Lens Injury Research Articles

Comparative proteomic analysis of regenerative mechanisms in mouse retina to identify markers for neuro-regeneration in glaucoma

The retina is part of the central nervous system (CNS). Neurons in the CNS and retinal ganglion cells lack the ability to regenerate axons spontaneously after injury. The intrinsic axonal growth regulators, their interaction and roles that enable or inhibit axon growth are still largely unknown. This study endeavored to characterize the molecular characteristics under neurodegenerative and regenerative conditions. Data-Independent Acquisition Mass Spectrometry was used to map the comprehensive proteome of the regenerative retina from 14-day-old mice (Reg-P14) and adult mice after lens injury (Reg-LI) both showing regrowing axons in vitro, untreated adult mice, and retina from adult mice subjected to two weeks of elevated intraocular pressure showing degeneration. A total of 5750 proteins were identified (false discovery rate < 1%). Proteins identified in both Reg-P14 and Reg-LI groups were correlated to thyroid hormone, Notch, Wnt, and VEGF signaling pathways. Common interactors comprising E1A binding protein P300 (EP300), CREB binding protein (CBP), calcium/calmodulin dependent protein kinase II alpha (CaMKIIα) and sirtuin 1 (SIRT1) were found in both Reg-P14 and Reg-LI retinas. Proteins identified in both regenerating and degenerative groups were correlated to thyroid hormone, Notch, mRNA surveillance and measles signaling pathways, along with PD-L1 expression and the PD-1 checkpoint pathway. Common interactors across regenerative and degenerative retinas comprising NF-kappa-B p65 subunit (RELA), RNA-binding protein with serine-rich domain 1 (RNPS1), EP300 and SIN3 transcription regulator family member A (SIN3A). The findings from our study provide the first mapping of regenerative mechanisms across postnatal, mature and degenerative mouse retinas, revealing potential biomarkers that could facilitate neuro-regeneration in glaucoma.

An Evaluation of the Precision of Ocular Trauma Score and Factors for Poor Visual Outcomes in Open Globe Injury: A Retrospective Analysis of Resourcelimited Hospital Settings

Objective: To evaluate the accuracy and validity of ocular trauma scores (OTS) among patients with open globe injury (OGI) in rural hospital settings and to identify the determinants predicting poor visual outcomes. Materials and Methods: A single-center retrospective cohort study was conducted through a chart review of OGI patients between July 2018 and June 2023 at Bueng Kan Hospital. Demographic and preoperative factors affecting the final visual outcome were evaluated. OTS score for each patient was calculated and categorized. Final VA after 6 months was compared to the predicted VA from OTS study. Poor visual outcome was defined as legal blindness after 6 months of treatment. Results: Thirty-nine eyes from patients with a mean age of 44.05 years were evaluated. Most subjects were male (94.87%), and workplace injuries were the most common (78.38%). Compared to the OTS study, patients in OTS category 2 achieved a significantly higher percentage of better final VA, while categories 3 and 4 showed similar outcomes. OTS category 1 patients had a lower proportion of no light perception (NLP) outcomes, though the difference was not significant. Poor visual outcomes were predicted by initial VA (OR=4.64), wound extension ≥10 mm (OR=20.66), and lens injury (OR=7.44). Conclusion: OTS is beneficial for predicting final vision in patients with OGI, particularly with less severe trauma. Severe cases often lead to better visual outcomes, emphasizing the need for cautious management and counseling by ophthalmologists. Factors that estimate poor visual outcomes involve poor initial VA, wound extension  10 mm, and lens damage.

“Don’t miss the globe” – Study of diagnostic accuracy of computed tomography in detecting open globe injury

Abstract: PURPOSE: The purpose is to determine the computed tomography (CT) characteristics of open globe injury and establish the relative accuracy and reliability of various features on CT. Second, to assess the significance of a difference in the anterior chamber depths (ACDs) on CT in cases of open globe injury. METHODS: The diagnostic database of our radiology department was retrospectively reviewed to obtain details of patients with a history of blunt or penetrating injury to the orbit between September 2018 and March 2021. A total of 190 patients (144 males and 46 females) were included. A radiologist analyzed the CT scans without prior knowledge of ophthalmologic findings or surgical outcomes. Operative and ophthalmic examination findings were considered the gold standard for comparison. RESULTS: Out of 190 injured globes, the final clinical diagnosis confirmed 54 (28.4%) open globe injuries and 136 (71.5%) closed globe injuries. Between the two groups, intraocular hemorrhage, lens dislocation, lens injury or absence, intraocular foreign body, intraocular air, wall/contour defect, and ACD change were considered statistically significant (P &lt; 0.05). The average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in diagnosing open globe injury were 71.3%, 98.5%, 83.6%, 95.75%, and 94.9%, respectively. CONCLUSION: Globe contour deformity or defect, intraocular hemorrhage, and a change in ACD were the three most predictive signs of open globe injury. CT is of valuable help in a multi-trauma setting and in an uncooperative patient for ophthalmological examination to draw attention to globe injury. However, CT examination alone is insufficient in detecting all cases of open globe injury. There is a need for a more collaborative approach among emergency physicians, ophthalmologists, and radiologists.

Establishing a safe, medical officer-led intravitreal injection clinic: minimizing inadvertent crystalline lens injury

Establishing a safe, medical officer-led intravitreal injection clinic: minimizing inadvertent crystalline lens injury

Clinical Presentations and Surgical Outcomes in Traumatic Iris and Lens-Related Injuries Due to Blunt Trauma

Purpose: The aim of this study was to evaluate the clinical presentation, treatment options, and surgical outcomes of patients admitted with traumatic iris and lens-related injuries due to blunt trauma. Methods: This retrospective study included 43 eyes of 43 patients who presented with traumatic iris and lens injuries between September 01, 2022 and July 01, 2023. Results: The mean age was 46.1±14.6 years and the mean ocular trauma score was 74.7±9.9. According to the cause of injury, the most common cause in males is assault, and the most common cause in females is fall. Nine (20.9%) patients underwent pars plana vitrectomy. Six (14%) patients underwent cataract surgery with phacoemulsification and intraocular lens implantation into “the bag.” Conclusions: In conclusion, other concomitant pathologies may make these surgeries difficult to perform. Early evaluation and timely management are essential to achieve the best possible outcomes in patients with traumatic iris and lens-related injuries.

Microsurgical Vitrectomy with Pars Plana Incision for the Removal of Posterior Segment Intraocular Foreign Bodies.

This study describes a pars plana incision surgical technique combined with 23 or 25-gauge vitrectomy in the management of intraocular foreign bodies (IOFBs) and to assess its anatomical and functional results. Sixteen patients with ocular trauma complicated with IOFB were enrolled in our study. The mean preoperative visual acuity was 2.01 ± 0.55 LogMAR, and the mean postoperative visual acuity at the final visit was improved to 0.91 ± 0.58 LogMAR (p < 0.001). Until the last follow-up, all IOFBs were successfully removed and anatomic success was obtained. Complications, such as endophthalmitis, silicone oil-dependent, and ocular hypotonia, were not observed. Microsurgical vitrectomy with modified pars plana incision is a safe and effective procedure in the treatment of retained IOFB, especially associated with transparent lens and posterior segment injury.

Lens injury as acomplication of intravitreal medication injection

Intravitreal medication injections are an efficient and low-risk delivery technique for treating various retinal diseases. Rare serious complications include increased intraocular pressure, vitreous hemorrhage, retinal tears and detachment, intraocular inflammation and endophthalmitis. In the case series presented here, we report iatrogenic lens injuries caused by inadequate performance of intravitreal injections. Amulticenter data collection of patients treated with intravitreal injections with visible iatrogenic lens defects from 2016 to 2023 was retrospectively performed. Lens trauma after intravitreal injections was identified in six cases (69.3±6.5 years). While five cases were observed after anti-VEGF therapy, we identified lens injury after dexamethasone implantation in one patient. Iatrogenic lens injury during intravitreal injection is preventable with the correct injection technique. Knowledge of individual axis length and lens status also helps to avoid this complication.

Wound healing and postoperative management in paediatric patients following 27-Gauge Transconjunctival Sutureless Vitrectomy for vitreoretinal conditions.

The utilization of 27-G TSV, or 27-Gauge Transconjunctival Sutureless Vitrectomy, poses distinct difficulties in the context of paediatric patients, particularly those younger than 14 years old, on account of the dearth of exhaustive documentation concerning the efficacy and results of these operations. Therefore, this retrospective study was to evaluate the safety and efficacy of 27-G TSV in paediatric patients, with emphasis on management of intraoperative and postoperative complications and postoperative wound healing. A total of 54 eyes of 52 paediatric patients who underwent 27-G TSV at Sichuan Provincial People's Hospital were included in the study. The average duration of follow-up was 9.32 ± 3.35 months. The complication with the highest incidence rate was Rhegmatogenous Retinal Detachment (RRD), which was detected in 27.8% cases. Familial Exudative Vitreoretinopathy (FEVR) and Persistent Fetal Vasculature (PFV) each accounted for 16.7% of the cases. Retinopathy of Prematurity (ROP) and Vitreous Haemorrhage (VH) constituted 11.1% and 14.8%, respectively, of the reported cases. Lens injury (1.9%), cannula slippage (7.4%) and wound leakage (5.6%) were intraoperative complications. Iatrogenic retinal detachment occurred at 3.7%. Hypotony (10.8% of patients), vitreous haemorrhage (9.3%), cataract formation (9.3%), ocular hypertension (8.1%) and retinal detachment (5.6%) were postoperative complications. Effective management strategies were executed, such as performing in situ trocar puncture to address cannula slippage and promptly suturing to address wound leakage. 27-G TSV exhibited promise as the therapeutic alternative for range of vitreoretinal disorders in paediatric patients, accompanied by complications that were controllable during and after the procedure. Strict preoperative planning and precise surgical technique are indispensable in order to maximize patient outcomes and guarantee effective wound healing and recovery within this particular demographic.

Immune Responses Induced at One Hour Post Cataract Surgery Wounding of the Chick Lens.

While the lens is an avascular tissue with an immune-privileged status, studies have now revealed that there are immune responses specifically linked to the lens. The response to lens injury, such as following cataract surgery, has been shown to involve the activation of the resident immune cell population of the lens and the induction of immunomodulatory factors by the wounded epithelium. However, there has been limited investigation into the immediate response of the lens to wounding, particularly those induced factors that are intrinsic to the lens and its associated resident immune cells. Using an established chick embryo ex vivo cataract surgery model has made it possible to determine the early immune responses of this tissue to injury, including its resident immune cells, through a transcriptome analysis. RNA-seq studies were performed to determine the gene expression profile at 1 h post wounding compared to time 0. The results provided evidence that, as occurs in other tissues, the resident immune cells of the lens rapidly acquired a molecular signature consistent with their activation. These studies also identified the expression of many inflammatory factors by the injured lens that are associated with both the induction and regulation of the immune response.

Surgical exposure for vitrectomy in retinopathy of prematurity.

Our purpose was to evaluate the efficacy of lateral canthotomy, sub-tenon anesthesia injection, and the use of modified speculum for gaining adequate surgical exposure during surgery for retinopathy of prematurity (ROP). Fourteen eyes of 10 consecutive patients undergoing microincisional vitrectomy surgery (MIVS) for stage 4 and stage 5 ROP were included. There was a significant widening of the palpebral fissure height and length using this technique. No patient developed a lens injury during the surgery. All the canthotomy incisions completely healed at a four-week follow-up visit. This is a safe and effective technique for increasing surgical exposure in cases of ROP requiring vitrectomy.

Traumatic dislocation of the iris into the vitreous cavity with intact lens: a case report

BackgroundTraumatic aniridia occurs when the iris is extruded from the eye and is often accompanied by lens injuries. However, traumatic aniridia due to dislocation of the iris into the vitreous cavity without lens damage has never been reported.Case presentationA 30-year-old man presented with visual loss and pain for 6 h after a thin wire injured his right eyeball. Ophthalmologic examinations manifested a 2 mm full-thickness corneal laceration and total hyphema. An intact clear lens, healthy attached retina, and almost complete iris tissue in the vitreous cavity were found after resolution of hyphema the next day. Further examination revealed that the defect in the zonule below the corneal wound was the path for the iris to enter the vitreous cavity. The patient opted for nonsurgical treatment until pigment granules and opacity were observed in the vitreous cavity after 50 days. Vitrectomy was performed to remove the dislocated iris.ConclusionsThe presentation of this unique case indicates that the torn iris was displaced to the vitreous cavity with an intact lens and missing local zonula instead of out the corneal laceration after a penetrating injury. The type of injury, mechanism, and force on the spot may contribute to the occurrence of this rare condition. Instead of artificial irises, tinted glasses were more appropriate treatment option for this patient. Peripheral retinal examination was essential in the management of this case. In such cases, the iris in the vitreous cavity should be resected to prevent complications.

Lens-related ocular emergencies (LROE) in dogs: treatment and visual outcome after late presentation of 90 eyes

BackgroundLens-related emergencies need immediate medical intervention to reduce complications, minimize pain, and improve the chances of retaining vision. The present study aimed to demonstrate the common lens-related ocular emergencies in dogs and evaluate the short-term outcomes after the treatment of these cases. Sixty dogs (90 eyes) of different breeds were presented with unilateral (30 eyes, OD = 18, OS = 12) and bilateral (60 eyes) ocular abnormalities related to crystalline lens injury. Clinical, ultrasonographic, and laboratory examinations were achieved. Different treatment protocols were conducted after a complete ophthalmic examination and the associated clinical outcomes were evaluated.ResultsMean (± SD) age of dogs at initial evaluation was 3.65 (± 2.4) years (range, 1˗12 years). Lens luxation and subluxation were diagnosed in 45 eyes (25 with anterior lens luxation, 15 with subluxation, and 5 with posterior lens luxation). Lens-induced anterior uveitis without ocular hypertension (n = 25 eyes), lens-induced uveitis with secondary glaucoma (uveitic glaucoma) (n = 15 eyes), and lens capsule disruption (n = 5 eyes) were also diagnosed. The vision was lost in all 5 eyes with posterior lens luxation and secondary glaucoma (100%), 18/25 eyes with anterior lens luxation (72%), and 5/15 eyes with lens subluxation (33.3%). Vision impairment was also identified in 10/25 eyes (40%) with unresponsive lens-induced anterior uveitis and in 5/5 eyes (100%) with traumatic rupture of the anterior lens capsule.ConclusionCrystalline lens pathology can cause a wide variety of ocular emergencies that may result in blindness. Early diagnosis and appropriate treatment are crucial for handling lens-related emergencies in dogs.

Protective effects of ferulic acid against ionizing radiation-induced oxidative damage in rat lens through activating Nrf2 signal pathway.

To examine the protection of ferulic acid (FA) against ionizing radiation (IR)-induced lens injury in rats, as well as the underlying mechanisms. FA (50 mg/kg) was administered to rats for 4 consecutive days before they were given 10 Gy γ-radiation, as well as for 3 consecutive days afterward. Two weeks after radiation, the eye tissues were collected. Histological alterations were evaluated by hematoxylin-eosin staining. Enzyme linked immunosorbent assay (ELISA) was utilized to assess the activities of glutathione reductase (GR) and superoxide dismutase (SOD), as well as the levels of glutathione (GSH) and malondialdehyde (MDA) in the lenses. The protein and mRNA levels of Bcl-2, caspase-3, Bax, heme oxygenase-1 (HO-1), and glutamate-cysteine ligase catalytic subunit (GCLC) were quantified using Western blot and quantitative reverse transcription polymerase chain reaction, respectively. With nuclear extracts, the nuclear factor erythroid-2 related factor (Nrf2) protein expressions in the nuclei were also measured. Rats exposed to IR showed lens histological alterations which could be alleviated by FA. FA treatment reversed apoptosis-related markers in IR-induced lens, as evidenced by lower levels of Bax and caspase-3 and higher level of Bcl-2. Furthermore, IR induced oxidative damage manifested by decreased GSH level, increased MDA level, and decreased SOD and GR activities. FA boosted nuclear translocation of Nrf2 and increased the expressions of HO-1 and GCLC to inhibit oxidative stress, as evidenced by an increase in GSH, a decrease in MDA, and an increase in GR and SOD activities. FA may work well in preventing and treating IR-induced cataract through promoting the Nrf2 signal pathway to attenuate oxidative damage and cell apoptosis.

Full-length optic nerve regeneration in the absence of genetic manipulations.

The inability of mature retinal ganglion cells (RGCs) to regenerate axons after optic nerve injury can be partially reversed by manipulating cell-autonomous and/or -nonautonomous factors. Although manipulations of cell-nonautonomous factors could have higher translational potential than genetic manipulations of RGCs, they have generally produced lower levels of optic nerve regeneration. Here, we report that preconditioning resulting from mild lens injury (conditioning LI, cLI) before optic nerve damage induced far greater regeneration than LI after nerve injury or the pro-inflammatory agent zymosan given either before or after nerve damage. Unlike zymosan-induced regeneration, cLI was unaltered by depleting mature neutrophils or T cells or blocking receptors for known inflammation-derived growth factors (oncomodulin, stromal cell-derived factor 1, CCL5) and was only partly diminished by suppressing CCR2+ monocyte recruitment. Repeated episodes of LI led to full-length optic nerve regeneration, and pharmacological removal of local resident macrophages with the colony stimulating factor 1 receptor inhibitor PLX5622 enabled some axons to reinnervate the brain in just 6 weeks, comparable to the results obtained with the most effective genetic manipulations of RGCs. Thus, cell-nonautonomous interventions can induce high levels of optic nerve regeneration, paving the way to uncovering potent, translatable therapeutic targets for CNS repair.

Clinical Findings Predicting Posttraumatic Endophthalmitis after Repair of Open Globe Injuries

ABSTRACT Background To evaluate risk factors for developing endophthalmitis after repair of open globe injuries. Methods Retrospective chart analysis of 1303 patients from May 1996 till December 2019. Results All patients received prophylactic intravenous broad-spectrum antibiotics for 5–7 days. Endophthalmitis was clinically suspected in 37 (2.8%) eyes and was culture proven in 14 of these eyes (1.1%). Univariate analysis identified poor initial visual acuity at presentation, rural setting of injury, contaminated wound and lens injury as significant predictors for the development of clinically suspected endophthalmitis. Intravitreal antibiotics at the time of primary repair in eyes with high-risk characteristics decreased risk of developing endophthalmitis (OR: 2.28;95% CI,1.07–4.86; p = .033). Conclusions Poor initial visual acuity, rural setting of injury, contaminated wound, and lens injury increased risk of suspected posttraumatic endophthalmitis. Prophylactic intravitreal antibiotics at the time of primary repair in eyes with high-risk characteristics reduced the risk of posttraumatic endophthalmitis.

The Immediate Early Response of Lens Epithelial Cells to Lens Injury.

Cataracts are treated by lens fiber cell removal followed by intraocular lens (IOL) implantation into the lens capsule. While effective, this procedure leaves behind numerous lens epithelial cells (LECs) which undergo a wound healing response that frequently leads to posterior capsular opacification (PCO). In order to elucidate the acute response of LECs to lens fiber cell removal which models cataract surgery (post cataract surgery, PCS), RNA-seq was conducted on LECs derived from wild type mice at 0 and 6 h PCS. This analysis found that LECs upregulate the expression of numerous proinflammatory cytokines and profibrotic regulators by 6 h PCS suggesting rapid priming of pathways leading to inflammation and fibrosis PCS. LECs also highly upregulate the expression of numerous immediate early transcription factors (IETFs) by 6 h PCS and immunolocalization found elevated levels of these proteins by 3 h PCS, and this was preceded by the phosphorylation of ERK1/2 in injured LECs. Egr1 and FosB were among the highest expressed of these factors and qRT-PCR revealed that they also upregulate in explanted mouse lens epithelia suggesting potential roles in the LEC injury response. Analysis of lenses lacking either Egr1 or FosB revealed that both genes may regulate a portion of the acute LEC injury response, although neither gene was essential for expression of either proinflammatory or fibrotic markers at later times PCS suggesting that IETFs may work in concert to mediate the LEC injury response following cataract surgery.

Efficacy and Safety of iStent Inject Implantation in Manual and Femtosecond Laser-assisted Cataract Surgery before Lens Extraction.

AimTo describe the efficacy and safety of iStent implantation prior to phacoemulsification in manual as well as femtosecond laser-assisted cataract surgery (FLACS), and highlight this approach as a reasonable, if not necessary, step to advance one's ability and confidence in the use of microinvasive glaucoma surgery (MIGS) technology in phakic patients.MethodsA retrospective consecutive case series of patients with open angle glaucoma or ocular hypertension who underwent iStent inject implantation followed by cataract surgery (manual or FLACS). All cases underwent postoperative video review and were assessed and classified for intraoperative lens injury and hyphaema. Postoperative data included intraocular pressure (IOP), medication usage and adverse events.ResultsSixty-three eyes (n = 40 manual, n = 23 FLACS) were analyzed. Preoperatively, the mean IOP was 19.2 ± 4.9 mm Hg on 1.4 ± 0.96 mean medications, with 100% of eyes treated with medication. Intraoperatively, no lens injury was identified, and no significant hyphaema that impeded surgery occurred. At 6 months postoperative, mean IOP was 14.2 ± 1.8 mm Hg (38% reduction: p < 0.001), and >90% of eyes had IOP ≤ 16 mm Hg. The mean number of medications reduced to 0.11 ± 0.3 (92% reduction: p < 0.001), with 89% of eyes medication free. Safety was excellent for both manual and FLACS, with two iStents implanted in all eyes, and no cases of significant hyphaema or lens injury.ConclusionEarly implantation is safe, maximizes corneal clarity and angle visualization, avoids the risk of non-implantation due to surgical complications, and has a high success rate in both manual cataract surgery and the setting of FLACS.Clinical significanceThe conventional recommended approach of iStent implantation following cataract extraction has been adopted by many, however, with the advent of stand-alone procedures and concern about potential lens injury, there is an opportunity to gain experience with minimal risk in patients undergoing MIGS procedures combined with cataract surgery by implanting iStents at the start of the procedure. There is currently little emphasis or data published in the literature on an early approach to implantation to guide surgeons.How to cite this articleManning DK, Haider A, Clement C, et al. Efficacy and Safety of iStent Inject Implantation in Manual and Femtosecond Laser-assisted Cataract Surgery before Lens Extraction. J Curr Glaucoma Pract 2022;16(2):105-110.

The Pro-Fibrotic Response to Lens Injury Is Signaled in a PI3K Isoform-Specific Manner.

The signaling inputs that function to integrate biochemical and mechanical cues from the extracellular environment to alter the wound-repair outcome to a fibrotic response remain poorly understood. Here, using a clinically relevant post-cataract surgery wound healing/fibrosis model, we investigated the role of Phosphoinositide-3-kinase (PI3K) class I isoforms as potential signaling integrators to promote the proliferation, emergence and persistence of collagen I-producing alpha smooth muscle actin (αSMA+) myofibroblasts that cause organ fibrosis. Using PI3K isoform specific small molecule inhibitors, our studies revealed a requisite role for PI3K p110α in signaling the CD44+ mesenchymal leader cell population that we previously identified as resident immune cells to produce and organize a fibronectin-EDA rich provisional matrix and transition to collagen I-producing αSMA+ myofibroblasts. While the PI3K effector Akt was alone insufficient to regulate myofibroblast differentiation, our studies revealed a role for Rac, another potential PI3K effector, in this process. Our studies further uncovered a critical role for PI3K p110α in signaling the proliferation of CD44+ leader cells, which is important to the emergence and expansion of myofibroblasts. Thus, these studies identify activation of PI3K p110α as a critical signaling input following wounding to the development and progression of fibrotic disease.

THE EFFECTS OF ALPHA LIPOIC ACID ON LENS INJURY IN RATS ADMINISTERED WITH VALPROIC ACID

Objective: Valproic acid (2-propyl valeric acid; VPA) is an effective short-chained fatty acid which is used for the treatment of migraine and schizophrenia. Though it provides effective treatment, its side effects are associated with free radicals and in this way it affects many organs and tissues. Alpha lipoic acid (ALA) is known to be a powerful antioxidant. Material and Methods: The aim of this current study was to investigate the protection of ALA on VPA induced lens injury. Female rats were split into four groups as follows: 1st group, control animals (corn oil per day for 15 days); 2nd group, ALA administered group (50 mg per kg each day for 15 days); 3rd group, VPA administered group (500 mg per kg each day for 15 days) and 4th group, VPA and ALA administered group to which the same dose was given at the same time each day. On the 16th day, lens tissues were taken. Results: Lens glutathione levels and glutathione-S-transferase activities were decreased while lipid peroxidation and protein carbonyl levels, superoxide dismutase, glutathione peroxidase and reductase, aldose reductase and sorbitol dehydrogenase activities were elevated after VPA administration. ALA reversed these levels and activities in the VPA group. Conclusion: We can conclude that ALA used its antioxidant property and ameliorated VPA induced lens injury.

Pattern of Susceptibility Antibiotics against Clinical Isolates of Conjunctivitis from Sudanese Patients in Khartoum State

Resistant Antibiotics of bacterial conjunctivitis is a major challenge globally. The study aimed to determine the most common bacterial agents and risk factors, associated with Conjunctivitis among Sudanese patients and the sensitivity of the antibiotics used against isolates bacteria. The study was cross-sectional and carried out in MAKKA and Allwaledin Eye Hospital over three months in 2019. Fifty samples were collected from patients suffer from conjunctivitis by fine swab. Isolates were cultured in different media agar media and biochemical tests were used for identifications. The demographic data was collected by a questionnaire filled by the patient after verbal consent. Antibiotic susceptibility testing was conducted by the disc diffusion method (Kirby-Bauer) was performed as recommended by the CLSI. Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922), and Pseudomonas aeruginosa (ATCC27853) were used as controls. The positive frequency samples were 38 (76%), and the negative samples were 12(24%). Among the 38 positive samples 19(50%) were females while 19(50%) were males. The difference was not significant P= 0.241) with highly infected age groups (1-10) years old. Our Results detected that Some Isolated bacteria developed resistance to certain antibiotics, such as Staphylococcus aureus exhibited resistance against Erythromycin 10/15 (66.7%).While Staphylococcus epidermidis resistant against Tetracycline, and Erythromycin 4/4 (100%). Also, Bacillus spp revealed resistance against Ceftazidime1/1(100%). Listeria monocytogenes was resistant against Ceftazidime and Erythromycin 1/1(100%).On the other hand Pseudomonas aeruginosa, klebsiella pneumonia and klebsiella oxytoca exhibited resistance against Amoxicillin clavulanic acid and Erythromycin. The record data of risk factors conducted by highest frequency include antibiotics (16(36%); P=0.874) and using makeup and viral infection 11(22%); P=0.142) followed by eye surgery, arthritis 6 (12%); P=0.145), diabetes mellitus and hypertension 5(13.2%) ; P=0.654), using the immunosuppressive drug, lens and eye injury 4(8%) ; P=0.654), Smoking (3(6%) ; P=0.961) and heart disease 1(2%) ; P=0.322) associated with conjunctivitis statistically in significant. According to the results, we obtained that the main bacteria that caused conjunctivitis were Staphylococcus aureus and Pseudomonas aeruginosa. The sensitivity test indicated that Ciprofloxacin, Ceftazidime and Gentamycin were the most effective than other drugs used against isolates identified in this study.