scholarly journals Microsporidial stromal keratitis: an uncommon etiology of bilateral simultaneous corneal infection

2020 ◽  
Vol 17 (3) ◽  
pp. 311-317
Author(s):  
Pragnya R. Donthineni ◽  
Somasheila I. Murthy ◽  
Joveeta Joseph ◽  
Prashant Garg ◽  
Manisha Acharya ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Corneal Transplantation ◽  
Predisposing Factors ◽  
Unusual Presentation ◽  
Corneal Tissue ◽  
Corneal Infection ◽  
Stromal Keratitis ◽  
Corneal Infiltrates ◽  
Possible Cause ◽  
Culture Negative

We report three cases of bilateral microsporidial keratitis, which is an unusual presentation. All three patients presented with bilateral, simultaneous, asymmetrical, deep stromal corneal infiltrates with symptoms ranging from 5 to 12 months. Predisposing factors were noted in two of three patients. Corneal scrapings for microbiology and histopathology of corneal tissue revealed microsporidial spores from both eyes of all patients. There was no response to medical therapy and all underwent bilateral corneal transplantation. Case one additionally had recurrences in the graft and underwent repeat keratoplasties and eventually keratoprosthesis. Microsporidial stromal keratitis is a possible cause of keratitis in cases of very long-standing, indolent, culture-negative, deep stromal corneal infiltrates. So far, this infection has been reported as unilateral; however, we report these cases of bilateral infection, which is rare. Corneal transplantation is the preferred line of management due to lack of response to medical therapy.

Primary surgical options for acute corneal hydrops: A review

2021 ◽  
pp. 112067212110378
Author(s):  
Gonzalo García de Oteyza ◽  
Guido Bregliano ◽  
Irene Sassot ◽  
Luis Quintana ◽  
Carolina Rius ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Medical Therapy ◽  
Penetrating Keratoplasty ◽  
Corneal Transplantation ◽  
Corneal Edema ◽  
Self Healing ◽  
Surgical Options ◽  
Corneal Hydrops

Acute corneal hydrops usually resolves alone or with medical therapy along the first 4–6 weeks. However, depending on the severity of the corneal edema or the size of the Descemet break, self-healing might be difficult. Years ago, those patients had no more options than corneal transplantation, but surgical alternatives are on the rise in this century. These surgeries are becoming more popular with a variety of techniques relegating penetrating keratoplasty to a residual role. These techniques aim to accelerate corneal healing, reduce the edema, improve visual acuity and prevent from severe complications that may appear if corneal hydrops is not treated rapidly. Feasibility and safety are the favorable aspects of these techniques since the complications rates described remain low. In this review, we emphasize the recently published studies that describe both the techniques and their results.

scholarly journals Recurrent Vulvovaginal Candidiasis

2021 ◽  
Vol 5 (5) ◽  
pp. 474-483
Author(s):  
Cyntya Sari Sovianti ◽  
Mutia Devi
Keyword(s):  
Quality Of Life ◽  
Topical Therapy ◽  
Predisposing Factors ◽  
Vulvovaginal Candidiasis ◽  
Suppressive Therapy ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Candida Sp ◽  
Microbiological Examination ◽  
Culture Negative

Vulvovaginal candidiasis is a common fungal infection caused by Candida Sp, especially Candida albicans. Recurrent vulvovaginal candidiasis was defined as the occurrence of four or more episodes of vulvovaginal candidiasis ​​in 12 months period. As many as 9% of women from various populations have recurrent vulvovaginal candidiasis. Vulvovaginal candidiasis affects the quality of life, mental health, and sexual activity. There are many predisposing factors that caused recurrent vulvovaginal candidiasis, such as genetics, host, habit, idiopathic and non-albican candida microbes. Management of recurrent vulvovaginal candidiasis includes elimination of predisposing factors; mycological culture diagnosis and identification of specific Candida species; followed by microbiological examination to confirm the sensitivity of the azole group to Candida sp. Further, oral, or topical therapy should be continued until the patient is asymptomatic and culture-negative. Patients should receive induction therapy followed by maintenance suppressive therapy for six months.

scholarly journals Total Corneal Transplantation after Trauma

2017 ◽  
Vol 17 (2) ◽  
pp. 37-38
Author(s):  
Elina Silina ◽  
Guna Laganovska
Keyword(s):  
Healthy Donor ◽  
Penetrating Keratoplasty ◽  
Ocular Trauma ◽  
Corneal Transplantation ◽  
Visual Outcome ◽  
Corneal Tissue ◽  
Full Thickness ◽  
Documented Case ◽  
Donor Graft ◽  
Penetrating Ocular Trauma

Abstract The first successful corneal transplantation is known since 1905, performed by Eduard Zirm (2). It has been implemented in order to restore vision in a variety of corneal diseases and after ocular traumas. The traditional technique for corneal transplantation, penetrating keratoplasty (PKP), refers to the full-thickness replacement of corneal tissue with a healthy donor graft (1). Authors report a well-documented case about successfully transplanted cornea after penetrating ocular trauma to improve visual outcome.

scholarly journals Recurrent Vulvovaginal Candidiasis

2021 ◽  
Vol 5 (3) ◽  
pp. 498-507
Author(s):  
Cyntya Sari Sovianti ◽  
Mutia Devi
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Topical Therapy ◽  
Predisposing Factors ◽  
Vulvovaginal Candidiasis ◽  
Suppressive Therapy ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Candida Sp ◽  
Culture Negative

Vulvovaginal candidiasis is a common fungal infection caused by Candida Sp,especially Candida albicans. Recurrent vulvovaginal candidiasis was defined asthe occurrence of four or more episodes of vulvovaginal candidiasis in 12 monthsperiod. As many as 9% of women from various populations have recurrentvulvovaginal candidiasis. Vulvovaginal candidiasis affects the quality of life,mental health, and sexual activity. There are many predisposing factors thatcaused recurrent vulvovaginal candidiasis, such as genetics, host, habit,idiopathic and non-albican candida microbes. Management of recurrentvulvovaginal candidiasis includes elimination of predisposing factors; mycologicalculture diagnosis and identification of specific Candida species; followed bymicrobiological examination to confirm the sensitivity of the azole group toCandida sp. Further, oral, or topical therapy should be continued until the patientis asymptomatic and culture-negative. Patients should receive induction therapyfollowed by maintenance suppressive therapy for six months.

Infectious Keratitis

2016 ◽  
Author(s):  
M. DeAugustinas ◽  
A Kiely
Keyword(s):  
The United States ◽  
Infectious Keratitis ◽  
Tissue Concentrations ◽  
Common Cause ◽  
Autoimmune Inflammation ◽  
Stromal Keratitis ◽  
Corneal Blindness ◽  
Simplex Virus ◽  
Corneal Infiltrates

Keratitis is an inflammation of the cornea, which can lead to corneal opacification or ulceration. The most common cause of infectious keratitis is herpes simplex virus type 1 (HSV-1). Noninfectious corneal infiltrates related to trauma, collagen vascular disease, autoimmune inflammation, vasculitis, or atopy (which predisposes to HSV keratitis) must be considered. HSV-associated stromal keratitis is the most common cause of infectious corneal blindness in the United States, yet its presentation can be fairly subtle. For this reason, symptoms out of proportion to exam findings or a history concerning for viral infection is an indication for prompt referral to ophthalmology. Topical antibiotic drops achieve high tissue concentrations and are the treatment of choice. Empiric coverage should be prescribed and tailored later under the care of an ophthalmologist. Other keys to effective treatment include discontinuing contact lens use and protecting the eye with a rigid shield without a patch, as patching provides a reservoir for infection.

scholarly journals Immune Checkpoints Contribute Corneal Immune Privilege: Implications for Dry Eye Associated with Checkpoint Inhibitors

2020 ◽  
Vol 21 (11) ◽  
pp. 3962
Author(s):  
Junko Hori ◽  
Tomoyuki Kunishige ◽  
Yuji Nakano
Keyword(s):  
T Cells ◽  
Regulatory T Cells ◽  
Dry Eye ◽  
Molecular Mechanisms ◽  
Checkpoint Inhibitors ◽  
Corneal Transplantation ◽  
Immune Privilege ◽  
Immune Checkpoints ◽  
Corneal Tissue ◽  
Immunosuppressive Microenvironment

The eye is provided with immune protection against pathogens in a manner that greatly reduces the threat of inflammation-induced vision loss. Immune-mediated inflammation and allograft rejection are greatly reduced in the eye, a phenomenon called ‘immune privilege’. Corneal tissue has inherent immune privilege properties with underlying three mechanisms: (1) anatomical, cellular, and molecular barriers in the cornea; (2) an immunosuppressive microenvironment; and (3) tolerance related to regulatory T cells and anterior chamber-associated immune deviation. This review describes the molecular mechanisms of the immunosuppressive microenvironment and regulatory T cells in the cornea that have been elucidated from animal models of ocular inflammation, especially those involving corneal transplantation, it also provides an update on immune checkpoint molecules in corneal and systemic immune regulation, and its relevance for dry eye associated with checkpoint inhibitor therapy.

scholarly journals Corneal transplantation during the COVID-19 pandemic: An operational guide

2021 ◽  
pp. 112067212110065
Author(s):  
Antonella Franch ◽  
Adriano Fasolo ◽  
Paolo Carraro ◽  
Mosè Favarato ◽  
Federica Birattari ◽  
...  
Keyword(s):  
Corneal Transplantation ◽  
Case Series ◽  
Lamellar Keratoplasty ◽  
Corneal Tissue ◽  
Test Results ◽  
Positive Predicted Value ◽  
Case Series Study ◽  
Anterior Lamellar Keratoplasty ◽  
Exposure Risks ◽  
Series Study

Purpose: To provide an operational guide for corneal transplantation during the COVID-19 pandemic aimed to maintain surgery and avoid spreading of SARS-CoV-2. Methods: Prospective observational case series study in patients requiring corneal graft manage toward separate free and restricted pathways for those COVID-19 negative or positive, respectively. Results: During the national lockdown, 30 consecutive patients underwent endothelial ( n = 16), penetrating ( n = 9), and anterior lamellar keratoplasty ( n = 5). Two patients followed the COVID-19 restricted pathway, as they were considered positive while waiting for test results. Nine patients were hospitalized one night in the hospital. On admission to the hospital before surgery, at surgery, the day after surgery and at 7 and 30 days all patients and health-care personnel showed no symptoms and resulted negative at risks factors/exposure to the SARS-CoV-2 infection and occurrence of COVID-19. Nucleic acid testing resulted not detectable in all patients and SARS-CoV-2 antibodies quantification showed IgG and IgM below the positive predicted value in 29 patients. One patient showed IgM above the cut-off of significance (1.21 and 1.03 preoperative and 1-month postoperative, respectively) that were considered irrelevant because of the absence of symptoms and exposure risks. Conclusions: The concept of donor emergency (i.e. short-term availability of transplant tissues), makes corneal transplantation an always-urgent activity because it is related to the availability of the corneal tissue from a donor. Modest adjustments to ophthalmic clinic and eye surgery organization are required to maintain surgery and care of eye patients in a safe environment.

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