The Experts below are selected from a list of 48003 Experts worldwide ranked by ideXlab platform
James Chodosh - One of the best experts on this subject based on the ideXlab platform.
-
resident corneal c fms macrophages and dendritic cells mediate early cellular infiltration in adenovirus Keratitis
Experimental Eye Research, 2016Co-Authors: Mirja Ramke, Xiaohong Zhou, Emma Materne, Jaya Rajaiya, James ChodoshAbstract:The cornea contains a heterogeneous population of antigen-presenting cells with the capacity to contribute to immune responses. Adenovirus Keratitis is a severe corneal infection with acute and chronic phases. The role of resident corneal antigen-presenting cells in adenovirus Keratitis has not been studied. We utilized transgenic MaFIA mice in which c-fms expressing macrophages and dendritic cells can be induced to undergo apoptosis, in a mouse model of adenovirus Keratitis. Clinical Keratitis and recruitment of myeloperoxidase and CD45+ cells were diminished in c-fms depleted, adenovirus infected mice, as compared to controls, consistent with a role for myeloid-lineage cells in adenovirus Keratitis.
-
photorefractive keratectomy for myopia in the setting of thygeson s superficial punctate Keratitis
Cornea, 2001Co-Authors: Steven W Fite, James ChodoshAbstract:PURPOSE To describe a patient with Thygeson's superficial punctate Keratitis who underwent photorefractive keratectomy for the correction of myopia. METHODS A 49-year-old woman with unilateral Thygeson's Keratitis was examined before and after photorefractive keratectomy. RESULTS A myopic patient underwent photorefractive keratectomy in the left eye and gained 20/20 uncorrected visual acuity. Seventeen months after surgery, symptomatic Thygeson's Keratitis lesions recurred in the peripheral but not the central cornea. CONCLUSION Photorefractive keratectomy reliably corrected myopia in a patient with previous Thygeson's Keratitis. The recurrence of lesions only in the peripheral untreated cornea suggests that the inflammatory signal in Thygeson's Keratitis may reside in the superficial corneal stroma.
Savitri Sharma - One of the best experts on this subject based on the ideXlab platform.
-
comparison between polymicrobial and fungal Keratitis clinical features risk factors and outcome
American Journal of Ophthalmology, 2015Co-Authors: Merle Fernandes, Divya Vira, Tanuja Tanzin, Nagendra Kumar, Savitri SharmaAbstract:Purpose To compare the clinical features, risk factors, and outcome of polymicrobial Keratitis with monomicrobial Keratitis due to fungus. Design Retrospective, comparative interventional case series. Methods Consecutive cases of microbial Keratitis with significant growth of more than 1 organism in culture and culture-proven fungal Keratitis treated with natamycin alone were retrieved from the microbiology department. Complete success was defined as resolution of the infiltrate with scar formation on medical treatment, partial success as resolution following tissue adhesive application, and failure as inadequate response to medical therapy with increasing infiltrate size, corneal melting, and/or perforation necessitating therapeutic penetrating keratoplasty (PKP) or evisceration. Results There were 34 eyes of 34 patients with polymicrobial Keratitis and 60 cases of fungal Keratitis. Compared to patients with fungal Keratitis, patients with polymicrobial Keratitis were significantly older (50.03 ± 9.81 years vs 42.79 ± 12.15 years, P = .0038), with larger infiltrates at presentation (61.8% vs 24.1%, P = .0007), a higher association with endophthalmitis (11.8% vs 0%, P = .03), previous history of corneal graft (20.6% vs 0%, P = .0012), and prior topical corticosteroid use (23.5% vs 5%, P = .019). In the polymicrobial group, a combination of bacteria and fungus was more frequently isolated (23, 67.6%), among which filamentous fungi (25, 39.1%) and coagulase-negative staphylococci (14, 21.9%) comprised a majority. Complete success was significantly lower in the polymicrobial group compared to the fungal Keratitis group (39.3% vs 73.7%, P = .0045). In multivariate logistic regression analysis comparing factors affecting the outcome between the 2 groups, older age ( P = .027) and ulcers larger than 6 mm ( P = .001) at presentation adversely affected outcome. Conclusions Polymicrobial Keratitis with fungus and bacteria was more common and more challenging to treat, with a poorer outcome than fungal Keratitis. Medical treatment may be effective; however, therapeutic PKP provided globe salvage at best. Early PKP may be advocated for larger ulcers at presentation.
-
review of epidemiological features microbiological diagnosis and treatment outcome of microbial Keratitis experience of over a decade
Indian Journal of Ophthalmology, 2009Co-Authors: Usha Gopinathan, Prashant Garg, Savitri Sharma, Gullapalli N RaoAbstract:Purpose : To review the epidemiological characteristics, microbiological profile, and treatment outcome of patients with suspected microbial Keratitis. Materials and Methods : Retrospective analysis of a non-comparative series from the database was done. All the patients presenting with corneal stromal infiltrate underwent standard microbiologic evaluation of their corneal scrapings, and smear and culture-guided antimicrobial therapy. Results : Out of 5897 suspected cases of microbial Keratitis 3563 (60.4%) were culture-proven (bacterial - 1849, 51.9%; fungal - 1360, 38.2%; Acanthamoeba - 86, 2.4%; mixed - 268, 7.5%). Patients with agriculture-based activities were at 1.33 times (CI 1.16-1.51) greater risk of developing microbial Keratitis and patients with ocular trauma were 5.33 times (CI 6.41-6.44) more likely to develop microbial Keratitis. Potassium hydroxide with calcofluor white was most sensitive for detecting fungi (90.6%) and Acanthamoeba (84.0%) in corneal scrapings, however, Gram stain had a low sensitivity of 56.6% in detection of bacteria. Majority of the bacterial infections were caused by Staphylococcus epidermidis (42.3%) and Fusarium species (36.6%) was the leading cause of fungal infections. A significantly larger number of patients (691/1360, 50.8%) with fungal Keratitis required surgical intervention compared to bacterial (799/1849, 43.2%) and Acanthamoeba (15/86, 17.4%) Keratitis. Corneal healed scar was achieved in 75.5%, 64.8%, and 90.0% of patients with bacterial, fungal, and Acanthamoeba Keratitis respectively. Conclusions : While diagnostic and treatment modalities are well in place the final outcome is suboptimal in fungal Keratitis. With more effective treatment available for bacterial and Acanthamoeba Keratitis, the treatment of fungal Keratitis is truly a challenge.
-
Is Microsporidial Keratitis an emerging cause of stromal Keratitis? – a case series study
BMC ophthalmology, 2005Co-Authors: Geeta K. Vemuganti, Prashant Garg, Usha Gopinathan, Savitri Sharma, Joveeta Joseph, Shashi Prakash SinghAbstract:Background Microsporidial Keratitis is a rare cause of stromal Keratitis. We present a series of five cases of microsporidial Keratitis from a single centre in southern India with microbiologic and histopathologic features.
-
evaluation of corneal scraping smear examination methods in the diagnosis of bacterial and fungal Keratitis a survey of eight years of laboratory experience
Cornea, 2002Co-Authors: Savitri Sharma, Usha Gopinathan, Derek Y Kunimoto, Sreedharan Athmanathan, Prashant GargAbstract:Purpose. To determine the sensitivity, specificity, and predictive values of Gram and potassium hydroxide with calcofluor white (KOH+CFW) stains in the diagnosis of early and advanced microbial Keratitis, a retrospective analysis of comparative data from a prospectively collected database was done. Methods. Patients with nonviral microbial Keratitis seen at L.V. Prasad Eye Institute between February 1991 and December 1998 were included in the study. The type of bacteria seen on Gram stain was determined from 251 corneal scrapings from patients with early Keratitis and 841 corneal scrapings from patients with advanced Keratitis. The presence of fungi in corneal scrapings was determined by KOH+CFW stain of 114 and 363 scrapings from patients with early and advanced Keratitis, respectively. The smear findings were compared with culture results to analyze specificity, sensitivity, and predictive values of the staining techniques. Results. The sensitivity of Gram stain in the detection of bacteria was 36.0% in early and 40.9% in advanced Keratitis cases; however, the specificity was higher in both groups (84.9% and 87.1%, respectively). Comparatively, the sensitivity and specificity of fungal detection were higher using KOH+CFW in early (61.1% and 99.0%, respectively) as well as advanced Keratitis (87.7% and 83.7%, respectively). Predictive values were high for KOH+CFW in fungus detection, while they were poor for Gram stain in bacteria detection. In advanced Keratitis cases, the false positives were higher in fungal detection (16.3%) than in bacterial detection (10.3%), while the false negatives were significantly higher in bacterial detection compared with fungal detection (59.1% versus 12.3%, p < 0.0001). In early Keratitis, on the other hand, both false positives and false negatives for bacterial detection were significantly higher than fungal detection. Conclusions. Decisions can reliably be based on KOH+CFW stain of corneal scrapings for initiation of antifungal therapy in mycotic Keratitis. The results of Gram stain, on the other hand, have limited value in therapeutic decisions for bacterial Keratitis. Therefore, the search for a better modality for early and efficient diagnosis of bacterial Keratitis needs to continue.
-
Keratitis
Bioscience Reports, 2001Co-Authors: Savitri SharmaAbstract:Corneal inflammation or Keratitis is a significant cause of ocular morbidity around the world. Fortunately, the majority of the cases are successfully managed with medical therapy, but the failure of therapy does occur, leading to devastating consequences of either losing the vision or the eye. This review attempts to provide current information on most, though not all, aspects of Keratitis. Corneal inflammation may be ulcerative or nonulcerative and may arise because of infectious or noninfectious causes. The nonulcerative corneal inflammation may be confined to the epithelial layer or to the stroma of the cornea or may affect both. For clarity, this section has been divided into nonulcerative superficial Keratitis and nonulcerative stromal Keratitis. While the former usually includes hypersensitivity responses to microbial toxins and unknown agents, the latter can be either infectious or noninfectious. In the pathogenesis of ulcerative Keratitis, microorganisms such as bacteria, fungi, parasites (Acanthamoeba), or viruses play an important role. Approximately, 12.2% of all corneal transplantations are done for active infectious Keratitis. Available world literature pertaining to the incidence of microbial Keratitis has been provided special place in this review. On the other hand, noninfectious ulcerative Keratitis can be related to a variety of systemic or local causes, predominantly of autoimmune origin.
Peter R. Laibson - One of the best experts on this subject based on the ideXlab platform.
-
Recognition and treatment of herpes simplex Keratitis
Acta Ophthalmologica, 2008Co-Authors: Peter R. LaibsonAbstract:Although the incidence of ocular herpes simplex virus infection has not diminished in recent years, we are encountering fewer severe problems such as necrotizing stromal Keratitis and diffuse disciform Keratitis which may necessitate penetrating keratoplasty. The earlier recognition of herpes simplex viral Keratitis and the better management utilizing oral antivirals and topical corticosteroids is probably responsible for this improved outlook of herpes simplex Keratitis. Early recognition and management of acute and chronic herpetic Keratitis, as well as the management of keratoplasty for herpes will be reviewed.
-
Risk factors for herpes simplex virus epithelial Keratitis recurring during treatment of stromal Keratitis or iridocyclitis. Herpetic Eye Disease Study Group.
British Journal of Ophthalmology, 1996Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Diane Jones, Joel Sugar, Bruce A. Barron, Peter Bacchetti, Herbert E. Kaufman, Robert A. Hyndiuk, Peter R. LaibsonAbstract:AIMS: Possible risk factors were evaluated for herpes simplex virus (HSV) epithelial Keratitis in patients with stromal keratouveitis. METHODS: The study population included 260 patients who had active stromal Keratitis and/or iridocyclitis without epithelial disease and who were enrolled in one of three clinical trials of the Herpetic Eye Disease Study. Study treatment involved a 10 week course of topical placebo, topical prednisolone phosphate, or topical prednisolone phosphate with oral acyclovir. All groups received topical trifluridine four times daily for 3 weeks then twice daily for another 7 weeks. Patients were examined for HSV epithelial Keratitis for 16 weeks. RESULTS: Dendritic or geographic epithelial Keratitis occurred in 12 (4.6%) study patients. Adverse effects attributable to trifluridine prophylaxis were acute allergic blepharoconjunctivitis in 10 (3.8%) study patients and corneal epithelial erosions in 11 (4.2%) study patients. No significant difference in the occurrence of HSV epithelial Keratitis was found among the study treatment groups: one (2.0%) of 49 topical placebo treated patients, nine (6.5%) of 138 patients treated with topical corticosteroids without acyclovir, and two (2.7%) of 73 patients treated with topical corticosteroids and oral acyclovir. Univariate exponential models suggested that patients with a history of previous HSV epithelial Keratitis and non-white patients were more likely to develop HSV epithelial Keratitis during treatment of stromal keratouveitis. CONCLUSION: Individuals with prior HSV epithelial Keratitis and certain ethnic groups may have a higher rate of recurrent epithelial Keratitis during the acute treatment of HSV stromal keratouveitis.
Kirk R. Wilhelmus - One of the best experts on this subject based on the ideXlab platform.
-
The Clinical Diagnosis of Microbial Keratitis
American journal of ophthalmology, 2007Co-Authors: Matthew A. Dahlgren, Ahila Lingappan, Kirk R. WilhelmusAbstract:Purpose To evaluate the ability of ophthalmologists to predict the laboratory results of presumed microbial Keratitis and to explore which findings may influence diagnostic prognostication. Design Prospective, cross-sectional study. Methods Fifteen ophthalmologists completed study forms at the initial presentation of patients with presumed microbial Keratitis. After predicting the category of microbial recovery, clinicians submitted corneal scrapings for masked laboratory processing. The relative effects of ocular inflammatory signs on correct microbial diagnosis were explored with Poisson regression. Results Clinical examiners correctly predicted the presence or absence of microbial recovery in 79 (76%) of 104 ulcerative Keratitis cases and successfully distinguished among bacterial, fungal, and amebic Keratitis for 54 (73%) of 74 culture-positive infections, although only 31 (42%) were subcategorized properly. The positive predictive value of clinical diagnosis was 65% (95% confidence interval [CI], 43% to 84%) for 20 eyes with Pseudomonas Keratitis cases, 48% (95% CI, 32% to 63%) for 38 other bacterial Keratitis, 45% (95% CI, 17% to 77%) for 13 fungal Keratitis, and 89% (95% CI, 52% to 100%) for nine Acanthamoeba Keratitis cases. The recognition of Pseudomonas Keratitis significantly improved by the occurrence of a larger infiltrate ( P = .02), and correctly predicting Acanthamoeba Keratitis was enhanced by observing a ring infiltrate ( P P = .03) and hampered microbial recovery ( P = .004). Conclusions Established Pseudomonas Keratitis and Acanthamoeba Keratitis can be suspected before laboratory confirmation, but overlapping inflammatory features and recent empiric antimicrobial treatment limits etiologic recognition of most microbial corneal infections.
-
Herpes simplex virus Keratitis in children.
American journal of ophthalmology, 2004Co-Authors: Eva-marie Chong, Alice Y. Matoba, Kirk R. Wilhelmus, Daniel B. Jones, David K. Coats, Evelyn A. PaysseAbstract:Abstract Purpose To describe the spectrum and recurrence of herpes simplex virus (HSV) Keratitis in children and adolescents. Design Retrospective cohort study. Methods Twenty-three patients younger than age 16 years were diagnosed with HSV Keratitis at one institution. Results All children presented with dendritic or punctate epithelial Keratitis, and stromal Keratitis occurred concurrently with epithelial Keratitis in 14 patients (61%). Six patients (26%) had bilateral HSV Keratitis. Eleven patients (48%) developed recurrent HSV Keratitis at a median of 15 months after the first documented episode. Amblyopia occurred in three children. Conclusion Children with herpetic Keratitis may have bilateral ocular involvement and are at risk for recurrent Keratitis and amblyopia.
-
Risk factors for herpes simplex virus epithelial Keratitis recurring during treatment of stromal Keratitis or iridocyclitis. Herpetic Eye Disease Study Group.
British Journal of Ophthalmology, 1996Co-Authors: Kirk R. Wilhelmus, Chandler R. Dawson, Diane Jones, Joel Sugar, Bruce A. Barron, Peter Bacchetti, Herbert E. Kaufman, Robert A. Hyndiuk, Peter R. LaibsonAbstract:AIMS: Possible risk factors were evaluated for herpes simplex virus (HSV) epithelial Keratitis in patients with stromal keratouveitis. METHODS: The study population included 260 patients who had active stromal Keratitis and/or iridocyclitis without epithelial disease and who were enrolled in one of three clinical trials of the Herpetic Eye Disease Study. Study treatment involved a 10 week course of topical placebo, topical prednisolone phosphate, or topical prednisolone phosphate with oral acyclovir. All groups received topical trifluridine four times daily for 3 weeks then twice daily for another 7 weeks. Patients were examined for HSV epithelial Keratitis for 16 weeks. RESULTS: Dendritic or geographic epithelial Keratitis occurred in 12 (4.6%) study patients. Adverse effects attributable to trifluridine prophylaxis were acute allergic blepharoconjunctivitis in 10 (3.8%) study patients and corneal epithelial erosions in 11 (4.2%) study patients. No significant difference in the occurrence of HSV epithelial Keratitis was found among the study treatment groups: one (2.0%) of 49 topical placebo treated patients, nine (6.5%) of 138 patients treated with topical corticosteroids without acyclovir, and two (2.7%) of 73 patients treated with topical corticosteroids and oral acyclovir. Univariate exponential models suggested that patients with a history of previous HSV epithelial Keratitis and non-white patients were more likely to develop HSV epithelial Keratitis during treatment of stromal keratouveitis. CONCLUSION: Individuals with prior HSV epithelial Keratitis and certain ethnic groups may have a higher rate of recurrent epithelial Keratitis during the acute treatment of HSV stromal keratouveitis.
David Hui-kang - One of the best experts on this subject based on the ideXlab platform.
-
Clinical characteristics of alternaria Keratitis.
Journal of ophthalmology, 2014Co-Authors: Ching-hsi Hsiao, Lung-kun Yeh, David Hui-kang, Hung-chi Chen, Hsin-chiung Lin, Phil Y. F. Chen, Hsin-yuan TanAbstract:Purpose. Alternaria spp. are an uncommon cause of mycotic Keratitis. Previous studies on Alternaria Keratitis have generally been limited to case reports. We examined the clinical characteristics of Alternaria Keratitis in this study. Methods. The characteristics and outcomes of 7 patients with culture-proven Alternaria Keratitis treated in our hospital were compared with 25 previously reported cases. Results. The risk factors for Alternaria Keratitis were trauma in 5 patients and soft contact lenses in 1 patient. Six patients with early diagnosis (
-
Pediatric herpes simplex virus Keratitis.
Cornea, 2009Co-Authors: Ching-hsi Hsiao, L. Yeung, Lung-kun Yeh, Ling-yu Kao, Hsin-yuan Tan, Nan-kai Wang, Ken-kuo Lin, David Hui-kangAbstract:Purpose To report the clinical characteristics and visual outcomes of pediatric herpes simplex virus (HSV) Keratitis. Methods The medical records of 29 patients younger than 16 years with HSV Keratitis who were diagnosed and treated at Chang Gung Memorial Hospital, Taoyuan, Taiwan, between 1996 and 2004 were retrospectively reviewed. The diagnosis of HSV Keratitis was proven by a positive viral culture and/or real-time quantitative polymerase chain reaction or by a clear history of dendritic Keratitis or herpetic kerato-uveitis. Type of HSV Keratitis, recurrence rate, and visual outcome were analyzed. Results The average age at the entry into the study was 5.7 years (range: 7 months to 15 years). Mean follow-up time was 35.3 months (range: 2-69 months). Epithelial Keratitis including dendritic and geographic ulcers was noted in 14 eyes, stromal Keratitis in 2 eyes, stromal Keratitis concurrent with epithelial Keratitis in 8 eyes, and endotheliitis in 6 eyes. One patient had sequential involvement of both eyes. Thirteen patients (45%) developed recurrent HSV Keratitis after the first documented episode. Female gender (but not age or the type of Keratitis) was significantly associated with recurrences. Five patients who were maintained on oral valacyclovir prophylaxis up to 1 year had no recurrence during the period. Fifteen of 21 patients younger than 8 years of age had best-corrected visual acuity available at last follow-up, and 10 patients developed amblyopia. Conclusions Children with HSV Keratitis are at risk for recurrent Keratitis and amblyopia. Prolonged systemic antiviral prophylaxis may help to prevent such consequences.
