Symptoms Of Keratitis Research Articles

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.

34927 Adverse events associated with dupilumab in the WHO pharmacovigilance

Background: Dupilumab, an anti-IL-4/13, is approved to treat atopic dermatitis and asthma with a favourable adverse event profile in a selected population from trials. Objective: To assess and describe the spectrum of dupilumab adverse events reported in a pharmacovigilance database. Methods: We used Vigibase, the WHO pharmacovigilance database, and included all physician reports with dupilumab as suspected cause. We used the information component (IC), an indicator for disproportionate reporting, and IC025, the lower limit of its 95% credibility interval. IC025>0 is the statistical significance threshold used in Vigibase, meaning that the adverse event is associated with dupilumab. Results: In 4894 physician reports, the median age was 44 years and 1884 patients were female (38%). The most common adverse events were skin disorders, with 53 (32%) associated adverse events, mostly related to atopic dermatitis, alopecia areata (IC025 4.1) and psoriasis-like eruptions (IC025 2.2). Eye disorders displayed 35 (21%) associated adverse events, mainly related to conjunctivitis and keratitis symptoms, infections and infestations, 14 adverse events (8%), mainly related to herpes infections. Musculoskeletal disorders displayed 8 adverse events (5%), blood and lymphatic disorders 5 adverse events, (3%) and immune disorders 5 adverse events (3%), including serum sickness (IC025 3.9). We found no association with serious infections, vascular events, psychiatric disorders or cancer, with the exception of cutaneous T cell lymphoma (IC025 2.8). Discussion: With few serious adverse events in routine clinical use, we confirm dupilumab favorable safety observed in clinical trials, such as the good overall benefit/risk ratio of dupilumab.

A Retrospective Study of Herpetic Keratitis in Patients with Keratoconus after Crosslinking Surgery.

Background: The aim of this study was to perform a retrospective analysis of patients who underwent cross-linking for keratoconus, in the Department of Ophthalmology of the Medical University of Silesia in Katowice, between 2011 and 2020, regarding the occurrence of herpetic keratitis after the procedure. Methods: We analyzed the medical history of 543 patients who underwent cross-linking surgery. Results: In the analyzed group, there were nine cases of herpetic keratitis (six men and three women), aged from 16 to 40 years (mean 26.2 years). The mean follow-up period was 49.3 months (16–82 months). The average time from surgery to the manifestation of the first symptoms of keratitis was 4.3 days (2–6 days). In two cases, iritis was observed, and in one of them, iritis was the first symptom. After systemic and topical administration of acyclovir, ulceration healed in all patients. Corneal healing time ranged from 10 days to 3 weeks (average 13.7 days). In one patient, a recurrence of the inflammation was observed after 8 months. Conclusion: Patients should be carefully observed in the early post-CXL period. Herpetic keratitis could be induced by CXL even in patients with no history of herpetic disease.

Ocular manifestations of small-vessel vasculitis

Ophthalmic manifestations of vasculitis can be orbital, ocular (affecting the globe), or intraocular. Orbital inflammation manifests as sudden onset of pain, erythema, and proptosis, and can be sight-threatening. In the globe, red eye is typical in both episcleritis and scleritis. Episcleritis is usually otherwise asymptomatic with blanching upon instillation of topical phenylephrine, whereas scleritis is painful and does not blanch. Infectious and rheumatic diseases are present in nearly 50% of patients with scleritis. The symptoms of keratitis are similar to those of scleritis; superficial keratitis is benign but peripheral ulcerative keratitis can be sight-threatening. Anterior uveitis is the most frequent ocular manifestation of Behçet disease. Approximately 30% of patients with granulomatosis with polyangiitis (Wegener's granulomatosis) have ocular involvement, with orbital disease being most common. With ophthalmic manifestations of vasculitis, tissue biopsy of any site that is amenable to biopsy is recommended. Biopsy must be interpreted within the context of treatment.

Dacryoadenitis Associated With Acanthamoeba Keratitis

To report the incidence of dacryoadenitis as a symptom associated with Acanthamoeba keratitis. We investigated all cases of Acanthamoeba keratitis (20 patients and 21 eyes) diagnosed and treated at Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan, between May 1, 1994, and November 30, 2005. We recorded the incidence of dacryoadenitis diagnosed using clinical signs of lacrimal gland swelling and pain on pressure, computed tomography, magnetic resonance imaging, and histopathologic analysis. Eight eyes (38%) of 8 patients had dacryoadenitis simultaneously with Acanthamoeba keratitis. Dacryoadenitis was diagnosed using histopathologic analysis and computed tomography in 1 patient, histopathologic analysis and magnetic resonance imaging in 1, magnetic resonance imaging in 2, and clinical signs alone in 4. Histopathologic examination in 2 patients revealed moderate infiltration of lymphocytes and plasma cells in the lacrimal gland compatible with dacryoadenitis. No Acanthamoeba organisms were found in the lacrimal gland. The standard protocol for Acanthamoeba keratitis was performed without particular treatment of dacryoadenitis in all patients. Lacrimal gland swelling improved after a mean of 10 weeks (range, 4-17 weeks) in conjunction with symptoms of keratitis; however, 1 patient (patient 1) required levator muscle surgery and blepharoplasty for residual ptosis. Dacryoadenitis is a clinical finding associated with Acanthamoeba keratitis.

Antagonists and Inhibitors of Lipid Mediators in Experimental Inflammation of the Cornea

In experimental immunogenic keratitis, provoked in rabbits by intracorneal injection of 20 microliters of human serum albumin (HSA), various anti-inflammatory agents were studied in their effects on corneal edema, neovascularisation and leukocyte infiltration. Prophylactic treatment with a corticosteroid completely prevented the occurrence of keratitis. Nonsteroidal anti-inflammatory drugs such as a cyclooxygenase inhibitor partly prevented neovascularisation and corneal edema, a lipoxygenase inhibitor, a leukotriene antagonist or platelet-activating factor (PAF)-antagonist BN 52021 partially prevented mainly leukocyte infiltration. Prophylactic topical treatment with the poly-unsaturated fatty acids eicosapentaenoic acid and columbinic acid or a dietary supplement with fish oil showed less symptoms of keratitis in all respects.