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ABSTRACT: To describe the case of a 74-year-old man who developed cytomegalovirus (CMV) retinitis after multiple ocular surgeries.
Observational case report.
A 74-year-old man who had a history of multiple ocular surgeries developed unilateral retinitis with whitening of the entire peripheral retina. A presumptive diagnosis of viral retinitis was considered, and polymerase chain reaction of the aqueous fluid was positive for CMV DNA. Laboratory examination revealed that the patient was completely immunocompetent. Moreover, the patient did not have any subtenon or intravitreal injection of triamcinolone acetonide (TA). The patient responded well to intravenous ganciclovir and oral valganciclovir.
CMV retinitis can occur to immunocompetent patients without local immunosuppression with TA injection.
Case reports in ophthalmology. 09/2012; 3(3):356-9.
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ABSTRACT: To investigate the relation between visual function, clinical findings, and visual symptoms in Stevens-Johnson syndrome (SJS) and to compare the results with Sjögren syndrome (SS) patients and normal subjects.
Cross-sectional comparative study.
One hundred fifteen eyes of 59 consecutive patients with SJS and toxic epidermal necrolysis (TEN), 208 eyes of 104 healthy normal subjects, and 132 eyes of 66 SS patients were investigated in this multicenter study. All study subjects underwent tear function and ocular surface examinations, Landolt and functional visual acuity examinations, and the Japanese version of the NEI VFQ-25 (National Eye Institute Visual Function Questionnaire).
The mean ocular surface grading scores were significantly higher and the mean score of all 12 NEI VFQ subscales was significantly lower in the SJS patients compared to the SS patients and the normal subjects (P < .05). The conventional and functional logarithm of minimal angle of resolution (logMAR) visual acuities in SJS patients with minimal corneal complications were significantly higher and the mean total composite NEI VFQ scores were lower compared to SS patients. The conventional and functional logMAR visual acuities and the mean ocular surface grading scores in SJS with aqueous deficiency were significantly higher and the mean total composite NEI VFQ scores were lower compared to SS patients. Strong correlations between best-corrected logMAR functional visual acuities and either ocular surface grading scores or the composite NEI VFQ-25 scores were observed.
The functional visual acuity examination reflects the severity of clinical ocular surface findings and vision-related quality of life more than the standard conventional visual acuity in SJS.
American journal of ophthalmology 07/2012; 154(3):499-511.e1. · 3.83 Impact Factor
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ABSTRACT: To study the roles played by stem cell factor (SCF) and SCF receptor c-kit in wound healing of corneal epithelial cells.
A 2 mm corneal epithelial wound was made in control (WBB6F1(+/+)), SCF (Sl/Sl(d))-, and c-kit (W/W(v)) mutant mice, and the speed of wound healing, 5-bromo-2'-deoxyuridine (BrdU) incorporation, and scanning electron microscopic (SEM) morphology of the corneas were examined. The incorporation of BrdU and the degree of cell attachment in cultured mouse corneal epithelial cells (MCECs) isolated from WBB6F1(+/+), Sl/Sl(d), and W/W(v) mice were examined. Cultured immortalized human corneal epithelial cells (HCECs) were examined by a cell attachment assay after their exposure to anti-SCF antibodies, tyrosine kinase inhibitor (genistein), and competitive Arg-Gly-Asp (RGD) peptide, as well as on cultures treated with extracellular matrix.
The speed of corneal wound healing was slower in Sl/Sl(d) and W/W(v) mice than in controls (p<0.01) and the speed of healing in Sl/Sl(d) mice recovered after topical application of SCF (8 ng/ml). No significant difference was found in the BrdU incorporation assay either in vivo or in vitro. Loosened epithelial cells were detected at wound margins in W/W(v) mice by SEM. The cell attachment rate was increased by 157% in cells from WBB6F1(+/+) and 252% in Sl/Sl(d) MCECs by recombinant mouse SCF; however, no significant difference was found in W/W(v) MCECs. Anti-SCF antibodies (Ab), genistein, and RGD peptide reduced the percentage of attached HCECs. Anti-SCF Ab inhibited the attachment of HCECs on fibronectin, laminin, or type IV collagen coated dishes.
These findings indicate that the SCF/c-kit system may play a role in corneal wound healing through epithelial cell attachment.
Molecular vision 01/2012; 18:1505-15. · 2.20 Impact Factor
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Clinical and Experimental Ophthalmology 09/2011; 39(7):710-2. · 1.98 Impact Factor
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Atsushi Shiraishi,
Kaoru Araki-Sasaki,
Arisa Mitani,
Hitoshi Miyamoto,
Atsuko Sunada,
Akiko Ueda,
Seishi Asari,
Xiaodong Zheng,
Yasuaki Yamamoto, Yuko Hara,
Yuichi Ohashi
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ABSTRACT: To determine the characteristics of the keratitis due to Colletotrichum gloeosporioides.
The medical records of 3 cases of fungal keratitis caused by C. gloeosporioides were reviewed to determine the clinical characteristics. The minimal inhibitory concentrations of different antifungal drugs for all 3 isolates were determined. All 3 isolates were grown on Sabouraud dextrose agar at 25°C, 35°C, and 37°C to determine the temperature-sensitive growth.
All 3 patients lived in the southwestern part of Japan and had an ocular trauma involving organic materials. The infectious foci were localized in the anterior stroma, and they did not extend deep into the stroma in all cases. The keratitis was treated with antifungal medications including topical voriconazole and natamycin eye ointment, and was resolved in 2-3 weeks. All of the isolated strains grew well at 25°C but poorly at 35°C and 37°C. All isolated strains had similar drug-sensitivity profiles; they were sensitive to amphotericin B, itraconazole, miconazole, micafungin, and voriconazole, and relatively resistant to flucytosine, fluconazole, and natamycin.
All 3 cases of C. gloeosporioides keratitis had similar clinical features. The similarities in the drug-sensitivity profiles should be helpful in treating C. gloeosporioides keratitis.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 07/2011; 27(5):487-91. · 1.46 Impact Factor
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ABSTRACT: To report a case of necrotizing nocardial scleritis treated with surgical debridement and topical polyvinyl alcohol iodine (PAI) and antibiotics.
A 78-year-old man underwent phacoemulsification with intraocular lens implantation in the left eye. He had an uncomplicated postoperative course for 2 months but then developed infectious scleritis. The patient received intensive antibiotics treatments; however, the lesion did not respond. Because of the poor response, Nocardia infection was suspected, and the lesion was repeatedly scraped and the patient was treated with systemic trimethoprim/sulfamethoxazole (TMP-SMX, 800 mg/day) and topical PAI (0.033%, 4 times/day). Cultures of the scrapings grew Nocardia. The treatment led to a complete resolution of the infection.
Necrotizing nocardial scleritis can be treated by surgical debridement and systemic TMP-SMX and topical PAI.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 06/2011; 27(4):415-8. · 1.46 Impact Factor
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ABSTRACT: To investigate the sustained effects of sodium hyaluronate solution (HA) on tear film stability using a Tear Stability Analysis System (TSAS), a method enabling quantitative evaluation of tear film stability.
Eighteen eyes of 18 normal subjects (N group) and 21 eyes of 21 dry eye patients (D group) were examined. Dry eye was diagnosed by the 2006 diagnostic criteria. In each subject, artificial tears (AT), 0.1% sodium hyaluronate solution (H 01) or 0.3% sodium hyaluronate solution (H 03) were instilled into both eyes, and tear film stability in the right eye before and 1, 5, 15, 30, 60 and 120 minutes after instillation was compared using a break up index (BUI: 0-100), the TSAS's index of tear film stability.
N group: In both the AT and H 01 subgroups, no significant change was found in the BUI ratios (BUI after instillation/before instillation) at any point during the 120 minute period after instillation. However, in the H 03 subgroup, the BUI ratio temporarily decreased to 0.650 one minute after H 03 instillation (p = 0.0038). D group: In the AT subgroup, the BUI ratio significantly increased to 1.568 five minutes after AT instillation (p = 0.0259), but began to decrease 15 minutes after instillation and returned to the initial value 30 minutes after instillation. In the H 01 subgroup, the BUI ratio significantly increased to 1.531 five minutes after H 01 instillation (p = 0.0087), and was maintained at 1.347 120 minutes after instillation (p = 0.0088). In the H 03 subgroup, the BUI ratio rose to 1.544 15 minutes after H 03 instillation (p = 0.0009), and was maintained at high levels of 1.413 30 minutes after (p = 0.0122), 1.629 60 minutes after (p = 0.0008), and 1.407 120 minutes after instillation (p = 0.0008).
The current study confirms that both 0.1 and 0.3% sodium hyaluronate solution effectively improve tear film stability in dry eyes for up to two hours after instillation.
Nippon Ganka Gakkai zasshi 02/2011; 115(2):134-41.
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ABSTRACT: To determine the effectiveness of laser confocal microscopy in detecting filamentous fungi in the cornea of patients with fungal keratitis (FK) and in evaluating the effectiveness of the treatment.
The corneas of 6 patients clinically diagnosed with FK were examined with the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRT II-RCM). Three of these patients were also monitored periodically with the HRT II-RCM after antifungal treatment.
The HRT II-RCM examination showed interlocking and branching, white, septated, hyphae-like lines in the cornea of all patients. All 6 patients had positive corneal smears and/or laboratory cultures. Three patients were monitored with HRT II-RCM after antifungal treatment. One patient, whose initial smear was negative, was diagnosed by HRT II-RCM before the positive culture results. In another case, the epithelial regeneration was impaired even 3 weeks after the initial treatment and HRT II-RCM revealed a mass of hyphae in the corneal ulcerated lesion. These findings indicated the necessity of surgical debridement. After the surgical debridement, the corneal epithelial defect was healed. HRT II-RCM was able to detect the morphological changes of hyphae after antifungal treatment and helped in the treatment modifications during the clinical course in all 3 patients.
These results indicate that HRT II-RCM can be used to diagnose FK and to monitor the effect of therapy on FK.
Cornea 12/2010; 29(12):1346-52. · 1.73 Impact Factor
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ABSTRACT: To determine the effectiveness of laser confocal microscopy in identifying Acanthamoeba cysts and trophozoites in the cornea of patients with Acanthamoeba keratitis (AK) and to evaluate its effectiveness in following AK after treatment.
The corneas of 9 patients clinically diagnosed with AK were monitored periodically with the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRT II-RCM) to examine for Acanthamoeba cysts and trophozoites during the clinical course.
Seven of 9 patients had positive corneal smears, and 5 of 9 patients had positive laboratory cultures. HRT II-RCM demonstrated the presence of highly reflective polygonal shadows with lower reflective borders in the cornea of all patients. In 1 patient, a highly reflective pleomorphic shadow with small less-reflective areas was detected inside the cell. The former finding resembled the image of Acanthamoeba cysts in culture as observed by HRT II-RCM, and the latter observation with that of Acanthamoeba trophozoites in culture. After treatment, the number of highly reflective inflammatory cells decreased and the number and morphology of the corneal epithelial cells with highly reflective nuclei recovered to normal levels.
These results indicate that in vivo laser confocal microscopy can be a useful method to make a diagnosis and to follow patients with AK.
Cornea 08/2010; 29(8):861-5. · 1.73 Impact Factor
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ABSTRACT: To report a case of fungal keratitis caused by Colletotrichum gloeosporioides, which is a rare pathogen in humans.
An 80-year-old woman developed fungal keratitis after having sustained a traumatic injury during field work. The patient was initially examined by slit-lamp biomicroscopy and the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRT II-RCM). Corneal scrapings were collected and submitted for laboratory investigations.
Many septate, hyphae-like interlocking and branching white lines were observed in the area of the infiltrate by HRT II-RCM. A tentative diagnosis of fungal keratitis was made, and the patient was treated with systemic and topical voriconazole and pimaricin ophthalmic ointment. The infectious focus resolved within 2 weeks, and there were no signs of a recurrence after 3 months of treatment with the antifungal agents. The culture of the corneal scraping grew C. gloeosporioides.
HRT II-RCM was useful in detecting filamentous fungi in the cornea. The treatment with voriconazole and pimaricin was effective in the treatment of C. gloeosporioides keratitis.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 12/2009; 25(6):563-5. · 1.46 Impact Factor
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ABSTRACT: The toll-like receptor 3 (TLR3) recognizes viral double-stranded RNA and its synthetic analog polyriboinosinic-polyribocytidylic acid (poly(I:C)), and the activation of TLR3 is known to induce the production of type I interferon (IFN) and inflammatory cytokines/chemokines. The purpose of this study was to determine the role played by innate responses to a herpes simplex virus 1 (HSV-1) infection of the corneal epithelial cells. In addition, we determined the effects of immunosuppressive drugs on the innate responses.
Cultured human corneal epithelial cells (HCECs) were exposed to poly(I:C), and the expressions of the mRNAs of the cytokines/chemokines macrophage-inflammatory protein 1 alpha (MIP1-alpha), macrophage-inflammatory protein 1 beta (MIP1-beta), interleukin-6 (IL-6), interleukin-8 (IL-8), regulated on activation, normal T cell expressed and secreted (RANTES), Interferon-beta (IFN-beta), and TLR3 were determined using real-time reverse transcription-polymerase chain reaction (RT-PCR). The effects of dexamethasone (DEX, 10(-6) or 10(-5) M) and cyclosporine A (CsA, 10(-6) or 10(-5) M) on the expression of these cytokines and TLR3 were also determined using real-time RT-PCR. Levels of MIP1-alpha, MIP1-beta, IL-6, IL-8, RANTES, and IFN-beta were measured using the enzyme-linked immunosorbent assay (ELISA). The activation of nuclear factor kappa B (NFkappaB) and interferon regulatory factor 3 (IRF3) in HCECs was assessed by immunohistochemical staining. The effects of DEX and CsA on HCECs exposed to HSV-1 (McKrae strain) were also examined.
The expressions of MIP1-alpha, MIP1-beta, IL-6, IL-8, RANTES, IFN-beta, and TLR3 were up-regulated in HCECs exposed to poly(I:C). The poly(I:C)-induced expressions of IL-6 and IL-8 were down-regulated by both DEX and CsA, while the expressions of IFN-beta and TLR3 were suppressed by DEX alone. Similarly, the poly(I:C)-induced activation of NFkappaB was decreased by both DEX and CsA, and the activation of IRF3 was reduced by DEX alone. When HCECs were inoculated with HSV-1, DEX led to a decrease in the expression of IL6, IFN-beta, and TLR3, and an extension of plaque formation.
These results indicate that DEX may increase the susceptibility of HCECs to viral infections by altering the TLR3 signaling pathways.
Molecular vision 02/2009; 15:937-48. · 2.20 Impact Factor
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ABSTRACT: Toll-like receptor 4 (TLR4), a member of the TLR family, is an important pattern recognition molecule that plays a role in the host's innate immune responses to lipopolysaccharide (LPS), a component of gram-negative bacteria. Contact lens wear is one of the risk factors for bacterial keratitis. The purpose of this study was to determine whether hypoxia or contact lens wear alters the TLR4 signaling pathways in human corneal epithelial cells (HCECs).
A simian virus 40-immortalized human corneal epithelial cell (SV40-HCEC) line was cultured under 20% O2 or 2% O2 and exposed to LPS. The expression of TLR4, interleukin-6 (IL-6), and IL-8 was determined using a real-time reverse transcription-polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay (ELISA), and immunoblotting. Immunoblotting was also used to determine whether the nuclear factor kappa B (NFkappaB) was activated in the SV40-HCEs. HCECs were obtained from 17 healthy volunteers and 18 hydrogel soft contact lens (SCL) wearers using impression cytology (IC), and the expression of the mRNA of TLR4 was determined using real-time RT-PCR.
A reduction in the expression of the mRNA and protein of TLR4 was detected in SV40-HCECs cultured under hypoxic conditions. Hypoxia also attenuated both the LPS-induced expression of IL-6 and IL-8, and the activation of NFkappaB in SV40-HCECs. The expression of the mRNA of TLR4 was down-regulated in the HCECs of soft contact lens wearers.
These results indicate that hypoxia attenuates the TLR4 signaling pathway in HCECs, suggesting that the increase in the susceptibility to bacterial infections under hypoxic conditions may be related to the TLR4 signaling pathways.
Molecular vision 01/2009; 15:2515-20. · 2.20 Impact Factor
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Noriko Koizumi,
Takashi Suzuki,
Toshihiko Uno,
Hidemi Chihara,
Atsushi Shiraishi, Yuko Hara,
Tsutomu Inatomi,
Chie Sotozono,
Satoshi Kawasaki,
Kenta Yamasaki,
Chikako Mochida,
Yuichi Ohashi,
Shigeru Kinoshita
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ABSTRACT: To investigate clinical manifestations and response to antiviral therapy of 8 patients with cytomegalovirus (CMV)-induced corneal endotheliitis who were diagnosed and treated at 2 university hospitals in Japan.
Retrospective, consecutive, multicenter case series.
Eight eyes of 8 patients diagnosed with active CMV corneal endotheliitis at Kyoto Prefectural University of Medicine and Ehime University School of Medicine. The diagnosis was made based on the detection by polymerase chain reaction assay of CMV, but not herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA, in the aqueous humor from the affected eye.
Retrospective review of the clinical manifestations and responses to antiviral treatment.
Patient profiles, including duration of corneal endotheliitis, systemic disease, intraocular pressure, and clinical manifestation of anterior and posterior segments. The clinical response to systemic and topical antiviral treatment was evaluated by slit-lamp examination. Corneal endothelial density was examined by specular microscopy.
The average observation period after CMV detection was 10.4 months (range, 2-24 months). None of the patients had systemic immunodeficiency. Corneal manifestations included linear keratic precipitates associated with multiple coin-shaped lesions and local corneal stromal edema. Of the 8 patients, 4 had undergone penetrating corneal transplantation. Systemic ganciclovir therapy was used in 7 patients, and in 1 patient, valacyclovir was administered, with the corneal endotheliitis responding quickly to the early administration of galovir. At the final examination, 6 eyes had a clear cornea, but 2 eyes had bullous keratopathy.
Besides HSV and VZV, CMV must be considered as an etiologic agent in patients with corneal endotheliitis. Cytomegalovirus corneal endotheliitis may be a newly identified clinical entity of reactivated CMV in the anterior chamber of individuals free of accompanying systemic symptoms.
Ophthalmology 03/2008; 115(2):292-297.e3. · 5.45 Impact Factor
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ABSTRACT: We report two cases of suture-related keratitis following penetrating keratoplasty. In both cases, Corynebacterium macginleyi was isolated from corneal specimens. Scanning electron microscopy revealed that corynebacteria could aggregate and form a biofilm. The MICs of sulbenicillin and fluoroquinolones were high for both isolates. Our findings show that C. macginleyi can cause keratitis with biofilm formation.
Journal of Clinical Microbiology 12/2007; 45(11):3833-6. · 4.15 Impact Factor
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ABSTRACT: Corneal endotheliitis often leads to severe endothelial dysfunction and can be caused by herpes simplex virus (HSV), varicella zoster virus (VZV), and other viruses (eg, the mumps virus). We report a case of corneal endotheliitis caused by cytomegalovirus (CMV) that developed after a penetrating keratoplasty.
A complete ophthalmologic examination was performed on a patient with corneal endotheliitis that developed after a penetrating keratoplasty. To determine the cause of the endotheliitis, polymerase chain reaction (PCR) was used to amplify the DNA of HSV, VZV, and CMV in samples of the aqueous humor.
Slit-lamp biomicroscopy showed a moderate stromal edema in the upper temporal part of the transplanted cornea along with keratic precipitates (KPs) arranged in a coin-shaped pattern. Repeated treatments with steroids and acyclovir were only temporarily successful. PCR detected the DNA of CMV in an aqueous sample, and the treatment was switched to topical and systemic application of ganciclovir. This resulted in the disappearance of the KPs and resolution of the stromal edema within 2 weeks.
From the PCR results and the favorable response to ganciclovir, the corneal endotheliitis was most likely caused by cytomegalovirus in this case.
Cornea 05/2007; 26(3):370-2. · 1.73 Impact Factor
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ABSTRACT: To report confocal microscopic observations of characteristic corneal endothelial lesions in a patient with presumed cytomegalovirus (CMV) corneal endotheliitis.
Case report.
A 77-year-old, immunocompetent man was admitted with corneal edema, keratic precipitates, and coin-shaped lesions in the right eye. Confocal microscopy was performed to examine the corneal endothelium. Polymerase chain reaction (PCR) was used to identify viral DNA in an aqueous humor sample.
CMV DNA was detected by PCR. Confocal microscopy showed large corneal endothelial cells with an area of high reflection in the nucleus surrounded by a halo of low reflection. This "owl's eye" morphology is characteristic of CMV infection. Topical and intravenous ganciclovir treatment resulted in rapid resolution of the corneal precipitates and edema, followed by disappearance of the owl's eye morphology.
Confocal microscopy can detect the owl's eye morphology in the corneal endothelium of patients with presumed CMV corneal endotheliitis.
American Journal of Ophthalmology 05/2007; 143(4):715-7. · 4.22 Impact Factor
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ABSTRACT: PurposeTo report confocal microscopic observations of characteristic corneal endothelial lesions in a patient with presumed cytomegalovirus (CMV) corneal endotheliitis.DesignCase report.MethodsA 77-year-old, immunocompetent man was admitted with corneal edema, keratic precipitates, and coin-shaped lesions in the right eye. Confocal microscopy was performed to examine the corneal endothelium. Polymerase chain reaction (PCR) was used to identify viral DNA in an aqueous humor sample.ResultsCMV DNA was detected by PCR. Confocal microscopy showed large corneal endothelial cells with an area of high reflection in the nucleus surrounded by a halo of low reflection. This “owl’s eye” morphology is characteristic of CMV infection. Topical and intravenous ganciclovir treatment resulted in rapid resolution of the corneal precipitates and edema, followed by disappearance of the owl’s eye morphology.ConclusionsConfocal microscopy can detect the owl’s eye morphology in the corneal endothelium of patients with presumed CMV corneal endotheliitis.
American Journal of Ophthalmology.
