CD3ε of a pan T cell marker involved in mouse Aspergillus fumigatus keratitis

AIM:To explore whether CD3ε is involved in the adaptive immunity of Aspergillus fumigatus(A.fumigatus)keratitis in mice and the role of innate and adaptive immunity in it.METHODS:Mice models of A.fumigatus keratitis were established by intra-stromal injection and corneal epithelial scratching.Subconjunctival injections of natamycin,wedelolactone,LOX-1 inhibitor(poly I)or Dectin-1 inhibitor(laminarin)were used to treat mice with A.fumigatus keratitis.Mice were pretreated by intraperitoneal injection of anti-mouse CD3ε.We observed the corneal infection of mice under the slit lamp microscope and made a clinical score.The protein expression of CD3ε and interleukin-10(IL-10)was determined by Western blotting.RESULTS:With the disease progresses,the degree of corneal opacity and edema augmented.In the intrastromal injection models,CD3εprotein expression began to increase significantly on the 2^(nd) day.However,in the scraping epithelial method models,CD3ε only began to increase on the 3^(rd) day.After natamycin treatment,the degree of corneal inflammation in mice was significantly attenuated on the 3^(rd) day.After wedelolactone treatment,the severity of keratitis worsened.And the amount of CD3ε protein was also reduced,compared with the control group.By inhibiting LOX-1 and Dectin-1,there was no significant difference in CD3ε production compared with the control group.After inhibiting CD3ε,corneal ulcer area and clinical score increased,and IL-10 expression was downregulated.CONCLUSION:As a pan T cell marker,CD3ε participate in the adaptive immunity of A.fumigatus keratitis in mice.In our mice models,the corneas will enter the adaptive immune stage faster.By regulating IL-10,CD3ε exerts antiinflammatory and repairs effects in the adaptive immune stage.

Advances in Drug Treatment of Fungal Keratitis

Fungal keratitis is an important cause of corneal blindness in China, accounting for 45% of infectious keratitis. The main pathogenic bacteria include yeast, filamentous bacteria and nearly 100 kinds of fungi, which are difficult to diagnose, difficult to treat and poor prognosis. When the infected fungal strains have strong virulence and poor drug sensitivity, it is easy to prolong the disease. Once the fungal infection involves the whole limbus and reaches the whole layer of the cornea, it will be followed by intraocular tissue infection such as anterior chamber, lens and vitreous body. When the infection is difficult to control and the visual function is seriously damaged, the enucleation of eye contents has to be performed, which causes irreversible harm to the patient’s appearance and physical and mental health. Therefore, in order to gain greater hope for the vision of patients with fungal keratitis, In recent years, with the continuous progress of clinical medicine and microbiological diagnostics, the treatment methods of fungal keratitis have been constantly updated. This article will briefly review the new progress in drug and surgical treatment of fungal keratitis in recent years to provide patients with better visual prognosis. .

Herpes simplex keratitis:A brief clinical overview

The aim of our minireview is to provide a brief overview of the diagnosis,clinical aspects,treatment options,management,and current literature available regarding herpes simplex keratitis(HSK).This type of corneal viral infection is caused by the herpes simplex virus(HSV),which can affect several tissues,including the cornea.One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea.After the initial infection,the HSV can establish a latent infection in the trigeminal ganglion,a nerve cluster near the eye.The virus may remain dormant for extended periods.Periodic reactivation of the virus can occur,leading to recurrent episodes of HSK.Factors triggering reactivation include stress,illness,immunosuppression,or trauma.Recurrent episodes can manifest in different clinical patterns,ranging from mild epithelial involvement to more severe stromal or endothelial disease.The severity and frequency of recurrences vary among individuals.Severe cases of HSK,especially those involving the stroma and leading to scarring,can result in vision impairment or even blindness in extreme cases.The cornea's clarity is crucial for good vision,and scarring can compromise this,potentially leading to visual impairment.The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization.Antiviral medications,such as oral Acyclovir or topical Ganciclovir,may be prescribed for prophylaxis.The immune response to the virus can contribute to corneal damage.Inflammation,caused by the body's attempt to control the infection,may inadvertently harm the corneal tissues.Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation.In summary,the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.

Infectious keratitis in Vietnam:etiology,organisms,and management at Vietnam National Eye Hospital

AIM:To report the etiologies,risk factors,treatments,and outcomes of infectious keratitis(IK)at a major Vietnamese eye hospital.METHODS:This is a retrospective review of all cases of IK at Vietnam National Eye Hospital(VNEH)in Hanoi,Vietnam.Medical histories,demographics,clinical features,microbiological results,and treatment outcomes were reviewed.RESULTS:IK was diagnosed in 1974 eyes of 1952 patients,with ocular trauma being the greatest risk factor for IK(34.2%),frequently resulting from an agriculturerelated injur y(53.3%).The mean duration between symptom onset and presentation to VNEH was 19.3±14.4 d,and 98.7%of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH.Based on smear results of 1706 samples,the most common organisms identified were bacteria(n=1107,64.9%)and fungi(n=1092,64.0%),with identification of both bacteria and fungi in 614(36.0%)eyes.Fifty-five of 374 bacterial cultures(14.7%)and 426 of 838 fungal cultures(50.8%)were positive,with the most commonly cultured pathogens being Pseudomonas aeruginosa,Streptococcus pneumonia,Fusarium spp.,and Aspergillus spp.Corneal perforation and descemetocele developed in 391(19.8%)and 93(4.7%)eyes,respectively.Medical treatment was successful in resolving IK in 50.4%eyes,while 337(17.1%)eyes underwent penetrating or anterior lamellar keratoplasty.Evisceration was performed in 7.1%of eyes,most commonly in the setting of fungal keratitis.CONCLUSION:Ocular trauma is a major risk factor for IK in Vietnam,which is diagnosed in almost 400 patients each year at VNEH.Given this,and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration,greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.

Two-step strategy—conjunctival flap covering surgery combined with secondary deep anterior lamellar keratoplasty for the treatment of high-risk fungal keratitis

AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.

Clinical observation of recombinant human nerve growth factor in the treatment of neurotrophic keratitis

AIM:To characterize changes of corneal nerve morphology and tear indices in patients with neurotrophic keratitis(NK)treated with recombinant human nerve growth factor(rhNGF).METHODS:In a prospective observational study,six patients(nine eyes)were locally treated with rhNGF.Visual acuity,corneal fluorescein staining score,the heights of the tear river,lipid layer thickness(LLT),tear ferning(TF)test,conjunctival impression cytology(CIC)examination,the densities of cornea subbasal nerve fibers were determined before and after treatment.RESULTS:Compared with baseline,there was a significant difference in corneal fluorescence staining scores(P<0.01);all patient corneal epithelial defects recovered completely within 8wk,but there was no significant improvement in the height of the tear river(P=0.202).LLT was significantly increased when compared with baseline(P=0.042);however,the function of conjunctival goblet cells and mucin content did not significantly improve using the TF test and CIC examination(P=0.557,P=0.539).After 8wk of treatment,the average corneal subbasal nerve fiber density increased significantly(P<0.01),as did the number of corneal nerve fiber branches(P=0.001).CONCLUSION:RhNGF can increase the density of corneal subbasal nerve fibers,promote the healing of persistent corneal epithelial defects and corneal ulcers in patients with NK,also improving tear function partially.

Should ocular Demodex be checked and treated in refractory keratitis patients without blepharitis?

AIM:To evaluate the correlation between Demodex infestation and keratitis,and to assess demodicosis using a simple approach.METHODS:A modified slit lamp illumination(at 40×magnification)was used to observe Demodex tails in 40patients with refractory keratitis and 80 healthy controls.Bacterial smear and culture of the conjunctival sac and corneal lesion were performed to identify the pathogen.Tea tree oil ointment(TTOO)was added as a Demodex killing agent for lid scrubs to the treatment when Demodex infestation was confirmed.RESULTS:Demodex tails were found in all patients compared to 42/80 of the controls(P<0.01).Seventeen patients presented blepharitis,while 23 were free of scales and inflammation at the lid margin.The demodicosis was mild,moderate,and severe in 8,19,and 13 patients,respectively,compared to mild in 42 controls(P<0.01).The keratitis was mild,moderate,and severe in 13,19,and 8patients,respectively.The severity of Demodex infestation was not correlated to the severity of keratitis(P=0.126).The growth of Staphylococcus was revealed in nine patients who did not react to antibiotic eye drops prior to the TTOO treatment.Patients’signs and symptoms got resolved after the lid scrub with TTOO.CONCLUSION:Ocular Demodex needs to be checked and treated in refractory keratitis patients with or without blepharitis.A slit-lamp illumination under high magnification favors the judgment of the severity of Demodex infestation.

Differential expression of antimicrobial peptides in human fungal keratitis

AIM:To analyze a series of antimicrobial peptides(AMPs)in corneal tissue from individuals with fungal keratitis(FK)during the active phase of the fungus infection and after healing.METHODS:Patients undergone lamellar keratoplasty for the treatment of severe FK or corneal scar had their corneal buttons sampled.Quantitative real-time polymerase chain reaction(PCR)was used to ascertain the gene expression of human beta-defensin(HBD)-1,-2,-3,-9,S100A7,8,9,and LL-37.RESULTS:All AMPs’messenger ribonucleic acid(mRNA)expression was considerably elevated in all samples(n=12).In contrast to controls,where HBD-2,-3,and S100A7 mRNAs were expressed at very low levels,it was discovered that HBD-1,-9,S100A8,S100A9,and LL-37 were constitutively expressed in all healed samples(n=4).HBD-1,-2-3,S100A7,and LL-37 mRNAs were significantly increased in all active FK samples(n=8).The levels of HBD-9,S100A8,and S100A9 mRNAs were moderately upregulated in all active FK samples.Subgroup comparison showed that HBD-2 was significantly increased in Fusarium keratitis samples(n=5),and LL-37 mRNAs were significantly enhanced in Aspergillus keratitis samples(n=3).Whereas there was not significantly increased of HBD-1,-3,-9,S100A7,8,9 mRNA in Aspergillus keratitis samples compared with Fusarium keratitis samples.CONCLUSION:AMPs expression is increased in active FK,but not all AMPs are equally expressed.HBD-2 and LL-37 expression levels are the highest,showing some specificity of AMP expression related to FK.Human AMPs,particularly HBD-2 may play a significant role in Fusarium keratitis and LL-37 might be the key player in Aspergillus keratitis.

Clinical Analysis of 137 Cases of Fungal Keratitis

Objective: To analyze the epidemiology, clinical diagnosis and treatment of fungal keratitis (FK) in hospitalized patients at the First Affiliated Hospital of Yangtze University in recent years. Methods: A retrospective investigation was conducted on the data of 137 cases of FK in our hospital from January 2019 to December 2022. The epidemiological characteristics, identification results of fungal strains, clinical treatment, and prognosis of the patients were analyzed. Results: Among the 137 FK patients, 89 were males and 48 were females, and the ratio of male to female was 1.85:1, The age of onset was the largest number of patients in 50-59 years old and 60-69 years old. The disease occurred most in autumn, winter and summer farming season (from September to December, January, May, June). 72 cases (52.6%) had a clear history of corneal injury, and 43 cases (31.4%) had a history of plant injury. Other risk factors include eye surface diseases, ophthalmic surgery, and wearing corneal contact lenses. The top three pathogens were fusarium (38.7%), aspergillus (23.3%), and alternaria (17.5%). 101 eyes showed improvement or cure after treatment with medication, 9 eyes underwent corneal stromal injection, 11 eyes were covered with conjunctival flap covering or amniotic membrane transplantation, 12 eyes were covered with corneal transplantation, and enucleation of ocular contents was performed in 4 eyes;Visual acuity was improved or maintained in 123 patients (about 89.8%). Conclusions: The incidence of FK in our hospital was mostly middle-aged and elderly men, mostly caused by corneal injury in the process of agricultural labor. The pathogens were mainly fusarium and aspergillus. The preferred treatment was medication, with severe cases requiring combined surgical treatment. Most patients can maintain or improve their vision after treatment.

Use of two combination creams for the treatment of ichthyoses and ichthyosiform disorders

Treatment options for ichthyosis and ichthyosiform disorders are limited and often unsatisfactory.Twenty-four patients used combination creams of 2%cholesterol with 2%lovastatin,and 10%glycolic acid with 0.025% tretinoin and 2%ketoconazole daily.At one month(n=20),the average percent reduction in severity scores was 40%,and at three months(n=10),it was 60.3%.Side effects were mainly mild irritation.These findings suggest that these two combination creams could be beneficial in the treatment of ichthyosiform disorders.

COVID-19 infection with keratitis as the first clinical manifestation

·AIM:To report a case which keratitis is the first clinical manifestation of COVID-19 that occurred 3 d earlier than the common COVID-19 symptoms.·METHODS:Regular slit lamp examination,corneal scraping test,and chest computed tomography(CT)were performed for patients with COVID-19 infection.The ophthalmologic treatment included ganciclovir eye drop(50 mglmL,6 times/d).The treatment for diarrhea included Guifu Lizhong pills(TID).The antiviral therapy consisted of oseltamivir(75 mg capsule Q12 H);therapy preventing bacterial infection consisted of azithromycin(250 mg tablet QD)and moxifloxacin(0.4 g tablet Q12 H);and therapy for cough relief and fever prevention consisted of Chinese herbal decoction.·RESULTS:A 35-year-old male suddenly suffered pain,photophobia,and tears in his right eye for one day without systemic COVID-19 symptoms.Patient was diagnosed with keratitis,which was seemingly different from common keratitis.Ganciclovir eye drop was initiated.The corneal scraping test for COVID-19 was positive.The chest CT images were abnormal confirming the diagnosis of COVID-19 infection.The antiviral and antibacterial therapies were initiated.Chinese herbal therapy was used for cough relief and fever prevention.After roughly two weeks,patient recovered from COVID-19.·CONCLUSION:A new type of keratitis,atypical keratitis,is a clinical manifestation of COVID-19,and this clinical manifestation could appear 3 d earlier than fever and cough.The earlier a COVID-19 clinical manifestation is identified,the earlier can a patient be directed to stay at home,and significantly fewer people would be infected.

Antifungal efficacy of natamycin in experimental fusarium solani keratitis

AIM: To evaluate the efficacy of topical administration Natamycin, which is produced by China, in an experimental rabbit model of Fusarium solani keratitis, to provide experimental basis for the application of clinical safety. METHODS: Fusarium solani was induced in the right eye of 30 New Zealand rabbits. Forty-eight hours after inoculation, the animals were divided into 3 different treatment groups, 10 rabbit eyes of each group: Group 1 (Natamycin) treated with topical Natamycin, group 2 (Natacyn) treated with topical Natacyn, group 3 (control) treated with topical saline solution. The eyes of each group was examined clinically with slit lamp using ulcer scoring system on day 4, 10, 15, and 21 for status of healing, corneal vascularisation, iritis, hypopyon and macular nebula. The findings were recorded on day 10 and day 21. RESULTS: Ulcer score on day 10, day 15, day 21: The score of Natamycin group are 1.45 +/- 0.16, 1.08 +/- 0.11, 0.70 +/- 0.40. The score of Natacyn group are 1.35 +/- 0.12, 1.10 +/- 0.12, 0.65 +/- 0.35. the score of control group are 1.30 +/- 0.08, 3.63 +/- 0.28, 3.80 +/- 0.16. Natamycin group and Natacyn group were different from control group (P <0.01). There is no difference between Natamycin group and Natacyn group. Status of healing on day 10 and day 21: The cure rate of the Natamycin group is 90% on day 10, and 100% on day 21. The cure rate of the Natacyn group is 80% on day 10, and 100% on day 21.Natamycin group and Natacyn group were different from control group (P<0.01). There is no difference between Natamycin group and Natacyn group. Corneal vascularisation, iritis, hypopyon and macular nebula on day 10 and day 21: in Natamycin group, the number of the eyes which have Corner vascularisation, iritis, hypopyon and macular nebula are 2,0,0,2. In Natacyn group, the number of the eyes which have Corner vascularisation, iritis, hypopyon and macular nebula are 1,0,0,2. In control group, the number of the eyes which have Corner vascularisation, iritis, hypopyon and macular nebula are 9,9,8,9.Natamycin group and Natacyn group were different from control group (P<0.01). There is no difference between Natamycin group and Natacyn group. CONCLUSION: Natamycin was found to be effective in fungal keratitis, similar to Natacyn, and it can stop the corner vascularisation, iritis, hypopyon and macular nebula to happen. Natamyin manufactured in China is effective against fungal keratitis, with esay availability and low toxicity in its use.

Inhibition of LOX-1 alleviates the proinflammatory effects of high-mobility group box 1 in Aspergillus fumigatus keratitis

AIM: To investigate the inflammatory amplification effect of high-mobility group box 1(HMGB1) in Aspergillus fumigatus(A. fumigatus) keratitis and the relationship between lectin-like oxidized low-density lipoprotein receptor 1(LOX-1) and HMGB1 in keratitis immune responses.METHODS: Phosphate buffer saline(PBS), and Boxb were injected into BALB/c mice subconjunctivally before the corneas were infected with A. fumigatus. RAW264.7 macrophages and neutrophils were pretreated with PBS and Boxb to determine the HMGB1 inflammatory amplification effects. Abdominal cavity extracted macrophages were pretreated with Boxb and Poly(I)(a LOX-1 inhibitor) before A. fumigatus hyphae stimulation to prove the the relationship between the two molecules. LOX-1, interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), macrophage inflammatory protein-2(MIP-2) and IL-10 were assessed by polymerase chain reaction and Western blot.RESULTS: Pretreatment with Boxb exacerbated corneal inflammation. In macrophages and neutrophils, A. fumigatus induced LOX-1, IL-1β, TNF-α and MIP-2 expression in Boxb group was higher than those in PBS group. Poly(I) treatments before infection alleviated the proinflammatory effects of Boxb in abdominal cavity extracted macrophages. Pretreatment with Boxb did not influence Dectin-1 mRNA levels in macrophages and neutrophils.CONCLUSION: In fungal keratitis, HMGB1 is a proinflammatory factor in the first line of immune response. HMGB1 mainly stimulates neutrophils and macrophages to produce inflammatory cytokines and chemokines during the immune response. LOX-1 participates in HMGB1 induced inflammatory exacerbation in A. fumigatus keratitis.

Conjunctival microbiome changes associated with fungal keratitis: metagenomic analysis

AIM: To investigate the ocular surface microbiome profile of patients with fungal keratitis(FK) through bacterial 16 S r DNA sequencing. METHODS: The swab samples were collected from 8 patients with FK(Group 1 from the corneal ulcer, Group 2 from the conjunctival sac of the infected eyes, and Group 3 from the conjunctival sac of the fellow eyes) and 10 healthy eyes(Group 4 from the conjunctival sac). Bacterial 16 S rDNA V4-V5 region sequencing was performed to characterize the bacterial communities on the ocular surfaces of the patients with FK. RESULTS: Our metagenomic data showed that 97% of the sequence reads were categorized into 245 distinct bacterial genera, with 67.75±7.79 genera detected in Group 1, 73.80±13.44 in Group 2, 74.57±14.14 in Group 3, and 89.60±27.49 in Group 4. Compared with the healthy eyes(Group 4), both infected(Groups 1 and 2) and fellow eyes(Group 3) of the patients with FK showed reduced bacterial diversity and altered ocular surface microbiota compositions, with lower abundance of Corynebacterium and Staphylo coccus and higher abundances of Pseudomonas, Achromobacter, Caulobacter and Psychrobacter. CONCLUSION: Our report depicts the altered ocular surface bacterial community structures both in the affected and fellow eyes of patients with FK. These changes may contribute to the pathogenesis of FK or the increased risk for FK.

Effects of COX-2 inhibitor NS-398 on IL-10 expression in rat fungal keratitis

AIM: To investigate the expression of interleukin-10 (IL-10) and the effect of NS-398 (COX-2 inhibitor) on the expression of IL-10 in fungal keratitis in rats, and analyze its effects on anti-fungus immunity. METHODS: Ninety Wister rats were randomly divided into 3 groups. Group A was blank control group (10 eyes). Group B was fungal keratitis group (40 eyes). Group C was fungal keratitis group treated with NS-398 (40 eyes). PAS staining, 100g/L potassium hydroxide (KOH) smear and fungal culture confirmed the successful establishment of fungal keratitis model. After the central epithelium was scraped, Fusarium solani colonies were applied and contact lens was put on the right cornea of group B and C, and plane contact lens was put on the left cornea of control eyes. Phosphate buffered saline (PBS) eyedrops were given for group B and NS-398 eyedrops for group C. The expression of IL-10 on corneas of group B and C on the 1(st) day, 3(rd) days, 75(th) days, and 14(th) days were detected by immunohistochemistry and semi- quantitative reverse transcription- polymerase chain reaction (RT-PCR). RESULTS: Histopathologic examination showed neutrophil infiltration and severe tissue necrosis in ulcer cornea. PAS staining confirmed the existence of hyphae and spores in the superficial layer of stroma. In the blank and control groups almost no expression of IL-10 was detected at any observing points. In group B the expression of IL-10 increased at first and decreased thereafter. Its expression also showed significant difference at any observing points (P < 0.01). Compared with group B, the expression of IL-10 in group C showed no difference on the 1(st)day, decrease on the 3(rd) day, but a significant increase on the 7(th) day and 14(th) day. CONCLUSION: IL-10 takes part in the occurrence and development of fungal keratitis. NS-398 can upgrade the expression of IL-10 in fungal keratitis in the later period of the ulcer. Meanwhile, pathologic observation showed a slightly corneal opacity. IL-10 may play an important role in the process of cornea anti-damage repair.

Curative effect assessment of bandage contact lens in neurogenic keratitis

AIM: To observe the curative effect of bandage contact lens in neurogenic keratitis.METHODS: Twenty cases of neurogenic keratitis were studied at the Department of Ophthalmology, the First Affiliated Hospital of China Medical University, between October 2012 and June 2013. These included 13 males and 7 females, aged from 35 to 88 y. Patients were voluntarily divided into an experimental group(lens wearing group, n =10) and control group(drug therapy,n =10). In experimental group patients wore silicone hydrogel bandage soft contact lens. Both groups used the following eyedrops: 0.5% levofloxacin TID; 0.5%Sodium carboxymethyl cellulose QID; fibroblast growth factor BID; ganciclovir BID [cases complicated with herpes simplex virus(HSV)]; compound tropicamide BID(cases concurrent hypopyon). The healing time of corneal ulcer and complication rates were observed in the two groups.RESULTS: The healing time of corneal ulcer in the experimental group was 10.80±4.44 d versus 46.70±13.88 d in the control group(P 【0.05). No complications occurred in the experimental group, except for the lens falling off twice in one case, the patient recovered eight days after rewearing the lens. While in the control group, all cases vascularized, 2 cases were complicated with descemetocele that recovered with amniotic membrane transplantation and 1 case was complicated with corneal perforation that recovered by autologous conjunctival flap covering.CONCLUSION: Bandage contact lens is a safe and effective method of treating neurogenic keratitis andsignificantly shortened the healing time of corneal ulcer.

Amniotic membrane covering promotes healing of cornea epithelium and improves visual acuity after debridement for fungal keratitis

AIM:To investigate the effect of amniotic membrane covering(AMC) on the healing of cornea epithelium and visual acuity for fungal keratitis after debridement.METHODS:Twenty fungal keratitis patients were divided into two groups randomly, the AMC group and the control group, ten patients each group. Both debridement of the infected cornea tissue and standard anti-fungus drugs treatments were given to every patients, monolayer amniotic membrane were sutured to the surface of the entire cornea and bulbar conjunctiva with 10-0 nylon suture for patients in the AMC group.The diameter of the ulcer was determined with slit lamp microscope and the depth of the infiltration was determined with anterior segment optical coherence tomography. Uncorrected visual acuity(UCVA) was tested before surgery and three month after healing of the epithelial layer. The healing time of the cornea epithelium, visual acuity(VA) was compared between the two groups using t- test.RESULTS:There was no statistical difference of the diameter of the ulcer, depth of the infiltration, height of the hypopyon and VA between the two groups beforesurgery(P 】0.05). The average healing time of the AMC group was 6.89 ±2.98 d, which was statistically shorter than that of the control group(10.23±2.78d)(P 【0.05).The average UCVA of the AMC group was 0.138 ±0.083,which was statistically better than that of the control group(0.053±0.068)(P 【0.05).CONCLUSION:AMC surgery could promote healing of cornea epithelium after debridement for fungal keratitis and lead to better VA outcome.

Review of clinical and basic approaches of fungal keratitis

Fungal keratitis（FK） is a serious disease which can cause blindness. This review has current information about the pathogenesis, limitations of traditional diagnosis and therapeutic strategies, immune recognition and the diagnosis and therapy of FK. The information of this summary was reviewed regularly and updated as what we need in the diagnosis and therapy of FK nowadays.

Clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis

AIM: To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis. METHODS:A retrospective study was done to 10 patients (10 eyes) who had accepted removal of the necrotic corneal tissue combined with conjunctival flap covering surgery for fungal keratitis,the diagnosis by corneal scraping and smear examination or confocal microscopy check hyphae. Local and systemic antifungal therapy more than one week for all patients, corneal ulcer enlarge or no shrink. Slit lamp microscope examination the diameter of corneal ulcer about 2mm-4mm. Anterior segment optical coherence tomography (AS-OCT)examine the depth of corneal ulcer between 1/3-1/2, infiltrate corneal stroma about 20um-80um,the diameter of corneal ulcer about 3mm-6mm.Type-B ultrasonic exclusion endophthalmitis. Complete removal lesions until transparent of stoma, make conjunctival flap equal or greater than ulcer 1mm nearby conjunctiva. Continued antifungal therapy. The vision, fungal recurrence, conjunctival flap rollback or desquamate were analysed. ' RESULTS:Ten patients had success done this surgery, the corneal ulcer was not enlarge and healing afteroperation. 7 cases were bridging conjunctival flap and 3cases were single conjunctival flap. Preoperation vision above 0.1 had 8 cases,7 cases had vision above 0.1 one week after surgery, while 1 cases vision droped from 0.3 to 0.05.There was not recurrent for fungal,2 cases conjunctival flap rollback:1 case was bridging and 1case was single flap, no conjunctival flap desquamate. CONCLUSION: It is safe and effective to perform removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis which werenot sensitive or aggravate for antifungal drugs.

Corneal collagen cross-linking and liposomal amphotericin B combination therapy for fungal keratitis in rabbits

AIM： To observe the therapeutic effect of corneal collagen cross-linking（CXL） in combination with liposomal amphotericin B in fungal corneal ulcers.METHODS： New Zealand rabbits were induced fungal corneal ulcers by scratching and randomly divided into 3groups, i.e. control, treated with CXL, and combined therapy of CXL with 0.25% liposomal amphotericin B（n =5 each）. The corneal lesions were documented with slit-lamp and confocal microscopy on 3, 7, 14, 21 and 28 d after treatment. The corneas were examined with transmission electron microscopy（TEM） at 4wk.RESULTS： A rabbit corneal ulcer model of Fusarium was successfully established. The corneal epithelium defect areas in the two treatment groups were smaller than that in the control group on 3, 7, 14 and 21d（P 〈0.05）. The corneal epithelium defect areas of the combined group was smaller than that of the CXL group（P 〈0.05） on 7 and 14 d, but there were no statistical differences on 3, 21 and 28 d. The corneal epithelium defects of the two treatment groups have been healed by day 21. The corneal epithelium defects of the control group were healed on 28 d. The diameters of the corneal collagen fiber bundles（42.960 ±7.383 nm in the CXL group and 37.040±4.160 nm in the combined group） were thicker than that of the control group（24.900±1.868 nm）,but there was no difference between the two treatment groups. Some corneal collagen fiber bundles were distorted and with irregular arrangement, a large number of fibroblasts could be seen among them but no inflammatory cells in both treatment groups. CONCLUSION： CXL combined with liposomal amphotericin B have beneficial effects on fungal corneal ulcers. The combined therapy could alleviate corneal inflammattions, accelerate corneal repair, and shorten the course of disease.