Corneal Ulcer Research Articles

Unilateral Mooren Ulcer After COVID-19 Vaccination

Introduction: Mooren ulcer is an immune-related corneal pathology of unknown origin, that often occurs following a triggering factor. Case Report: We report the case of a 32-year-old woman who presented with a red painful right eye. The clinical findings were in favor of peripheral ulcerative keratitis. The etiological assessment came back negative. The retained diagnosis was Mooren ulcer. The treatment was based on oral corticosteroid therapy and immunosuppressants prescribed by internists. The evolution was marked by the regression of the pain and the stability of the lesion. Discussion: Currently in the literature, rare cases of corneal ulcers following COVID-19 vaccination have been described. A causal link remains possible but not yet proven. This subject needs more perspective and research. Conclusion: The COVID-19 vaccine has several ocular side effects. The mechanism of triggering a mooren ulcer remains unclear.

Retrospective assessment of ophthalmic disease development in domestic dogs and cats when hospitalised with tick paralysis caused by Ixodes holocyclus.

To investigate the incidence and predisposing factors leading to the development of corneal ulcers and the loss of a palpebral reflex in hospitalised canine and feline patients with tick paralysis (TP). A total of 102 dogs and 100 cats retrospectively were assessed from previously hospitalised patients. A retrospective cohort study was performed on 102 different canine and 100 different feline patients who were hospitalised for TP from October 2020-January 2022. Patient data were collected, and logistic regression was conducted to determine factors affecting the palpebral reflex and the development of corneal ulcers. Corneal ulcers occurred in 23/102 (22.5%) dogs during hospitalisation and were strongly associated with an incomplete palpebral reflex ipsilaterally during hospitalisation (P < 0.001), hospitalisation ≥3 days (P = 0.004), mechanical ventilation ≥3 days (P = 0.015) or a tick location cranial to C1 (P = 0.003). An incomplete palpebral reflex during hospitalisation was observed in 29/102 (28.4%) dogs and was significantly associated with decreasing patient weight (P = 0.018), increasing days hospitalised (P = 0.001), having a tick found cranial to C1 (P = 0.004), highest recorded GP grade (P = 0.01), highest recorded RP grade (P = 0.005), use of amoxycillin-clavulanic acid during hospitalisation (P = 0.002) and use of piperacillin/tazobactam during hospitalisation (P = 0.003). There was a significant association between the loss of a complete palpebral reflex and mortality during hospitalisation in dogs (OR = 4.5, P = 0.029). Corneal ulcers occurred in 10/100 (10.0%) cats during hospitalisation, and was significantly more likely to occur to an eye if an incomplete palpebral reflex was observed ipsilaterally during hospitalisation (OR = 20.1, P < 0.0001) and with increasing patient age (P = 0.019). The absence of a complete palpebral reflex during hospitalisation was observed in 18/10 (18.0%) cats and was significantly associated with increasing days hospitalised (P = 0.034). There was no significant association between the loss of a complete palpebral reflex and mortality during hospitalisation in cats. The frequency of corneal ulcers and loss of palpebral reflexes were significant in dogs and cats hospitalised by TP, with many factors contributing to the risk of these developing.

Efficacy and Rapidity of Potassium Hydroxide Mount and Modified Chicago Sky Blue 6B Stain with Potassium Hydroxide in Fungal Keratitis Detection.

To compare the efficacy and rapidity of direct microscopic detection of fungal elements from corneal ulcers between 10% potassium hydroxide (KOH) and 1% Chicago Sky Blue 6B (CSB) in 10% KOH (CSB-KOH). Thirty patients with clinically suspected fungal keratitis were recruited. Participants with impending corneal perforation were excluded. Two slides were smeared with corneal ulcer scrapings from the ulcer's edge and base for comparison of fungal staining solutions. One slide was infused with KOH, and the other slide was filled with CSB-KOH. Additional scraping was collected for inoculation on Sabouraud dextrose agar for fungal culture. The sensitivity, specificity and rapidity of both stainings were analyzed. The sensitivity of fungal culture, KOH, and CSB-KOH were 43.75% (95% confidence interval [CI], 19.75%-70.12%), 62.50% (95% CI, 35.43%-84.80%), and 87.50% (95% CI, 61.65%-98.45%), respectively. The specificity were 100% (95% CI, 69.15%-100%) of both stainings and fungal culture which analyzed from 16 fungal keratitis cases by laboratory and clinical diagnosis. Mean CSB-KOH examination time was quicker than KOH with the mean time difference of 5.6 minutes (95% CI, 3.22-7.98 minutes) and p-value &lt; 0.001. CSB-KOH was more effective and faster than KOH in detecting fungal elements from corneal ulcers. Therefore, CSB-KOH may be beneficial in diagnosing fungal keratitis and preventing blindness. Moreover, to the best of our knowledge, this is the first use of CSB stain in fungal keratitis detection.

Monitoring the transition from corneal ulceration to healed scar using a Scheimpflug tomography-based densitometry.

To compare corneal haze between active ulcer and healed scarring using a Scheimpflug densitometry. A prospective longitudinal study enrolled 30 patients (30 eyes) with ulcerative keratitis (UK). Each subject's corneal optical density (COD) was measured with a Scheimpflug corneal densitometry, Pentacam® AXL (Oculus GmbH, Wetzlar, Germany), at the active ulcerative and complete scarring stage. The COD data were analyzed through distinct methods (inbuilt, sorted annular partitions, and ulcer-matching densitometric maps). We compared different CODs to select the better index for clinically monitoring the transition from corneal ulceration to healed scar. The CODs of the periphery (P = 0.0024) and outside of the active ulcer (P = 0.0002) significantly decreased after scarring. Partitioning the cornea into different depths and annular zones, the anterior layer, center layer, and the 2-6mm annular zone had a more remarkable COD decrease after scar formation. The 3rd-sorted COD in the anterior layer revealed the highest area under the receiver-operating characteristic curves (0.709), in which 90% of subjects had COD reduction during the ulcer-to-scar transition. Aside from subjective judgment based on clinical signs, the Scheimpflug tomography-based densitometry could provide objective and efficient monitoring of the corneal opacity evolution in UK patients. Because the 3rd-sorted annular COD is a better index than the inbuilt or mapping CODs in differentiating active ulcers from healed scars, this COD could be a clinically promising parameter to monitor the progression of UK patients.

MANAGEMENT OF CORNEAL ULCER PRESENTED WITH RARE PATHOGEN : STREPTOCOCCUS MITIS

Introduction : Corneal ulcers can arise from various corneal diseases, including infections, inflammation, and autoimmune disease. Staphylococcus aureus is the most common bacterial pathogen, but lesser- known bacteria like Streptococcus mitis can also cause corneal ulcers. Accurate diagnosis and treatment are essential to prevent vision loss and complications.&#x0D; Case Illustration : A 19-year-old female patient presented with a chief complaint of white spots on her right eye for three months. Previously, her right eye was hit by a foreign object and subsequently, the patient experienced redness and pain in the affected eye. One week later, white spot appeared in the patient's eye and reported to enlarge in the last month. The patient also complained of pain, blurry vision with visual acuity of 1/300, redness, glare, and a foreign body sensation. Corneal swab culture discovered Streptococcus mitis to be the causative agent. The patients was given hourly drop of topical levofloxacin. One month after initial treatment, patient’s symptoms was improving with visual acuity of 6/60 on her affected eye and the ulcer was healed.&#x0D; Discussion : Streptococcus mitis is a commensal pathogen in oral cavity and not normally cause infection of ocular tissue. It may cause ulcer due to prolonged use of topical steroid and previous ocular trauma, since Streptococcus mitis had low virulence rate.&#x0D; Conclusion : Corneal scraping culture should be carried out before treatment of infectious corneal ulcer. Streptococcus mitis is considered rare for corneal ulcer pathogen. Topical quinolones are the first- line drug for bacterial corneal ulcer and worked exceptional for wide range of bacteria.

A Case: The Strategy of Corneal Ulcers

Introduction : Corneal ulcers are considered an ophthalmologic emergency because of their potential to permanently impair vision or perforate the eye. Accurate and quick diagnosis and prompt treatmentis a key to improve clinical and visual outcomes in cases of corneal ulceration.&#x0D; Case Illustration : In this paper, we present the case of male 40-year-old presented with complaints of pain and defective vision in the right eye. Visual examination of the right eye is 1/~. It was found, palpebral edema, hyperemic tarsal conjunctiva. The bulbar conjunctiva showed conjunctival injection, ciliary injection. The cornea looks completely cloudy, the surface is not slippery, infiltrates and edema. The patient was treated with medical and surgical therapy, and then the patient’s have a good clinical response and was able to return to work.&#x0D; Discussion : The diagnosis of corneal ulcers was established based on history, physical examination and clinical examination using a slit lamp and laboratory examinations. Patient's examination revealed the presence of Candida albicans. This examination is important to distinguish the cause of the corneal ulcer so that it can help select an adequate therapy.&#x0D; Conclusion : Indonesian farmers have highrisk of fungal corneal ulcers. Fungal corneal ulcers is important cause of corneal blindness all over the world especially in develoving countries. Fungal corneal ulcers can diagnosis by slitlamp biomicroscopic examination and culture are essential for early specific diagnosis and must be taken consideratiaon to establish the most effective treatment and avoid severe complications

Moxifloxacin Treatment for Contact Lens-Related Corneal Ulcer: A Case Report

Introduction : A corneal ulcer is an ophthalmological emergency that can threaten vision. It is characterized by inflammation or infection involving the corneal epithelium and stroma. Prolonged use of contact lenses is more likely to cause corneal ulcers. The purpose of this paper is to report on the management of corneal ulcers.&#x0D; Case Illustration : A 30-year-old female complained of blurred vision, redness, pain, swelling, and sensitivity to light in both eyes for the last two days. She reported falling asleep in her contact lenses two nights before the visit. The patient had compound myopic astigmatism before and her visual acuity was decreased to 3/60 in the right eye and 5/60 in the left eye, examinations showed palpebral edema and conjunctival hyperemia in both eyes. The use of fluorescein in both eyes highlighted the area of the defect. The patient was diagnosed with corneal ulcers. Treatments were Moxifloxacin Eye Drop every hour and Ibuprofen 2x400 mg by intravenous infusion. On the last visit, the corneas were clear with visual acuity 6/15 in both eyes.&#x0D; Discussion : According to the study by Kishor et al., ophthalmic eye drop is the most effective treatment and fourth-generation fluoroquinolones represent the most frequently used strategies in Corneal Ulcer.Conclusion : Antibiotics and analgesics are effective for the management of corneal ulcers in this patient. Education regarding contact lenses is important to prevent the occurrence of corneal ulcers.

Conjunctival flap surgery for traumatic corneal ulcers

Introduction : Trauma was the most common risk factor for corneal ulcers and blindness. Death of corneal tissue due to loss of part of the surface of the cornea is called a corneal ulcer. Conjunctival flap (CF) surgery has an acknowledged role in assuring a stable ocular surface and repressing inflammation in compromised corneas or eyes with reduced visual potential.&#x0D; Case Illustration : 26-year- old male patient came to the Chasan Boesorie Ternate Hospital polyclinic with pain in the left eye after splash cement 3 days before being admitted to the hospital. The left eye is runny, feels itchy, looks red and like there is a block and glare. On ophthalmology status there was a visual acuity OD 6/6, OS 1/300, OS cloudy cornea, hypopion, prolapse of iris and central corneal ulcer with a size of ± 2 x 1 mm.&#x0D; Discussion : The remaining flaps were performed for corneal perforation, graft rejection, bullous keratopathy, and secondary corneal edema. Conjunctival flaps have previously proven to be effective in preserving the globe for individuals with severe ocular surface disease. The flaps promote nutrition, metabolism, structure, and vascularity, as well as reduce pain, irritation, inflammation, and infection. After 6 weeks of surgery visual acuity become better, OS 20/200.&#x0D; Conclusion : Conjunctival flap surgery is an important and useful surgical option of ocular surface disease, especially recalcitrant infectious keratitis and corneal ulcers, particularly in nonresponsive and some perforated cases. CF procedure went well, provides mechanical support for corneal wound healing with good visual outcomes on the patient.

AMNIOTIC MEMBRANE TRANSPLANT AS ADJUVANT THERAPY FOR SEVERE INFECTIOUS CORNEAL ULCER

Introduction : Infectious corneal ulcer may lead to visual impairment and contribute to five percent of blindness worldwide. Amniotic membrane transplant is one of adjuvant therapies listed to aid in the management of corneal ulcer.&#x0D; Case Illustration : There were two cases of severe corneal ulcer, both patients had exposure from vegetative matter. Case 1: A 40 years old male came with decreased VA in left eye (VA OS 1/300) and VAS 4, corneal epithelial stromal defect measuring 3x5 mm with 2 mm hypopyon. After three days of inpatient management, AMT procedure was done followed by temporary tarsorrhaphy. On 14th day of observation, tarsorrhaphy was removed, VAS was decreased to 0 and hypopyon resolved. On 28th day, corneal leukoma was observed with visual acuity improved (VA OS 1/60). Case 2: A 63 years old female came with decreased visual acuity (VA OD 1/300), followed by VAS 4, epithelial stromal defect measuring 7.3x5.4 mm, and 1 mm hypopyon. AMT procedure was done in fourth day of hospitalization. On seventh day, VAS was reduced to 1-2. On 14th day, tarsorrhaphy was removed, corneal leukoma was observed and on 28th day of observation, visual acuity was improved (VA OD 6/21).&#x0D; Discussion : AMT may induce faster regeneration of wound healing, as it halts inflammation, fibrosis, angiogenesis, and protease activities. AMT also increases the stromal thickness, as the membrane becomes incorporated into the stroma. By placing a temporary tarsorrhaphy, it may promote healing further into the corneal defects.&#x0D; Conclusion : AMT is effective in promoting epithelialization and preventing corneal perforations in corneal ulcers.

A snake venom ophthalmia: A case – report

Introduction : Snake venom ophthalmia is caused by venoms of spitting snakes. Delayed treatment may result in corneal ulcer, corneal perforation and blindness. We aim to report a fortunate snake venom ophthalmia case.&#x0D; Case Illustration : A-54-year-old male complained of burning eye pain, watery, and redness of the right eye (RE) after being spat by a snake 3 hours before admission. The snake was identified as a cobra-snake, spitted at a distance of 1 meter without body bite. He rinsed his eyes with tap water and irrigated at a nearby hospital before referred. During the admission, the pH of both eyes (BE) was 8. The patient was irrigated with normal-saline. The visual acuity (VA) of the right eye was 6/12 and left eye 6/6. There was RE conjunctival and ciliary injection. Other examinations were unremarkable. The patient was discharged and treated with levofloxacin eye-drop, sulfas-atropine 1%, EDTA 1%, artificial tears, and vitamin C. He did self-eye irrigation. Two days later, he presented with VA of 6/6 for BE with normal ocular examinations and pH of 7 for BE.&#x0D; Discussion : The general principle is prompt and copious irrigation of the eyes in chemical contact. The snake venom mixture of chemicals was washed out, which local necrosis can be prevented. Managing snake venom as a chemical splash injury with considerable irrigation, lubricants, and topical antibiotics, resulted a good outcome and prevented sequelae in this patient.&#x0D; Conclusion : Urgent irrigation of the affected eyes and other mucous membranes is the key in treating snake venom ophthalmia

Nocturnal Lagophthalmos in Pediatric Patient with Hydrocephalus

Introduction : Nocturnal lagophthalmos is a physiologic and asymptomatic condition observed in 1.4-5% of the population. In unconscious patients, using mechanical ventilation and neuromuscular blocker medication can worsen the lagophthalmos, causing the patient to have exposure keratopathy. This report aims to emphasize the importance of eye care in unconscious patients.&#x0D; Case Illustration : A 5-year-old girl came with a chief complaint of a whitish lesion on the right eye. She got the lesion when hospitalized in Pediatric Intensive Care Unit for two weeks due to seizure attacks. A red and watery eye accompanied the whitish lesion. The patient had history of nocturnal lagophthalmos and Dandy-Walker syndrome, a complex malformation characterized by agenesis or hypoplasia of the vermis and cystic enlargement of the fourth ventricle. The corneal ulcer was treated with antibiotic treatment. After several visits, her infection had subsided but left a corneal cicatrix on her right eye.&#x0D; Discussion : In unconscious patients, it’s important to pay attention to the eyelid. Lagophthalmos can be divided into three groups; where grade 1 has complete eyelid closure; grade 2 has conjunctival exposure; and grade 3 has corneal exposure. It’s important to lubricate the eye in each grade and keep it closed using eyelid tape or cover in grades 2 and 3 to prevent exposure keratopathy. Surgical intervention can be considered when there is a risk of corneal ulcer.&#x0D; Conclusion : Prevention is always better than cure. Establishing standardized eye care in the intensive care unit is crucial to prevent ocular complications and preserve visual acuity.

Allogeneic limbo-deep anterior lamellar keratoplasty (Limbo-DALK)-A novel surgical technique in corneal stromal disease and limbal stem cell deficiency.

To describe a novel corneal surgical technique combining Deep Anterior Lamellar Keratoplasty (DALK) with grafting of allogeneic limbus (Limbo-DALK) for the treatment of eyes with corneal stromal pathology and limbal stem cell deficiency (LSCD). Clinical records of six Limbo-DALKs performed in five patients diagnosed with LSCD and corneal stromal pathology requiring keratoplasty were retrospectively reviewed. All patients were diagnosed with LSCD due to various pathologies including thermal and chemical burns, congenital aniridia or chronic inflammatory ocular surface disease. Parameters analysed included demographics, diagnoses, clinical history, thickness measurements using anterior segment OCT, visual acuity, and epithelial status. Regular follow-up visits were scheduled at 6 weeks as well as 3, 6, 9, and 12 and 18 months postoperatively. Main outcome measures were time to graft epithelialisation and the occurrence of corneal endothelial decompensation. Two grafts showed complete epithelial closure at 2 days, two at 14 days. In one eye, complete epithelial closure was not achieved after the first Limbo-DALK, but was achieved one month after the second Limbo-DALK. No endothelial decompensation occurred except in one patient with silicone oil associated keratopathy. Endothelial graft rejection was not observed in any of the grafts. Based on the data from this pilot series, limbo-DALK appears to be a viable surgical approach for eyes with severe LSCD and corneal stromal pathology, suitable for emergency situations (e.g. corneal ulceration with impending corneal perforation), while minimising the risk of corneal endothelial decompensation.

CHALLENGING DIAGNOSIS AND MANAGEMENT OF INFECTIOUS SCLERITIS COMPLICATED WITH CORNEAL PERFORATION CAUSED BY MULTI DRUG RESISTANT Proteus mirabilis

Introduction : Scleritis is a destructive inflammatory disease of sclera and may involve the cornea that associated with an underlying systemic disease and smaller minority are due to infections. The two conditions closely mimic each other, and diagnostic delay can lead to a poor outcome&#x0D; Case Illustration : A 72 year old male presented with severe pain, redness, swelling, and dimness of vision in his left eye. On slitlamp examination, a superonasal scleral nodule with overlying conjunctival defect and corneal ulcer was found. Both ANA test and RA factor were negative. Microbiological investigations of the lessions revealed MDR Proteus mirabilis. His left eye rapidly deteriorated leading to an impending perforation of the sclera and corneal perforation despite intensive antimicrobial therapy, then patient underwent a tibial periosteal graft on his left eye. Although the visual prognosis was poor, structural integrity of the eye was achieved&#x0D; Discussion : Infection is a rare cause of scleritis. Among the organism reported till date, Proteus mirabilis, a gram negative, rod shaped bacterium is the rarest to found. The inciting factors are mostly surgical. There was history of cataract surgery on left eye in this case&#x0D; Conclusion : infectious scleritis is often initially diagnosed as autoimmune, and cause diagnostic delay, the aggressive nature of the associated microbes further complicates the situation. Appropriate diagnosis generally includes lession scrapings with thorough culturing and antibiotic sensitivity testing. Both adequate medical and surgical methods are needed to save the globe from loss

Recurrent Candida Parapsilopsis Corneal Ulcer cum Hypopion: A Case Report

Introduction : Candida is common in tropical and subtropical climes estimated for 20-60% of all culture-positive corneal infection. Over the past two-decades, candida parapsilosis has become a common opportunistic fungal pathogen.&#x0D; Case Illustration : A-60-years-old-man, came with redness and pain in the left eye since one month ago after working at field. In the left eye, visual acuity was hand movement, palpebra was spasm and oedema, conjunctiva was hyperaemia, hazy, feathery edge and fluorescein test were positive in paracentral corneal 6x7 mm and hypopyon in anterior chamber. KOH staining revealed yeast, corneal scrapping revealed candida parapsilopsis, and antifungal sensitive to fluconazole. Fluconazole intravenous 200mg 2-times-a-day, moxifloxacin eyedrop loading dose, fluconazole eyedrop fortified every-one- hour, atropine 1% eyedrop 2-times-a-day, artificial tears eyedrop every-one-hour was administered.In the fifth-day, hypopyon was improved, and patient was discharged. Tenth-days after, patient felt pain and hypopyon raised 4mm. Debridement in the ulcer, and therapy was continued. Two weeks later, hypopyon was less than 1 mm, and pain was relieved.&#x0D; Discussion : There was clinically improvement using antifungal therapy. Recurrent hypopyon was happen, and mechanical debridement in the ulcer was administered. In four-times within two-weeks, hypopyon was improved. Although, initial treatment was antibiotics until microbiological confirmation, antifungal therapy, combined with mechanical eradication of fungal filaments could be administered for fungal corneal ulcer.&#x0D; Conclusion : In this case, combination of antifungal therapy with mechanical debridement could be the right choice to treat candida parapsilopsis corneal ulcer. Better outcomes can be achieved and complications can be avoided with appropriate diagnosis and efficient therapy.

Severe Ocular Manifestations in Stevens-Johnson syndrome : a case report

Introduction : Stevens-Johnson syndrome (SJS) is a severe mucocutaneous reactions, characterized by cell death in the epidermis, resulting in blistering and sloughing. Hypersensitivity reaction to drug causes the majority of SJS cases. Ocular involvement occurs in 80% of patients in the acute phase.&#x0D; Case Illustration m A 38-year-old female was consulted to the ophthalmology department with diagnosis of Stevens- Johnson syndrome (SJS). She complained of bilateral eye redness and blurred vision. She was first admitted to the Emergency Department with complaints of burning sensation, progressive rash, and blistering skin all over her body for the past 2 weeks. Ophthalmology examination revealed a visual acuity of no-light perception (NLP) for both eyes. The anterior segment examination in both eyes showed the palpebra was edema and lagophthalmos, conjunctival hyperemia and corneal ulcer, while the posterior segment could not be identified. The patient was hospitalized in the intensive care unit (ICU) due to her symptoms and clinical findings. She was treated with combination of systemic intravenous antibiotics and steroid, eye drops and eye ointment. After 2 weeks, she was able to blink partially. She was discharged after 20 days of intensive treatment.&#x0D; Discussion : &#x0D; Conclusion : Ocular manifestations in SJS are a significant aspect of the disease that can lead to severe visual impairment or even blindness. A multidisciplinary approach to managing SJS is necessary to prevent and treat the ocular manifestations of the disease effectively.

Peripheral Ulcerative Keratitis: A Serious Corneal Inflammation

Abstract&#x0D; Introduction : Peripheral ulcerative keratitis (PUK) is a rare, but severe sight-threatening inflammatory condition that affects the cornea. PUK is characterized by peripheral corneal ulceration, stromal thinning, and neovascularization that can lead to corneal perforation and vision loss. Although PUK can occur in individuals without underlying systemic disease, it is most commonly associated with autoimmune disorders.&#x0D; Case Illustration : A 53-year-old woman presented to the ophthalmology clinic with complaints of redness, foreign body sensation, and blurred vision in her both eye for the past three days. On examination, slit-lamp biomicroscopy revealed a peripheral corneal ulcer. She had a history of rheumatoid arthritis for the past 2 months and was being treated with methotrexate and metylprednisolone. Laboratory investigations revealed elevated Anti-CCP IgG, which confirmed the presence of rheumatoid arthritis.&#x0D; Discussion : PUK is most commonly associated with autoimmune disorders, particularly rheumatoid arthritis, but may also occur in individuals with infectious, degenerative or traumatic corneal injuries. Immune- mediated inflammation, complement activation, and tissue destruction are thought to be involved in the pathogenesis of PUK. The diagnosis of PUK requires a thorough ophthalmic examination, including slit-lamp biomicroscopy, and laboratory investigations for underlying autoimmune disorders.&#x0D; Conclusion : PUK is a rare but serious ocular disease that requires prompt diagnosis and management to prevent severe complications such as corneal perforation and vision loss. Although PUK can occur in individuals without underlying systemic disease, it is most commonly associated with autoimmune disorders, particularly rheumatoid arthritis.

Devastating Mooren Ulcer Halt by Timely Aggressive Treatment - A Case Report

Introduction : Mooren ulcer is a progressive and painful peripheral ulcerative keratitis of unknown cause. Study aims to show effective aggressive treatment for Mooren ulcer.&#x0D; Case Illustration : A 43-year-old man was admitted with a marked clinical worsening of the white tissue covering the cornea, accompanied by pain, redness, and blurry vision of the left eye. Initial examination showed visual acuity of 6/21cc. Peripheral corneal ulcer was found from 6 to 2 clock hours with superficial vascularization and epithelial defect. Patient underwent ancillary examinations with unremarkable findings. Patient was diagnosed with Mooren Ulcer and treated with artificial tears and steroid topical. Patient had no significant improvement; therefore conjunctival resection with immunosuppressive therapy were performed. At follow up, no pain was reported, vision improved to 6/15cc, and the ocular surface inflammation resolved.&#x0D; Discussion : Mooren ulcer is usually misdiagnosed since the clinical signs are similar to other differential diagnoses. The examination must be performed carefully to rule out autoimmune and corneal infection. Treatment goals are to halt the destructive process and promote reepithelization. The stepwise aggressive approach of Mooren Ulcer treatments is crucial. It starts directly with topical steroid to control the progression of inflammation. However, when used alone, topical steroid usually cannot prevent the rapid progression so conjunctival resection is needed to remove the source of collagenase production by cutting the perilimbal blood vessels’ access to the area of the ulcer. Combination with an immunosuppressant will effectively maintain a stable condition.&#x0D; Conclusion : Early diagnosis and aggressive treatment for Mooren ulcer are needed to prevent the rapid progression.

Sociodemographic and Clinical Predictors of Prolonged Length of Corneal Ulcer Hospitalizations

The length of stay (LOS) of hospitalizations may be a useful indicator of the burden of disease of corneal ulcers. Identifying variables associated with longer LOS may help to enhance delivery of care for high-risk patients. To investigate the sociodemographic, social, and clinical factors associated with LOS in hospitalizations for corneal ulcers in the US. This was a retrospective cross-sectional study of adult patients (aged >18 years) admitted with a primary diagnosis of corneal ulcer between quarter 4 of 2015 through 2020 and conducted using data from the National Inpatient Sample (NIS). Patients were stratified into 2 even cohorts based on LOS: LOS of 4 days or less and LOS greater than 4 days. Individual-level sociodemographic, social risk factors, and medical comorbidities associated with longer LOS were examined by multivariable regression. Data were analyzed from October 2015 to December 2020. Potential sociodemographics or medical comorbidities at hospital admission. The primary outcome of interest was factors associated with extended length of stay. The hypothesis being tested was formulated during data collection. A total of 1187 patients (mean [SD] age, 53.5 [20.9] years; 602 female [50.7%]) were included for analysis. The cohort with LOS greater than 4 days had higher total charges than the cohort with LOS of 4 days or less (mean [SD] charges, $79 504 [$86 719] vs $26 474 [$20 743]; P < .001). Sociodemographic variables associated with LOS greater than 4 days were Black race (adjusted odds ratio [aOR], 1.41; 95% CI, 1.03-1.92; P = .03), Medicare insurance (aOR, 1.42; 95% CI, 1.09-1.85; P = .009), and housing insecurity (aOR, 1.99; 95% CI, 1.29-3.06; P = .002). Medical comorbidities associated with LOS greater than 4 days were alcohol use (aOR, 1.50; 95% CI, 1.00-2.26; P = .05), dementia (aOR, 2.35; 95% CI, 1.36-4.07; P = .002), complicated diabetes (aOR, 1.75; 95% CI, 1.21-2.53; P = .003), uncomplicated diabetes (aOR, 1.57; 95% CI, 1.02-2.42; P = .04), drug misuse (aOR, 1.66; 95% CI, 1.08-2.57; P = .02), and legal blindness (aOR, 3.42; 95% CI, 1.19-9.82; P = .02). Based on NIS national estimates, corneal ulcers were estimated to have a direct annual health care expenditure of $35 819 590 in the US. Corneal ulcer hospitalizations represent a significant burden of disease for patients and health care systems. This study highlights sociodemographic and clinical factors that may help clinicians identify high-risk patients vulnerable to complications and morbidity due to corneal ulcers.

Equine uveitis: Outcome and adverse effects after one or two intravitreal low-dose gentamicin injections.

Uveitis is common in horses, potentially turning chronic (persistent or recurrent) resulting in impaired vision or blindness. All mainstay therapeutics aims at controlling inflammation, but long-term or lifelong treatment is often needed with possibly severe side effects. Therefore, intravitreal injections with low-dose gentamicin (IVGI) have been used in attempt to give a long-lasting result with potentially less side effects. To retrospectively assess outcome and long-term complications following one or two low-dose IVGI in Swedish horses with chronic uveitis. Retrospective case series. Medical records of horses diagnosed with uveitis examined at the Equine Clinic of the University Animal Hospital of Sweden between 2016 and 2021 were reviewed. Inclusion criteria were horses with a diagnosis of chronic uveitis that were treated with 4 mg IVGI. After injection, tapering doses of anti-inflammatory medications were administered. Due to persistence or recurrence of uveitis despite IVGI, some horses received a second injection. A positive outcome was defined as controlled uveitis, despite no or minimal anti-inflammatory medication. 32 eyes (29 horses) were included. Based on clinical evaluation, uveitis was classified as anterior (91%) or panuveitis (9%). 10 eyes were treated with IVGI twice. A positive outcome was observed in 13/32 eyes (41%). Inflammation in 9/32 eyes was controlled after the first, and in 4/10 eyes after the second IVGI treatment. Long-term complications included retinal degeneration in seven eyes, and mature cataracts in five eyes. Enucleations were performed in 14/32 eyes, due to lack of favourable response of IVGI, or due to complications, that is, glaucoma, corneal ulceration, and/or corneal mineralisation. One horse was euthanised due to painful bouts of inflammation in both eyes despite treatment. Small sample size, retrospective design with no control group, no histopathology performed, infrequent sampling for Leptospira and no standardised treatment protocol after the IVGI. In this group of Swedish horses, predominantly diagnosed clinically with anterior uveitis, a positive outcome was observed in 41% of eyes following one or two low-dose IVGI. Retinal degeneration in the visual streak was observed in 22% of eyes, which is a higher proportion of this complication than previously described.

496 - Conjunctivitis does not increase with longer duration of lebrikizumab exposure in patients with moderate-to-severe atopic dermatitis

Abstract IntroductionIntegrated safety data for lebrikizumab (LEB) treatment in moderate-to-severe atopic dermatitis (AD) has been previously published. Conjunctivitis and keratitis were identified as adverse events (AEs) of special interest in the AD ­program. Objectives Further characterize patient-reported conjunctivitis and keratitis AEs in LEB clinical trials for AD. Methods Data from adult and adolescent patients were analyzed in 2 groups: a) LEB 250mg every 2 weeks (LEBQ2W, N=783) vs placebo (PBO, N=404), weeks 0-16 (PC 0-16wk) from 4 clinical trials (ADvocate1, ADvocate2, ADhere, Phase 2b study); and b) patients who received at least one dose of LEB (ALL-LEB, N=1720) from 8 clinical trials (ADvocate1, ADvocate2, ADhere, ADore, ADjoin (ongoing), ARBAN, TREBLE, Phase 2b study). Conjunctivitis and keratitis refer to cluster definitions defined by MedDRA preferred terms conjunctivitis, allergic conjunctivitis, bacterial conjunctivitis, viral conjunctivitis, giant papillary conjunctivitis; and keratitis, atopic keratoconjunctivitis, allergic keratitis, ulcerative keratitis, vernal keratoconjunctivitis, respectively. Exposure adjusted incidence rates (IR) are provided as per 100 patient-years. Results In PC 0-16wk, at baseline, similar proportions of LEB (21.5%) and PBO (19.3%) patients had medical history (MH) of conjunctivitis. Of ALL-LEB, 22.2% had MH of conjunctivitis; of those with conjunctivitis or keratitis AE, 40% had MH of conjunctivitis. In PC 0-16wk, conjunctivitis cluster was reported by 8.5% (IR:30.6) LEBQ2W vs 2.5% (IR:8.9) PBO; keratitis cluster was reported by 0.6% (IR:2.2) and 0.3% (IR:0.9) of patients, respectively. All conjunctivitis and keratitis events in PC 0-16wk were mild or moderate in severity; 5 events (3 conjunctivitis, 2 keratitis) led to treatment discontinuation (LEBQ2W) vs 1 conjunctivitis event (PBO). ALL-LEB treatment duration ranged from 1 dose to 100 weeks. In ALL-LEB, conjunctivitis cluster was reported by 10.6% (IR:12.2), with the majority being mild or moderate (10.3%) and 0.3% severe. Keratitis was reported by 0.5% (IR:0.6), with 1 severe event of vernal keratoconjunctivitis. Conjunctivitis and keratitis events resulted in 17 (1.0%) and 3 (0.2%) treatment discontinuations, respectively. Similar proportions of adult (11.3%; 0.6%) and adolescent (8.3%; 0.3%) patients reported conjunctivitis and keratitis events. The majority were reported within first 16 weeks of treatment. ConclusionsConjunctivitis is an AE reported by LEB-treated patients. Patients with MH of conjunctivitis may have higher risk of developing treatment-emergent conjunctivitis or keratitis. Most events were mild or moderate in severity, did not lead to treatment discontinuation, were reported within first 16 weeks of treatment, and IR did not increase with longer duration of exposure.