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Cabrera‐Aguas M, Khoo P, Watson SL. Infectious keratitis: A review. Clin Exp Ophthalmol 2022; 50:543-562. [PMID: 35610943 PMCID: PMC9542356 DOI: 10.1111/ceo.14113] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
Globally, infectious keratitis is the fifth leading cause of blindness. The main predisposing factors include contact lens wear, ocular injury and ocular surface disease. Staphylococcus species, Pseudomonas aeruginosa, Fusarium species, Candida species and Acanthamoeba species are the most common causal organisms. Culture of corneal scrapes is the preferred initial test to identify the culprit organism. Polymerase chain reaction (PCR) tests and in vivo confocal microscopy can complement the diagnosis. Empiric therapy is typically commenced with fluoroquinolones, or fortified antibiotics for bacterial keratitis; topical natamycin for fungal keratitis; and polyhexamethylene biguanide or chlorhexidine for acanthamoeba keratitis. Herpes simplex keratitis is mainly diagnosed clinically; however, PCR can also be used to confirm the initial diagnosis and in atypical cases. Antivirals and topical corticosteroids are indicated depending on the corneal layer infected. Vision impairment, blindness and even loss of the eye can occur with a delay in diagnosis and inappropriate antimicrobial therapy.
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Affiliation(s)
- Maria Cabrera‐Aguas
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Corneal Unit Sydney Eye Hospital Sydney New South Wales Australia
| | - Pauline Khoo
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Corneal Unit Sydney Eye Hospital Sydney New South Wales Australia
| | - Stephanie L. Watson
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Corneal Unit Sydney Eye Hospital Sydney New South Wales Australia
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2
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Das S, D’Souza S, Gorimanipalli B, Shetty R, Ghosh A, Deshpande V. Ocular Surface Infection Mediated Molecular Stress Responses: A Review. Int J Mol Sci 2022; 23:ijms23063111. [PMID: 35328532 PMCID: PMC8952005 DOI: 10.3390/ijms23063111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
Infection mediated ocular surface stress responses are activated as early defense mechanisms in response to host cell damage. Integrated stress responses initiate the host response to different types of infections and modulate the transcription of key genes and translation of proteins. The crosstalk between host and pathogen results in profound alterations in cellular and molecular homeostasis triggering specific stress responses in the infected tissues. The amplitude and variations of such responses are partly responsible for the disease severity and clinical sequelae. Understanding the etiology and pathogenesis of ocular infections is important for early diagnosis and effective treatment. This review considers the molecular status of infection mediated ocular surface stress responses which may shed light on the importance of the host stress-signaling pathways. In this review, we collated literature on the molecular studies of all ocular surface infections and summarize the results from such studies systematically. Identification of important mediators involved in the crosstalk between the stress response and activation of diverse signaling molecules in host ocular surface infection may provide novel molecular targets for maintaining the cellular homeostasis during infection. These targets can be then explored and validated for diagnostic and therapeutic purposes.
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Affiliation(s)
- Samayitree Das
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560 099, India;
| | - Sharon D’Souza
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore 560 010, India; (S.D.); (B.G.); (R.S.)
| | - Bhavya Gorimanipalli
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore 560 010, India; (S.D.); (B.G.); (R.S.)
| | - Rohit Shetty
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore 560 010, India; (S.D.); (B.G.); (R.S.)
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560 099, India;
- Correspondence: (A.G.); (V.D.)
| | - Vrushali Deshpande
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560 099, India;
- Correspondence: (A.G.); (V.D.)
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Satpathy G, Behera HS, Sharma A, Mishra AK, Mishra D, Sharma N, Tandon R, Agarwal T, Titiyal JS. A 20‐year experience of ocular herpes virus detection using immunofluorescence and polymerase chain reaction. Clin Exp Optom 2021; 101:648-651. [DOI: 10.1111/cxo.12669] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gita Satpathy
- Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Himansu S Behera
- Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Anjana Sharma
- Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Abhisek K Mishra
- Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Deepanshi Mishra
- Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Namrata Sharma
- Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Radhika Tandon
- Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Tushar Agarwal
- Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Jeewan S Titiyal
- Department of Ocular Microbiology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
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Mohammadpour M, Alizadeh L, Jabbarvand Behrouz M, Khorrami-Nejad M. Quantitative real-time polymerase chain reaction analysis in herpes simplex virus keratitis with and without epithelial involvement. Int Ophthalmol 2021; 41:1807-1813. [PMID: 33630251 DOI: 10.1007/s10792-021-01741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the quantitative real-time polymerase chain reaction (qRT-PCR) analysis in herpes simplex virus (HSV) keratitis with and without epithelial involvement. METHODS This cross-sectional study was performed on 70 patients with different HSV types and an active ocular lesion in Farabi Eye Hospital, Tehran, Iran. From these 70 patients, 171 samples were collected, including seventy tear samples and 33 scraping samples from involved eyes; and 68 samples from uninvolved fellow eyes. Samples were frozen at - 70 °C until DNA extraction was performed. Quantity of HSV was measured using qRT-PCR in all three samples. RESULTS The mean age of HSV patients was 52.19 ± 20.42 years (range, 4-85 years). Forty-one (58.6%) HSV patients had epithelial involvement, and 29 (41.4%) patients did not have epithelial involvement. In PCR-positive cases, the mean number of viruses in affected eyes' tears (8,831,234 ± 4,051,979) was significantly higher than uninvolved eyes' tears (182,603 ± 69,141) (P = 0.02). The mean of PCR in HSV patients with and without epithelial involvement was 10,320,269 ± 5,329,800 and 1,469,419 ± 1,070,396, respectively (P = 0.04). The qRT-PCR of involved tears in both groups (with and without epithelial involvement) was significantly higher than unaffected eyes' tears (P < 0.0001 and P = 0.01, respectively). In cases with and without epithelial involvement, the cutoff points of viral load in involved eyes' tears were 281,000 and 126,000 copies, respectively. CONCLUSION The results indicated that qRT-PCR is an excellent method for the detection of herpes simplex keratitis.
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Affiliation(s)
- Mehrdad Mohammadpour
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Leyla Alizadeh
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabbarvand Behrouz
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Optometry, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Koganti R, Yadavalli T, Naqvi RA, Shukla D, Naqvi AR. Pathobiology and treatment of viral keratitis. Exp Eye Res 2021; 205:108483. [PMID: 33556334 DOI: 10.1016/j.exer.2021.108483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022]
Abstract
Keratitis is one of the most prevalent ocular diseases manifested by partial or total loss of vision. Amongst infectious (viz., microbes including bacteria, fungi, amebae, and viruses) and non-infectious (viz., eye trauma, chemical exposure, and ultraviolet exposure, contact lens) risk factors, viral keratitis has been demonstrated as one of the leading causes of corneal opacity. While many viruses have been shown to cause keratitis (such as rhabdoviruses, coxsackieviruses, etc.), herpesviruses are the predominant etiologic agent of viral keratitis. This chapter will summarize current knowledge on the prevalence, diagnosis, and pathobiology of viral keratitis. Virus-mediated immunomodulation of host innate and adaptive immune components is critical for viral persistence, and dysfunctional immune responses may cause destruction of ocular tissues leading to keratitis. Immunosuppressed or immunocompromised individuals may display recurring disease with pronounced severity. Early diagnosis of viral keratitis is beneficial for disease management and response to treatment. Finally, we have discussed current and emerging therapies to treat viral keratitis.
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Affiliation(s)
- Raghuram Koganti
- Department of Ophthalmology and Visual Sciences, University of Illinois Medical Center, Chicago, IL, 60612, USA
| | - Tejabhiram Yadavalli
- Department of Ophthalmology and Visual Sciences, University of Illinois Medical Center, Chicago, IL, 60612, USA
| | - Raza Ali Naqvi
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Deepak Shukla
- Department of Ophthalmology and Visual Sciences, University of Illinois Medical Center, Chicago, IL, 60612, USA; Department of Microbiology and Immunology, University of Illinois at Chicago, IL, 60612, USA.
| | - Afsar R Naqvi
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, 60612, USA.
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Wang WY, Chen C, Chang J, Chien L, Shih YF, Lin LLK, Pang CP, Wang IJ. Pharmacotherapeutic candidates for myopia: A review. Biomed Pharmacother 2021; 133:111092. [PMID: 33378986 DOI: 10.1016/j.biopha.2020.111092] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 01/11/2023] Open
Abstract
This review provides insights into the mechanism underlying the pathogenesis of myopia and potential targets for clinical intervention. Although the etiology of myopia involves both environmental and genetic factors, recent evidence has suggested that the prevalence and severity of myopia appears to be affected more by environmental factors. Current pharmacotherapeutics are aimed at inhibiting environmentally induced changes in visual input and subsequent changes in signaling pathways during myopia pathogenesis and progression. Recent studies on animal models of myopia have revealed specific molecules potentially involved in the regulation of eye development. Among them, the dopamine receptor plays a critical role in controlling myopia. Subsequent studies have reported pharmacotherapeutic treatments to control myopia progression. In particular, atropine treatment yielded favorable outcomes and has been extensively used; however, current studies are aimed at optimizing its efficacy and confirming its safety. Furthermore, future studies are required to assess the efficacy of combinatorial use of low-dose atropine and contact lenses or orthokeratology.
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Affiliation(s)
- Wen-Yi Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Camille Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Justine Chang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Lillian Chien
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Feng Shih
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Luke L K Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, KLN, Hong Kong, China.
| | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.
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7
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Laver NMV. Ocular cytology: Diagnostic features and ongoing practices. Cancer Cytopathol 2020; 129:419-431. [PMID: 33136340 DOI: 10.1002/cncy.22384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/28/2022]
Abstract
Ocular cytology specimens are small, with limited options for a repeat biopsy. Appropriate handling of these specimens and triaging for ancillary testing can be taxing. In this article, the author reviews a selection of potentially challenging diagnoses and current common practices and methods used in diagnosing ocular diseases by cytology. The majority of cytology specimens submitted for evaluation of ocular diseases can be divided into 3 major categories: surface epithelial corneal and conjunctival cytology samples, intraocular fluids from the anterior (aqueous fluid) or posterior (vitreous fluid) chambers of the eye, and intraocular fine-needle aspiration specimens. The clinical findings, testing, and cytologic features of ocular surface epithelial infections, inflammations and neoplasia are discussed; and challenges in processing and diagnosing intraocular infections, chronic uveitis, and vitreoretinal lymphoma are reviewed. Novel molecular testing in the cytologic diagnosis and classification of uveal melanoma also is explored. Cytology evaluation of corneal epithelial and stromal cells, anterior chamber and vitreous samples, and fine-needle aspiration biopsies can provide detailed diagnostic findings to aid in the treatment and follow-up of patients with ocular diseases.
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Affiliation(s)
- Nora M V Laver
- Departments of Ophthalmology, Pathology and Laboratory Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
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8
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Sibley D, Larkin DFP. Update on Herpes simplex keratitis management. Eye (Lond) 2020; 34:2219-2226. [PMID: 32843744 DOI: 10.1038/s41433-020-01153-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022] Open
Abstract
Herpes simplex keratitis (HSK) is a common, potentially blinding condition characterised by recurrent infections of the cornea, seen by both general ophthalmologists and corneal specialists. Successful treatment of recurrences reduces disease duration, prevents progressive corneal scaring leading to vision loss and reduces risk of further recurrences. In this review we discuss the relative advantages of the diagnostic laboratory investigations including polymerase chain reaction, viral culture and fluorescence-based immunohistochemistry. We review treatment strategies in selected aspects of HSK and discuss the management options in cases not responding to treatment.
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Affiliation(s)
- Daniel Sibley
- Cornea & External Diseases Service, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
| | - Daniel F P Larkin
- Cornea & External Diseases Service, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK. .,NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, UK. .,UCL Institute of Ophthalmology, London, UK.
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9
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Atypical herpes simplex keratitis: frequency, clinical presentations and treatment results. Int Ophthalmol 2019; 40:659-665. [PMID: 31754891 DOI: 10.1007/s10792-019-01226-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
AIMS To determine herpes simplex virus (HSV) DNA positivity in corneal scraping samples obtained from patients with microbial keratitis whose findings were not specific for HSV keratitis and to evaluate these particular cases with respect to clinical features and antiviral treatment results. METHODS Records of patients with microbial keratitis treated in a tertiary eye care hospital within the 3-year period were evaluated retrospectively. Real-time polymerase chain reaction (PCR) was used to identify HSV DNA. Smear slides were evaluated by light microscopy. Patients with typical presentations and histories of HSV keratitis were excluded. RESULTS Two hundred and seventy-six eyes of 276 patients were included in the study. HSV-1 DNA was detected in 25 eyes (9%). In these 25 eyes, the initial diagnosis was fungal or bacterial keratitis. The mean symptom duration was 20 ± 14 days (2-60 days). The risk factors were ocular surgery (20%), blepharitis (16%), trauma (8%) and contact lens wear (4%); however, the majority of patients did not have any specific cause for keratitis (52%). Clinical features were variable and not typical for any particular etiology. Culture and microscopic examinations revealed bacteria and/or fungi in 6 patients in addition to herpes infection. Antiviral treatment was successful in 72% of patients. CONCLUSION Herpetic corneal infections can present without typical dendritic or geographic ulcers and may be masked by other infections. Real-time PCR is a useful method for rapid and definitive diagnosis. HSV infection should be considered for microbial keratitis without specific risk factors, with negative culture results and poor response to antimicrobial agents.
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Consultation Section: Cataract. October consultation #5. J Cataract Refract Surg 2019; 45:1520-1521. [PMID: 31564330 DOI: 10.1016/j.jcrs.2019.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Alkatan HM, Al-Essa RS. Challenges in the diagnosis of microbial keratitis: A detailed review with update and general guidelines. Saudi J Ophthalmol 2019; 33:268-276. [PMID: 31686969 PMCID: PMC6819704 DOI: 10.1016/j.sjopt.2019.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 11/04/2022] Open
Abstract
The incidence of microbial keratitis (MK) is variable worldwide with an estimated 1.5–2 million cases of corneal ulcers in developing countries. The complications of MK can be severe and vision threatening. Therefore, proper diagnosis of the causative organism is essential for early successful treatment. Accurate sampling of microbiological specimens in MK is an important step in identifying the infective organism. Corneal scrapping, tear samples and corneal biopsy are examples of specimens obtained for the investigative procedures in MK. Ophthalmologists especially in an emergency room setting should be aware of the proper sampling techniques based on their microbiology-related basic information for each category of MK. This review article briefly describes the clinical presentation and defines in details the best updated diagnostic methods used in different types of MK. It can be used as a guide for ophthalmology trainees and general ophthalmologists who may be handling such cases at initial presentation.
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Affiliation(s)
- Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia
| | - Rakan S Al-Essa
- Department of Ophthalmology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia
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12
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Utility of HSV Serology for Chronic Corneal Pathology. Eye Contact Lens 2019; 46:190-193. [PMID: 31306215 DOI: 10.1097/icl.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study is to determine the utility of obtaining herpes simplex virus (HSV) serology for patients presenting with chronic corneal pathology of unknown etiology for which HSV is a diagnostic consideration. METHODS A retrospective analysis was performed of all patients presenting to one cornea specialist (J.M.G.) between August 2011 and April 2018 with a chronic (>6 weeks) corneal condition for which HSV was suspected and serology was performed. Patient demographics, clinical presentation, treatment, final diagnosis, and follow-up duration were recorded. RESULTS Fifty-four patients with a median age of 52 (range: 5-85) years were included in the study. Patients were classified by presenting clinical features as corneal ulcer (46.2%), stromal keratitis (24.1%), superficial keratitis (18.5%), or keratouveitis (11.1%). The seroprevalence of HSV-1 and HSV-2 antibodies were 42.6% and 18.5%, including 5 patients (9.3%) positive for both HSV-1 and HSV-2. Serology impacted management for all patients with negative titers (48.1%), defined as discontinuing antiviral medication, electing not to start antiviral medication, or continuing antiviral medication for a non-HSV etiology (e.g., varicella zoster keratitis). No patients with HSV serology were ultimately diagnosed with HSV keratitis. Median follow-up duration was 1.5 years (range 0.8-6.6 years). CONCLUSION Although only useful when negative, our study confirms that serology may be useful for excluding HSV as a diagnostic consideration for patients presenting with chronic corneal pathology. The seroprevalence of HSV antibodies for our patient cohort was comparable with previous population-based studies.
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Pérez-Bartolomé F, Mingo Botín D, de Dompablo E, de Arriba P, Arnalich Montiel F, Muñoz Negrete FJ. Post-herpes neurotrophic keratopathy: Aetiopathogenesis, clinical signs and current therapies. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:171-183. [PMID: 30718014 DOI: 10.1016/j.oftal.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by damage of trigeminal innervation. This leads to epithelial defects, ulceration and, eventually, perforation. Both herpes simplex and varicella zoster keratitis are reported to be the main causes of NK. Furthermore, prognosis in this type of NK is poor. Classic clinical findings in post-herpes NK are spontaneous epithelial breakdown, round and central epithelial defects with smooth edges, stromal melting and thinning, scarring, and neovascularisation. Although several medical and surgical treatments have been reported, no therapies are currently available to definitely restore corneal sensitivity. Therefore, NK remains a challenging disease to treat. In this review a summary is presented of the pathogenesis, manifestations, and current management of post-herpes NK. The role of antiviral treatment and varicella-zoster vaccination is also discussed. A description is also presented on both medical and surgical novel therapies, such as regenerative drugs and corneal neurotization.
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Affiliation(s)
- F Pérez-Bartolomé
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España.
| | - D Mingo Botín
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España
| | - E de Dompablo
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España
| | - P de Arriba
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España
| | | | - F J Muñoz Negrete
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España
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14
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Landis ZC, Pantanelli SM. Corneal and Conjunctival Infectious Disease Diagnostics. Int Ophthalmol Clin 2018; 57:1-11. [PMID: 28590277 DOI: 10.1097/iio.0000000000000182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Yoshida M, Hariya T, Yokokura S, Maruyama K, Sato K, Sugita S, Tomaru Y, Shimizu N, Nakazawa T. Diagnosing superinfection keratitis with multiplex polymerase chain reaction. J Infect Chemother 2018; 24:1004-1008. [PMID: 30006249 DOI: 10.1016/j.jiac.2018.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/16/2018] [Accepted: 06/21/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE To report the potential usefulness of multiplex polymerase chain reaction (mPCR) for diagnosing superinfection keratitis caused by herpes simplex virus-1 (HSV-1), bacteria and fungus. METHODS Case series. Corneal scrapings were analyzed with mPCR for human herpes virus 1-8, bacterial 16S ribosomal DNA (rDNA) and fungal 28S rDNA. RESULTS Case 1 was a 69-year-old man who presented with refractory infectious keratitis. PCR examination was positive for bacterial 16S rDNA and negative for fungal 28S rDNA. HSV-1 was not examined at this time. A geographic ulcer arose after 2 months of intensive antibacterial treatment. Herpes simplex keratitis (HSK) was suspected; PCR analysis was positive for HSV-1. Corneal scrapings obtained at the initial visit were re-analyzed and found to be HSV-1 positive. Thus, it turned out that this was a case of superinfection keratitis caused by bacteria and HSV-1. Case 2 was a 60-year-old man with corneal ulcer who had received unsuccessful treatment with antibiotics. mPCR analysis was positive for HSV-1, bacterial 16S rDNA and fungal 28S rDNA. The patient was diagnosed with superinfection keratitis caused by HSV-1, bacteria and fungus. Case 3 was an 82-year-old woman who had been treated for HSK and then developed bacterial keratitis during treatment. mPCR analysis was positive for HSV-1 and bacterial 16S rDNA. The patient was diagnosed with superinfection keratitis caused by HSV-1 and bacteria. CONCLUSION Superinfection keratitis is hard to diagnose because of its atypical manifestation. mPCR has the potential to allow prompt diagnosis and appropriate treatment in these cases.
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Affiliation(s)
- Masaaki Yoshida
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takehiro Hariya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Shunji Yokokura
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kota Sato
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sunao Sugita
- Laboratory for Retinal Regeneration, RIKEN Center for Developmental Biology, Kobe, Hyogo, Japan
| | - Yasuhiro Tomaru
- Department of Virology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norio Shimizu
- Department of Virology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Austin A, Lietman T, Rose-Nussbaumer J. Update on the Management of Infectious Keratitis. Ophthalmology 2017; 124:1678-1689. [PMID: 28942073 PMCID: PMC5710829 DOI: 10.1016/j.ophtha.2017.05.012] [Citation(s) in RCA: 299] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022] Open
Abstract
Infectious keratitis is a major global cause of visual impairment and blindness, often affecting marginalized populations. Proper diagnosis of the causative organism is critical, and although culture remains the prevailing diagnostic tool, newer techniques such as in vivo confocal microscopy are helpful for diagnosing fungus and Acanthamoeba. Next-generation sequencing holds the potential for early and accurate diagnosis even for organisms that are difficult to culture by conventional methods. Topical antibiotics remain the best treatment for bacterial keratitis, and a recent review found all commonly prescribed topical antibiotics to be equally effective. However, outcomes remain poor secondary to corneal melting, scarring, and perforation. Adjuvant therapies aimed at reducing the immune response associated with keratitis include topical corticosteroids. The large, randomized, controlled Steroids for Corneal Ulcers Trial found that although steroids provided no significant improvement overall, they did seem beneficial for ulcers that were central, deep or large, non-Nocardia, or classically invasive Pseudomonas aeruginosa; for patients with low baseline vision; and when started early after the initiation of antibiotics. Fungal ulcers often have worse clinical outcomes than bacterial ulcers, with no new treatments since the 1960s when topical natamycin was introduced. The randomized controlled Mycotic Ulcer Treatment Trial (MUTT) I showed a benefit of topical natamycin over topical voriconazole for fungal ulcers, particularly among those caused by Fusarium. MUTT II showed that oral voriconazole did not improve outcomes overall, although there may have been some effect among Fusarium ulcers. Given an increase in nonserious adverse events, the authors concluded that they could not recommend oral voriconazole. Viral keratitis differs from bacterial and fungal cases in that it is often recurrent and is common in developed countries. The Herpetic Eye Disease Study (HEDS) I showed a significant benefit of topical corticosteroids and oral acyclovir for stromal keratitis. HEDS II showed that oral acyclovir decreased the recurrence of any type of herpes simplex virus keratitis by approximately half. Future strategies to reduce the morbidity associated with infectious keratitis are likely to be multidimensional, with adjuvant therapies aimed at modifying the immune response to infection holding the greatest potential to improve clinical outcomes.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Antifungal Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Corneal Ulcer/diagnosis
- Corneal Ulcer/drug therapy
- Corneal Ulcer/microbiology
- Diagnostic Techniques, Ophthalmological
- Eye Infections, Bacterial/diagnosis
- Eye Infections, Bacterial/drug therapy
- Eye Infections, Bacterial/microbiology
- Eye Infections, Fungal/diagnosis
- Eye Infections, Fungal/drug therapy
- Eye Infections, Fungal/microbiology
- Female
- Glucocorticoids/therapeutic use
- Humans
- Keratitis, Herpetic/diagnosis
- Keratitis, Herpetic/drug therapy
- Keratitis, Herpetic/virology
- Male
- Randomized Controlled Trials as Topic
- Visual Acuity/physiology
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Affiliation(s)
- Ariana Austin
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Tom Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Jennifer Rose-Nussbaumer
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California.
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Azher TN, Yin XT, Tajfirouz D, Huang AJ, Stuart PM. Herpes simplex keratitis: challenges in diagnosis and clinical management. Clin Ophthalmol 2017; 11:185-191. [PMID: 28176902 PMCID: PMC5261835 DOI: 10.2147/opth.s80475] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Herpes simplex virus is responsible for numerous ocular diseases, the most common of which is herpetic stromal keratitis. This is a recurrent infection of the cornea that typically begins with a subclinical infection of the cornea that establishes a latent infection of sensory ganglia, most often the trigeminal ganglia. Recurring infections occur when the virus is reactivated from latency and travels back to the cornea, where it restimulates an inflammatory response. This inflammatory response can lead to decreased corneal sensation, scarring, and blindness. The diagnosis of these lesions as the result of a recurrent herpes simplex virus infection can at times be problematic. Currently, herpetic stromal keratitis is diagnosed by its clinical presentation on the slit-lamp examination, but the literature does not always support the accuracy of these clinical findings. Other diagnostic tests such as polymerase chain reaction assay, enzyme-linked immunosorbent assay, immunofluorescent antibody, and viral cultures have provided more definitive diagnosis, but also have some limitations. That said, accurate diagnosis is necessary for proper treatment, in order to prevent serious consequences. Current treatment reduces the severity of lesions and controls further viral spread, but does not provide a cure.
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Affiliation(s)
| | | | | | - Andrew Jw Huang
- Department of Ophthalmology and Visual Sciences, Washington University, St Louis, MO, USA
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Auchère Lavayssiere C, Lux AL, Degoumois A, Stchepinsky Launay M, Denion E. [Neurotrophic keratitis after vitrectomy and circumferential endophotocoagulation for retinal detachment]. J Fr Ophtalmol 2015; 39:195-201. [PMID: 26679387 DOI: 10.1016/j.jfo.2015.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/29/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Circumferential (360°) endophotocoagulation is frequently implemented during vitrectomies for retinal detachment. This photocoagulation may result in neurotrophic keratitis by damaging the ciliary nerves in the suprachoroidal space on their way to the pupil. We report a series of 4 cases of neurotrophic keratitis following a circumferential endophotocoagulation. PATIENTS AND METHODS A retrospective observational case series of 4 non-diabetic patients having presented with a neurotrophic keratitis following a retinal detachment treated with vitrectomy and circumferential endophotocoagulation (532 nm) at Caen University Hospital. We report the various forms of corneal lesions and the diagnostic criteria allowing for the diagnosis of neurotrophic keratitis. DISCUSSION Neurotrophic keratitis is caused by lesions occurring at various levels of corneal innervation. Endophotocoagulation may cause a neurotrophic keratitis by damaging the short and long ciliary nerves on their way to the pupil in the suprachoroidal space. The sequelae of this condition can limit visual recovery. Hence, it is probably advisable to screen for corneal anesthesia or severe hypesthesia following a retinal detachment treated with vitrectomy and circumferential endophotocoagulation and to implement prophylactic treatment (intensive lubricant therapy; preservative-free eye drops) if needed. CONCLUSION The risk of neurotrophic keratitis should be weighed against the dose of laser retinopexy necessary and sufficient to obtain a sustained retinal reattachment. If circumferential endophotocoagulation is implemented, it is probably sensible to monitor corneal sensitivity and to adapt postoperative treatment if necessary.
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Affiliation(s)
- C Auchère Lavayssiere
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - A-L Lux
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - A Degoumois
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - M Stchepinsky Launay
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - E Denion
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France.
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Abstract
Although microbial culture remains the gold standard for diagnosis of many ocular infections, the technique is limited by low yield, inability to detect certain organisms, and potentially long delays to results. DNA-based molecular diagnostic techniques use detection of specific nucleic acid sequences as evidence for presence of suspected pathogens. The polymerase chain reaction (PCR) is a powerful molecular biology technique that allows for detection of fewer than 10 copies of pathogen genome. Recent technical advances in PCR have permitted quantitation of pathogen load using quantitative PCR (qPCR), and have permitted multiplexing of primer sets. Use of pan-bacterial and pan-fungal primers for ribosomal DNA sequences has allowed diagnosis of bacterial and fungal infections using molecular techniques. In this review, we highlight recent advances in the application of PCR to the diagnosis of anterior segment and posterior segment ocular infectious diseases.
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Could polymerase chain reaction tests on conjunctival swabs be useful to diagnose herpetic keratitis? Enferm Infecc Microbiol Clin 2013; 32:28-30. [PMID: 24060450 DOI: 10.1016/j.eimc.2013.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/12/2013] [Accepted: 07/22/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Diagnosis of HSV-1 keratitis (HK) is frequently based on clinical findings. Invasive specimens (corneal scrapings, biopsies) are required for microbiological diagnosis. METHODS Corneal scrapings and conjunctival swabs were collected on patients with/without clinical suspicion of HK from 2007 to 2012. RESULTS The sensitivity, specificity, positive and negative predictive values for conjunctival swabs by PCR was 77.8, 92.1, 84.4 and 88.3, respectively. DISCUSSION Conjunctival swabs by PCR may help in the diagnosis of HK, despite the limited sensitivity.
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Lee SY, Kim MJ, Kim MK, Wee WR. Comparative analysis of polymerase chain reaction assay for herpes simplex virus 1 detection in tear. KOREAN JOURNAL OF OPHTHALMOLOGY 2013; 27:316-21. [PMID: 24082768 PMCID: PMC3782576 DOI: 10.3341/kjo.2013.27.5.316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 12/21/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose To comparatively analyze the methodological efficacy of the polymerase chain reaction (PCR) assay for herpes simplex virus 1 (HSV) detection in tears. Methods This retrospective study reviewed the medical records of 115 patients who were clinically diagnosed with herpes keratitis, and their tear samples were collected for HSV detection. PCR positive rates were analyzed for their dependence on the PCR primers used (conventional PCR primer vs. nested PCR primer), the tear collecting method used (micropipetting vs. collection with schirmer strip), the disease manifestation and the patient's previous medication history. Results HSV DNA was detected in 23 out of 115 (20%) tear samples. The PCR positive rate in tear samples did not differ depending on the PCR primer or tear collection method used. Typical epithelial lesions showed a higher positive rate (31.4%) than atypical epithelial lesions (10.9%). The previous history of the antiviral agent seemed to affect the PCR positive rate. Conclusions Although the PCR positive rate was not dependent on the tear collection method or primers, HSV detection in tears using PCR was shown to be a supplementary diagnostic test in typical and atypical herpes epithelitis.
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Affiliation(s)
- Seung Yong Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. ; Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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22
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Targeting herpetic keratitis by gene therapy. J Ophthalmol 2012; 2012:594869. [PMID: 23326647 PMCID: PMC3541562 DOI: 10.1155/2012/594869] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 11/30/2012] [Indexed: 01/15/2023] Open
Abstract
Ocular gene therapy is rapidly becoming a reality. By November 2012, approximately 28 clinical trials were approved to assess novel gene therapy agents. Viral infections such as herpetic keratitis caused by herpes simplex virus 1 (HSV-1) can cause serious complications that may lead to blindness. Recurrence of the disease is likely and cornea transplantation, therefore, might not be the ideal therapeutic solution. This paper will focus on the current situation of ocular gene therapy research against herpetic keratitis, including the use of viral and nonviral vectors, routes of delivery of therapeutic genes, new techniques, and key research strategies. Whereas the correction of inherited diseases was the initial goal of the field of gene therapy, here we discuss transgene expression, gene replacement, silencing, or clipping. Gene therapy of herpetic keratitis previously reported in the literature is screened emphasizing candidate gene therapy targets. Commonly adopted strategies are discussed to assess the relative advantages of the protective therapy using antiviral drugs and the common gene therapy against long-term HSV-1 ocular infections signs, inflammation and neovascularization. Successful gene therapy can provide innovative physiological and pharmaceutical solutions against herpetic keratitis.
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Inoue Y, Shimomura Y, Fukuda M, Miyazaki D, Ohashi Y, Sasaki H, Tagawa Y, Shiota H, Inada N, Okamoto S, Araki-Sasaki K, Kimura T, Hatano H, Nakagawa H, Nakamura S, Hirahara A, Tanaka K, Sakuma H. Multicentre clinical study of the herpes simplex virus immunochromatographic assay kit for the diagnosis of herpetic epithelial keratitis. Br J Ophthalmol 2012; 97:1108-12. [DOI: 10.1136/bjophthalmol-2012-302254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reyes-Goddard JM, Barr H, Stone N. Surface enhanced Raman scattering of herpes simplex virus in tear film. Photodiagnosis Photodyn Ther 2008; 5:42-9. [DOI: 10.1016/j.pdpdt.2008.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 11/26/2022]
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25
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Connell PP, O'Reilly J, Coughlan S, Collum LMT, Power WJ. The role of common viral ocular pathogens in Thygeson's superficial punctate keratitis. Br J Ophthalmol 2007; 91:1038-41. [PMID: 17389746 PMCID: PMC1954834 DOI: 10.1136/bjo.2006.104802] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The aetiology of Thygeson's superficial punctate keratitis (TSPK) remains elusive. A viral aetiology has been suggested by the absence of bacterial infection and clinical resemblance to other viral keratopathies. We report the results of polymerase chain reaction analysis for the detection of herpes simplex virus (HSV) 1 and 2, herpes zoster virus, varicella zoster virus (VZV) and adenovirus from corneal epithelial samples from patients with active signs and symptoms of TSPK. METHODS Schirmer strip impressions were taken from the epithelium of eight patients with a known history of TSPK and symptoms and signs of active disease. Three patients were recruited as positive controls (two with herpes simplex keratitis and one with herpes zoster ophthalmicus). Samples from a further three patients acted as negative controls. All 14 samples underwent polymerase chain reaction testing for HSV 1, HSV 2, VZV and adenovirus. RESULTS DNA corresponding to the expected viral DNA was amplified from all three positive control samples. The three negative control samples showed no evidence of viral DNA. Similarly, all samples from patients with TSPK showed no evidence of the presence of HSV 1, HSV 2, VZV or adenovirus. CONCLUSION We conclude that HSV, VZV and adenovirus are not present in the epithelium of patients with TSPK. These results are considered in light of existing theories regarding the aetiology and treatment of this condition.
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Affiliation(s)
- Paul P Connell
- Royal Victoria Eye and Ear Hospital, Adelaide Rd, Ballsbridge, Dublin 4.
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Abstract
PURPOSE OF REVIEW Infectious keratitis is a medical emergency. Improper management can lead to marked loss of vision. This review identifies recent trends in the study of infectious keratitis. RECENT FINDINGS A multicountry outbreak of Fusarium keratitis emphasizes that contact lens wear is a major risk factor for infectious keratitis. Acanthamoeba and fungal keratitis are the most expensive forms of infectious keratitis to treat. Noninvasive methods and molecular techniques have improved diagnosis of infectious keratitis. Fortified topical antibiotics and fluoroquinolones are still the mainstay of bacterial keratitis therapy. Voriconazole and new routes of administration of conventional antifungals appear promising for fungal keratitis. Antivirals and amelioration of host inflammatory response are promising for viral keratitis; the host response is also crucial in pathogenesis of Pseudomonas aeruginosa keratitis. Trauma-induced bacterial and fungal keratitis and contact lens-associated keratitis are preventable entities. SUMMARY Improved modalities of diagnosis and treatment have improved the outcome of infectious keratitis, but therapy of acanthamoebal, fungal and P. aeruginosa keratitis is still a challenge. Effective strategies must neutralize potential risk factors and counter host response overactivity without impairing killing of infecting microorganisms. Trauma-induced bacterial and fungal keratitis can be prevented.
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Ritterband DC. Herpes simplex keratitis: classification, pathogenesis and therapy. EXPERT REVIEW OF OPHTHALMOLOGY 2006. [DOI: 10.1586/17469899.1.2.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Goldschmidt P, Rostane H, Saint-Jean C, Batellier L, Alouch C, Zito E, Bourcier T, Laroche L, Chaumeil C. Effects of topical anaesthetics and fluorescein on the real-time PCR used for the diagnosis of Herpesviruses and Acanthamoeba keratitis. Br J Ophthalmol 2006; 90:1354-6. [PMID: 16899529 PMCID: PMC1857468 DOI: 10.1136/bjo.2006.098830] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The early microbiological diagnosis of corneal infections may prevent the condition from worsening. AIM To study the potential interferences of oxybuprocain and fluorescein solutions used by ophthalmologists on the performances of the real-time polymerase chain reaction (PCR) carried out as routine test for diagnosis of keratitis. METHODS Quantified suspensions of Herpes simplex virus (HSV1), Varicella zoster virus (VZV), Cytomegalovirus (CMV) and Acanthamoeba with and without oxybuprocain or fluorescein added before DNA extraction were tested by real-time PCR. RESULTS The capacities of the real-time PCR to detect HSV, VZV, CMV and Acanthamoeba were reduced by oxybuprocain and fluorescein. Both products diluted to 1/16 reduced the PCR detection capacities for more than 2 logs (DNA copies/sample). CONCLUSIONS The simultaneous introduction of fluorescein or topical anaesthetics into the tubes containing the specimens to be tested by PCR may lead to false negative results. Because corneal specimens for microbiological diagnosis of keratitis are obtained after topical administration of anaesthetics and corneal staining with fluorescein, ophthalmologists should be aware to rinse the eye surface intensively with appropriate eye solutions to minimise the risks of misdiagnosis.
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Affiliation(s)
- P Goldschmidt
- Laboratoire du Centre Hospitalier National d'Ophtalmologie des Quinze Vingts, 28 rue de Charenton, Paris 75012, France.
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