Recurrent Keratitis Research Articles

Onset of Rheumatoid Arthritis with eye manifestations (clinical case report)

Objective. Rheumatoid Arthritis may onset with ocular manifestations. The purpose of our work was presentation of clinical case of the onset of rheumatoid arthritis with an eye lesion.Materials and methods. A clinical case of rheumatoid arthritis with an atypical onset was analyzed. As well, a search and review of relevant literature was performed.Results. Patient with rheumatoid arthritis got bilateral ulcerous keratitis, refractory to conventional treatment and complicated by bilateral corneal perforation with iris prolapse. Due to the atypical clinical course of ophthalmic lesions being insusceptible of medical treatment, the patient was examined further. Laboratory immunological workup revealed positive rheumatoid factor, anti-CCP and anti-MCV antibodies. The typical symmetric presentation of arthritis developed 8 months after the onset of ophthalmic disorders. Baseline therapy of rheumatoid arthritis has demonstrated efficacy both in controlling the joint manifestations and preventing relapse of keratitis.Conclusion. The development of eye syndrome may precede articular manifestation of rheumatoid arthritis. While managing patients with recurrent bilateral keratitis, rheumatologic pathology should be suspected.

Recurrent Betaherpetic Keratitis. Therapy Stages and Monitoring Methods of the Disease Dynamics

Purpose: to propose a step­by­step treatment regimen for betaherpetic keratitis with a method for monitoring the dynamics of the disease.Patients and methods. The study group included 40 patients (40 eyes). Each patient had a history of diagnosed unilateral recurrent acute or subacute keratitis, the etiology of the betaherpetic process was confirmed by laboratory diagnostic methods, confocal microscopy, based on the detection of specific “owl eye” cells. All subjects had previously received specific therapy with acyclovir. All patients underwent an ophthalmological examination, and then a two­stage treatment regimen for keratitis was proposed. The main way to assess the dynamics of the disease, the presence of viral load and the need to intensify antiviral therapy was confocal microscopy data. The condition was assessed 1, 3, 6 and 12 months after the start of therapy. Results. As a result of the observation of a group of patients of 40 people, after 12 months, 33 patients achieved stable remission, 4 patients developed neurotrophic keratitis, and 3 patients had a relapse of betaherpetic keratitis. Recurrence of keratitis in 3 patients was detected within 2 to 4 months from the start of observation. Neurotrophic keratitis developed in 4 patients within 3 to 6 months from the start of observation.Conclusion. 1) The method of in vivo confocal microscopy can be used to monitor the dynamics of betaherpetic keratitis, based on the state of specific cells. 2) Therapy of betaherpetic keratitis requires the use of specific antiviral drugs with mandatory repeated preventive courses. 3) A history of herpesvirus infection requires assessment of the development of neurotrophic keratitis.

Atopic Disease as a Risk Factor for Recurrent Herpetic Keratitis.

Recurrent herpetic keratitis is a leading cause of blindness worldwide. In this population-based cross-sectional study, the medical records of Israeli adolescents and young adults who underwent systematic preconscription evaluation for mandatory military service were reviewed. The prevalence of atopic conjunctival disease was evaluated in cases with and without documented recurrent herpetic keratitis. The association was tested using uni- and multivariant analyses. Overall, 940,892 adolescents and young adults were included. The mean age was 17.57 ± 1.50 years (range 16-20 years), and 40.70% of participants were female. Recurrent herpetic keratitis was documented in 160 cases, with a prevalence of 0.017% in this age group. Compared to the general population, patients with recurrent herpetic keratitis were significantly more likely to be males (p = 0.003) with a concomitant diagnosis of atopic conjunctival disease (p < 0.0001). Patients with atopic conjunctival disease were 10.60-fold more likely to experience recurrent herpetic keratitis (95% confidence interval (CI): 6.76-16.64, p < 0.0001). Upon multivariate analysis, the results remained significant (p < 0.001). Cases of severe atopic conjunctival disease were more prone to recurrent HSV keratitis compared to mild cases (p < 0.001). These findings suggest that the timely appropriate treatment of atopic conjunctival disease may help reduce the frequency and severity of recurrent HSV keratitis and its complications.

Three cases of recalcitrant Paecilomyces keratitis in Southern California within a short period

BackgroundThe aim of this report is to describe the risk factors, clinical course, and characteristics of three cases of Paecilomyces keratitis presenting concurrently within three months in the same location. We used in vivo confocal microscopy and histopathology to corroborate our clinical findings.ObservationsThree eyes of three elderly patients with culture-proven Paecilomyces keratitis were included in this series. These patients resided within a 15-mile radius and presented to a tertiary care eye institute in Southern California between February and April 2022. All three eyes experienced a prolonged, recalcitrant course with recurrence of keratitis in donor corneal tissue despite antifungal therapy and multiple therapeutic penetrating keratoplasties. In vivo confocal microscopy, histopathology, and microbiologic findings corroborated the diagnosis of fungal keratitis with Paecilomyces. With surgical intervention and extensive medical therapy, all three cases resolved after the addition of oral Posaconazole.ConclusionsPaecilomyces is a rare cause of infectious keratitis. Herein we report three similar cases in elderly patients. All had prolonged, recalcitrant infections that required multiple treatment modalities. Our cases, which were supported by in vivo confocal microscopy and histopathology, highlight the importance of timely and aggressive therapy to prevent recurrence.

Herpes simplex keratitis: an epidemiologic study

Background Recurrent keratitis due to herpes simplex virus (HSV) infection is called herpes simplex keratitis. Aim of the work The aim of the study was to assess the incidence of herpes simplex keratitis to total infectious keratitis, risk factors, and complications of different presentations of herpes simplex keratitis. Patients and methods This prospective and observational clinical study was carried out at the cornea unit of the Tanta University Ophthalmology Hospital on 100 patients who suffered from herpes simplex keratitis during 1 year from the first of January 2021 to the end of December 2021. Results The incidence of HSK was 100, 5.12% cases of total cases of keratitis (1950) who attended the Ophthalmology Outpatient Clinic. The incidence of HSK peaks in middle age from 20- to 60 years, younger patients tend to have more recurrences and complications leading to a greater reduction of vision. Conclusion Recurrences of the disease are the major cause of ocular morbidity. HSV stromal keratitis is found to occur more commonly in recurrences than other types. Earlier diagnosis through increased suspicion in patients with risk factors and rapid diagnostic techniques improve outcomes for HSK patients.

Бетагерпетические кератиты. Обоснование диагноза и тактики ведения пациентов

Relevance. This publication presents an algorithm for the management of patients with recurrent keratitis associated with betaherpesviruses and outlines the possibilities of laboratory and instrumental diagnostics. Purpose. To systemize the algorithm for the management of patients with superficial keratitis associated with betaherpesviruses confirmed by confocal microscopy. Material and methods. A group of 21 patient (21 eye) with superficial keratitis associated with betaherpesviruses was under observation during 12 months. The diagnosis was made on the basis of confocal microscopy results, clinical picture and results of laboratory tests. Each patient received a two-stage treatment with nucleoside analogues locally and systemically; treatment with anti-inflammatory and reparative medicine. Results. Remission as a result of the treatment was achieved in 20 of the 21 patients. Conclusion.The only reliable diagnostic method of keratitis associated with betaherpesviruses is a confocal microscopy, with identification of betaherpesvirus specific «owl's eye» cells. In view of frequent recurrence leading to increase of cornea opacity area, therapy of keratitis associated with betaherpesviruses requires a two-stage treatment. In first stage it is mandatory to prescribe increased dosages of nucleoside analogues, second stage requires prescription of local glucocorticoids and long-term reparative treatment. Key words: keratitis, herpesviruses, cytomegalovirus, human herpesvirus 6, «owl's eye» cells

Recurrent Vascularizing Keratitis in Infants With Hereditary Mucoepithelial Dysplasia Related to SREBF1 Mutation.

This study aims to present ophthalmic manifestations of 2 infants with hereditary mucoepithelial dysplasia (HMD) related to SREBF1 mutation over a 5-year period. Two female infants with an unremarkable perinatal history were evaluated for photophobia that had been manifest since 3 months after birth and diffuse scalp alopecia. Complete ocular examinations under anesthesia were performed, as well as genetic and systemic workup. Both patients had vascularizing keratitis in both eyes, characterized by the growth of corneal new vessels from the 360 degrees periphery to the center and the formation of stromal leucomatous opacity at the leading edge. The keratitis partially regressed in response to topical corticosteroids and waxed and waned during the 5 years of follow-up. In addition, the loss of scalp hair developed in a cyclical pattern, causing diffuse scalp alopecia in the patients. Rheumatologic, nutritional, and developmental evaluations were within normal ranges. Whole-exome sequencing identified a heterozygous c.1669C>T (p.Arg557Cys) pathogenic variant in the SREBF1 gene associated with HMD in both patients. In pediatric patients with recurrent vascularizing keratitis and diffuse scalp alopecia starting early in life, HMD should be considered, and genetic tests and collaboration with dermatologists and pediatricians on the diagnosis should be provided.

Management of perforated corneal ulcer with iris prolapse by cyanoacrylate glue: A case report

We report a rare case of perforated corneal ulcer due to recurrent viral keratitis with stromal necrosis and iris prolapse. The patient was 75 years old farmer, normotensive, diabetic, and presented with complaints of pain, watering, photophobia, redness and dimness of vision in the left eye. The left eye's visual acuity was perception of light and projection of rays in all four quadrants. Slit lamp examination found swollen eyelids, matted eyelashes, congested conjunctiva, seidel test positive, an inferonasal corneal perforation, shallow anterior chamber, irregular pupil, and prolapse of the iris through the perforated cornea. The patient was diagnosed with a left-sided perforated corneal ulcer (recurrent viral keratitis with stromal necrotizing variety) having iris prolapse. The perforation was sealed by cyanoacrylate glue and a soft bandage contact lens. This improved the patient’s condition. Early medical and surgical interventions thus can save vision as well as the eyeball.

Clinical Features of Pediatric Age Herpes Simplex Virus Keratitis.

The objective of this study is to evaluate the clinical features of pediatric herpes simplex virus keratitis, its recurrence rates, and its effects on visual acuity. In this retrospective case series, records of pediatric patients (0-16 years) who presented with herpes simplex virus keratitis between January 2012 and September 2021 were evaluated. Data including age, gender, additional systemic diseases, the number of recurrences, recurrence time, treatment protocol, follow-up period, and presence of amblyopia were reviewed. Twenty-four patients (16 females and 8 males) with a mean age of 6.6 ± 4 (1.1-15) years were included in the study. The mean follow-up time was 21 ± 19.9 (7-94) months. Four patients (16.6%) had bilateral keratitis. Including all 4 patients with bilateral involvement, a total of 10 (41.6%) patients had additional systemic diseases that cause immunodeficiency. After prophylactic antiviral treatment for at least 6 months (except for isolated epithelial keratitis), recurrence was detected in 5 (22.7%) patients, who were all immunodeficient. Among immunodeficient individuals, the recurrence rate was found to be 50%. Keratitis recurrence was significantly associated with immunodeficiency ( P = 0.03). However, type of keratitis ( P = 0.42), gender ( P = 0.47), and bilaterality ( P = 0.54) were not related with recurrence. 66.7% of the patients younger than 10 years developed amblyopia during follow-up. In childhood, the most frequent corneal manifestation of herpes simplex virus is stromal keratitis that mostly progresses with corneal scarring, residual astigmatism, and amblyopia. The recurrence rate increases in the presence of immunosuppression. Close follow-up, rapid diagnosis, and treatment are critical for battling against amblyopia and achieving good visual prognosis.

Reports of New and Recurrent Keratitis following mRNA-based COVID-19 Vaccination

ABSTRACT Purpose As ophthalmic side effects of messenger RNA (mRNA)-based COVID-19 vaccination are not well understood, it is crucial to document and report such instances should they occur. Methods In this observational case series, we report nine patients (55.6% male, mean age 58.9) who received either the BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) COVID-19 vaccinations from January to June of 2021, and presented with symptoms of keratitis within 14 days. All patients underwent slit-lamp examination and histories were taken. Results Most subjects (66.7%) had a history of corneal inflammatory diseases and resolved under antiviral and/or steroidal treatment. Patients who reported symptoms after their second vaccine dose presented earlier than those who reported symptoms after the first dose (mean 4.4 days vs 10.5 days, respectively). Conclusions The immunological reaction following mRNA-based COVID-19 vaccinations may trigger new-onset or reactivation of keratitis, though causality cannot be proven. Despite its rarity, clinicians should be aware of this possible complication and be prepared to treat.

Impact of the use of anti-glaucoma medications on the risk of herpetic keratitis recurrence.

Numerous case reports have associated anti-glaucoma medications with recurrence of herpes simplex virus (HSV) and herpes zoster virus (HZV) keratitis. The aim of our study was to determine whether different anti-glaucoma agents are associated with recurrence of herpetic keratitis. This was a retrospective cohort study using health databases from a Canadian province from January 2001 to December 2012. A new cohort of users on topical prostaglandins (PGs), beta blockers (BBs), alpha-2 agonists (AAs) and carbonic anhydrase inhibitors (CAIs) was created. The date of the third anti-glaucoma drug dispensation within 90days was deemed the index date of the case. Herpetic keratitis events, as defined by an ICD-9/10 code for HSV or HZV keratitis, or the dispensation of an anti-viral medication by either an ophthalmologist or an optometrist, were examined prior to and following the index date. Risk ratios (RRs) were computed to compare the risk of HSV/HZV keratitis among the PG, BB, AA, and CAI groups individually and collectively while adjusting for age and sex. Among 19,986 users of glaucoma medications identified, there were 684 cases of HSV/HZV keratitis. There was no increased risk of HSV/HZV keratitis recurrence for any of the four glaucoma medications classes individually or collectively when adjusted for age and sex. There was also no increased risk for redeveloping either HSV keratitis only or HZV keratitis only amongst all anti-glaucoma users. There is no association between the use of topical ocular hypotensive therapies and HSV/HZV keratitis recurrence. Further studies are needed to confirm these findings.

Using Convolutional Neural Network as a Statistical Algorithm to Explore the Therapeutic Effect of Insulin Liposomes on Corneal Inflammation.

Aiming at the disadvantages of easy recurrence of keratitis, difficult eradication by surgery, and easy bacterial resistance, insulin-loaded liposomes were prepared, and convolutional neural network was used as a statistical algorithm to build SD rat corneal inflammation model and study insulin-loaded liposomes, alleviating effect on corneal inflammatory structure in SD rats. The INS/PFOB@LIP was developed by means of thin-film dispersive phacoemulsification, its structure was monitored using a transmission electron microscope, particle size and appearance potential were monitored using a Malvern particle sizer, and ultraviolet consumption spectrum was monitored using a UV spectrophotometer. The encapsulation rate, drug loading, and distribution of insulin liposomes in rat corneal inflammatory model were measured and calculated. The cytotoxicity of liposome materials was evaluated by CCK-8 assay, and the toxic effects of insulin and insulin liposomes on cells were detected. The cornea of SD rats was burned with NaOH solution (1 mol/L), and the SD rat corneal inflammation model was created. The insulin liposome was applied to the corneal inflammation model, and the therapeutic effect of insulin liposome on corneal inflammation was evaluated by slit lamp, corneal immunohistochemistry, corneal HE staining, and corneal Sirius red staining. Insulin-loaded liposomes were successfully constructed with an average particle size of (130.69 ± 3.87) nm and a surface potential of (−38.24 ± 2.57) mV. The encapsulation rate of insulin liposomes was (48.89 ± 1.24)%, and the drug loading rate was (24.45 ± 1.24)%. The SD rat corneal inflammation model was successfully established. After insulin liposome treatment, the staining area of corneal fluorescein sodium was significantly reduced, the corneal epithelium was significantly thickened, the content of corneal collagen was increased, the expression of inflammatory factors was significantly reduced, and new blood vessels (corneal neovascularization, CNV) growth was inhibited.

Swarms of chemically modified antiviral siRNA targeting herpes simplex virus infection in human corneal epithelial cells.

Herpes simplex virus type 1 (HSV-1) is a common virus of mankind and HSV-1 infections are a significant cause of blindness. The current antiviral treatment of herpes infection relies on acyclovir and related compounds. However, acyclovir resistance emerges especially in the long term prophylactic treatment that is required for prevention of recurrent herpes keratitis. Earlier we have established antiviral siRNA swarms, targeting sequences of essential genes of HSV, as effective means of silencing the replication of HSV in vitro or in vivo. In this study, we show the antiviral efficacy of 2´-fluoro modified antiviral siRNA swarms against HSV-1 in human corneal epithelial cells (HCE). We studied HCE for innate immunity responses to HSV-1, to immunostimulatory cytotoxic double stranded RNA, and to the antiviral siRNA swarms, with or without a viral challenge. The panel of studied innate responses included interferon beta, lambda 1, interferon stimulated gene 54, human myxovirus resistance protein A, human myxovirus resistance protein B, toll-like receptor 3 and interferon kappa. Our results demonstrated that HCE cells are a suitable model to study antiviral RNAi efficacy and safety in vitro. In HCE cells, the antiviral siRNA swarms targeting the HSV UL29 gene and harboring 2´-fluoro modifications, were well tolerated, induced only modest innate immunity responses, and were highly antiviral with more than 99% inhibition of viral release. The antiviral effect of the 2’-fluoro modified swarm was more apparent than that of the unmodified antiviral siRNA swarm. Our results encourage further research in vitro and in vivo on antiviral siRNA swarm therapy of corneal HSV infection, especially with modified siRNA swarms.

Офтальмологические средства с компонентами внеклеточного матрикса. Их эффективность в процессе репарации роговицы при нейротрофических, герпетических, рецидивирующих кератитах и эрозиях

Introduction. One of the topical issues of modern ophthalmology is the widespread prevalence of corneal blindness among the working-age population. The cause of this condition in most cases are infectious and inflammatory diseases of the anterior segment of the eye, the outcome of which is a violation of the architectonics of the extracellular matrix (ECM) of the cornea, clinically manifested by edema of the stroma, its fibrosis. Purpose. Comparative analysis of the effectiveness of existing ophthalmic agents based on biomimetics of ECM to stimulate the processes of reparative regeneration in neurotrophic, herpetic, recurrent keratitis and corneal erosions. Material and methods. Our literature review has shown the great importance of the components in maintaining corneal homeostasis, its transparency, strength, shape stability, as well as differentiation, proliferation, migration and growth of cellular structures of the ECM, and therefore the need to maintain its physiological architectonics in the treatment of infectious and inflammatory pathology. Results. The range of ophthalmic medicines and medical devices based on biomimetics of ECM is quite diverse. The active substances of such ophthalmic agents are the main components of the ECM, namely, glycosaminoglycans (GAG), glycoproteins, collagen, hyaluronic acid, heparin. Conclusion. Among the many biomimetics, we can single out the multicomponent hydrogel composition «Corneal Epithelium gel Protector (CEGP) SPHERO ® oko (JSC «BIOMIR Service», Russia), designed to restore the corneal epithelium, which includes both the main components of ECM and other biologically active substances, including peptides, amino acids, uronic acids, monosaccharides, growth factors, etc. The multicomponent composition of SPHERO ® oko provides the microenvironment necessary for the cells of the eye tissues, contributing to the processes of their proliferation and differentiation and, as a final result, to the acceleration of reparative regeneration of tissues damaged as a result of injury or infectious-inflammatory process. And also SPHERO ® oko demonstrates anti-inflammatory, decongestant, tear-substituting action, contributes to reducing neovascularization. Key words: SPHERO ® oko, extracellular matrix, keratitis, erosion, herpes, dry eye disease, cornea

Sensory Nerve Retraction and Sympathetic Nerve Innervation Contribute to Immunopathology of Murine Recurrent Herpes Stromal Keratitis.

PurposeHerpes stromal keratitis (HSK) represents a spectrum of pathologies which is caused by herpes simplex virus type 1 (HSV-1) infection and is considered a leading cause of infectious blindness. HSV-1 infects corneal sensory nerves and establishes latency in the trigeminal ganglion (TG). Recently, retraction of sensory nerves and replacement with “unsensing” sympathetic nerves was identified as a critical contributor of HSK in a mouse model where corneal pathology is caused by primary infection. This resulted in the loss of blink reflex, corneal desiccation, and exacerbation of inflammation leading to corneal opacity. Despite this, it was unclear whether inflammation associated with viral reactivation was sufficient to initiate this cascade of events.MethodsWe examined viral reactivation and corneal pathology in a mouse model with recurrent HSK by infecting the cornea with HSV-1 (McKrae) and transferring (intravenous [IV]) human sera to establish primary infection without discernible disease and then exposed the cornea to UV-B light to induce viral reactivation.ResultsUV-B light induced viral reactivation from latency in 100% of mice as measured by HSV-1 antigen deposition in the cornea. Further, unlike conventional HSK models, viral reactivation resulted in focal retraction of sensory nerves and corneal opacity. Dependent on CD4+ T cells, inflammation foci were innervated by sympathetic nerves.ConclusionsCollectively, our data reveal that sectoral corneal sensory nerve retraction and replacement of sympathetic nerves were involved in the progressive pathology that is dependent on CD4+ T cells after viral reactivation from HSV-1 latency in the UV-B induced recurrent HSK mouse model.

Spectrum of herpetic eye disease during COVID-19 pandemic

Purpose: To analyze clinical presentation, outcome and upsurge in the acute presentation of Herpetic eye disease (Herpes simplex keratits and Herpes Zoster Ophthalmicus) cases during coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Retrospective analysis of case records of patients diagnosed with either acute HSV or HZO from April 2020 to March 2021 for demography, ocular manifestations, and management and clinical outcome was done. Results: We had 71 patients presenting to our hospital with herpetic eye disease with 50.70% being HZO. The majority (64.78%) of the patients were <50 years of age. The mean time to presentation from the onset of symptoms was earlier in HZO compared to HSV. Three patients were post-COVID-19 infection while six patients were post-COVID-19 vaccination. Stromal keratitis (48.5%) was the most common presentation in patients with HSV while keratitis and uveitis (31.57% each) were the most common presentation in HZO. 83.08% resolved without any visual sequelae. We also observed atypical presentation in the form of multidermatomal involvement and recurrence of keratitis in HZO patients. We observed an alarming two-fold increase in the number of cases that presented this year (2020–21) as compared to the same time (n = 33) in the past year (2019–20). Conclusion: This study highlights an increase in viral eye disease presenting atypically and higher incidence in young individuals during the COVID pandemic. Viral disease of the eye during the pandemic may be related to the altered immunity in coexisting asymptomatic COVID-19-infected patients and similar in postvaccinated individuals or the stress-induced immune alteration by the pandemic itself in healthy individuals. However, though this study suggests direct causal relation of either of the above as possibility and needs to be kept in mind in clinical practice, for definite association, we need further exploration and more data.

The Therapeutic Effects of a 0.03% Tacrolimus Ointment on Childhood Phlyctenular Keratitis

Purpose: We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. Methods: We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. Results: The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. Conclusions: Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.

Healing of Ocular Herpetic Disease Following Treatment With an Engineered FGF-1 Is Associated With Increased Corneal Anti-Inflammatory M2 Macrophages.

Herpes simplex virus 1 (HSV-1) infects the cornea and caused blinding ocular disease. In the present study, we evaluated whether and how a novel engineered version of fibroblast growth factor-1 (FGF-1), designated as TTHX1114, would reduce the severity of HSV-1-induced and recurrent ocular herpes in the mouse model. The efficacy of TTHX1114 against corneal keratopathy was assessed in B6 mice following corneal infection with HSV-1, strain McKrae. Starting day one post infection (PI), mice received TTHX1114 for 14 days. The severity of primary stromal keratitis and blepharitis were monitored up to 28 days PI. Inflammatory cell infiltrating infected corneas were characterized up to day 21 PI. The severity of recurrent herpetic disease was quantified in latently infected B6 mice up to 30 days post-UVB corneal exposure. The effect of TTHX1114 on M1 and M2 macrophage polarization was determined in vivo in mice and in vitro on primary human monocytes-derived macrophages. Compared to HSV-1 infected non-treated mice, the infected and TTHX1114 treated mice exhibited significant reduction of primary and recurrent stromal keratitis and blepharitis, without affecting virus corneal replication. The therapeutic effect of TTHX1114 was associated with a significant decrease in the frequency of M1 macrophages infiltrating the cornea, which expressed significantly lower levels of pro-inflammatory cytokines and chemokines. This polarization toward M2 phenotype was confirmed in vitro on human primary macrophages. This pre-clinical finding suggests use of this engineered FGF-1 as a novel immunotherapeutic regimen to reduce primary and recurrent HSV-1-induced corneal disease in the clinic.

Experience in managing glaucoma filtration surgery complications with oral doxycycline: A case series.

To report the clinical profile and effectiveness of oral doxycycline as a non-invasive treatment for glaucoma filtering surgery complications. Prospective case series. Doxycycline is widely used in treating corneal melts, ocular surface diseases, meibomian gland disease, recurrent epithelial cell erosion, rosacea, and keratitis sicca. This prospective case series highlights the successful treatment of five patients with leaking blebs and conjunctiva erosion from glaucoma filtration surgery with the use of oral doxycycline. There was no adverse event reported in our cases. This study suggests that oral doxycycline may be a feasible non-surgical treatment modality due to its ability to inhibit collagenolysis, restore the Meibomian gland function, thereby stopping breakdown and promote conjunctival tissue healing.

Clinical Characteristics and Outcomes of Short-term Repeat Corneal Transplantation

ABSTRACT Purpose To explore the primary indications, direct causes and graft survival of short-term repeat keratoplasty. Methods An analytical cross-sectional study. Results The primary indications for keratoplasty were infectious keratitis (67.9%) and immune keratopathy (12.8%). The direct causes of graft failure were infectious ulcer (43.6%) and recurrence (30.8%). Pre-operative hypopyon (P = 0.017, HR = 1.757) and use of decellularized porcine corneas as grafts (P = 0.005, HR = 2.690) were independent risk factors for graft failure. The Kaplan–Meier analysis revealed that the 1-year survival rate of 88 repeat grafts was 85.2%, and the 5-year survival rate was 79.2%. The survival rates of the repeat grafts were significantly higher than those of the first grafts (P < 0.001). Conclusion Infectious keratitis is the most common indication of short-term graft failure and is often failed by infectious ulcer and keratitis recurrence. While the decellularized porcine cornea is a promising application in developing countries, certain difficulties, such as graft melting, remain unresolved.