OBJECTIVE

Despite being a preventable and treatable condition, central microbial keratitis (CMK) and its complications remain to be a significant cause of vision loss in our country. This study presents the demographic profile, risk factors, etiologies, treatments, and outcomes of CMK in the Philippines.

The study was a two-center, prospective, non-randomized clinical study involving the patients of the External Disease and Cornea Clinics of two tertiary eye referral centers in the Philippines. It was conducted as the Philippine leg of the Asia Cornea Society Infectious Keratitis Study (ASCIKS).1 Patients with a clinical diagnosis of CMK rendered by a cornea specialist, and who signed the consent form, were recruited into the study. They underwent uniform sample collection and culture techniques as described in the ACSIKS. All patients were followed-up for 6 months. Data collected included demographics, risk factors, culture results, management, and treatment outcomes. Descriptive statistics and frequency were used to analyze the data.

A total of 348 patients diagnosed with CMK were included. Trauma (65.5%) among the middle-aged (42.9 ± 17.9 years) male population was the most significant risk factor for development of CMK, followed by contact lens wear (12.9%), prior ocular surgery (6.0%), and ocular surface diseases (3.4%). Bacterial keratitis (53.2%) was still the most common etiology of CMK, followed by fungal keratitis (27.0%), Acanthamoeba keratitis (5.7%), and viral keratitis (2.0%). Aspergillus species (18.3%) were the most common microbial isolates. Pseudomonas species (13.9%) were the most common bacterial isolates. The median time from onset of symptoms to consultation with the study centers was 2 weeks. Medical treatment was enough to treat the infection in 34.8% of cases. Surgical intervention was necessitated in 22.6% with evisceration/enucleation done in 1 out of 3 patients who had surgery.

Bacterial infection remains the most common cause of CMK in the Philippines, followed by fungal infection. Significant risk factors include trauma and contact lens wear. Aspergillus species and Pseudomonas species were the most common fungal and bacterial isolates, respectively. Despite medical treatment, almost a quarter of the cases still required surgical intervention.

OBJECTIVES

Acanthamoeba spp. are free-living amoebae commonly found in aquatic environments, with pathogenic genotypes capable of causing severe diseases such as acanthamoeba keratitis and granulomatous amoebic encephalitis. Environmental factors, particularly pH, influence their survival and distribution. Tadlac Lake located at Los Baños, Laguna, Philippines is a Class C freshwater body used for aquaculture, recreation, and irrigation. To date, no study has specifically assessed Acanthamoeba colonization in Tadlac Lake.

In this study, detection of the presence of Acanthamoeba spp. and evaluation of pH as a potential factor influencing their persistence in Tadlac Lake was conducted. One-time sampling was conducted from nine sites of the lake. Surface water samples were collected at a depth of 10–20 cm, filtered through 1.2 μm glass microfiber filters, and cultured on non-nutrient agar plates lawned with live Escherichia coli. Plates were incubated at 30°C for 14 days and examined daily under light microscopy, while pH was measured in situ.

Cyst-like structures resembling amoebae were observed, but these did not exhibit definitive Acanthamoeba morphology under light microscopy. No Acanthamoeba spp. were confirmed and the recorded pH levels ranged from 8.72 to 10.51, exceeding the optimal growth range (7.0–9.0) reported for the organism.

Findings of this study suggest alkaline conditions may have inhibited the proliferation and persistence of Acanthamoeba spp. in the lake. These findings highlight pH as a potential limiting factor for Acanthamoeba survival in alkaline freshwater bodies and underscore the importance of integrating physicochemical monitoring into pathogen surveillance frameworks.

Aspergillus fumigatus ; Cytokines ; Humans ; Interleukin-1beta ; Keratitis ; Receptors, IgE ; Tumor Necrosis Factor-alpha ; Tumor Necrosis Factors

Acanthamoeba Keratitis/epidemiology* ; Hospitals ; Humans ; Referral and Consultation ; Retrospective Studies ; Singapore/epidemiology*

OBJECTIVE: To investigate the clinical characteristics, risk factors and prognosis of ulcerative keratitis (UK) in patients with rheumatoid arthritis (RA). METHODS: Sixteen patients with UK (the UK group) were screened among 4 773 RA patients hospitalized at Peking University People's Hospital from January 2003 to May 2021, and 72 patients with RA without UK in the control group were selected by propensity score matching (PSM). The clinical features, laboratory data and medications between the two groups were collected and analyzed. RESULTS: The average age of the patients with RA was 60 years at the time of the complication of UK. UK appeared on average in the 16th year of RA, with the majority of UK occurring in the 7th year of RA and beyond (14 cases), however, a minority of UK was the first symptom of RA (1 case). UK associated with RA manifested as simple marginal UK in 8 cases, marginal UK with perforation in 5 cases, marginal UK with uveitis in 2 cases and central UK with perforation in 1 case. The number of swollen joints was significantly higher in the UK group than in the control group [6.0(2.5, 23.0) vs. 3.0(1.0, 9.8), Z=-2.047, P=0.041], and the proportion of secondary Sjögren syndrome (SS, 37.5% vs. 6.9%, χ²=11.175, P=0.004) and interstitial lung disease (ILD, 37.5% vs. 8.3%, χ²=9.456, P=0.008) were significantly higher in the RA patients with UK than the patients without UK. The uses of sulfasalazine (12.5% vs. 48.6%, χ²=7.006, P=0.008), leflunomide (31.3% vs. 63.9%, χ²=5.723, P=0.017) and gold salt(6.3% vs. 33.8%, χ²=4.841, P=0.032)were significantly lower in the UK group than in the control group. However, there was no statistically significant comparison between the two groups for the 28-joint disease activity score-erythrocyte sedimentation rate (5.3±1.8 vs. 5.1±1.6, t=0.309, P=0.761). Logistic analysis showed the number of swollen joints (OR=1.148), secondary SS (OR=79.118), complicated with ILD (OR=6.596) and the use of sulfasalazine (OR=0.037) were independent relevant factors (P < 0.05) for UK in RA patients. CONCLUSION The number of swollen joints, secondary SS, complicated with ILD and the use of sulfasalazine are independent relevant factors for UK in patients with RA.
Arthritis, Rheumatoid/epidemiology* ; Corneal Ulcer/etiology* ; Humans ; Middle Aged ; Minority Groups ; Risk Factors

PURPOSE: To evaluate clinical findings in phlyctenular keratoconjunctivitis patients and assess the function and morphology of Meibomian glands using an interferometer (LipiView®, TearScience, Morrisville, NC, USA) in such patients.METHODS: This retrospective study included 19 eyes of 13 patients diagnosed with phlyctenular keratoconjunctivitis. The lipid layer thickness (LLT) and meibograph of each eye was quantified by tear interferometry. Tear film break-up time (TBUT) and corneal staining score were measured. Meibomian gland morphology (lid margin vascularity, plugging of gland orifices, lid margin irregularity, lid margin thickening, and partial glands) was evaluated based on anterior photographs and meibographs.RESULTS: The mean age was 21.3 years (8–44 years). Mean BUT and Oxford corneal staining scores were 2.6 ± 1.2 seconds and 1.9 ± 0.8, respectively. Abnormal findings of the Meibomian glands were observed in all patients. The mean LLT was 79.6 ± 27.4 µm and the incomplete eye blinking frequency was 3.8 ± 5.9 during 20 seconds. The graphs of the tear lipid layer showed various patterns such as flat, up-hill, down-hill, and mixed.CONCLUSIONS: Meibomian gland dysfunctions and changes in the tear film lipid layer were noted in patients with phlyctenular keratoconjunctivitis. These factors are to be considered for the treatment of phlyctenular keratoconjunctivitis in young patients under 10 years of age.
Blinking ; Humans ; Interferometry ; Keratoconjunctivitis ; Meibomian Glands ; Retrospective Studies ; Tears

PURPOSE: To report a case of corneal collagen cross-linking for corneal ulcer caused by the Moraxella group.CASE SUMMARY: A 77-year-old male had decreased visual acuity for several days in his right eye. The patient showed severe stromal ring infiltrates with a corneal epithelial defect measuring (5.0 × 7.0 mm), a corneal endothelial plaque, and a hypopyon measuring less than 1.0 mm in height in the anterior chamber of the right eye. There was no abnormal finding in the right eye using B-scan ultrasonography. Before starting treatment, a corneal culture was conducted. The culture tests showed the presence of the Moraxella group. Because the patient was diagnosed with a corneal ulcer caused by the Moraxella group, corneal collagen cross-linking (CXL) was performed. The antimicrobial susceptibility test confirmed that this Moraxella group was sensitive to ceftazidime, so the patient was treated with 5% ceftazidime eye drops and 0.5% moxifloxacin eye drops every 2 hours for 9 months after corneal collagen CXL. The uncorrected visual acuity was 0.1 in the right eye, and there was almost no corneal stromal melting on anterior segment optical coherence tomography.CONCLUSIONS: This is the first known case of a corneal ulcer, in the Republic of Korea, caused by the Moraxella group and treated with corneal collagen CXL. Corneal collagen CXL should be considered as a surgical treatment for patients who have an impending corneal perforation due to a corneal ulcer because it is a simple procedure and causes fewer serious complications than other treatments.
Aged ; Anterior Chamber ; Ceftazidime ; Collagen ; Cornea ; Corneal Perforation ; Corneal Ulcer ; Freezing ; Humans ; Male ; Moraxella ; Ophthalmic Solutions ; Republic of Korea ; Tomography, Optical Coherence ; Ultrasonography ; Visual Acuity

Keratoplasty, which is cornea transplant surgery, is one of the treatment methods for patients with turbidity or keratitis. Recently, keratoplasty using a surgical robot was studied to increase precision. In this study, the effect of surgical factors on the deformation and curvature of the cornea were analyzed in order to improve the accuracy of keratoplasty and derive the optimal surgical factors using finite element method (FEM). Suturing tension and depth were selected as surgical factors. An FEM model, a constitutive equation, and boundary conditions were determined using experiments and reference data. Suturing tension significantly impacted deformation and curvature change, and suturing depth affected the position of the thread-cornea contact point. Both factors have a significant impact on a focal point in the retina and the patient's visual acuity after keratoplasty.
Cornea ; Corneal Transplantation ; Finite Element Analysis ; Humans ; Keratitis ; Methods ; Retina ; Visual Acuity

No abstract available.
Keratitis

PURPOSE: To report a case of a Corynebacterium macginleyi-infected corneal ulcer of a patient who had been treated for conjunctivitis for more than 3 months. CASE SUMMARY: A 72-year-old female was transferred from a private ophthalmic clinic for evaluation of herpetic keratitis with progressive corneal edema and infiltration in the left eye. She had a history of conjunctival hyperemia and eyeball pain in her left eye 3 months prior to her visit. She was treated with levofloxacin eye drops and acyclovir ointment (Herpesid®, Samil, Co., Ltd. Seoul, Korea). On slit lamp examination, 5.4 × 4.0 mm corneal epithelial defects and stromal infiltrations were observed in the upper to central cornea, and endothelial keratic precipitates were found. Gram positive bacteria were detected on Gram staining and Corynebacterium macginleyi was identified on bacterial cultures from the conjunctiva and cornea. She was treated with topical vancomycin eye drops. After 3 months of treatment, the corneal ulcer was completely resolved, leaving mild superficial opacity on the cornea. CONCLUSIONS: While Corynebacterium macginleyi, normal flora of the conjunctiva, is considered a major causative agent for conjunctivitis and blepharitis, Corynebacterium macginleyi should also be considered a possible cause of slowly progressive keratitis in patients with chronic conjunctivitis.
Acyclovir ; Aged ; Blepharitis ; Conjunctiva ; Conjunctivitis ; Cornea ; Corneal Edema ; Corneal Ulcer ; Corynebacterium ; Female ; Gram-Positive Bacteria ; Humans ; Hyperemia ; Keratitis ; Keratitis, Herpetic ; Levofloxacin ; Ophthalmic Solutions ; Seoul ; Slit Lamp ; Vancomycin