Lens Aspirate Research Articles

Spiroplasma infection as a cause of severe congenital keratouveitis, cataract and glaucoma

BackgroundOnly seven cases of ocular Spiroplasma infection have been reported to date, all presenting as congenital cataracts with concomitant intraocular inflammation. We describe the first case of Spiroplasma infection initially presenting as a corneal infiltrate.Case presentationA 1-month-old girl was referred for a corneal infiltrate in the left eye. She presented in our hospital with unilateral keratouveitis. Examination showed a stromal corneal infiltrate and dense white keratic precipitates in the left eye. Herpetic keratouveitis was suspected and intravenous acyclovir therapy was initiated. Two weeks later, the inflammation in the left eye persisted and was also noticed in the right eye. Acute angle-closure glaucoma and a cataract with dilated iris vessels extending onto the anterior lens capsule developed in the left eye. The inflammation resolved after treatment with azithromycin. Iridectomy, synechiolysis and lensectomy were performed. Bacterial metagenomic sequencing (16 S rRNA) and transmission electron microscopy revealed Spiroplasma ixodetis species in lens aspirates and biopsy. Consequently, a diagnosis of bilateral Spiroplasma uveitis was made.ConclusionsIn cases of congenital cataract with concomitant intraocular inflammation, Spiroplasma infection should be considered. The purpose of this case report is to raise awareness of congenital Spiroplasma infection as a cause of severe keratouveitis, cataract and angle-closure glaucoma in newborns. Performing molecular testing on lens aspirates is essential to confirm diagnosis. Systemic macrolides are suggested as the mainstay of treatment.

Congenital Infection and Congenital Cataract in Tanzania: A Case Control Study

Background: Cataract is the commonest cause of childhood blindness in sub Saharan Africa (SSA). The significance of congenital rubella and human cytomegalovirus (HCMV) infection in the etiology is not known. Objectives: We aimed to investigate prevalence of both viruses in cases of congenital cataract and controls. Methods: Lens tissue was collected (from cases), blood and saliva from cases and controls. Using ELISA, we tested blood samples for rubella and cytomegalovirus IgM. Quantitative polymerase chain reaction (qPCR) was also used for detection of the viruses. Results: Cytomegalovirus was detected using qPCR in 72.9% saliva specimens of cases compared to 38.5% of controls (P = 0.0001). Cytomegalovirus IgM was also detected in 10.8% blood specimens of cases and only 1.5% control (P = 0.01). Rubella IgM was detected in 13.8% blood specimens of cases and only 3.1% controls (P = 0.01). In lens aspirates of cases, 12.7% were HCMV positive and 11.1% were rubella positive by qPCR. Cases had lower birth weights (mean = 2.8 kg) than controls (mean = 3.2 kg), independent of viral status (P = 0.004). Conclusions: Although most of the children in the study presented too late to be sure that infection was congenital, our study strongly suggests that HCMV and rubella infection appear important causes of congenital cataract in Tanzania hence virology testing of infantile cataract cases may be useful in assessing effectiveness of immunization programs as they are established throughout SSA.

Rubella virus in association with congenital cataract at makkah eye complex

Background: Rubella is a viral disease that causes many systemic and ocular postnatal anomalies known as congenital rubella syndrome (CRS). The most common ocular disorder is congenital cataract. Purpose: The purpose of this study was to determine the prevalence of CRS and its association with congenital cataract and systemic comorbidities. Materials and Methods: In this cross-sectional, hospital-based study, full ophthalmic and systemic examination was carried out on 45 infants (n = 45), aged below 1 year, with congenital cataract, attending the Pediatric Ophthalmology Clinic at Makkah Eye Complex, Khartoum, Sudan, in the period between February 2015 and June 2016. The 45 children were booked for phacoemulsification plus intraocular lens implantation. The children's biodata and maternal and neonatal history were obtained from the mothers and plotted in case investigation forms. Venous blood sample and lens aspirate were studied for rubella IgM, IgG, and polymerase chain reaction beside rubella virus detection in the National Laboratory of Measles and Rubella. Results: Blood and lens aspirate was collected from the study infants, which revealed that 38 infants (84%) were negative for rubella, whereas only seven infants (16%) showed positive result. The majority of the rubella-positive patients (n = 5, 71%) had bilateral cataract and only two infants had unilateral cataracts. Only one rubella-positive case (14.3%) had microphthalmia in one eye. Unfortunately, screening for pigmentary retinopathy was not done postoperatively. Four (57%) out of the seven rubella-positive cases reported systemic CRS. Microcephaly, patent ductus arteriosus, ventricular septal defect, and pulmonary hypertension were reported in one case (14.3%) each. Three mothers (43%) from the rubella-positive group had a history of febrile illness during pregnancy. Conclusion: Congenital cataract and systemic comorbidities are common in infants with congenital rubella.

Iron-Overload, Oxidative DNA Damage and Differential Transcript Expression of Iron Homeostasis Genes in Human Cortical Cataracts

Human whole lenses (WLs) were obtained from donors' eyes (n = 33) within 8 hours of death. A total of 167 (control, n = 35 and cataract, n = 132) anterior central capsules (ACC) harboring lens epithelial cells (LECs) and lens aspirate containing LECs, primary and secondary lens fiber cells (LFCs) were collected postoperatively. Control samples were obtained mainly from patients suffered from lenticular trauma or subjected for myopic corrections. Lenticular total iron was determined by Atomic Absorption Spectrophotometer (AAS).

Candida species lens abscesses in infants with a history of neonatal Candida sepsis

We report 3 patients who were delivered prematurely and who developed a lens opacity with signs of ocular inflammation at a postgestational age of 10-52 weeks. All patients had been treated for Candida sepsis as neonates. Each patient underwent lensectomy and anterior vitrectomy. In 2 infants Candida albicans was cultured from the lens/anterior chamber membrane; in 1 Candida parapsilosis was cultured from a lens aspirate. Despite eradication of the fungal infection, outcomes were poor: 2 eyes developed glaucoma, and 1 developed a retinal detachment with subsequent phthisis.

Relative efficiency of polymerase chain reaction and enzyme-linked immunosorbant assay in determination of viral etiology in congenital cataract in infants

Perinatal viral infections of fetus are among the leading causes of congenital cataract and identifying the viral etiology is important. To detect the presence of Rubella virus (RV), herpes simplex virus (HSV) and cytomegalovirus (CMV) in lens aspirate specimens obtained from patients with congenital cataract and relate the results with serology. Prospective study carried out in tertiary care hospital. Fifty lens aspirates from 50 infants with congenital cataract were subjected to HSV, RV isolation and polymerase chain reaction (PCR) for detection of HSV and CMV. Reverse transcription polymerase chain reaction (RT-PCR) was applied for RV detection. Peripheral blood specimens were screened for anti-HSV, RV and CMV antibodies by enzyme-linked immunosorbant assay (ELISA). Rubella virus was detected in nine (18%) lens aspirates, by nRT-PCR which includes six positive by culture. HSV-2 DNA was detected in nine other lens aspirates, while CMV was not detected by PCR. Serological results did not correlate with the presence of viruses in the lens aspirates. This is the first report of detection of HSV-2 DNA in cases of congenital cataract. Cytomegalovirus may not be playing a significant role in causation of congenital cataract. The role of serology in identifying causative viral infection for congenital cataract needs to be re-evaluated.

Traumatic intralenticular abscess: a case series

To report the clinical presentation, management and outcome of eyes with traumatic intralenticular abscess. In this interventional case series, records of eight patients (eight eyes) with intralenticular abscess developing following trauma were reviewed. All patients underwent extracapsular cataract extraction with intracameral antibiotics with or without pars plana vitrectomy. Main outcome measures studied were resolution of infection and final visual outcome. Lens abscess developed in six eyes following penetrating injury and in two eyes following intraocular penetration of caterpillar hair. Gram positive cocci were cultured from the lens aspirate in five eyes and Staphylococcus epidermidis was the most common organism isolated. Cataract extraction resulted in control of the infection in all eyes and seven eyes (87.5%) had a favourable visual outcome. Early lens extraction with intracameral antibiotics in eyes with intralenticular abscess allows control of infection with good visual outcome.

Toxoplasma gondii Detection by Nested Polymerase Chain Reaction in Lens Aspirate and Peripheral Blood Leukocyte in Congenital Cataract Patients: The First Report from a Tertiary Eye Hospital in India

Purpose: To detect T. gondii DNA and specific antibodies in lens aspirates (LA) and peripheral blood leucocytes (PBL) of congenital cataract patients. Methods: ELISA for T. gondii antibodies on sera nPCR for T. gondii DNA (B1 gene) on LA and PBL were performed for 52 patients. Results: T. gondii DNA was detected in 29 (55.8%) of the 52 patients (LA-14, PBL-13, LA and PBL-2, and specific IgM in 2 sera). nPCR in PBL was more sensitive than ELISA (p < 0.005). Conclusion: nPCR is a sensitive technique to detect T. gondii from LA and PBL in congenital cataract patients.

Herpes simplex virus-1–associated congenital cataract

Purpose To report association of herpes simplex virus-type 1 (HSV-1) in four cases of congenital cataract. Design Prospective interventional case series. Methods Four infants younger than 12 months, presenting with unilateral or bilateral congenital cataract, were included. The cases were clinically evaluated by the pediatric ophthalmologist. The lens aspirates collected at the time of cataract surgery were processed for HSV-1 culture in rabbit corneal epithelial (SIRC) cell line and for HSV-1 DNA by polymerase chain (PCR). The sera of the children and the mother were tested for HSV-1 immunoglobulin (Ig) M and IgG by enzyme linked immunosorbent assay (ELISA). Results HSV-1 was isolated in tube cultures in three of four lens aspirates, and all four lens aspirates were positive for HSV-1 DNA by PCR. Serum HSV-1 IgM was positive in all babies and in three cases HSV-1 IgM was positive in the mother's serum. Conclusion Based on a computerized literature search, we believe this may be the first report of HSV-1 associated congenital cataract.

The association of rubella virus in congenital cataract - a hospital-based study in India.

The association of rubella virus (RV) with congenital cataract has been well established. Since the data on association of RV with congenital cataract in India are scanty, a study was done based on virus isolation from lens aspirates in patients undergoing therapeutic lensectomy and serology. To determine the incidence of the association of rubella virus with congenital cataract. The lens aspirates collected during the 9-year period (from 1990 to 1998), from 70 children up to 12 years of age with congenital cataract were processed for the isolation of rubella virus by conventional viral isolation culture method using BHK-21 and Vero cell lines. Identification of the virus was confirmed by immunofluorescence using human anti-rubella virus specific hyperimmune serum. Serum samples were collected from 55 out of these 70 children and the presence of antibodies to RV was detected by ELISA test. RV was isolated from lens aspirates in seven (10%) out of the 70 children with congenital cataract. Of the 55 sera tested, 22 had both anti-rubella IgM and IgG antibodies, in 13 only anti-RV IgG antibodies, in seven only IgM antibodies and the rest of the 13 samples did not have detectable levels of rubella antibodies. Among the children who had IgM antibodies, 12 (24.5%) were below the age of 6 months. It can be concluded based on virus isolation that 10% of patients with congenital cataract were due to rubella infection and the detection of 24.5% anti-RV IgM antibodies in children below 6 months old shows the possible association of rubella virus with congenital cataract.

Herpes simplex virus-induced congenital cataracts.

Herpes simplex virus (HSV) was cultured from the lens aspirate of a dense cataract present in the right eye of an 18-month-old healthy white girl. A small linear anterior cortical opacity was present in the other eye along with an unusual pattern of chorioretinal scarring.

Cytology of human lens aspirate. Its relationship to phacolytic glaucoma and phacoanaphylactic endophthalmitis.

Following needling and aspiration of cataract, the anterior chamber aspirate from 28 eyes of 23 patients was analyzed cytologically. The almost purely macrophagic cellular response was directly related to the time elapsed between needling and aspiration. The type of cell was identical to but much fewer in number than cells seen with phacolytic glaucoma. The escaping lens protein of senile hypermature cataracts is probably altered and more noxious than the normal lens substance found in the anterior chamber following needling of soft cataracts. No difference in cellular response was noted between those eyes from 15 patients who had had no previous surgical manipulation of the lens in the fellow eye and 13 who had experienced such surgery. Phacoanaphylactic endophthalmitis must involve factors (such as the genetic makeup of the individual) other than simply the presence of altered lens protein within the eye following disruption of the lens capsule.