Severe Ocular Surface Inflammation Research Articles

A Severe and Prolonged Case of Ocular Monkeypox Without Systemic Manifestations.

The objective of this study was to present a rare case of prolonged and severe ocular monkeypox virus infection in the absence of systemic manifestations. This was a single case report. A 60-year-old man, having been symptomatic for 9 days, presented with several umbilicated, ulcerated papules on the left cheek, left side of the nose, and left upper eyelid, along with marked follicular conjunctivitis and multiple conjunctival ulcerations. Two weeks after presentation, he developed an irregular, 360° circumferential opacity in the peripheral cornea that progressed to a large epithelial defect with corneal thinning. Although the initial eyelid lesions and conjunctivitis quickly resolved, the patient experienced nonresolving corneal inflammation manifest with peripheral corneal thinning, epithelial defects, and stromal keratitis. Four months after presentation, with the presumptive diagnosis of peripheral ulcerative keratitis, the patient was treated with intravenous steroids and immunosuppressive treatment, after which the ocular surface inflammation improved. However, the inflammation recurred 12 weeks later, and the patient developed severe perilimbal necrotizing conjunctivitis, followed by recurrence of ulcerated nodular eyelid lesions. Eight months after presentation, nucleic acid amplification tests from eyelid lesion swabs returned positive for nonvariola Orthopoxviruses, which led to the diagnosis of mpox. Within 2 weeks of beginning antiviral treatment with systemic tecovirimat and cidofovir and topical trifluridine, the eyelid lesions, conjunctivitis, and corneal inflammation resolved. We present an unusual and challenging case of ocular mpox with severe ocular surface inflammation including peripheral corneal thinning and epithelial defects, without systemic disease. Initiation of antiviral treatment resulted in a quick resolution of the ocular disease.

Ocular Cicatricial Pemphigoid in Young Patients.

The purpose of this study is to report ocular cicatricial pemphigoid (OCP) occurring in young patients. Relevant literature is also reviewed. Medical records of patients aged 30 years or younger who were treated for OCP between August 2021 and May 2023 at a tertiary care eye institute were reviewed. The most common differential diagnoses of cicatrizing conjunctivitis, such as Stevens-Johnson syndrome sequelae, chemical injury, chronic topical/systemic drug use, autoimmune connective tissue disorders, or allergic eye diseases, were ruled out based on clinical history, examination, and the Cicatrizing Conjunctivitis Score described by Shanbhag et al. The diagnosis of OCP was confirmed by positive direct immunofluorescence of oral mucosal and/or conjunctival biopsy in a majority of the patients. Seven patients fulfilled the criteria for a diagnosis of OCP. The mean age at presentation was 21.86 ± 5.25 years (13-28 years). Some of the patients presented with relatively atypical features for OCP such as corneal immune ring infiltrate and bilateral corneal perforation. Six patients exhibited systemic mucosal lesions, and the direct immunofluorescence yield was 85.71%. All patients required aggressive immunosuppressive treatment. OCP is classically described as a rare disease that occurs in old age. This case series highlights the importance of a higher index of suspicion for diagnosing OCP at a younger age. Early administration of immunosuppressive agents can potentially control severe ocular surface inflammation and its sequelae.

Kératoprothèse de Boston avec greffe d’aponévrose temporale : une solution quand il semble ne plus y en avoir

To report cases of patients with severe bilateral corneal blindness and recurrent refractory perforation to keratoplasty and conventional treatment, for whom Boston keratoprosthesis (KP) was a satisfactory alternative when combined with a temporalis aponeurosis graft. The first patient had progressive Lyell syndrome with spontaneous corneal perforation. The second had a severe graft vs. host reaction with a persistent Seidel-positive descemetocele. Despite repeated penetrating keratoplasties, amniotic membrane (AM) transplantations, and buccal mucosal (BM) grafts, they both experienced recurrent corneal perforation. The only solution thus appeared to be Boston Type I KP surgery. One month postoperatively, the first patient had to receive a temporalis aponeurosis (TA) graft, due to thinning of the recipient graft. Six months postoperatively, his visual acuity (VA) was 1/10 without correction, and the corneal status had been stabilized. The second patient underwent KP and TA graft concurrently. Six months after surgery, VA was 2/10 uncorrected, and the local inflammation had been stabilized. Boston type I keratoprostheses constitute an alternative in cases of severe bilateral corneal blindness with perforation refractory to conventional treatment and surgery, with satisfactory visual results. Patients with preoperative severe ocular surface disease are at greater risk of postoperative keratolysis. For our patients with a higher risk, TA graft prevented corneal melt. TA seems to be more effective than AM or BM in preventing corneal thinning or melt. We would recommend performing a TA graft in combination with Boston KP surgery concurrently as first line treatment in eyes with severe ocular surface inflammation.

Specifics of viral entry in epidemic keratoconjunctivitis

AbstractCellular entry pathways for viruses dictate the types of immune responses elicited upon infection. Human adenovirus species D type 37 (HAdV‐D37) causes epidemic keratoconjunctivitis (EKC), associated with severe ocular surface inflammation. However, viral entry is known to be cell type and virus specific. To examine basic mechanisms of HAdV‐D37 pathogenesis in EKC, we studied entry of HAdV‐D37 in vivo in our mouse corneal adenovirus keratitis model, and in vitro in cultured human corneal cells. In the mouse model at 1 hour post infection, viruses appeared to be entering cells by macropinocytosis. By 8 hours post infection, viruses formed regular packed intracytoplasmic arrays adjacent to cell nuclei, with minimal capsid uncoating. Therefore, viral entry occurred, but transport of virus to the cell nucleus appeared abortive, possibly explaining the failure of HAdV‐D37 replication in the mouse cornea. In vitro, inhibition of PKCα reduced viral entry and phosphorylation of both Src and caveolin‐1 in lipid raft fractions, suggesting that PKCα activity occurs upstream of both molecules. Phosphorylated PKCα and Src were found in same endosomal fractions and may be physically associated. These results suggest a central role for PKC in HAdV‐D37 entry and regulation of downstream molecules in corneal cells, including caveolin‐1. Interestingly, the small GTPase dynamin II, did not appear necessary for HAdV‐D37 entry into corneal epithelial cells, but was critical for viral entry in corneal fibroblasts.

CD44 and RHAMM hyaluronan receptors in human ocular surface inflammation.

CD44 and RHAMM hyaluronan (HA) receptors have been studied in several systemic diseases such as osteoarthritis and cancer. However, not too much is known about their role in ocular surface disorders. The purpose of this research was to determine if CD44 and RHAMM are implicated in human ocular surface inflammation. Upper tarsal conjunctival epithelial samples from patients with active ocular surface inflammation (n = 17) and healthy controls (n = 14) were recovered by brush cytology. Patients were evaluated by an ophthalmologist and classified in different groups according to the etiology (immune atopic diseases or immune non-atopic diseases) and inflammation intensity (mild/moderate or severe). CD44, RHAMM, and p53 mRNAs were measured using real-time PCR. CD44, RHAMM, and p53 mRNAs were detected in all samples. In immune atopic diseases, higher levels of CD44 and RHAMM mRNAs were present, reaching a 300% increase for RHAMM in severe inflammation (p < 0.001). In contrast, in immune non-atopic diseases, the HA receptors were downregulated. CD44 tended to decrease up to 30% in severe patients (p = 0.06), and RHAMM decreased 40% in severe inflammation (p = 0.021). RHAMM may be implicated in severe ocular surface inflammation affecting the upper tarsal conjunctiva.

Cultivated oral mucosal epithelial transplantation for persistent epithelial defect in severe ocular surface diseases with acute inflammatory activity.

PurposeTo assess the clinical efficacy of cultivated oral mucosal epithelial transplantation (COMET) for the treatment of persistent epithelial defect (PED).MethodsWe treated 10 eyes of nine patients with PED (Stevens–Johnson syndrome: three eyes; thermal/chemical injury: five eyes; ocular cicatricial pemphigoid: two eyes) with COMET at Kyoto Prefectural University of Medicine, Kyoto, Japan from 2002 to 2008.ResultsPreoperatively, PED existed on over more than 50% of the corneal surface in seven eyes. Severe ocular surface inflammation with fibrovascular tissue surrounded the PED in all 10 eyes. At 24-weeks postoperative, PED had improved in all cases except 1 in which the patient was unable to return to the hospital (95% CI, 55.5–99.7; Wilcoxon signed-rank test, p = 0.0078). The preoperative median of logarithmic minimum angle of resolution was 1.85 (range 0.15–2.70), and 1.85, 1.85, and 1.52 at the 4th, 12th, and 24th postoperative week, respectively. The mean total preoperative ocular surface grading score was 7.0 (range 4–17). At 4 and 12 weeks postoperative, the total ocular surface grading score had improved significantly (p = 0.0020, p = 0.0078), and at 24 weeks postoperative, it was 3.0 (range 2–12, p = 0.0234). During the follow-up period (median 23.3 months, range 5.6–39.7 months), no recurrence of PED was observed in any eye, and long-term ocular surface stability was obtained.ConclusionCOMET enabled complete epithelialization of PED and stabilization of the ocular surface in patients with severe ocular surface disease, thus preventing end-stage cicatrization and vision loss at a later stage.

Indications and Outcomes of Amniotic Membrane Transplantation in the Management of Acute Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

To evaluate the indications and outcomes of amniotic membrane transplantation (AMT) performed within the first 2 weeks of presentation in the management of patients with acute Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). A retrospective chart review from January 1998 to May 2011 identified 128 SJS/TEN patients admitted to Loyola University Medical Center Burn intensive care unit. The degree of initial ocular surface inflammation was graded as mild, moderate, or severe within the first 2 weeks of admission. Patients were managed either medically or with amniotic membrane (AM). Outcomes were graded as good [best-corrected visual acuity (BCVA)>20/40], fair (BCVA 20/40 to 20/200 or with ocular surface discomfort, requiring contact lens or reconstructive surgeries), or poor (BCVA<20/200). Of the 182 eyes (91 patients) with documented inpatient eye examinations, 108 eyes (59.4%) had mild or no initial ocular involvement, 37 eyes (20.3%) had moderate, and 37 eyes (20.3%) had severe inflammation. Of the 29 patients (58 eyes) with greater than 1 month of follow-up, 17 patients (33 eyes) were treated with medical management and 13 patients (25 eyes) were treated with early AM. One of the 23 eyes with moderate or severe presentation treated with early AMT (4.3%) resulted in a poor outcome within 3 months compared with 8 of 23 eyes (34.8%) that were medically managed (P=0.022). We present the first case-control study of the use of AM in the management of acute SJS/TEN. Early use of AMT prevents severe vision loss in SJS/TEN patients with initial moderate or severe ocular surface inflammation.

Treatment of Acute Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Using Amniotic Membrane: A Review of 10 Consecutive Cases

To describe the clinical course, treatments, and outcomes of 10 consecutive patients treated with amniotic membrane transplantation (AMT) applied to the eyelid margins, palpebral conjunctiva, and ocular surface during the acute phase of Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Prospective case series of 10 consecutive patients treated by 1 surgeon. Ten consecutive patients with severe ocular surface and eyelid inflammation treated with AMT during the acute phase of SJS or TEN. Cryopreserved amniotic membrane was applied to the eyelids and ocular surface of each patient during the first 10 days of illness. Repeat AMT was performed every 10-14 days as long as severe ocular surface inflammation and epithelial sloughing persisted. Visual acuity, dry eye severity, and scarring of the ocular surface and eyelids were assessed after a follow-up of ≥6 months. All patients had best-corrected visual acuity of ≥20/30, with 9 of the 10 seeing 20/20. Dry eye severity was moderate or less in all patients. Overall ocular surface and eyelid scarring was mild to moderate in all patients. In acute SJS and TEN, AMT is an effective treatment for severe ocular surface and eyelid inflammation, greatly decreasing the risk of significant ocular and visual sequelae.

The Effects of Cheap Tinted Contact Lenses on Corneal Swelling and Ocular Surface Inflammation

Purpose: To evaluate the effects of cheap tinted contact lenses on corneal swelling and ocular surface inflammation, compared to hydrogel and silicone hydrogel contact lenses. Methods: Forty eyes of 20 New Zealand white rabbits were randomly assigned to 4 groups. Two types of tinted contact lenses, hydrogel lenses, and silicone hydrogel lenses were each applied to 10 rabbit eyes. Corneal thickness and tear lactate dehydrogenase (LDH) activity were measured at 1 and 4 days after contact lens wear, and the inflammation of ocular surface was scored at 4 days after contact lens wear. The internal surface of the cheap tinted lens was examined with a scanning electron microscope to compare the surface quality between the tinted and non-tinted area. Results: Although the corneal swelling of the silicone hydrogel lens group was significantly lower than the other 3 lens groups after contact lens wear (p0.1). Tear LDH activity at 1 and 4 days after contact lens wear showed no significant difference among the 4 groups (p>0.29). The scores of ocular surface inflammation in the 2 tinted contact lens groups were greater than the hydrogel and silicone hydrogel lens groups (p=0.03). The scanning electron microscope revealed the internal surface of the tinted area in the tinted contact lens was coarse and irregular though the surface of the non-tinted area was relatively smooth. Conclusions: Regarding corneal swelling and tear LDH activity, the cheap tinted contact lenses used in Korea were not significantly different from the common hydrogel contact lenses. However, tinted contact lenses showed a greater tendency to provoke ocular surface inflammation than other lenses. The coarse and irregular surface of the tinted area in the tinted contact lens appears to play a role in provoking severe ocular surface inflammation.

Giant fornix syndrome: a recently described cause of chronic purulent conjunctivitis and severe ocular surface inflammation, with a new diagnostic sign on CT

Giant fornix syndrome: a recently described cause of chronic purulent conjunctivitis and severe ocular surface inflammation, with a new diagnostic sign on CT