated with FAc implants, particularly in immunosuppressed patients. Recognition of atypical presentations, early PCR testing and timely antiviral therapy are essential to preserve vision.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}