Severe Ocular Damage Research Articles

Did the metal object hit the cornea? A case report of penetrating ocular injury with embedded foreign body

Introduction : Penetrating ocular injury with IOFBs may cause severe ocular damage. We demonstrate the diagnostic and treatment approach in a case of scleral laceration with a large IOFB.
 Case Illustration : A-24-year-old male presented with a rusty segment of fence wire, sized 15x11 mm, embedded near the nasal corneal margin of the right eye. Upon initial examination the vision was 6/9 with normal IOP. The object obstructed the view of the entry site, therefore corneal wound was suspected. CT scan showed penetrating metal object without posterior segment involvement. Anti-tetanus injection, topical and oral levofloxacin were given. He underwent exploration, foreign body removal and repair surgery. During surgery, the wound was revealed as a scleral laceration, 4 mm from nasal limbus. One day post-operative, vision was 6/20. A 0.1 mm hypopyon was found, along with fibrin at nasal vitreous. Oral and topical corticosteroids were given, and hypopyon disappeared the next day. One week after surgery, vision improved to 6/7.5, with clear vitreous and normal retina.
 Discussion : Ocular injuries with large IOFBs can hinder clinical examination. Corneal entry wound should be ruled out, due to potential permanent damage to visual axis. CT scan was helpful in assessing the depth of object penetration. The object was removed successfully, with no damage to the cornea and retina. Anti-tetanus, antibiotics and corticosteroids were able to control infection and inflammation.
 Conclusion : Large IOFBs which do not affect the visual axis, can be managed with successful outcome, by prompt removal and repair of the entry wound, and control of infection and inflammation.

LFA-1/ ICAM-1 promotes NK cell cytotoxicity associated with the pathogenesis of ocular toxoplasmosis in murine model.

Ocular toxoplasmosis (OT) is one of the most common causes of posterior uveitis. However, the pathogenic mechanisms of OT have not been well elucidated. Here, we used C57BL/6 (B6) mice to establish OT by peroral infection with 20 cysts of the TgCtWh6 strain, and severe ocular damage was observed by histopathological analysis in the eyes of infected mice. RNA-sequencing results showed that infection with T. gondii increased the expression of the NK-mediated cytotoxicity gene pathway at Day 30 after ocular T. gondii infection. Both NK-cell and CD49a+ NK-cell subsets are increased in ocular tissues, and the expression levels of LFA-1 in NK cells and ICAM-1 in the OT murine model were upregulated upon infection. Furthermore, inhibition of the interaction between LFA-1 and ICAM-1 with lifitegrast, a novel small molecule integrin antagonist, inhibited the protein expression of LFA-1 and ICAM-1 in murine OT and NK cells, improved the pathology of murine OT and influenced the secretion of cytokines in the OT murine model. In conclusion, the interaction between LFA-1 and ICAM-1 plays a role in the early regulation of the CD49a+ NK-cell proportion in an OT murine model. LFA-1/ ICAM-1 may be a key molecule in the pathogenesis of OT, and may provide new insights for potential immunotherapy.

The traumatic iris sunset

Cataract extraction with intra-ocular lens (IOL) implantation is the most common sight-restoring surgery performed in the elderly. Blunt trauma is usually associated with severe ocular damage and grave consequences in post-operative eyes. Here, we report a case of a 70-year-old male, who suffered from blunt ocular trauma following one and a half month of phacoemulsification in the right eye. Phaco-tunnel wound was healthy, the iris was crumpled and settled at the bottom of anterior chamber, and the IOL was in the bag. There was no wound dehiscence. This is a rare presentation as the majority of reported cases had wound dehiscence and iris expulsion.

Corneal in vivo confocal microscopy to detect belantamab mafodotin-induced ocular toxicity early and adjust the dose accordingly: a case report

BackgroundNew targeted antibody–drug conjugates (ADCs) against multiple myeloma are known to induce adverse effects that may lead to treatment discontinuation. Preclinical studies reported early severe ocular damage related to the use of belantamab mafodotin (belamaf), including ocular surface inflammation, severe dry eye, and a specific toxicity to the cornea, namely microcystic keratopathy. While belamaf-induced ocular changes have not been prospectively studied, a better understanding of mechanisms involved as well as kinetics may aid in anticipating dose adjustment rather than stopping the treatment once clinical ocular damage is too severe.Case presentationA 61-year-old woman scheduled for belamaf as a fifth-line treatment against multiple myeloma was prospectively included. Clinical examinations were performed before and every 3 weeks afterward, together with in vivo confocal microscopy (IVCM) of the cornea. Visual acuity, symptoms, slit-lamp examination, and ultrastructural changes of the cornea were recorded according to the received dose of belamaf. More precisely, kinetics, shape, density, and location of the toxic corneal lesions have been followed and analyzed using IVCM. Also, specific lesions at the sub-basal nerve plexus layer were detected and characterized for the first time. This advanced approach allowed a better understanding of the belamaf-induced toxicity, further balancing the dose to maintain good vision and eye health while continuing the treatment.ConclusionsSystematic ultrastructural analysis and follow-up of the corneal state during ADCs treatment for multiple myeloma may open new avenues in the therapeutic approach. Early preclinical detection of ocular damage may accurately contribute to finding the correct dose for each patient and not stopping the treatment due to severe ocular adverse effects.

The role of IL-12 in stimulating NK cells against Toxoplasma gondii infection: a mini-review.

Toxoplasma gondii is an intracellular protozoan parasite that can remarkably infect, survive, and replicate in almost all mammalian cells and can cause severe neurological and ocular damage in immunocompromised individuals. It is known that Natural Killer cells (NK cells), as a type of cytotoxic lymphocyte, have critical protective roles in innate immunity during the T. gondii infection through releasing interferon gamma (IFN-γ). Interleukin 12 (IL-12) is a pivotal critical cytokine for the generation of IFN-γ-producing NK cells. Several studies have shown cytokines' impact on NK cell activation; and IL-2 has an important role with a potent stimulatory factor for NK cells. In this review, we summarized the mechanism of interleukin-12 production stimulation by T. gondii tachyzoites and discussed several factors affecting this mechanism.

106 XPC splice site founder mutation in families with xeroderma pigmentosum from Dominican Republic and Honduras

Xeroderma pigmentosum (XP) is a rare autosomal recessive DNA repair disorder. XP is caused by mutations in 7 nucleotide excision repair genes, XP-A to XP-G, and POLH gene involved in trans lesion synthesis pathway by which cells replicate across UV-induced DNA lesions. XP-C is the most common in the U.S. XP patients are highly sun-sensitive with 10,000-fold increased risk of skin cancer. In a cohort of 123 XP patients and their families enrolled at the National Institutes of Health (NIH), we identified a founder XPC splice site mutation (c.2251-1G>C) in 8 XP patients (4 from the Dominican Republic, 2 from Honduras and 2 from Tanzania). They all had extensive sun exposure with multiple skin cancers and severe ocular damage (blindness or ocular cancer). Seven XP patients were homozygous for the splice mutation and one was a compound heterozygote. Microsatellite analysis surrounding the XPC founder mutation indicates that these patients might share a common ancestor. This splice mutation has been reported as very frequent in parts of Africa (1/5,000 in Mayotte). This African XPC founder mutation may have been brought to the Dominican Republic and Central America as part of the slave trade that flourished in the 16th to 18th centuries. Other founder mutations have been reported in XP patients in Japan (XPA) and Morocco (XPC, TG-deletion). The increase in frequency of XPC founder mutations in Dominican Republic and Honduras would have public health implications. The early detection and rigorous UV protection can improve XP patient clinical outcomes in these countries.

Agents Involved and Severity of Acute Ocular Exposure Reported at a Poison Control Center

ABSTRACT Purpose The aim was to identify severity factors useful in the initial management of patients with acute ocular exposure while considering both categories of products involved and circumstances of exposure. Methods A retrospective study over a one-year period that included patients who benefited from the poison center services for eye exposure to a chemical substance. Results Within a year, 1582 patients were identified. The sex ratio (M/F) was 0.8. The mean age was 28.5 ± 20.3 years. Among children, those under 4 years represented the most significant age category (n = 277; 50.1%). Exposure to chemicals were mild (n = 1342, 84.8%). Adults over 65 years appeared to be more likely to have severe ocular damage (OR: 4.75; [2.26; 9.98]). Unintentional exposures were the most frequent (n = 1548; 97.8%). Ocular exposure primarily occurred at home (n = 937; 59.2%), and at the workplace (n = 396; 25%) which was associated with a higher risk of severe injury (OR: 2.93 [2.16; 3.97]). Cleaning products accounted for 31.2% of exposure cases (n = 457). Exposure to disinfectants is a risk factor of more severe injuries (OR: 1.48 [1.002; 2.19] p = .0472) whereas pH and severity of injuries were not statistically significant. Conclusions Our study showed the very wide variety of products involved in ocular exposures. Clinicians should pay attention to factors associated with severe injury, including young and old age, work-related injury, substances such as disinfectants, in addition to previously known factors such as acids and bases.

Anhydrous Ammonia Chemical Release - Lake County, Illinois, April 2019.

On April 25, 2019, a farm tractor towing two 2-ton ammonia tanks on a county road in Lake County, Illinois, experienced a mechanical failure that resulted in the release of anhydrous ammonia, a colorless, pungent, irritating gas that can cause severe respiratory and ocular damage (1). Approximately 80% of anhydrous ammonia produced in the United States is used as a fertilizer in agriculture (1). Eighty-three persons, including first responders, motorists, and neighborhood residents, were evaluated at area hospitals because of exposure to the gas. Two weeks after the release, the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC's National Center for Environmental Health (NCEH) collaborated with the Lake County Health Department and the Illinois Department of Public Health on an investigation using ATSDR's Assessment of Chemical Exposures program to describe the release, review the emergency response, and determine health effects associated with the exposure. First responders, community residents, and hospital personnel reported communication challenges related to the nature of the gas release and effective protective measures. Among the 83 persons evaluated at six area hospitals for effects of the chemical release, 14 (17%) were hospitalized, including eight (10%) who were admitted to the intensive care unit (ICU), seven (8%) of whom required endotracheal intubation and mechanical ventilation; no deaths occurred. In addition, ICU health care providers experienced symptoms of secondary exposure. The National Institute for Occupational Safety and Health's Emergency Responder Health Monitoring and Surveillance Program has specific recommendations and tools to protect responders during all phases of a response (2). Hospitals also need to review institutional policies and procedures for chemical mass casualty events, including decontamination (3). Prompt and correct identification of hazardous material (hazmat) events, and clear communication among responding entities, including on-scene and hospital responders, is important to ensure effective response after a chemical release.

Virulence Factors of Bacteria Related to Ocular Infections in Non Immunocompromised Patients: Review Article

The ocular surface is constantly exposed to pathogenic bacteria. Many Gram positive and Gram negative bacteria have been implicated in ocular infections, in non immunocompromised patients, causing severe vision impairment. These microorganisms have in their quiver a variety of arrows to cause infection. The aim of this study is to list the virulence factors of the main ocular pathogens. Data were extracted from PubMed and Google Scholar. <i>S. aureus</i> and <i>Streptococci, Bacillus cereus</i> and <i>Corynebacterium (non-diphtheriae)</i> are the main culprits as far as Gram positive bacteria are concerned. <i>S. aureus</i> causes infections of the lacrimal apparatus, cornea and eyelids, conjunctivitis, keratitis, and endophthalmitis. <i>Streptococcus pneumoniae, Streptococcus pyogenes, Enterococcus</i> and <i>Streptococcus viridians</i> are isolated from post injection endophthalmitis cases. S. pneumoniae</i> is most involved in keratitis, conjunctivitis, and endophthalmitis. <i>Streptococcus pyogenes</i> is most involved in blepharitis and hospital acquired conjunctivitis in neonates in the intensive care unit. <i>Enterococcus faecalis</i> is implicated in postoperative endophthalmitis cases. <i>Corynebacterium (non-diphtheriae) species</i> are involved mainly in infections complicating cataract surgery, keratoplasty, and vitrectomy. <i>Bacillus species</i> provoke conjunctivitis, keratitis and post-traumatic endophthalmitis. <i>Bacillus cereus</i> can cause rapidly destructive endophthalmitis. Among Gram negative bacteria, <i>Neisseria gonorrhoeae, Pseudomonas aeruginosa, Chlamydia trachomatis</i>, and <i>Bartonella species</i> are major ocular pathogens, responsible for severe ocular damage. Gonococcal conjunctivitis (GC) is still a cause of blindness in some developing countries. When it occurs in neonates, it is called gonococcal ophthalmia neonatorum. <i>P. aeruginosa</i> is related to contact lens-associated keratitis. <i>Chlamydia trachomatis</i> is the culprit of trachoma and inclusion conjunctivitis. <i>Bartonella henselae</i> causes bartonellosis or cat scratch disease, or cat scratch fever. Eye infection includes optic neuropathy and neuroretinitis. When the eye is the primary site of inoculation, the patients are diagnosed with Parinaud oculo-glandular syndrome (infection of the conjunctiva, eyelid and adjacent skin with regional lymphadenopathy). Chronic <i>Bartonella</i> infection provokes blurred vision, photophobia and eye irritation. Comprehension of the mechanism of infection, caused by these pathogens, is crucial in diagnosis and treatment.

Association of TREM-1, IL-1β, IL-33/ST2, and TLR Expressions With the Pathogenesis of Ocular Toxoplasmosis in Mouse Models on Different Genetic Backgrounds.

Ocular toxoplasmosis (OT) is one of the most common causes of posterior uveitis. The signaling of triggering receptor expressed on myeloid cells (TREM)-1 amplifies inflammation, whereas TREM-2 signaling is anti-inflammatory. IL-1β is a major driver of inflammation during infection. Toll-like receptors (TLRs) play important roles in protective immune response during Toxoplasma gondii infection, and interleukin (IL)-33 receptor (T1/ST2) signaling prevents toxoplasmic encephalitis in mice. However, the pathogenic mechanisms of OT are not yet well elucidated. To investigate the role of TREM-1, TREM-2, IL-1β, IL-33/ST2, and TLRs in OT of susceptible C57BL/6 (B6) and resistant BALB/c mice, both strains of mice were intravitreally infected with 500 tachyzoites of the RH strain of T. gondii. Histopathological analysis showed that T. gondii-infected B6 mice had more severe ocular damage observed by light microscopy, higher number of neutrophil elastase-positive cells in the eyes detected by immunohistochemical staining, more T. gondii tachyzoites in the eyes observed by transmission electron microscopy, and higher mRNA expression levels of tachyzoite-specific surface antigen 1 detected by quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) in comparison of T. gondii-infected BALB/c mice. Detected by using qRT-PCR, the mRNA expression levels of TREM-1, IL-1β, IL-33, ST2, TLR11, TLR12, and TLR13 were significantly higher in the eyes of T. gondii-infected B6 mice than those of T. gondii-infected BALB/c mice, whereas the mRNA expression levels of TLR3 and TLR9 were significantly higher in the eyes of T. gondii-infected BALB/c mice than those of T. gondii-infected B6 mice. Correlation analysis showed that significant positive correlations existed between TREM-1 and IL-1β/IL-33/ST2/TLR9/TLR11 in the eyes of B6 mice and existed between TREM-1 and IL-33/ST2/TLR3/TLR9/TLR13 in the eyes of BALB/c mice after ocular T. gondii infection. Our data revealed that, compared with T. gondii-resistant BALB/c mice, ocular T. gondii infection can stimulate higher production of TREM-1, IL-33, ST2, TLR11, TLR12, and TLR13 in the eyes of T. gondii-susceptible B6 mice, however, whether those lead to more severe ocular pathology in the susceptible B6 mice remain to be further studied.

Ocular alterations, molecular findings, and three novel pathological mutations in a series of NF2 patients.

To evaluate ophthalmological and molecular findings in eight patients with a clinical diagnosis of neurofibromatosis type 2 (NF2). New pathological mutations are described and variability in the ophthalmic phenotype and NF2 allelic heterogeneity are discussed. Eye examination was performed in eight NF2 patients, and it included the measurement of the visual acuity, biomicroscopy, dilated fundus examination, color fundus photography, infrared photography, and spectral domain optical coherence tomography (SD-OCT). Molecular analysis was performed with whole-exome sequencing using DNA derived from peripheral blood mononuclear cells from each individual. Ophthalmological features were present in all patients, ranging from subtle retinal alterations identified only using SD-OCT to severe ocular damage present at birth. Six mutations were observed: two patients with stop codon mutation as shown on table 1 and result section, three patients with frameshift mutation as shown on table 1 and result section. Three novel mutations were found among them. It is a descriptive study of a rare disease, with poor previous literature. Clinical and genetic data are shown, reviving the need to further studies to clarify the genotype-phenotype correlations in NF2.

Severe ocular damage secondary to a pseudotumor cerebri

Severe ocular damage secondary to a pseudotumor cerebri

Cellular immunopathogenesis in primary Toxoplasma gondii infection during pregnancy.

Congenital toxoplasmosis is caused by the vertical transmission of infection from mother to foetus through the placenta when a pregnant woman is infected with Toxoplasma gondii (T.gondii). Congenital infection can have serious consequences, such as intrauterine abortion, foetal death and severe neurological, ocular or other organ damage in the foetus. In this review, we focus on recent publications investigating vertical transmission of T.gondii infection, cellular immunopathogenesis and protective immunity in primary toxoplasmosis during pregnancy.

Inhibitors of the Histone Methyltransferases EZH2/1 Induce a Potent Antiviral State and Suppress Infection by Diverse Viral Pathogens.

ABSTRACTEpigenetic regulation is based on a network of complexes that modulate the chromatin character and structure of the genome to impact gene expression, cell fate, and development. Thus, epigenetic modulators represent novel therapeutic targets used to treat a range of diseases, including malignancies. Infectious pathogens such as herpesviruses are also regulated by cellular epigenetic machinery, and epigenetic therapeutics represent a novel approach used to control infection, persistence, and the resulting recurrent disease. The histone H3K27 methyltransferases EZH2 and EZH1 (EZH2/1) are epigenetic repressors that suppress gene transcription via propagation of repressive H3K27me3-enriched chromatin domains. However, while EZH2/1 are implicated in the repression of herpesviral gene expression, inhibitors of these enzymes suppressed primary herpes simplex virus (HSV) infection in vitro and in vivo. Furthermore, these compounds blocked lytic viral replication following induction of HSV reactivation in latently infected sensory ganglia. Suppression correlated with the induction of multiple inflammatory, stress, and antipathogen pathways, as well as enhanced recruitment of immune cells to in vivo infection sites. Importantly, EZH2/1 inhibitors induced a cellular antiviral state that also suppressed infection with DNA (human cytomegalovirus, adenovirus) and RNA (Zika virus) viruses. Thus, EZH2/1 inhibitors have considerable potential as general antivirals through the activation of cellular antiviral and immune responses.

Accidental macular injury with class IVb laser outside the medical settings

In the medical settings, safety precautions are used to mitigate inadvertent ocular damage due to laser beams. High power lasers are illegal in many countries; however, they are sometimes used on social occasions. Use by an untrained member of the public can result in severe accidental ocular damage. We report a case of macular damage and central visual loss due to the illegal use of a class IVb 2000mW power laser in a 20-year-old male. To our knowledge, this is the first case of macular injury due to this particular type of laser. The case history and management over a 6-month period is described. Pubic education initiatives are required to increase the awareness of the dangerous nature of laser beam exposure outside a medical setting.

Clinical features and management of ocular lesions after stings by hymenopteran insects

We describe the ocular alterations and the management after stings from Hymenopteran insects. In all the five patients, the insect was identified as bee. The patients presented with significant corneal edema, which resolved dramatically in three of them after removal of stingers. Among the other two one went for permanent corneal decompensation and the other developed Intumuscent cataract with increased intraocular pressure. Although a rare occurrence, ocular trauma caused by Hymenopteran insects has a potential to cause severe ocular damage in humans. A high level of clinical suspicion and immediate removal of the stingers along with administration of high doses of topical and systemic steroids is a must to prevent chances of permanent corneal damage and intraocular complications.

Trauma ocular por explosão acidental de disco compacto

Despite being rare, ocular injury due to a compact disc burst can be responsible for severe ocular damage. We present in this article a case of corneal perforation in addition to lens trauma caused by intentional compact disc break. A 44 year old female physician was examined complaining of visual acuity decrease, light sensitivity, tearing and foreign body sensation on OD after watching a compact disc being broken intentionally. In the first examination, she had a corneal perforation with aqueous humor leakage, anterior lens capsule lesion and anterior cortical opacity. The visual acuity was 0.1. She was treated with a therapeutic soft contact lens and the regular use of topical antibiotic and hypotension solutions, evolving with the healing of the corneal injury and lens opacity stabilization. Twenty four months later, the OD refraction was similar to that measured before the trauma and the visual acuity was 1.0 (-1).

Severe ocular injury and its management following self induced plant extracts: A case report

IntroductionHomemade and folk remedies’ use is widely practiced in under developed countries, of the used materials are plant extracts, lemon juice and some dried insect bodies. Case presentationWe report a case of severe ocular injury and its management after self administered plants seeds in both the eyes of a 47-year-old man who had bilateral severe ocular damage after he put the seeds of a plant Lepidium Sativum (Rashad) in his eyes. He reported severe ocular pain and redness, conjunctival epithelial defect and symblepharon. A conjunctival biopsy was taken which turned out to be negative for the immunological staining studies for Ocular Cicatricial Pemphegoid (OCP). The patient’s visual acuity improved from 20/40 before treatment to 20/25 after treatment with no further sequelae after 3months follow-up. ConclusionsSelf induced plant extracts can cause ocular complications. Public awareness is necessary to help in discouraging the use of these harmful plant extracts in human eyes.

Ocular injuries from improvised explosive devices

To document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs). Retrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre. In total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20-42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury. In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twenty-two (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4-34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (<5/200, P<0.05). In eyes with open-globe injury, the presence of an IOFB was not associated with poor visual outcome (P>0.05). Ocular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome.

Ocular surface reconstruction and cultivated stem cell transplantation:new progresses and challenges

Recent years,progress has been made on the basic researches and clinical applications of ocular surface reconstruction with autologous or allogeneic limbal stem cells,oral mucosa epithelium and ex vivo cultured limbal stem cells.However,there are several issues,including the successful treatment for severe ocular damage,longterm follow-up and evaluation of clinical outcome,and the in vivo tracking of donor stem cells,remained to have definitive conclusions.Future studies should address the questions and challenges based on the basic research of limbal stem cell deficiency and standardized evaluation of clinical outcome. Key words: Stem cells; transplantation; Corneal reconstruction