Corneal Stromal Infiltration Research Articles

Mycobacterium abscessus Corneal Ulcer with Conjunctival Toxicity due to Topical Amikacin

Purpose: This report presents a case of repeated toxic conjunctival necrosis caused by amikacin eye drops in a patient with a corneal ulcer induced by Mycobacterium abscessus (M. abscessus).Case summary: During treatment for herpetic keratitis with complaints of conjunctival hyperemia and eye pain in the right eye for 1 month. Slit-lamp microscopy revealed a circular corneal epithelial defect and stromal infiltration of her right eye. Gram staining and culture were performed, and eye drops were prescribed for empirical treatment. The bacterial culture grew M. abscessus. Antibiotic susceptibility tests showed resistance to quinolone. The patient was prescribed amikacin eye drops and the corneal epithelial defects improved. Two weeks later, circular conjunctival epithelial defects and hyperemia were observed on the inferior conjunctiva. Conjunctival necrosis caused by amikacin was suspected. The amikacin eye drops were discontinued and the conjunctival lesion improved. However, the patient’s corneal ulcer recurred. The amikacin eye drops were restarted, but conjunctival toxicity recurred, so she was treated with topical clarithromycin and moxifloxacin. The eye drops were gradually reduced and the lesion healed leaving mild corneal opacity.Conclusions: M. abscessus-induced keratitis resistant to quinolone antibiotics requires long-term combined therapy with multiple drugs. Amikacin eye drops should be used carefully as conjunctival toxicity may occur.

Failed Treatment of Multidrug-resistant Acinetobacter Baumannii Keratitis Mistaken for a Mixed Infection

Purpose: To report treatment failure of multidrug-resistant <i>Acinetobacter baumannii</i> keratitis in a patient wearing contact lenses for a long time.Case summary: A 48-year-old man using daytime soft lenses for 20 years was transferred due to decreased visual acuity and eye pain. Slit-lamp biomicroscopy showed a large corneal epithelial defect and stromal infiltration, but no hypopyon. Treatment was initiated with moxifloxacin, polyhexamethylene biguanide eye drops, and oral antibiotics. Corneal infiltration worsened, corneal scrapings and culture were performed. Gram staining showed Gram-positive bacteria, potassium hydroxide (KOH) hyphae-positive, and culture yielded Bacillus. He was hospitalized and vancomycin, voriconazole, and amphotericin B eye drops were administered. Oral antifungal agents were also prescribed. The corneal epithelial defect was restored from temporal side for a while, and then deteriorated with an endothelial plaque. Therefore, voriconazole and amphotericin B were injected intracamerally. All four repeated culture tests were negative. Despite total conjunctival flap, the patient complained of severe pain and eventually underwent evisceration. In the culture of intraocular contents, <i>Acinetobacter baumannii</i>, which is resistant to all drugs except minocycline, was detected.Conclusions: In patients wearing contact lens for a long time, not only mixed infection with acanthamoeba and fungi, but also gram-negative bacteria should be considered first, and multidrug-resistant <i>Acinetobacter baumannii</i> should also be considered.

Repeated sessions of PACK-CXL WA for the treatment of resistant bacterial keratitis: a retrospective study

ObjectiveThe aim of this work is to evaluate the safety and efficacy of repeated sessions of photo-activated chromophore for keratitis-cross linking (PACK-CXL) window absorption (WA) for the treatment of resistant bacterial keratitis (BK).Patients and methodsThis is a retrospective clinical cohort study. Thirty eyes with clinically suspected and lab-confirmed bacterial keratitis, resistant to appropriate antibiotic therapy- which was modified by sensitivity reports- for 2 weeks with failure of epithelialization for 4 weeks after the standard anti-microbial therapy (SAT) together with one setting of PACK-CXL WA were included. If after the first session of PACK-CXL, there is a start of improvement in the form of reduction of the size of corneal ulcer and stromal infiltrates together with the start of epithelialization on clinical examination and AS-OCT, another session of PACK-CXL WA was performed after one week, and so on, till the complete healing and resolution of bacterial keratitis and confirmation by negative bacterial culture. Identification of the micro-organisms was done by lab study before and after treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT).ResultsThirty eyes of 30 patients were recruited in this study. They were 16 males and 14 females, their mean age was 44.3 ± 5.38 years. The mean ulcer size was 3.96 ± 1.87 (mm3), while the mean size of stromal infiltrates was 4.52 ± 2.24 (mm3). PACK-CXL WA treatment was performed an average of 2.87 times for the 30 eyes. Complete healing and resolution (Successful treatment) was observed in 27 eyes (90%) of cases and failure of epithelialization was observed only in 3 eyes (10%). Complete corneal healing was reported in the second month postoperatively in 90% of eyes.Conclusion and recommendationPACK-CXL WA may be a promising, non-invasive treatment option for resistant bacterial keratitis. It may have a synergistic effect with standard antimicrobial treatment (SAT). Also, it can overcome the antibiotics resistance that has become rapidly spreading worldwide. Repeated sessions of PACK-CXL WA may be more effective for the treatment of resistant bacterial keratitis till complete epithelialization and resolution of BK than a single session with few complications. However, further prospective and comparative studies to support the results are needed.

A Case of Contact Lens Induced Acute Red Eye

Purpose: To report a rare case of acute red eye in a contact lens user.Case summary: An 18-year-old female presented with decreased visual acuity and ocular pain in the right eye for 4 days. The patient had used contact lenses for > 8 hours a day, even while sleeping at night, for the past 3 months. Corneal epithelial edema and punctate stromal infiltration along with diffuse conjunctival hyperemia and corneal limbal injection in the right eye were observed in slit lamp examination. The uncorrected and corrected visual acuities of the right eye were 0.02 (20/1000) and 0.16 (20/125), respectively. The right eye had an intraocular pressure of 10 mmHg, and the left eye was within normal range. The patient stopped wearing contact lenses and was prescribed steroid and antibiotic eye drops and artificial tears. The corrected visual acuity increased to 0.5 (20/40) on the first day of treatment and to 1.0 (20/20) after 2 months. The cornea and conjunctiva also returned to the normal appearance.Conclusions: It is important to differentiate contact lens-induced acute red eye from microbial keratitis. Discontinuation of contact lens use and education are required to prevent acute red eye caused by contact lens use.

The outcome of microbiologically proven fungal keratitis following standard treatment protocol

To describe the baseline characteristics, microbiological spectrum, therapy and assess the visual outcome in patients proven with fungal keratitis following standard treatment protocol. This longitudinal study was reviewed all patients with culture-proven fungal keratitis over a year at a tertiary referral facility in Bangladesh. All of the patients who had corneal stromal infiltrates had their corneal scrapings subjected to the normal microbiologic examination process, as well as a smear and culture-guided antimicrobial medication. Epidemiological features of patients (n=100), the mean age of patients was 55.6±9.8 years. More in the age group 51 to 60 years (28%). Males were more predominant (67%), commonly come from rural areas (59%). More were agriculture in workers (57%). Predisposing factors in fungal keratitis were trauma with vegetative matter (58%), herpetic keratitis (16%), penetrating keratoplasty (10%), extended wear of contact lens(12%), LASIK(4%). Treatment taken by another ophthalmologist before the presentation (46%). Low vision (20/50 to 20/160) was found in 58% cases and legal blindness (20/200 to worse ) was 40% of cases on visual acuity test at presentation. Filamentous Aspergillus (68%), Fusarium (2%), Scedosporium species (6%) and Candida(20%) were found by doing culture. Surgical intervention was needed in 36% of cases with topical and systemic anti fungal medications for management. Visual acuity after treatment was 20/40 or better in 16% of cases, low vision (20/50 to 20/160) in 39% of cases and legal blindness (20/200 to worse) in 45% of cases. Fungal keratitis causes irreparable vision damage. Yeast infections were less common than infections with filamentous fungus, which were typically treated more aggressively through both medicinal and surgical means. Similar durations of infections and visual results were observed in filamentous and yeast keratitis. In 80% of the cases where it was done, antifungal susceptibility testing had an impact on the course of treatment.

Adverse Reactions from Topical Ophthalmic Anesthetic Abuse.

To assess the adverse drug reactions (ADR) of tetracaine among patients referred to an eye emergency department in the southeast of Iran. In this case series study, we assessed 31 eyes of 24 patients who were referred due to adverse effects of ocular anesthetics during2017-2020. We collected the data, including age, sex, job, how the medicine was obtained, symptoms, examination results, and ADR. Of 24 patients, 22 (91.7%) were male. The mean (standard deviation) age of the patients was 32.6 (1.9) years. Twenty-two patients obtained the medicines without a prescription and a general practitioner prescribed the medicine to two patients. In the first interview, the most common symptoms were: photophobia, reduced vision, ocular pain, and redness. The main signs of persistent epithelial defect, patchy or diffuse corneal stromal infiltration, ring infiltration, and Descemet's folds were noticed in the examinations. Finally, 51.6% (n =16) of the eyes had decreased vision, 45.2% (n =14) had corneal opacity, 16.1% (n = 5) had elevated intraocular pressure that needed long-term anti-glaucoma therapy, and 6.5% (n = 2) had corneal pannus. Corneal perforation and phthisis bulbi were the final results in one eye. ADR related to the use of ophthalmic topical anesthetics could cause sight-threatening severe morbidities. It seems that some general practitioners are not careful regarding the prescription of these kinds of medicine. Moreover, the over-the-counter availability of tetracaine eye drops should be managed.

Acremonium keratitis: Risk factors, clinical characteristics, management, and outcome in 65 cases.

To study the risk factors, clinical presentation, management options, and outcomes in cases of culture-proven Acremonium keratitis. Medical and microbiology records of culture-proven Acremonium keratitis from Jan 2007 to Dec 2019 at a tertiary eye care center were reviewed. Details of clinical findings on each visit and operating notes were reviewed from the medical records. All cases were subjected to corneal scraping at the first visit for microbiological investigation consisting of direct smear examination and culture. Topical natamycin 5% was the mainstay of medical treatment. Surgical treatment was considered for nonresponding patients. During the 13-year study period, 65 cases of culture-proven Acremonium keratitis were identified out of 1605 cases of fungal keratitis. Trauma was the most common predisposing factor in 32 cases (49.2%). The average area of the corneal stromal infiltrate was 24.8 mm2 at the initial presentation. Hypopyon at the time of presentation was evident in 28 (43.1%) cases. Staphylococcus spp. was the most common (n = 22, 33.8%) organism coexistent with Acremonium. Direct microscopy of corneal scraping was positive for fungal filaments in 57/65 (87.6%) cases. Medical management alone was given in 44 patients (67.6%). Age (>50 years) and treatment delay (>15 days) were found to be independent risk factors for the poor final visual outcome (VA <20/60). When treated early, Acremonium keratitis responds well to medical therapy with currently available topical antifungals. However, advanced and nonresponding cases require surgical intervention for resolution of the infection.

A Case of Unilateral Corneal Edema after Exposure to 0.12% Cholorohexidine

Purpose: We report a case of permanent corneal opacity caused by unilateral chemical burns after exposure to a low-dose (0.12%) chlorhexidine antiseptic solution during a dental procedure.Case summary: A 33-year-old woman presented to our clinic with conjunctival injection, ocular irritation, and blurred vision in her right eye; all symptoms had been present for 2 weeks. These symptoms began several hours after a dental procedure, in which 0.12% chlorhexidine antiseptic solution had been splashed into the right eye. Initial examination revealed that the patient’s best-corrected visual acuity (BCVA) was 20/200 in the right eye. Slit lamp examination and anterior segment optical coherence tomography revealed substantial corneal edema and stromal infiltration on the nasal side. The patient’s BCVA improved to 20/20 in the right eye after 3 months of treatment with topical corticosteroid. However, the stromal opacity was permanent and the corneal endothelial cell count was substantially reduced to approximately 550 cells/mm2.Conclusions: Low-dose (0.12%) chlorhexidine on the ocular surface may cause irreversible corneal opacity and chemical burn-induced endothelial cell damage.

Evaluation of conjunctival graft procedures and factors that lead to graft complications in canine cases.

To describe the complications of conjunctival graft surgery occurring in cases at a referral ophthalmic service and evaluate factors that lead to occurrence of complications in canine cases. A retrospective case-control study was completed using data from the Veterinary Medical Center at the Western College of Veterinary Medicine, Saskatoon, Canada, between May 2015 and March 2020. Case records from dogs that underwent conjunctival pedicle graft surgery and subsequently either did or did not develop a conjunctival graft complication were reviewed. One hundred and six dogs undergoing conjunctival graft surgeries were identified. Sixteen conjunctival graft complications occurred, of which, eight led to negative outcomes. Univariable analysis comparing canine eyes that developed complications to control eyes revealed potential (p ≤ .05) differences between the groups in post-operative fluoroquinolone use, Streptococcus canis isolation, intraoperative intravenous cefazolin use, corneal stromal white cell infiltrate, and mean ulcer diameter. The use of intraoperative cefazolin could not be effectively evaluated with available data; however, no dogs (n=22) receiving intraoperative cefazolin developed complications. Multivariable analysis revealed that dogs that were treated with a second-generation fluoroquinolone and that had S.canis isolated had higher odds of experiencing complications than dogs that were not treated with a second-generation fluoroquinolone and that were S.canis negative (Odds ratio=64.7 [95% CI 6.3-669], p < .0001). Streptococcus species played a role in conjunctival graft complications in our study. Empiric selection of second-generation fluoroquinolone monotherapy may need reconsideration given the frequent isolation of Streptococcus spp. from canine ulcers. The use of intraoperative cefazolin may be associated with a lower complication rate.

Factors associated with poor prognosis in corneal ulcer: A clinical and epidemiological study

Aim: To explore the factors associated with culture positivity and worsening of corneal ulcers in patients presenting to a tertiary care teaching hospital in south Kerala. Methods: We did a retrospective review of hospital-based case records from June 2018 to May 2019 and included all cases of infective corneal ulcer admitted during the period of study with corneal stromal infiltrate on slit-lamp examination. Results of gram stain, potassium hydroxide stain, and culture result were noted. The treatment history (moxifloxacin (0. 3%) or fortified cephalosporin and gentamicin or natamycin) was recorded. The data were exported to the statistical software SPSS V27.0 for further analysis. Results: The data of 125 culture-positive and 250 culture-negative ulcers were studied. Most patients were aged >55 years (n = 201, 53.6%) and 35–55 years (n = 120, 32.0%). The association of culture negativity with nontraumatic risk factors was significant (P = 0.01) but not with the size of the ulcer, progress score, or worsening clinical status of the ulcer. More persons with pretreatment (15.2%) showed worsening of the clinical status compared to those who did not (6.3%) (P = 0.005). 63% of the culture-positive cases had not taken any pretreatment. Compared to noncentral ulcers there was a marked deterioration of central ulcers (16.7%) (P = 0.005). Conclusion: Pretreatment and centrally located ulcers were significantly associated with a worsening clinical condition in this study. Culture-positive corneal ulcers showed a tendency toward improvement, but we could not find an association between the detection of the organism and its favorable response to treatment.

Correlation between histopathologic features and clinical outcomes of acanthamoeba keratitis

Objective: To study the relationship between the clinical characteristics and the histopathological changes in acanthamoeba keratitis. Methods: In this retrospective study, the clinical data and histopathological features of 15 Acanthamoeba keratitis patients (15 eyes) treated in Henan Eye Hospital were collected and analyzed. There were 8 males and 7 females. Mean age was 49.2 years old. The corneal specimens were stained with hematoxylin eosin, periodic acid-schiff, Gomori's methenamine silver, Gram and Gimsa respectively. The pathological changes and characteristics were observed under microscope, to analyze the relationship between histopathology and clinical features. Results: All patients had moderate conjunctival congestion. Five patients showed corneal ring stromal infiltration, 8 had central corneal ulcers, 1 had corneal opacity, and 1 had a matrix ulcer. We found corneal neovascularization around the ulcer in 4 eyes and a dense ulcer in 2 eyes. Histopathological examinations with hematoxylin-eosin, periodic acid-Schiff, Gomori's methenamine silver, Gram and Giemsa stainings revealed round or oval amoebic cysts and amebic trophozoites which were of an elongated oval, spine-or spear-like. Twelve patients (80%) showed corneal stromal purulent inflammation infiltrated by neutrophils. Many degenerated amoebic cysts were found. Degeneration and necrosis of corneal stromal fibers were observed in 3 eyes (20%). There were no neutrophils. Amoebic cysts were seen in necrotic tissue. Ten eyes (66.7%) had no inflammatory cell infiltration areas, with edematous or mildly degenerated corneal fibers, scattered or grouped cysts and trophozoites. Conclusions: Clinical manifestations of acanthamoeba keratitis are various. Acanthamoeba cysts and trophozoites also exist in the transparent corneal area on the histopathological examination. This is important for the therapeutic outcomes. (Chin J Ophthalmol, 2021, 57: 939-943).

Hydrogels derived from acellular porcine corneal stroma enhance corneal wound healing

Acellular cornea derived hydrogels provide significant advantages in preserving native corneal stromal keratocyte cells and endothelial cells. However, for clinical application, hydrogel physical properties need to be improved, and their role in corneal epithelial wound healing requires further investigation. In this study, an acellular porcine corneal stroma (APCS) hydrogel (APCS-gel) was successfully prepared from 20 mg/ml APCS, demonstrated optimal light transmittance and gelation kinetic properties and retained critical corneal ECM of collagens and growth factors. Compared with fibrin gel, the APCS-gel had a higher porosity ratio and faster nutrition diffusion with an accompanying improvement in the proliferation of primary rabbit corneal epithelial cells (RCECs) and stromal cells (RCSCs). These corneal cell types also displayed improved viability and cellular infiltration. Furthermore, the APCS-gel provides significant advantages in the preservation of RCECs stemness and enhancement of corneal wound healing in vitro and in vivo. After 7 days of culture, 3-4 layers of RCECs were formed on the APCS-gel in vitro, while only 1-2 layers were found on the fibrin gel. More corneal stem/progenitor cell phenotypes (K12-, p63+, ABCG2+) and proliferation phenotypes (Ki67+) were detected on the APCS-gel than fibrin gel. Using a corneal epithelial wound healing model, we also found faster reepithelization in corneas that received APCS-gel compared to fibrin gel. Additionally, our APCS-gel demonstrated better physical and biological properties when compared to Tisseel, a clinically used type of fibrin gel. In conclusion, our APCS-gel provided better corneal epithelial and stromal cell biocompatibility to fibrin gels and due to its transparency and faster gelation time could potentially be superior for clinical purposes. Statement of significanceExtracellular matrix (ECM) can be used to provide tissue specific physical microstructure and biochemical cues for tissue regeneration. Here, we produced an ECM hydrogel derived from acellular porcine cornea stroma (APCS-gel) that retained critical biological characteristics of the native tissue and provided significant transparency and fast gelation time. Our data demonstrated that the APCS-gel was superior to clinically used fibrin gel, as the APCS-gel showed high porosity and permeability, better corneal stromal keratocytes infiltration, increased cellular proliferation and retention of corneal epithelial cells stemness. The APCS-gel improved corneal wound healing in vitro and in vivo. This APCS-gel may have clinical utility for corneal diseases, and the more general approach used to make this hydrogel might be used in other tissues.

A PROSPECTIVE STUDY OF EPIDEMIOLOGICAL FEATURES, MICROBIOLOGICAL DIAGNOSIS & TREATMENT OUTCOME OF INFECTIVE KERATITIS

Aim: To study the epidemiological characteristics, microbiological profile, and treatment outcome of patients with suspected microbial keratitis in the region of Udaipur, Rajasthan. Materials &amp; methods: A prospective, analytical, hospital-based study conducted, all the patients presenting with corneal stromal infiltrate were enrolled for study and underwent standard microbiologic evaluation of their corneal scrapings, and smear and culture-guided antimicrobial therapy. Follow up was done for 1month and outcome were evaluated. Results: In our study, 60 patients with infective keratitis were enrolled. 38 (63.3%) were male patients while 22 (36.7%) patients were females. 58% people with infective keratitis had trauma as a leading predisposing factor.19 patients were diagnosed viral keratitis and 41 (68.33%) patients were found to be culture positive. Among the 41 culture positive patients 31.7% were bacterial, 30% were fungal, 6.7% were mixed. The majority of our patients 44 (73.3%) healed with the corneal scar, 12 [20%] healed with clear cornea. Conclusion: Our study observed trauma with vegetative material is the most common predisposing for infective keratitis. Males were affected more than females. Among organisms coagulase negative staphylococci and aspergillus were most common bacterial &amp; fungal isolates respectively. Herpes simplex virus was the most common viral isolate. Most of the patients of infective keratitis healed with the corneal scar.

Significant correlation between meibomian gland dysfunction and keratitis in young patients with Demodex brevis infestation

AimsTo report the clinical characteristics and correlation between meibomian gland dysfunction (MGD) and keratitis in young patients with ocular demodicosis.MethodsObservational case series of 60 patients younger than 35 years with...

Analysis of corneal complications in children wearing orthokeratology lenses at night

Objective: To explore the characteristics, prognoses and corneal complications of children wearing orthokeratology lenses (Ortho-K) at night. Methods: Retrospective case analysis. A total of 113 cases (219 eyes) wore Ortho-K for myopia at night, including 7 cases with unilateral glass wear. The average age was (11.5±2.0) years old. The myopia ranged from -1.00 D to -9.00 D in all eyes and from -2.00 D to -4.00 D in 157 of them. Examinations were performed before lens wearing, at 1 hour, the next morning, 2 days, 3 days, 1 week and 2 weeks after lens wearing, and thereafter once a month. The follow-up was 6 months. Slit lamp examination was used to observe whether there was edema, mechanical damage, pigment deposition, turbidity or infiltration. The morphology, location, number, range and depth of fluorescein staining were tracked for more than 6 months. Results: There were punctate corneal epithelial exfoliation in 18 cases (29 eyes, 13.24%), corneal stromal infiltration and opacity in 5 cases (6 eyes, 2.74%), and corneal iron deposition in 9 cases (17 eyes, 7.76%), with no obvious symptoms. After stopping wearing lenses and related treatment, the punctate epithelial exfoliation was completely cured, and the other complications gradually disappeared within 6 months. These complications occurred within 3 months after lens wearing in six eyes and after at least 6 months of lens wearing in 46 eyes. Conclusions: Children who have complications after wearing Ortho-K at night should immediately stop wearing the lenses. Timely treatment and follow-up help to avoid deterioration and serious complications. Orthokeratology should be performed in medical institutions, with the follow-up by qualified ophthalmic doctors. (Chin J Ophthalmol, 2017, 53:198-202).

Longitudinal Changes to Tight Junction Expression and Endothelial Cell Integrity in a Mouse Model of Sterile Corneal Inflammation.

We previously reported that applying toll-like receptor (TLR) ligands to an injured cornea induces corneal edema at 24 hours, which subsides by 1 week. We tested the hypotheses that endothelial expression of the tight-junction protein, zonula occludens-1 (ZO-1), would be altered during experimental sterile corneal inflammation and that endothelial cell density (ECD) would remain unaffected. Anesthetized C57BL/6J mice received central 1-mm corneal abrasions followed by topical application of saline or cytosine-phosphate-guanosine oligodeoxynucleotide (CpG-ODN, TLR-9 agonist). At 24 hours, 1 week and 4 weeks post treatment, spectral-domain optical coherence tomography images were captured. Eyes were enucleated and processed for zonula occludens-1 (ZO-1) immunofluorescent staining. Corneal flatmounts were analyzed for endothelial ZO-1 expression, cell density, polymegethism, and polymorphism. Corneal stromal inflammatory cell infiltration was evaluated at 4 weeks by immunostaining for CD45. Central corneal thickness (CCT) was increased in CpG-ODN treated eyes at 24 hours, had normalized by 1 week, but was again thickened by 4 weeks. In eyes with CpG-ODN, endothelial cell ZO-1 expression was reduced at 24 hours but returned to normal levels by 1 week. Endothelial cell density was not altered at 24 hours or 1 week. By 4 weeks, only CpG-ODN eyes showed relatively reduced ECD, as well as large numbers of CD45+ cells in the stroma. Changes to ECD correlated with CCT (r = -0.53, P < 0.01). Compared with naïve controls, more saline- and CpG-ODN-treated eyes exhibited polymegethism. This study provides novel insights into the interplay between endothelial cell integrity, corneal edema, and chronic stromal leukocyte activation during sterile corneal inflammation in mice.

Longitudinal Changes to Tight Junction Expression and Endothelial Cell Integrity in a Mouse Model of Sterile Corneal Inflammation.

PURPOSE: We previously reported that applying toll-like receptor (TLR) ligands to an injured cornea induces corneal edema at 24 hours, which subsides by 1 week. We tested the hypotheses that endothelial expression of the tight-junction protein, zonula occludens-1 (ZO-1), would be altered during experimental sterile corneal inflammation and that endothelial cell density (ECD) would remain unaffected. METHODS: Anesthetized C57BL/6J mice received central 1-mm corneal abrasions followed by topical application of saline or cytosine-phosphate-guanosine oligodeoxynucleotide (CpG-ODN, TLR-9 agonist). At 24 hours, 1 week and 4 weeks post treatment, spectral-domain optical coherence tomography images were captured. Eyes were enucleated and processed for zonula occludens-1 (ZO-1) immunofluorescent staining. Corneal flatmounts were analyzed for endothelial ZO-1 expression, cell density, polymegethism, and polymorphism. Corneal stromal inflammatory cell infiltration was evaluated at 4 weeks by immunostaining for CD45. RESULTS: Central corneal thickness (CCT) was increased in CpG-ODN treated eyes at 24 hours, had normalized by 1 week, but was again thickened by 4 weeks. In eyes with CpG-ODN, endothelial cell ZO-1 expression was reduced at 24 hours but returned to normal levels by 1 week. Endothelial cell density was not altered at 24 hours or 1 week. By 4 weeks, only CpG-ODN eyes showed relatively reduced ECD, as well as large numbers of CD45+ cells in the stroma. Changes to ECD correlated with CCT (r = −0.53, P < 0.01). Compared with naive controls, more saline- and CpG-ODN–treated eyes exhibited polymegethism. CONCLUSIONS: This study provides novel insights into the interplay between endothelial cell integrity, corneal edema, and chronic stromal leukocyte activation during sterile corneal inflammation in mice.

A Case of Recurrent External Ophthalmomyiasis Caused byLucilia sericataMeigen in a Healthy Patient

Purpose: To report a case of recurrent external ophthalmomyiasis caused by Lucilia sericata Meigen in a healthy patient. Case summary: A 72-year-old male, who was diagnosed 7 months earlier with ophthalmomyiasis and obtained permanent relief by surgical treatment, presented with severe tearing, redness, foreign body sensation, pain in both eyes and aural discomfort in the left ear. On presentation, visual acuity in both eyes was hand movement. On slit lamp examination, total corneal epithelial defect with stromal infiltrations was observed. However, there were no motile organisms in his eyes due to previous removal of maggots at a local clinic. On physical examination, eschar change was observed at the inferomedial area of the left lower eyelid. On otorhinolaryngological examination, several motile organisms with tympanic membrane perforation were observed in the left external acoustic meatus. The patient was treated with topical antibiotic eye drops hourly with systemic antibiotics, and 6 larvae were removed from the external acoustic meatus using otoscopy. Microscopic findings of the removed larvae revealed L. sericata in their third stage of development. After 1 month, corneal epithelial defect and stromal infiltration improved. However, visual acuity in both eyes was 0.1 due to remaining stromal opacities. Conclusions: In a healthy patient without any predisposing factors, recurrent ophthalmomyiasis accompanied with aural myiasis can develop under poor hygiene conditions. J Korean Ophthalmol Soc 2016;57(4):657-661

Cosmetic soft contact lens associated ulcerative keratitis in southern Saudi Arabia.

Purpose:To review the microbiologic profile, clinical course, treatment, and outcome of patients with cosmetic contact lens (CL)-associated ulcerative keratitis.Materials and Methods:Observational noncomparative case series selected from an ongoing prospective series. Forty-six subjects examined at a corneal specialty practice in Abha, southern Saudi Arabia between April 2012 and June 2013, who presented with corneal stromal infiltrate on slit-lamp examination, were included in the study.Results:All patients were emmetropic, and lenses were worn solely for cosmetic purposes. Nine (19.5%) of 46 CL-wearing patients presented with laboratory-proven infectious keratitis. Pseudomonas was the most common organism (6/9; 66.6%). Staphylococcus species were the second most common, occurring in two (22.2%) of the nine cases. Streptococcus viridans in one case (11%). Laboratory-based medical therapy led to the healing of ulcers in all cases. Thirty-seven (80.4%) patients had sterile infiltrates.Conclusions:Over-the-counter use of cosmetic lenses is rapidly increasing. The easy availability of these lenses is resulting in severe sight-threatening complications in some young emmetropic individuals. Prompt treatment of microbial keratitis is important to prevent vision loss.

Effectiveness of posaconazole in recalcitrant fungal keratitis resistant to conventional antifungal drugs.

Purpose. To present the success of posaconazole in two cases with recalcitrant fugal keratitis that were resistant to conventional antifungal drugs. Method. We presented two cases that were treated with posaconazole after the failure of fluconazole or voriconazole, amphotericin B, and natamycin therapy. Case 1 was a 62-year-old man with a history of ocular trauma. He had been using topical fluorometholone and tobramycin. His best corrected visual acuity (BCVA) was hand motion. He had 5.0 × 4.5 mm area of deep corneal ulcer with stromal infiltration. Case 2 was a 14-year-old contact lens user. He had been using topical moxifloxacin, tobramycin, and cyclopentolate. His BCVA was 20/200. He had a 4.0 × 3.0 mm area of pericentral corneal ulcer with deep corneal stromal infiltration and 2 mm hypopyon. Results. Both patients initially received systemic and topical fluconazole or voriconazole and amphotericin B and topical natamycin that were all ineffective. But the response of posaconazole was significant. After posaconazole, progressive improvement was seen in clinical appearance. BCVA improved to 20/100 in case 1 and 20/40 in case 2. Conclusion. Posaconazole might be an effective treatment option for recalcitrant fusarium keratitis and/or endophthalmitis resistant to conventional antifungal drugs.