Journal of Ophthalmic Inflammation and Infection最新文献

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Orbital tuberculosis presenting as vision loss and headache: early management is paramount. 眼眶结核表现为视力下降和头痛:早期治疗至关重要。
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-10-14 DOI: 10.1186/s12348-024-00425-x
Sandeep Pal, Narendra Patidar, Gunjan Tomar, Himanshu Gaikwad
{"title":"Orbital tuberculosis presenting as vision loss and headache: early management is paramount.","authors":"Sandeep Pal, Narendra Patidar, Gunjan Tomar, Himanshu Gaikwad","doi":"10.1186/s12348-024-00425-x","DOIUrl":"https://doi.org/10.1186/s12348-024-00425-x","url":null,"abstract":"<p><p>Orbital tuberculosis is a rare form of extra pulmonary TB and may arise either by hematogenous route or spread directly from the paranasal sinus. We herein report two cases of orbital TB with a vision threatening complication. Case-1 is a 31-year-old female with a headache, a diminution of vision in the right eye, and pain in ocular movement. On examination, there was no proptosis with RAPD present in right eye and tenderness on palpation. CEMRI revealed a diffuse infiltrating lesion at the orbital apex, suggesting of inflammatory pathology. Case-2 is a 40-year-old male with similar complaints in the left eye, CECT showed edema and swelling in the optic nerve and extraocular muscle of the left eye. A detailed investigation was done, and a diagnosis of orbital tuberculosis was made in both patients. They were started on ATT and oral steroids but lost follow-up initially and due to delayed treatment, it led to irreversible vision loss. A long-term follow-up showed resolution of ocular symptoms with occasional headaches.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"51"},"PeriodicalIF":2.9,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468028","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}
引用次数: 0
Cytomegalovirus chronic retinal necrosis with ganciclovir resistance: a case report. 巨细胞病毒慢性视网膜坏死伴更昔洛韦耐药:病例报告。
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-10-08 DOI: 10.1186/s12348-024-00434-w
Julia Xia, Sanjana Kantipudi, Christopher C Striebich, Andrés F Henao-Martinez, Niranjan Manoharan, Alan G Palestine, Amit K Reddy
{"title":"Cytomegalovirus chronic retinal necrosis with ganciclovir resistance: a case report.","authors":"Julia Xia, Sanjana Kantipudi, Christopher C Striebich, Andrés F Henao-Martinez, Niranjan Manoharan, Alan G Palestine, Amit K Reddy","doi":"10.1186/s12348-024-00434-w","DOIUrl":"10.1186/s12348-024-00434-w","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) chronic retinal necrosis (CRN) is a rare viral retinal infection that occurs in mildly immunocompromised people. It shares some features with both acute retinal necrosis and CMV retinitis. It is typically treated with combination intravitreal and systemic ganciclovir. We discuss the management of a case of CMV CRN with ganciclovir resistance.</p><p><strong>Case presentation: </strong>An 80-year-old female presented with one month of blurry vision in the left eye. She was being treated with abatacept, methotrexate, and prednisone for rheumatoid arthritis. Examination revealed anterior chamber and vitreous cell along with peripheral retinal whitening. Fluorescein angiogram showed diffuse retinal non-perfusion. Aqueous fluid PCR testing returned positive for CMV. The retinitis was initially controlled with oral and intravitreal ganciclovir, but then recurred and progressed despite these therapies. Ganciclovir resistance was suspected and the patient was switched to intravitreal foscarnet injections, along with oral letermovir and leflunomide, which lead to resolution of the retinitis. The patient has now continued with letermovir and leflunomide for approximately 2.5 years without reactivation of the retinitis or need for further intravitreal anti-viral injections and with adequate control of her rheumatoid arthritis.</p><p><strong>Conclusion: </strong>The incidence of CMV CRN may increase in the future as the use of non-cytotoxic immunosuppressive therapies that result in relatively mild immunosuppression also increases. Treatment with ganciclovir is effective but frequently leads to resistance, as in our case. In this situation, combination therapy with letermovir and leflunomide, particularly in the setting of rheumatoid arthritis where leflunomide can also have an anti-inflammatory effect, can be considered.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"50"},"PeriodicalIF":2.9,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391199","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}
引用次数: 0
Characterization of infectious bacterial keratitis in Östergötland County, Sweden: a 10-year retrospective study. 瑞典Östergötland县传染性细菌性角膜炎的特征:一项为期10年的回顾性研究。
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-10-07 DOI: 10.1186/s12348-024-00432-y
Jenny Roth, Baris Toprak, Sofia Somajo, Antonio Filipe Macedo, Neil Lagali
{"title":"Characterization of infectious bacterial keratitis in Östergötland County, Sweden: a 10-year retrospective study.","authors":"Jenny Roth, Baris Toprak, Sofia Somajo, Antonio Filipe Macedo, Neil Lagali","doi":"10.1186/s12348-024-00432-y","DOIUrl":"10.1186/s12348-024-00432-y","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to characterize bacterial species, aetiology and antibiotic susceptibility connected to bacterial keratitis infections in Östergötland, Sweden.</p><p><strong>Methods: </strong>Retrospective cross-sectional study based on electronic health records for the period 2010-2019. Records of patients diagnosed with infectious keratitis were screened for microbiology confirmed infectious bacterial keratitis. Bacterial species and their susceptibility to antibiotics were determined from microbiology test results.</p><p><strong>Results: </strong>One-hundred and ninety patients with lab culture-confirmed infectious bacterial keratitis were included in the analysis. The most frequently found bacterial species were coagulase-negative staphylococci (39%), Staphylococcus aureus (17%) and Cutibacterium acnes (10%). Pseudomonas spp. was the most frequently found Gram-negative bacterial species (7%). Contact lens wear and severely ill/blind eye were the top two aetiologies associated with bacterial keratitis, 22% of the patients with bacterial keratitis were also diagnosed with glaucoma. Most isolates, 157 out of 173, were susceptible to fluoroquinolones, and 145 out of 155 isolates were susceptible to chloramphenicol.</p><p><strong>Conclusion: </strong>Our results revealed a positive rate of bacterial keratitis of 59% for the samples sent to the laboratory. There was a high susceptibility of the bacterial species to the recommended antibiotics. Our results indicate that it is likely that patients are receiving the correct treatment. Future studies are necessary to monitor changes in antibiotic susceptibility.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"49"},"PeriodicalIF":2.9,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11458852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381092","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}
引用次数: 0
Clinical and radiological characteristics of odontogenic orbital cellulitis. 牙源性眼眶蜂窝织炎的临床和放射学特征。
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-10-01 DOI: 10.1186/s12348-024-00422-0
Vinay Tumuluri, Jessica Y Tong, Krishna Tumuluri, Dinesh Selva
{"title":"Clinical and radiological characteristics of odontogenic orbital cellulitis.","authors":"Vinay Tumuluri, Jessica Y Tong, Krishna Tumuluri, Dinesh Selva","doi":"10.1186/s12348-024-00422-0","DOIUrl":"10.1186/s12348-024-00422-0","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the radiological features and clinical outcomes of odontogenic orbital cellulitis.</p><p><strong>Method: </strong>Multi-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes.</p><p><strong>Results: </strong>Four patients with odontogenic orbital cellulitis were identified for inclusion. There was an equal proportion of men and women with a mean age of 43 years (range 25-56 years). All patients presented with an orbital compartment syndrome, with visual acuity of counting fingers (n = 1, 25%), hand movements (n = 1, 25%) and no perception of light (n = 2, 50%). The organisms implicated were Streptococcus milleri (n = 3, 75%) and Streptococcus constellatus (n = 1, 25%). MRI findings showed a subperiosteal abscess was present in all cases, which was characterised radiologically as a T1-hyperintense, T2 minimally hyperintense collection with restricted diffusion and a low apparent diffusion coefficient signal. Final visual acuity ranged from 6/6 to no light perception. One patient required an orbital exenteration due to extensive necrosis with sepsis and systemic deterioration.</p><p><strong>Conclusions: </strong>Odontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to Streptococcus species. Outcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"48"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11445216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348543","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}
引用次数: 0
Bilateral purtscher-like retinopathy associated with DRESS syndrome: a case report. 与 DRESS 综合征相关的双侧脓肿样视网膜病变:病例报告。
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-09-30 DOI: 10.1186/s12348-024-00433-x
Langxuan Yuan, Yuchen Li, Hanze Zhang, Yucen Hou, Qianyan Kang, Jianqin Lei
{"title":"Bilateral purtscher-like retinopathy associated with DRESS syndrome: a case report.","authors":"Langxuan Yuan, Yuchen Li, Hanze Zhang, Yucen Hou, Qianyan Kang, Jianqin Lei","doi":"10.1186/s12348-024-00433-x","DOIUrl":"10.1186/s12348-024-00433-x","url":null,"abstract":"<p><strong>Background: </strong>To report a case of Bilateral Purtscher-like retinopathy associated with DRESS syndrome managed with ocular and systemic treatments.</p><p><strong>Case presentation: </strong>A 29-year-old healthy female developed multi-organ (cutaneous, hematologic, renal and hepatic) disfunction and profound vision loss 1 month after Human papillomavirus vaccine injection. At the first presentation, her visual acuity was counting fingers in both eyes. Fundus exam showed remarkable cotton-wool spots, retinal hemorrhages and macular edema. She was diagnosed DRESS syndrome and Purtscher-like retinopathy and treated with intravitreal injection of ranibizumab, systemic steroids anticoagulants, and plasma exchange. The patient finally recovered from this life-threatening condition but left with permanent visual damage.</p><p><strong>Conclusion: </strong>Purtscher-like retinopathy could be complicated by DRESS syndrome which is usually considered a type IV hypersensitivity reaction.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"46"},"PeriodicalIF":2.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348542","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}
引用次数: 0
Tocilizumab for cystoid macular edema secondary to retinitis pigmentosa. 托西珠单抗治疗继发于视网膜色素变性的囊样黄斑水肿。
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-09-30 DOI: 10.1186/s12348-024-00430-0
Stéphane Abramowicz, Prochore Kamgang Semeu, Isabelle Nubourgh, Laurence Postelmans, François Willermain
{"title":"Tocilizumab for cystoid macular edema secondary to retinitis pigmentosa.","authors":"Stéphane Abramowicz, Prochore Kamgang Semeu, Isabelle Nubourgh, Laurence Postelmans, François Willermain","doi":"10.1186/s12348-024-00430-0","DOIUrl":"10.1186/s12348-024-00430-0","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the effect of tocilizumab (TCZ) on cystoid macular edema (CME) and retinal vascular leakage (RVL) in retinitis pigmentosa (RP).</p><p><strong>Methods: </strong>Retrospective case series.</p><p><strong>Results: </strong>We present 2 cases of RP with marked inflammatory features in the form of CME and RVL. There was initial diagnostic uncertainty with posterior uveitis. Both patients were treated with corticosteroids, conventional disease-modifying antirheumatic drugs (cDMARDs), and biological DMARDs (bDMARDs) for the inflammatory features with partial and inconsistent treatment response. When treatment was switched to intravenous (IV) TCZ, dramatic reduction in CME and RVL were observed in both patients. Diagnosis of RP was eventually made based on findings of ancillary tests (macular spectral-domain optical coherence tomography, visual fields, full-field electroretinogram). Genetic testing led to a molecular diagnosis of EYS-related autosomal recessive RP in patient 1, while patient 2 had negative gene panel results.</p><p><strong>Conclusions: </strong>IV TCZ can be an effective treatment option in RP-related CME and RVL. Whether this treatment strategy has an effect on prognosis remains to be established, but it is possible considering chronic CME-related retinal damage is a major driver of central vision loss in RP.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"47"},"PeriodicalIF":2.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348545","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}
引用次数: 0
Occlusive retinal vasculitis associated with intravitreal Faricimab injections. 与玻璃体内注射 Faricimab 相关的闭塞性视网膜血管炎。
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-09-27 DOI: 10.1186/s12348-024-00429-7
Felix F Reichel, Peter Kiraly, Roopa Vemala, Stella Hornby, Samantha R De Silva, M Dominik Fischer
{"title":"Occlusive retinal vasculitis associated with intravitreal Faricimab injections.","authors":"Felix F Reichel, Peter Kiraly, Roopa Vemala, Stella Hornby, Samantha R De Silva, M Dominik Fischer","doi":"10.1186/s12348-024-00429-7","DOIUrl":"https://doi.org/10.1186/s12348-024-00429-7","url":null,"abstract":"<p><strong>Purpose: </strong>We describe a case of occlusive vasculitis associated with intravitreal Faricimab (Vabysmo) injections.</p><p><strong>Methods: </strong>A retrospective case report.</p><p><strong>Results: </strong>A 52-year old man treated with monthly Faricimab injections for diabetic macula oedema presented with sudden reduced vision, new retinal hemorrhages, significant retinal vascular occlusions and ischemia. After screening for differential diagnoses was unremarkable, the patient was treated with oral and intravitreal steroid therapy under which the occlusive vasculitis was stabilized.</p><p><strong>Conclusion: </strong>Occlusive vasculitis, though rare, is a potential complication of Faricimab therapy. Comprehensive reporting and large-scale analyses are essential to better understand and manage this adverse event.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"45"},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348544","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}
引用次数: 0
Fluocinolone acetonide 0.18-mg implant for treatment of recurrent inflammation due to non-infectious uveitis: a case series of 15 patients 治疗非感染性葡萄膜炎复发性炎症的 0.18 毫克氟西诺龙醋内酯植入剂:15 例患者的病例系列研究
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-09-19 DOI: 10.1186/s12348-024-00427-9
Robert A. Sisk, Daniel F. Kiernan, David Almeida, Anton M. Kolomeyer, David Eichenbaum, John W. Kitchens
{"title":"Fluocinolone acetonide 0.18-mg implant for treatment of recurrent inflammation due to non-infectious uveitis: a case series of 15 patients","authors":"Robert A. Sisk, Daniel F. Kiernan, David Almeida, Anton M. Kolomeyer, David Eichenbaum, John W. Kitchens","doi":"10.1186/s12348-024-00427-9","DOIUrl":"https://doi.org/10.1186/s12348-024-00427-9","url":null,"abstract":"Uncontrolled non-infectious uveitis affecting the posterior segment (NIU-PS) can lead to vision loss due to repeated bouts of inflammation and consequent tissue damage. Patients with chronic NIU-PS who experience recurrent uveitis after being treated with systemic and short-acting local corticosteroids may benefit from the sustained-release 0.18-mg fluocinolone acetonide implant (FAi). In this case series, 18 eyes with chronic, recurrent NIU-PS and cystoid macular edema (CME) treated with the 0.18-mg FAi were analyzed retrospectively. Data on patient demographics, clinical history, previous and concomitant treatments for uveitis recurrence, time to and number of uveitis recurrences, intraocular pressure (IOP), central subfield thickness (CST), and visual acuity (VA) were collected and summarized. A majority of patients (14/15 [93%]) had a history of ocular surgery, largely cataract extraction, and all developed chronic and recurrent NIU-PS and CME. At baseline, patients had a mean age of 72 years (range: 46 to 93), were 53% male, and had a mean duration of NIU-PS of 3 years (range: 1 to 19). Patients were followed for an average of 16.5 months (range: 2 to 42.5 months) post FAi. Eleven of the 18 eyes (61%) had ≥ 5 recurrences of uveitis since diagnosis, with an average time to recurrence of approximately 12 weeks (range: 1 to 27). All eyes treated with the 0.18-mg FAi showed reduced NIU-PS recurrence and visual and anatomical improvement, as measured by VA and CST, respectively. Two eyes had an IOP elevation that was managed with topical therapy, and one eye was treated with topical prednisolone for additional inflammation management. Two eyes required adjunct therapy with short-acting intravitreal corticosteroids at 7 and 16 weeks for NIU-PS recurrence after 0.18-mg FAi insertion. After receiving the 0.18-mg FAi, eyes with uncontrolled NIU-PS had sustained resolution of CME and inflammation with limited need for supplementary steroid drops or injections and minimal steroid class-specific adverse effects; none required incisional IOP-lowering surgery.","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"2 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Use of in vivo confocal microscopy in suspected Acanthamoeba keratitis: a 12-year real-world data study at a Swedish regional referral center 活体共聚焦显微镜在疑似阿卡阿米巴角膜炎中的应用:瑞典地区转诊中心 12 年真实数据研究
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-09-10 DOI: 10.1186/s12348-024-00424-y
Bogdana Toba, Neil Lagali
{"title":"Use of in vivo confocal microscopy in suspected Acanthamoeba keratitis: a 12-year real-world data study at a Swedish regional referral center","authors":"Bogdana Toba, Neil Lagali","doi":"10.1186/s12348-024-00424-y","DOIUrl":"https://doi.org/10.1186/s12348-024-00424-y","url":null,"abstract":"To report real-world data (RWD) on the use of in vivo confocal microscopy (IVCM) in handling cases of suspected Acanthamoeba keratitis (AK) cases at a regional referral center during a 12-year period. Retrospective study of patients with suspected AK presenting at a regional referral center for IVCM in Sweden from 2010 to 2022. Demographics, symptoms, outcomes, and clinical management were analyzed, and IVCM images were interpreted. Of 74 included patients with suspected AK, 18 (24%) were IVCM-positive, 33 (44%) were IVCM-negative, 15 had inconclusive IVCM results (20.2%), and 8 (11%) were referred for a second opinion based on IVCM, 4 of which were IVCM-positive (5.5%), yielding an overall IVCM-positive rate of 29.5%. Cultures were taken in 38 cases (51%) with only 2 cases (2.7%) culture-positive for AK. Of IVCM-negative cases, cultures were taken in 22 (67%) of cases and 100% of these were AK-negative. IVCM-positive cases had more clinic visits (median 30, P = 0.018) and longer follow-up time (median 890 days, P = 0.009) than IVCM-negative patients, while visual acuity improvement did not differ (P > 0.05). Of IVCM-positive cases, 10 (56%) underwent surgery despite prior anti-amoebic treatment, and 14 (78%) had 3 or more IVCM examinations during follow-up, with cysts (100%), dendritic cells (89%) and inflammatory infiltrate (67%) as the most prevalent features. Longitudinal IVCM indicated improvement in cysts, dendritic cells and subbasal nerves with treatment, while clinical resolution was not always consistent with complete absence of cysts. In a real-world setting, IVCM has a high reliability in classifying AK-negative cases, while IVCM detects AK-positive cases more frequently than the gold-standard culture method, leading to its preferential use over the culture method where time or resources are limited. Despite this, a subset of cases are IVCM-inconclusive, the clinical course of referred patients is long requiring many hospital visits, and visual acuity in most cases does not improve with medical treatment alone. Information sharing across centers and standardization of referral and diagnostic routines is needed to exploit the full potential of IVCM in AK patient management.","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"57 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between in vitro susceptibility and clinical outcomes in fungal keratitis. 真菌性角膜炎的体外易感性与临床结果之间的关系。
IF 2.9
Journal of Ophthalmic Inflammation and Infection Pub Date : 2024-09-02 DOI: 10.1186/s12348-024-00418-w
Louisa Lu, N Venkatesh Prajna, Prajna Lalitha, Revathi Rajaraman, Muthiah Srinivasan, Benjamin F Arnold, Nisha Acharya, Thomas Lietman, Jennifer Rose-Nussbaumer
{"title":"Association between in vitro susceptibility and clinical outcomes in fungal keratitis.","authors":"Louisa Lu, N Venkatesh Prajna, Prajna Lalitha, Revathi Rajaraman, Muthiah Srinivasan, Benjamin F Arnold, Nisha Acharya, Thomas Lietman, Jennifer Rose-Nussbaumer","doi":"10.1186/s12348-024-00418-w","DOIUrl":"10.1186/s12348-024-00418-w","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess the association between antifungal susceptibility as measured by minimum inhibitory concentration (MIC) and clinical outcomes in fungal keratitis.</p><p><strong>Methods: </strong>This pre-specified secondary analysis of the Mycotic Ulcer Treatment Trial II (MUTT II) involved patients with filamentous fungal keratitis presenting to Aravind Eye Hospitals in South India. Antifungal susceptibility testing for natamycin and voriconazole was performed on all samples with positive fungal culture results according to Clinical and Laboratory Standards Institute Guidelines. The relationship between MIC and clinical outcomes of best-corrected visual acuity, infiltrate or scar size, corneal perforation, need for therapeutic penetrating keratoplasty, and time to re-epithelialization were assessed.</p><p><strong>Results: </strong>We obtained MIC values from 141 patients with fungal keratitis. The most commonly cultured organisms were Aspergillus (46.81%, n = 66) and Fusarium (44.68%, n = 63) species. Overall, there was no association between antifungal MICs and clinical outcomes. Subgroup analysis revealed that among Fusarium-positive cases, higher voriconazole MIC was correlated with worse three-month best-corrected visual acuity (p = 0.03), increased need for therapeutic penetrating keratoplasty (p = 0.04), and time to re-epithelialization (p = 0.03). No significant correlations were found among Aspergillus-positive cases. There were no significant correlations found between natamycin MIC and clinical outcomes among organism subgroups.</p><p><strong>Conclusions: </strong>Decreased susceptibility to voriconazole was associated with increased odds of requiring a therapeutic penetrating keratoplasty in Fusarium-positive cases. Susceptibility to natamycin was not associated with any of the measured outcomes.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":"14 1","pages":"42"},"PeriodicalIF":2.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108386","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}
引用次数: 0
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