Corneal Ulcer Research Articles

Ophthalmic Parameters of Healthy Captive Blue-Tongued Skinks (Tiliqua scincoides)

Abstract Normal ophthalmic parameters of the blue-tongued skink (Tiliqua scincoides), one of the largest members of the skink family of lizards, have yet to be evaluated. The objective of this study was to establish baseline ophthalmic parameters for a captive population of 12 healthy, one year old, blue-tongued skinks. Ophthalmic examination, corneal touch threshold, tear production including phenol red thread test (PRTT) and modified Schirmer tear test-2 (mSTT-2), horizontal palpebral fissure length (HPFL), rebound tonometry (TONOVET and TONOVET Plus), and bacterial and fungal culture were performed. The blue-tongued skinks were all amenable to ocular diagnostic testing. Corneal touch threshold (mean ± SD) was 5.48 ± 0.81 cm. PRTT (mean ± SD) was 9.17 ± 6.62 mm/15 seconds. mSTT-2 (mean ± SD) was 2.54 ± 2.72 mm/60 seconds. HPFL (mean ± SD) was 6.96 ± 0.62 mm and was positively correlated with body weight. Intraocular pressure (IOP) assessed using TONOVET (mean ± SD) was 8.43± 1.51 mmHg, while IOP assessed using TONOVET Plus (mean ± SD) was 12.39± 1.54 mmHg. Differences in TONOVET and TONOVET Plus tonometry values were statistically significant (P<0.0001) and TONOVET values positively correlated with body weight. The most common bacterial species identified were Staphylococcus xylosus (10/12) and Staphylococcus sciuri (8/12). Fungal cultures were all negative. One animal had superficial corneal ulceration which resolved with treatment. Ophthalmic examination and testing is readily performed in blue-tongued skinks. These parameters may be useful for ocular assessment of this species in a clinical setting.

An evaluation of intracapsular lens extraction and transcorneal lens reduction for treatment of anterior lens luxation in dogs.

The aim of the study was to evaluate success rate, complications, and outcomes in dogs with anterior lens luxation (ALL) treated with intracapsular lens extraction (ICLE) or transcorneal lens reduction (TCLR). Medical records of dogs with ALL undergoing ICLE or TCLR from 2014 to 2021 were reviewed. Signalment, presenting complaint, history, ophthalmic examination findings, short-term complications, and outcomes were analyzed. There were 20 ICLEs and 31 TCLRs; however, some cases were included in both groups. One ICLE was unsuccessful and four had undergone TCLR first, leaving 15 ICLEs. Three TCLRs were unsuccessful, four were lost to follow up, and three subsequently underwent ICLE due to recurrent ALL, leaving 21 TCLRs. Anterior uveitis was more common following ICLE than TCLR, p < .001 The frequencies of other short-term complications (post-operative hypertension and corneal ulceration) were not statistically different between groups. Median follow-up was 256 and 48 days for ICLE and TCLR, respectively. Vision was retained in 7/10 (70%) eyes following ICLE and 4/9 (44%) eyes following TCLR, p = .34. Enucleation was recommended for fewer eyes following ICLE (2/15 [13%]) than TCLR (7/21 [33%], p = .47). In total, lens extraction was achieved in 19/20 (95%) ICLEs and lens reduction was achieved in 28/31 (90%) TCLRs. Anterior lens luxation recurred in 10/24 (41%) TCLRs. The present study adds data to the current knowledge base regarding the treatment of ALL in dogs and highlights the need for future prospective studies containing a larger number of animals to help inform treatment decisions for dogs with ALL.

Solid Dispersion Incorporated into Dissolving Microneedles for Improved Antifungal Activity of Amphotericin B: In Vivo Study in a Fungal Keratitis Model.

Fungal keratitis (FK) is a fungal infection of the cornea, which is part of the eye and causes corneal ulcers and an increased risk of permanent blindness, which is often found in Candida albicans species. Amphotericin B (AMB), which is a group of polyenes as the first-line treatment of FK, is effective in annihilating C. albicans. However, AMB preparations such as eye drops and ointments have major drawbacks, for instance, requiring more frequent administrations, loss of the drug by the drainage process, and rapid elimination in the precornea, which result in low bioavailability of the drug. An ocular dissolving microneedle containing the solid dispersion amphotericin B (DMN-SD-AMB) had been developed using a mixture of poly(vinyl alcohol) (PVA) and poly(vinylpyrrolidone) (PVP) polymers, while the solid dispersion AMB (SD-AMB) was contained in the needle as a drug. This study aims to determine the most optimal and safest DMN-SD-AMB formula for the treatment of FK in the eye as well as a solution to overcome the low bioavailability of AMB eye drops and ointment preparations. SD-AMB had been successfully developed, which was characterized by increased antifungal activity and drug release in vitro compared to other treatments. Furthermore, DMN-SD-AMB studies had also been successfully performed with the best formulation, which exhibited the best ex vivo corneal permeation profile and antifungal activity as well as being safe from eye irritation. In addition, an in vivo antifungal activity using a rabbit infection model shows that the number of fungal colonies was 0.98 ± 0.11 log10 CFU/mL (F3), 5.76 ± 0.32 log10 CFU/mL (AMB eye drops), 4.01 ± 0.28 log10 CFU/mL (AMB ointments), and 9.09 ± 0.65 log10 CFU/mL (control), which differed significantly (p < 0.05). All of these results evidence that DMN-SD-AMB is a new approach to developing intraocular preparations for the treatment of FK.

Proportion and characteristics of lacrimal drainage pathway disease and keratopathy in non-infectious corneal perforation using lacrimal syringing test

AbstractLacrimal drainage pathway disease-associated keratopathy (LDAK) has been associated with corneal perforation, which arises from both infectious and non-infectious corneal disorders. However, patients with corneal perforation are often not routinely tested for LDAK, and the potential risk posed by LDAK in the development of corneal ulcers has not been investigated in detail. This study aimed to assess the proportion and characteristics of LDAK in patients with non-infectious corneal perforation using lacrimal syringing test. This study enrolled 56 patients with corneal perforation treated at Saitama Medical University Hospital between January 2016 and September 2022. The causes of corneal perforation were trauma (n = 17, 30%), infection (n = 19, 34%), non-infection (n = 16, 29%), and unknown (n = 4, 7%). A lacrimal syringing test was performed on 12 patients with non-infectious corneal perforation and 4 with an unknown diagnosis. Among the 16 patients with non-infectious corneal perforation, 13 (81%) had lacrimal drainage disease, but only 3 (19%) patients had lacrimal puncta, as revealed by slit-lamp examinations. The primary bacterial species identified in lacrimal obstructive disease and lacrimal canaliculitis were Staphylococcus spp. and Actinomycetes spp. respectively. Lower temporal and peripheral corneal perforations were common. All patients underwent lacrimal surgery, and 6 (38%) were treated for corneal perforation without corneal surgery. Interestingly, several patients with LDAK who did not exhibit any lacrimal duct obstruction on slit-lamp examination. The study findings demonstrate the significance of the lacrimal syringing test for assessing LDAK in patients with corneal perforation, indicating LDAK as a potential cause of corneal perforation.

Progressive ulcerative keratitis in dogs in the United Kingdom: Microbial isolates, antimicrobial sensitivity, and resistance patterns.

The objective of the study was to identify bacterial pathogens and their antimicrobial sensitivity profile associated with cases of canine progressive ulcerative keratitis. Analysis of microbial culture and sensitivity results from dogs with progressive ulcerative keratitis presenting to a UK referral practice between December 2018 and August 2020. Positive bacterial cultures were obtained from 80/148 (54%) of the canine ulcers sampled with 99 bacterial isolates cultured. Streptococcus canis (n = 29), Pseudomonas aeruginosa (n = 19), and Staphylococcus pseudintermedius (n = 16) were the most common isolates. Pseudomonas aeruginosa was more likely to be isolated whether the ulcer was clinically malacic at the time of sampling (OR = 10.1, p < .001). Ulcers treated prior to culture with fusidic acid were 7.6 times more likely to be positive than those treated with any other antimicrobial(s). Bacterial isolates demonstrated resistance against neomycin (85%), fusidic acid (78%), and tetracycline (68%). Conversely, isolates were most likely to be sensitive to gentamicin (88%), ofloxacin (77%), ciprofloxacin (73%), and chloramphenicol (64%). Antimicrobial combinations of chloramphenicol or gentamicin with a fluoroquinolone (ofloxacin or ciprofloxacin) or chloramphenicol combined with gentamicin were the most effective on invitro analysis (over 90% susceptibility of all isolates). The most common bacterial species associated with canine progressive ulcerative keratitis in a UK referral population were S. canis, P. aeruginosa, and S. pseudintermedius. Combination antimicrobial therapy is recommended pending culture and sensitivity results given the varied antimicrobial susceptibility profiles and significant bacterial invitro resistance to antimicrobial monotherapy.

In situ forming hydrogel loaded with predatory bacteria treats drug-resistant corneal infection

The development of potent bactericidal antibiotic alternatives is important to address the current antibiotic crisis. A representative example is the topical delivery of predatory Bdellovibrio bacteriovorus bacteria to treat ocular bacterial infection. However, the direct topical use of B. bacteriovorus suspensions has the problem of easy loss and inactivation. Here, a B. bacteriovorus in situ forming hydrogel (BIG) was constructed for the ocular delivery of B. bacteriovorus. BIGs, as a fluid in their primitive state, were temperature- and cation- dually sensitive, which was rapidly transformed into immobile gels in the ocular environment. BIGs not only kept the activity of B. bacteriovorus but also retained on the ocular surface for a long time. The biosafety of BIGs was good without HCEC cell toxicity and hemolysis. More importantly, BIGs highly inhibited the growth of drug-resistant Pseudomonas aeruginosa whether in vitro or in the infected rat eyes. The ocular infection was completely controlled by BIGs with no corneal ulcers and inflammations. This living bacteria gel is a promising medication for the local treatment of drug-resistant bacteria-induced ocular infection.

Diminished pupillary light reflexes, elevated third eyelids, and decreased tear production are commonly associated with canine dysautonomia.

To retrospectively describe ocular abnormalities reported in dogs with presumed dysautonomia. 79 dogs with dysautonomia. Medical records from the Kansas State University Veterinary Health Center from 2004 to 2021 were reviewed for dogs with a clinical or histopathologic diagnosis of canine dysautonomia (CD). Ophthalmic exam abnormalities, nonocular clinical signs, and outcomes were recorded. Most dogs (73/79 [92.4%]) with CD exhibited at least 1 ocular abnormality. The most common ocular abnormalities were diminished pupillary light reflexes (PLRs) in 55 of 79 (69.6%) dogs and elevation of the third eyelids in 51 of 79 (64.6%) dogs. Schirmer tear test values were bilaterally decreased in 32 of 56 (57.1%) dogs. Other ocular abnormalities included resting mydriasis, ocular discharge, photophobia, blepharospasm, corneal ulceration, and conjunctival vessel pallor. The most common nonocular clinical signs were vomiting or regurgitation in 69 of 79 (87.3%) and diarrhea in 34 of 79 (43.0%) dogs. Pharmacologic testing with dilute 0.01%, 0.05%, or 0.1% pilocarpine yielded pupillary constriction in 42 of 51 (82.4%) dogs. Thirty-two of 79 (40.5%) dogs survived to discharge. Resolution of ocular abnormalities was variable. Ophthalmic abnormalities such as diminished PLRs, elevation of the third eyelids, and decreased tear production are commonly associated with CD and provide support for its antemortem clinical diagnosis, though dogs with normal PLRs can be diagnosed with the disease. Pharmacologic testing with dilute topical pilocarpine in dogs with clinical signs suggestive of dysautonomia supports a diagnosis of CD. Ophthalmic abnormalities may improve or resolve over time.

Preclinical evaluation of the safety and effectiveness of a new bioartificial cornea.

Cross-linking agents are frequently used to restore corneal properties after decellularization, and it is especially important to select an appropriate method to avoid excessive cross-linking. In addition, how to promote wound healing and how to improve scar formation require further investigation. To ensure the safety and efficacy of animal-derived products, we designed bioartificial corneas (BACs) according to the criteria for Class III medical devices. Our BACs do not require cross-linking agents and increase mechanical strength via self-cross-linking of aldehyde-modified hyaluronic acid (AHA) and carboxymethyl chitosan (CMC) on the surface of decellularized porcine corneas (DPCs). The results showed that the BACs had good biocompatibility and transparency, and the modification enhanced their antibacterial and anti-inflammatory properties in vitro. Preclinical animal studies showed that the BACs can rapidly regenerate the epithelium and restore vision within a month. After 3 months, the BACs were gradually filled with epithelial, stromal, and neuronal cells, and after 6 months, their transparency and histology were almost normal. In addition, side effects such as corneal neovascularization, conjunctival hyperemia, and ciliary body hyperemia rarely occur in vivo. Therefore, these BACs show promise for clinical application for the treatment of infectious corneal ulcers and as a temporary covering for corneal perforations to achieve the more time.

Insulin eye drops for treating corneal ulcer in a non-diabetic patient: regarding a case

Corneal ulcers are included in a heterogeneous group of eye injuries. When patients do not respond to treatment, including even corneal transplant, other alternatives need to be explored.We present a case of a patient who suffered an accidental spillage from the contents of a car battery. This corneal lesion was refractory to both surgical and pharmacological treatment. After four years of a persistent ulcer, insulin topical treatment 50 IU/mL was started. Improvement began to be observed and currently the patient has completely recovered the corneal epithelium.Nowadays, evidence of the topical insulin use for the treatment of corneal ulcers is higher in diabetic patients. In non-diabetic patients, evidence is restricted to a series of cases of neurotrophic corneal ulcers and a case report of a patient who presented a persistent epithelial defect after resection of a neurinoma. This case presents the experience of using an insulin drop formulation with effectiveness and absence of toxicity in a patient non-diabetic with a post-caustic corneal ulcer.

Updates in Diagnostic Imaging for Infectious Keratitis: A Review.

Infectious keratitis (IK) is among the top five leading causes of blindness globally. Early diagnosis is needed to guide appropriate therapy to avoid complications such as vision impairment and blindness. Slit lamp microscopy and culture of corneal scrapes are key to diagnosing IK. Slit lamp photography was transformed when digital cameras and smartphones were invented. The digital camera or smartphone camera sensor's resolution, the resolution of the slit lamp and the focal length of the smartphone camera system are key to a high-quality slit lamp image. Alternative diagnostic tools include imaging, such as optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM). OCT's advantage is its ability to accurately determine the depth and extent of the corneal ulceration, infiltrates and haze, therefore characterizing the severity and progression of the infection. However, OCT is not a preferred choice in the diagnostic tool package for infectious keratitis. Rather, IVCM is a great aid in the diagnosis of fungal and Acanthamoeba keratitis with overall sensitivities of 66-74% and 80-100% and specificity of 78-100% and 84-100%, respectively. Recently, deep learning (DL) models have been shown to be promising aids for the diagnosis of IK via image recognition. Most of the studies that have developed DL models to diagnose the different types of IK have utilised slit lamp photographs. Some studies have used extremely efficient single convolutional neural network algorithms to train their models, and others used ensemble approaches with variable results. Limitations of DL models include the need for large image datasets to train the models, the difficulty in finding special features of the different types of IK, the imbalance of training models, the lack of image protocols and misclassification bias, which need to be overcome to apply these models into real-world settings. Newer artificial intelligence technology that generates synthetic data, such as generative adversarial networks, may assist in overcoming some of these limitations of CNN models.

Allergic and immunopathological diseases of the ocular surface

Allergic and immunopathological diseases of the ocular surface are inflammations that can occur with mild to severe symptoms that cause visual impairment. Allergic inflammations mainly affect the conjunctiva, causing acute and/or chronic conjunctivitis. Several forms are distinguished: seasonal allergic conjunctivitis, vernal conjunctivitis, atopic keratoconjunctivitis, contact allergy, giant papillary conjunctivitis. The most common is the seasonal form, which is linked to seasons. Allergic ocular surface processes require local treatment with artificial tears, anti-allergic eye drops. If complications occur, topical corticosteroid and cyclosporin treatment may be used. Immunopathological inflammations of the ocular surface are associated with systemic diseases. Keratoconjunctivitis sicca, although occurring in the absence of systemic disease, is a common companion of Sjögren's syndrome and collagen diseases. Ocular pemphigoid belongs to the group of mucous membrane pemphigoids. After the initial conjunctivitis symptoms, subconjunctival fibrosis begins, leading to the development of sym- and ankyloblepharon. In the final stage, the ocular surface is covered by scar tissue (ocular cicatricial pemphigoid) which practically results in loss of vision. Peripheral ulcerative keratitis is usually associated with collagen vascular disease, rheumatoid arthritis. A 3-4 mm long, curved infiltration starting near the limbus becomes ulcerated and then perforates, on which the iris may prolapse. First, systemic treatment is required, which is an interdisciplinary task. Topical corticosteroid and cyclosporine eye drops may be administered. In the case of corneal perforation, amniotic membrane transplantation and/or keratoplasty may be performed. Orv Hetil. 2023; 164(43): 1686-1692.

Outcome of conjunctival flap surgery in case of non-healing corneal ulcer in a multi-specialty eye hospital of Northern Bangladesh

Background: This retrospective study evaluates the outcomes of conjunctival flap surgery for non-healing corneal ulcers at a tertiary eye hospital that were resistant to medical treatment. Methods: The study included 47 eyes of 47 patients with deep corneal ulcers who underwent conjunctival flap surgery in a multi-specialty eye hospital between April 2020 and January 2022. The follow-up period was 12 months. Primary outcome measures included the restoration of ocular surface integrity, while secondary outcomes assessed improvements in visual acuity and postoperative complications. Results: Among the 47 patients, 30 (63.82%) were male, and 17 (36.17%) were female, with a mean age of 52.13±14.91 years. The mean ulcer diameter was 4.52±2.02 mm, and the mean ulcer depth was 65±22.20% of the corneal thickness. An anatomic cure was achieved in 34 (72.34%) of the 47 eyes. Three eyes that failed to respond to conjunctival flap surgery required evisceration. Postoperative visual acuity improved in 15 eyes with peripheral ulcers. Common postoperative complications included flap retraction, flap necrosis, granuloma formation, and perforation. Conclusions: Conjunctival flap surgery is an effective treatment for non-healing corneal ulcers, providing ocular surface integrity and supporting corneal healing. It can potentially eliminate the need for emergency penetrating keratoplasty or prepare the eye for future optical keratoplasty.

Investigating the effect of eye drops based on iodine nanoparticles in the treatment of corneal ulcers in rabbit eyes

BackgroundVarious organisms, such as bacteria, viruses, and fungi, can cause corneal ulcers. One of the leading causes of vision loss and disability worldwide is corneal ulceration. Practical, accessible, and affordable treatment for this disease seems essential.Materials and methodsFifteen New Zealand rabbits infected with Staphylococcus aureus (ATCC 25923) corneal ulcers were randomly divided into three groups of five for the present study. (I, II, and III). Group I was used as the control group (without treatment). The second group received an iodine solution (1.25%) without a nanoparticle structure (betadine). The third group received an iodine solution with a nanoparticle structure used as eye drops. Drops in the corneal ulcer group were used five times daily for 14 days.Microbial counts and disease severity scores were measured on the first, second, fifth, and fourteenth days and compared between groups separately for each disease.ResultsThe results showed that the changes in microbial load were significant in the group that received betadine and nanoparticles. The microbial load was further reduced when using iodine nanoparticles than betadine. The betadine and nano-iodine groups significantly reduced the severity of the disease in rabbits with corneal ulcers (p < 0.05). The average changes in disease severity score were 4.8 ± 1.3, -2.6 ± 0.89, and -2.22 ± 1.22 in the untreated, nano iodine, and betadine groups, respectively. However, a significant increase in disease severity was observed in the untreated group (p = 0.001). It shows a significant difference (p < 0.001) between the nano iodine, betadine, and untreated groups. However, the difference in disease severity changes between nano iodine and non-nano iodine groups was insignificant.ConclusionNanoparticle iodine is more effective than non-nanoparticle iodine in reducing bacterial load. In reducing the severity of the disease, both types of iodine were superior to no treatment. But there was no apparent difference between the two groups treated with iodine.

Innovative cold atmospheric plasma (iCAP) decreases corneal ulcer formation and bacterial loads and improves anterior chamber health in methicillin resistant Staphylococcus aureus keratitis

Bacterial keratitis is a vision-threatening infection of the cornea that is typically treated with antibiotics. However, antibiotics sometimes fail to eradicate the infection and do not prevent or repair the damage caused directly by the bacteria or the host immune response to the infection. Our group previously demonstrated that treatment of Pseudomonas aeruginosa keratitis in rabbits with innovative cold atmospheric plasma (iCAP) resulted in reduced edema, ulcer formation, and bacterial load. In this study, we investigated the efficacy of iCAP treatment in methicillin-resistant Staphylococcus aureus (MRSA). New Zealand white rabbits were infected intrastromally with MRSA then treated with iCAP, moxifloxacin, vancomycin, or combination of iCAP with each antibiotic to assess the safety and efficacy of iCAP treatment compared to untreated controls and antibiotics. iCAP treatment significantly reduced bacterial loads and inflammation, improved anterior chamber clarity, and prevented corneal ulceration compared to untreated controls and antibiotic treatment. Safety assessments of grimace test scores and tear production showed that iCAP was not significantly different from either antibiotic treatment in terms of distress or tear production. Combination iCAP/antibiotic treatment did not appear to provide significant added benefit over iCAP alone. Our findings suggest that the addition of iCAP may be a viable tool in reducing damage to the cornea and anterior chamber of the eye following S. aureus keratitis.

TREATMENT OF UNILATERAL ULCERATIVE KERATITIS IN LOCAL CATS BY COMBINATION THERAPY WITH AUTOLOGOUS EYE DROP SERUM IMMUNOTHERAPY

Keratitis is an eye disorder due to the infiltration of inflammatory cells in the cornea which will cause the cornea to become cloudy, causing disruption of the animal's vision. Keratitis can result from the constant exposure of the outer cornea and conjunctiva not only to hazardous materials such as wind, dust, and microorganisms (bacteria, fungi and viruses), but also to other sources of irritation such as hair from the animal itself. Writing this report aims to determine the effectiveness of autologous serum administration in keratitis. The case animal is a local female cat aged 4 months with a body weight of 0.9 kg coming with complaints of watery and reddish right eye. Physical examination showed clouding of the cornea of the eye and excessive tearing. Opthalmoscope examination showed internal bleeding of the eye and the fluorescein ophthalmic strip test showed positive results for an ulcer on the cornea. Case animals were diagnosed with ulcerative keratitis. The treatment given was the oral antibiotic doxycyclin, tobramycin drops and autologous serum. The eye condition of the case animal showed improvement in the second week after treatment, but still showed a little turbidity in the cat's right eye. Treatment of case animals should be continued in order to produce maximum treatment and a collar should be attached to help speed up the healing process.

Demographic and microbiological profile of corneal ulcer patients presenting at a tertiary healthcare center of Eastern India during the COVID era: A hospital-based cross-sectional study.

To determine the demographic and microbiological profile involved in the causation of corneal ulcers in Eastern India during the COVID era. Patients presenting with corneal ulcers fulfilling the inclusion and exclusion criteria were taken as the case. The study duration was from January 2021 to December 2021. Socio-demographic details and information about risk factors were noted. A detailed corneal examination followed by corneal scraping was performed for microbiological evaluation. In 1 year, 99 infective corneal ulcer patients were evaluated. Farmers (24.2%) were found to be maximally affected by corneal ulcers. The peak in cases was recorded from October to December (38.4%). Ocular trauma was the commonest risk factor (42.4%). The majority (80.8%) of patients were already on some topical antimicrobials. 22.2% of samples showed fungal filaments on KOH mount; 54.5% of these cases turned out to be culture-positive. 17.56% of KOH-negative samples turned out to be culture-positive (fungal). Overall, the culture positivity rate was 28.28% out of which fungal isolates were 89.28% and bacterial isolates were 10.72%. Fusarium species were identified as the most common organism contributing 42.85%, followed by Aspergillus fumigatus (14.28%). 10.72% of cases were culture positive for Pseudomonas aeuroginosa. Trauma with the organic matter was the predominant cause of fungal keratitis. In this study, fungal keratitis was found to be more common. Fusarium was the most common isolate.

The identification of a novel mutation (p.I223fs) in WRN associated with Werner syndrome.

Werner syndrome (WS) is a rare autosomal recessive genetic disease caused by mutations in the WRN gene, and it is characterized by multiple manifestations corresponding to early-onset aging. This study reports the case of a WS patient with a novel WRN mutation. A 36-year-old male patient with WS was evaluated after approval from the local ethics committee. The clinical and biochemical findings of the patient were described. Peripheral blood sample was collected to extract genomic DNA for WRN gene exome sequencing. The three-dimensional (3D) protein structural prediction analysis was performed via the AlphaFold 2.2 program and PyMol software. We report the case of a clinically diagnosed WS patient with consanguineous parents who presented with complex manifestations including early-onset diabetes mellitus, binocular cataracts, cerebral infarction, cerebral atherosclerosis, hypertension, dyslipidemia, hypothyroidism, and suspected meningioma, accompanied by short stature, gray hair, rough skin with subcutaneous fat atrophy, a high-pitched voice, palmoplantar keratoderma, bilateral flat feet, and an indolent deep ulceration on the foot. Exome sequencing identified a novel homozygous frameshift mutation in the WRN gene, c.666-669 del TATT, p.I223fs. The 3D structure prediction showed that premature termination and significant structural changes could occur in the mutant WRN protein. We identified a novel homozygous frameshift mutation, p.I223fs, in WRN in a Chinese patient with WS, expanding the spectrum of mutations in WS.

A Case of Allergic Reaction to 0.5% Moxifloxacin Eye Drops

Purpose: We report a rare case of allergic contact dermatitis after the use of a non-preservative 0.5% moxifloxacin ophthalmic solution.Case summary: A 60-year-old male presented with bacterial corneal ulceration of the right eye. He was treated with 50 mg/mL of fortified cefazolin and 14 mg/mL of tobramycin that were tapered as the corneal lesion improved after 1 month, and 0.5% moxifloxacin application was started. After 2 weeks of moxifloxacin treatment, the patient developed conjunctival injection, lid swelling, redness, and itching in the right eye. An allergic reaction was suspected and moxifloxacin administration was immediately stopped. The symptoms improved after the administration of oral antihistamines, 0.5% loteprednol eye drops, and steroid combination ointment.Conclusions: Patients treated with 0.5% topical moxifloxacin should be monitored for allergic contact dermatitis, even if preservative-free eye drops are used.

Risk factors, diagnostics and treatment of corneal melting after cataract phacoemulsification

Inflammatory complications of cataract phacoemulsification are among the most urgent and potentially vision-threatening conditions. Corneal melting is a rare but clinically significant condition preceding corneal perforation. The main risk factors are the use of nonsteroidal anti-inflammatory drugs (NSAIDs), severe dry eye disease and rheumatic diseases. The paper presents a literature review and offers an analysis of a clinical case of corneal melting after cataract phacoemulsification in a female patient with severe dry eye disease, which was undiagnosed before surgery. The follow-up period was 5 years. The possibilities and limitations of multiple methods of corneal melting treatment at the stages of persistent epithelial defect and corneal ulcer are discussed. The mechanism of disease development and its link with the pathogenesis of dry eye disease and the role of topical NSAIDs as a trigger for the initiation and progression of corneal melting are considered.

Interrupted Versus Running Sutures for Amniotic Membrane Fixation in Cases of Resistant Infected Corneal Ulcers

Background: Infected corneal ulcers that don't show any healing within two weeks despite proper medical treatment are considered resistant and need surgical intervention [1] the amniotic membrane transplantation has been used to treat resistant corneal ulcers because it acts as a bioactive substratum that accelerates epithelial healing [2].&#x0D; Aim of the Work: comparison between interrupted and running sutures for amniotic membrane fixation in cases of resistant infected corneal ulcers.&#x0D; Patients and Methods: This prospective, comparative, interventional randomized study was carried out on 40 eyes with resistant infected corneal ulcers. They underwent amniotic membrane transplantation as an adjunctive to the medical treatment. Divided into 2 groups: group A (interrupted suture group) and group B (running suture group). The duration of study was 12 months.&#x0D; Results: The duration of healing in group A ranged from 25 to 40 days with mean duration of 34.25±4.94 days, while in group B the duration of healing ranged from 20 to 40 days with mean duration of 31.0±6.61 days. UDVA didn’t improve in 65% of cases in group A and 45% of cases in group B.&#x0D; Conclusion: Amniotic membrane transplantation is an adjunctive surgical procedure for the management of infectious corneal ulcer by promoting wound healing and reducing inflammation. We noticed that the running suture adhered the amniotic membrane firmly to the entire corneal surface so it accelerated the corneal epithelial healing and made it less affected with eyelid movement and less annoying to patient.