Effect of diluted povidone iodine in adenoviral keratoconjunctivitis on the rate of subepithelial corneal infiltrates

AIM: To evaluate the clinical characteristics of adenoviral keratoconjunctivitis, the management modalities, as well as the incidence of subepithelial corneal infiltrates(SEI).METHODS: Patients with characteristic clinical symptoms and signs, who presented to our clinic within the first week of symptoms and received the diagnosis of adenoviral keratoconjunctivitis between January 2013 and April 2016, were included in the study. A total of 211 patients were included in the study. Patients were evaluated for the incidence of clinical signs, late complications, management preferences, and the effect of diluted povidone-iodine(d-PVP-I) 2%. RESULTS: Patients’ mean age was 33.03±14.76 y. We observed an increase in the number of cases according to the years. At presentation and/or early follow-up, the clinical signs were conjunctival hyperemia(100%), conjunctival follicules(79.1%), edema of the eyelids(39.3%), chemosis(16.1%), pseudomembrane formation(16.6%), and corneal epitheliopathy(29.9%). During late follow-up 13.3% patients developed conjunctival subepithelial fibrosis, and 39.8% developed SEI. A significant decrease in the incidence of SEI development was observed in patients who used d-PVP-I 2%(P=0.032;33.3% vs 45.9%, respectively in patients who received d-PVP-I 2% and who did not).CONCLUSION: Adenoviral keratoconjunctivitis has a tremendous effect on patient’s comfort and abilities in short-term. Additionally, almost half of the patients develop visual problems related to SEI. According to our clinical experience, using d-PVP-I 2% in the first days of adenoviral keratoconjunctivitis might be helpful in reducing the risk of SEI as a complication.

Autonomic reinnervation and functional regeneration in autologous transplanted submandibular glands in patients with severe keratoconjunctivitis sicca

Autologous submandibular gland（SMG） transplantation has been proved to ameliorate the discomforts in patients with severe keratoconjunctivitis sicca. The transplanted glands underwent a hypofunctional period and then restored secretion spontaneously.This study aims to investigate whether autonomic nerves reinnervate the grafts and contribute to the functional recovery, and further determine the origin of these nerves. Parts of the transplanted SMGs were collected from the epiphora patients, and a rabbit SMG transplantation model was established to fulfill the serial observation on the transplanted glands with time. The results showed that autonomic nerves distributed in the transplanted SMGs and parasympathetic ganglionic cells were observed in the stroma of the glands. Low-dense and unevenly distributed cholinergic axons, severe acinar atrophy and fibrosis were visible in the patients＇ glands 4–6 months post-transplantation, whereas the cholinergic axon density and acinar area were increased with time. The acinar area or the secretory flow rate of the transplanted glands was statistically correlated with the cholinergic axon density in the rabbit model, respectively. Meanwhile, large cholinergic nerve trunks were found to locate in the temporal fascia lower to the gland, and sympathetic plexus concomitant with the arteries was observed both in the adjacent fascia and in the stroma of the glands. In summary, the transplanted SMGs are reinnervated by autonomic nerves and the cholinergic nerves play a role in the morphological and functional restoration of the glands. Moreover, these autonomic nerves might originate from the auriculotemporal nerve and the sympathetic plexus around the supplying arteries.

Excellent outcome of primary Neisseria meningitidis keratoconjunctivitis

Infectious conjunctivitis is a very common presentation to medical professional and ophthalmologist all over the world.Although its typically self-limiting and treatable in almost all of the cases,but we need to be aware of the rare and potentially life threatening if the cause is not promptly identified and treated accordingly.In our case report,we highlighted the rare case of Neisseria meningitidis as a primary cause of keratoconjunctivitis.Neisseria meningitidis is a rare etiology of keratoconjunctivitis and its ocular presentations are quite similar with other bacterial or viral infection.The infection may potentially fatal if systemic invasion occurred,however with immediate and proper treatment the outcome is satisfactory.Early diagnosis and proper antibiotic treatment are critical to prevent systemic spread of the infection.Public health intervention is needed to prevent outbreak of the disease.

Effect of Cyclosporin a Eye Drop on Keratoconjunctivitis Sicca and Its Mechanism

In this study, the effect of cyclosporin A （CsA） eye drop on keratoconjunctivitis Sicca （KCS） and its mechanism were studied. The KCS models were established by injecting Pertussis vaccine, complete freund＇s adjuvant （CFA） and antigen of conjunctiva from isotype mice. Then the KCS models were treated with cyclosporin A eye drop. Changes in breaking-up time （BUT）, lacrimal secretion in 30 min and diversion in 24 h were measured. The percentage of beaker cells, the lymphocytic infiltration in conjunctiva were observed. The expression levels of Aquaporin-3 （AQP3） in conjunctiva epithelial cells, beaker cells and accessory lacrimal gland were immunohistochemically detected. The results showed that there were significant differences in BUT, the percentage of beaker cells, lacrimal secretion in 30 min, the lymphocytic infiltration and the expression of AQP3 between the experimental group and an control group. It was concluded.that CsA eye drop exerts marked therapeutic effect on KCS by inhibiting T lymph cells, increasing the goblet cells and AQP3 expression in conjunctiva.

Resection and Cryotherapy Combined with Amniotic Membrane Transplantation for the Treatment of Vernal Keratoconjunctivitis with Giant Papillae

To evaluate the efficacy and safety of resection and cryotherapy combined with amniotic membrane transplantation （AMT） for the treatment of vernal keratoconjunctivitis （VKC） with giant papillae （GP）. Eight patients （16 eyes involved） with VKC, characterized by GP on the upper tarsal conjunctiva, underwent resection and cryotherapy in combination with AMT. The follow-up lasted for 3-22 months. The results showed that corneal shield ulcers and superficial punctuate keratitis healed during the first week after surgery and did not recur. Fourteen eyes （87.5 %） were symptom-free l month after surgery, and no GE ectropion, trichiasis and other complications were noted, but the blood vessels of upper tarsal conjunctiva could not be clearly seen and a little conjunctival scar was observed. Recurrence of GP was observed in 2 eyes （12.5 %）, with the area being less and irritation milder as compared with those before the operation. Among the two eyes, one eye was treated by cyclosporine eyedrops with improvement, but the other eye showed no improvement after the treatment, and underwent a second surgery with a cotton patch soaked in fluorouracil applied onto the supratarsal area after resection and cryotherapy. Four months after the treatment the patient presented no symptoms and GP did not recur. It is concluded that the resection and cryotherapy combined with AMT is an effective and safe treatment for VKC with GP.

Isolation of <i>Moraxella</i>sp. from Cases of Keratoconjunctivitis in an Organized Sheep Farm of India

Keratoconjunctivitis in sheep causes severe ocular irritation thereby reducing the production performance thus causing economic loss to the farmers. Bacterial cause of keratoconjunctivitis in sheep may be due to Listeria monocytogenes, Moraxella ovis, Mycoplasma conjunctivae, etc. An investigation carried out at Tirupathur, Sivagangai district, Tamil Nadu, India revealed keratoconjunctivitis in sheep (population 100 animals). Isolation and identification of eye swabs from ailing animals (n = 5) showed that the bacteria was Moraxella sp. Polymerase chain reaction (PCR) of the isolate was positive for Moraxella sp. Antimicrobial sensitivity testing of the isolate showed that it was sensitive to all antibiotics used in the study. This study reports the presence of Moraxella sp. infection in sheep warranting further studies to know the exact status of this organism so as to prevent keratoconjunctivitis in sheep.

Serum Vitamin D Levels of Children with Vernal Keratoconjunctivitis and Normal in Kinshasa

Background: Data on the serum vitamin D3 levels of vernal keratoconjunctivitis (VKC) children are not known well in Central Africa. Children with vernal keratoconjunctivitis are less exposed to sunlight. There is no study that shows the breadth of the serum vitamin D3 levels of vernal keratoconjunctivitis children and normal in our setting. Purpose: This study aimed to compare the serum 25-hydroxy vitamin D [25(OH)D3] levels of children with and without VKC. Methods: An observational, case-control study was performed from September 2019 to February 2020 in the Ophthalmology Department and the Clinical Biology Department of the University Hospital of Kinshasa. The case group was recruited consecutively in the consultation while the control group was enrolled in the nearest Rehoboth school complex using a systematic sample method (k = 4) on the presence register. Both cases and controls underwent the routine ophthalmological examination of the anterior segment and serum vitamin D3 levels were measured in both cases and controls using Mindray Chimic-Luminescence (CL)-1200i. Data were entered in Microsoft Sheets and analyzed using SPSS version 20.0. The Mann-Whitney-U test (M-U), and the t-Student test were used respectively to compare the mean serum vitamin D3 levels in both cases and controls. The correlation of Spearman (rho) was used to determine the association between Body Mass Index and serum vitamin D3 levels in the case group. Results: A total of 75 children with VKC (mean age 7.8 ± 4.4 years) and 75 children without VKC non-atopic control group (mean age 7.9 ± 4.3 years) were enrolled in this study. The vitamin D3 deficiency was more frequent among the case group than in the control group (40% vs 8%, p = 0.0001). Vitamin D3 insufficiency was more frequent in the case group than in the control group (33.3% vs 18.6%, p = 0.04). The mean serum vitamin 25(OH)D3 levels were statistically lower in children with VKC compared to those without (25.5 ± 8.7 ng/ml and 44.3 ± 18.5 ng/ml, p = 0.0001). Time spent outdoors during daylight by children with VKC was statistically lower than children without VKC (1.59 ± 0.71 hours and 2.28 ± 1.08 hours, respectively) (p = 0.0001). Body Mass Index and serum vitamin D3 levels in VKC children showed a negative correlation statistically significant (Spearman, rho = -0.452, p = 0.0001). Conclusion: This study showed statistically values of serum vitamin D3 levels in VKC children lower than in children without VKC.

从亚洲VKC专家共识看我国VKC的防治

亚洲专家工作组完成了2022年春季角结膜炎(VKC)共识,对亚洲VKC的定义、分类、临床表现、诊断与治疗等做出了详细介绍,确定了尚未满足的临床需求,包括:(1)VKC患者的诊断和治疗尚无明确的标准,该病的发病机制尚不清楚,且抗变态反应治疗对中度或重度患者往往无效;(2)治疗和管理亟待规范,亚洲各国对相同严重程度的患者所采用的治疗和管理策略差别很大,缺乏明确的、标准化的指南和分级系统;(3)安全性以及药物相关并发症;(4)药物治疗的最佳剂量方案。本文将对上述内容进行解读,并结合《我国过敏性结膜炎诊断和治疗专家共识(2018年)》进行分析,以期对我国VKC防治有所帮助。

春季角结膜炎发生圆锥角膜的机制研究进展

春季角结膜炎是一种好发于儿童及青少年,以反复发作的慢性炎症为主要表现的过敏性眼表疾病,容易出现角膜并发症如圆锥角膜。圆锥角膜是一种以角膜局部圆锥样突起为主要特征的角膜病变。既往研究分别提出了春季角结膜炎及圆锥角膜的发病机制及前者进展为后者的危险因素,但具体机制尚不明确。回顾文献发现二者有共同的发生机制及类似的细胞因子表达,包括Ⅰ型及Ⅳ型超敏反应、炎症反应、酶学变化、氧化应激、机械性损伤等方面。文章旨在概述春季角结膜炎发生圆锥角膜的机制及可能涉及的细胞因子,以期为春季角结膜炎发生圆锥角膜的预防和临床诊疗策略提供参考。

眼表综合分析仪联合角膜激光共聚焦显微镜检查对睑缘炎相关性角结膜病变45例的价值

目的应用眼表综合分析仪和角膜激光共聚焦显微镜(IVCM),探讨睑缘炎相关性角结膜病变(BKC)病人角膜细胞密度和眼表功能的变化及与蠕形螨感染的关系。方法选取2020年9月至2022年3月就诊于沧州市中心医院的45例BKC病人为观察组,同期的健康志愿者45例为对照组。根据观察组是否感染蠕形螨,分为蠕形螨感染组和未感染组。对所有研究对象使用眼表综合分析仪和IVCM进行检查,收集观察组和对照组的非侵入式平均泪膜破裂时间(NITBUTav)、非侵入式首次泪膜破裂时间(NIBUTf)、角膜荧光素染色(FL)评分、泪液分泌试验(SⅠt)、蠕形螨感染情况和角膜细胞密度。Pearson相关性分析蠕形螨感染数量与病人角膜细胞密度及眼表功能的相关性。结果观察组的NITBUTav[(6.31±2.95)s比(14.85±3.88)s]和NIBUTf[(4.65±2.03)s比(11.88±3.14)s]低于对照组,FL评分高于对照组(P<0.05)。观察组蠕形螨感染阳性率高于对照组,中央角膜浅基质层的细胞密度低于对照组(P<0.05)。观察组下方角膜基底细胞层和浅基质层的细胞密度低于对照组(P<0.05)。蠕形螨感染组的FL评分高于未感染组,下方角膜基底细胞层、浅基质层和中央角膜浅基质层的细胞密度低于未感染组(P<0.05)。蠕形螨感染数量与BKC病人下方角膜基底细胞层、浅基质层和中央角膜浅基质层的细胞密度呈负相关,与FL评分呈正相关(均P<0.05)。结论眼表综合分析仪联合IVCM可对BKC病人的眼表损害进行综合评价;BKC病人下方角膜基底细胞层、浅基质层和中央角膜浅基质层的细胞密度降低,FL评分增加,与蠕形螨感染数量增多有关。

清热散结胶囊对流行性角结膜炎患者视力、泪膜稳定性及泪液蛋白水平的影响

目的:探讨清热散结胶囊对流行性角结膜炎患者视力、泪膜稳定性及泪液蛋白水平的影响。方法:随机将316例流行性角结膜炎患者纳入对照组和试验组,各158例。对照组给予更昔洛韦眼用凝胶进行治疗,试验组在此基础上加用清热散结胶囊,两组均治疗2周,并随访6个月。比较两组疗效、中医证候、眼表功能、视力情况、泪膜稳定性、泪液蛋白水平、不良反应及复发情况。结果:试验组治疗2周后的总有效率高于对照组(P<0.05)。治疗2周后与治疗前比,两组中医证候、眼表疾病指数(OSDI)、泪膜破裂时间(BUT)、泪液分泌量(SIT)、角膜荧光素染色(FL)评分降低,试验组更低(P<0.05);两组视力及泪液乳铁蛋白(LF)、总蛋白(TP)、分泌型免疫球蛋白A(sIgA)、溶菌酶(LZM)水平升高,试验组更高(P<0.05)。两组治疗期间的并发症总发生率比较无统计学差异(P>0.05);试验组随访期间的复发率为1.90%,低于对照组的12.03%(P<0.05)。结论:流行性角结膜炎患者经清热散结胶囊治疗后其泪液蛋白水平得到有效调节,中医证候、眼表功能、视力情况及泪膜稳定性得到有效改善,疗效提高,且复发风险降低,安全性良好。

鱼腥草滴眼液治疗流行性角结膜炎的效果观察

目的:观察鱼腥草滴眼液治疗流行性角结膜炎的效果。方法:选取2022年12月—2023年6月莱西市人民医院眼科收治的流行性角结膜炎患者76例(102眼)作为研究对象,随机分为对照组(38例,48眼)与观察组(38例,54眼)。对照组应用氧氟沙星滴眼液,观察组应用鱼腥草滴眼液。比较两组临床症状积分、不良反应发生情况、最佳矫正视力、眼内压水平、炎症消失时间、治疗满意度、泪液分泌试验结果(SⅠt)、泪膜破裂时间(BUT)、治疗效果。结果:治疗后,两组流泪、结膜充血、异物感、畏光评分降低,观察组低于对照组,差异有统计学意义(P<0.05);观察组不良反应总发生率低于对照组,差异有统计学意义(P=0.021);治疗后,两组最佳矫正视力及眼内压水平升高,观察组高于对照组,差异有统计学意义(P<0.05);观察组炎症消失时间短于对照组,差异有统计学意义(P<0.001);观察组治疗满意度评分高于对照组,差异有统计学意义(P<0.001);治疗后,两组SⅠt、BUT水平降低,观察组低于对照组,差异有统计学意义(P<0.05);观察组治疗总有效率高于对照组,差异有统计学意义(P=0.003)。结论:鱼腥草滴眼液治疗流行性角结膜炎的效果显著,可缓解患者临床症状,改善最佳矫正视力及眼内压,缩短炎症消失时间,提高治疗满意度,改善泪腺功能,降低不良反应发生风险。

春季卡他性角结膜炎正虚邪恋证治疗经验

春季卡他性角结膜炎(VKC)是过敏性结膜炎(AC)中最常见的一个类型,中医药联合滴眼液治疗春季卡他性角结膜炎具有特殊的优势。本文分析春季卡他性角结膜炎的病因病机,李良长认为本病有风邪内伏、湿热上犯的病机特点,后期素体虚弱、邪气残留导致目痒,治疗当以扶正祛邪、疏风清热止痒为要,以脱敏止痒方(自拟)为主,据症加减,可获良效。

亚洲春季角结膜炎的诊疗规范:2022年亚洲专家共识解读

春季角结膜炎(VKC)是一种反复发作的眼部过敏性疾病,其特征表现为双侧眼表慢性炎症,若不及时干预,可导致眼表不可逆性损伤甚至失明。《亚洲春季角结膜炎的诊断、管理和治疗:亚洲春季角结膜炎管理专家工作组的建议》详细介绍了VKC的最新管理方法。本文就该共识进行全面解读,旨在进一步提高广大医务工作者诊断和治疗VKC的水平,以便更好地服务于广大眼病患者。

不同浓度氟米龙滴眼液治疗儿童重度混合型春季角结膜炎

目的:观察不同浓度氟米龙滴眼液治疗儿童重度混合型春季角结膜炎的临床效果。方法:选取2022-03/09于我院门诊就诊的重度混合型春季角结膜炎儿童患者50例100眼,随机分为两组,A组患者25例50眼给予0.1%氟米龙滴眼液联合0.05%环孢素滴眼液(Ⅱ)治疗;B组患者25例50眼给予0.02%氟米龙滴眼液联合0.05%环孢素滴眼液(Ⅱ)治疗。治疗1mo,观察两组患者SPEED问卷评分及角膜荧光素染色(FL)评分、泪膜破裂时间(TBUT)、泪液分泌试验(SⅠt)、眼红分析、非侵入式泪河高度(NIKTMH)、角膜光密度等眼部参数,记录不良反应发生情况。结果:治疗1mo,两组患者SPEED评分、FL评分及眼红分析结果均有显著差异(均P<0.05),TBUT、SⅠt及NIKTMH结果均无差异(均P>0.05),但角膜不同深度、不同直径范围角膜光密度具有差异性(均P<0.05)。治疗1mo,两组患者眼压无显著差异(16.21±2.90mmHg vs 16.05±2.75mmHg,P>0.05),且治疗过程中均未出现明显不良反应。结论:0.1%氟米龙滴眼液可有效治疗儿童重度混合型春季角结膜炎,效果优于0.02%氟米龙滴眼液。

关注0.1%CsA阳离子乳剂在眼表免疫性疾病中的合理选择及应用

眼表免疫性疾病(OSID)是由全身免疫性疾病引起,或是有局部免疫系统参与的慢性炎性眼部疾病,通过在眼及其附属器产生持续性炎症而引起泪液高渗环境和眼表上皮损伤,从而导致或加重干眼。常见的免疫炎性相关眼表疾病包括春季角结膜炎(VKC)、干燥综合征、移植物抗宿主病、干眼、免疫性角膜疾病等,严重影响患者的视觉功能和生活质量。目前,OSID主要采用人工泪液和糖皮质激素滴眼液进行治疗,但治疗效果欠佳且不良反应风险较大,因此OSID的有效治疗一直面临很大挑战。环孢素A(CsA)是一种临床常用的免疫抑制剂,具有很强的免疫调节作用,但由于其既有眼用剂型的通透性低,在临床上的应用受到一定限制。CsA眼用制剂的研发改变了OSID的治疗策略,近来研发的0.1%CsA阳离子乳剂显著提高了CsA局部应用的作用效果及安全性,值得临床医生关注。眼科医生应该充分认识各种OSID的免疫相关病理机制,充分了解0.1%CsA阳离子乳剂对OSID的疗效、适应证、眼表局部应用方法、不良反应等,进而在各种OSID的治疗中进行合理选择。

疏肝润目汤联合眼部中药熏蒸对干燥性角膜结膜炎患者视力恢复的影响

目的 分析疏肝润目汤联合眼部中药熏蒸对干燥性角膜结膜炎患者视力恢复的促进作用。方法 根据随机数字表法,将2021年1月-2022年1月在山东省青岛市黄岛区中医医院收治的86例干燥性角膜结膜炎患者分为观察组和对照组,各43例。2组均采用常规治疗,同时观察组另予以疏肝润目汤联合眼部中药熏蒸治疗。比较2组患者视觉质量、泪膜破裂时间与泪腺分泌实验、临床疗效。结果 治疗后观察组视觉质量相比对照组较高(P<0.05);治疗后观察组泪膜破裂时间相比对照组较长,泪腺分泌相比对照组较多(P<0.05);观察组治疗总有效率为95.35%(41/43),高于对照组的81.40%(35/43)(P<0.05);治疗后2组C-反应蛋白(CRP)和白细胞介素-6(IL-6)水平均有所下降,且观察组相对更低(P<0.05)。结论 经疏肝润目汤联合眼部中药熏蒸治疗干燥性角膜结膜炎,效果显著,可有效延长泪膜破裂时间,促进泪腺分泌,促进患者视力恢复。

角膜上皮细胞IL-1β含量与干眼症关系的实验研究

目的 研究高渗透压对人角膜上皮细胞 IL - 1β含量的影响。方法 在液渗透压分别为 4 0 0 m Osm、4 5 0 m Osm、5 0 0 m Osm的细胞培养液中分别加入等量的人角膜上皮细胞 ,采用酶标法 (EL ISA法 )测定 2 4小时后培养液中 IL- 1β含量。结果 不同渗透压组 IL- 1β含量有显著差异 (P<0 .0 5 ) ;培养液渗透压越高 ,IL- 1β含量越高。结论 IL-

自体唇腺移植治疗重症角结膜干燥症

目的评价自体唇腺移植治疗重症角结膜干燥症的临床效果。方法 16例重症角结膜干燥症患者接受自体唇腺移植,术中自同侧下唇制取唇腺黏膜瓣,将其植于同侧上睑穹隆。所有患者术前进行唾液分泌试验及涎腺核素扫描检查。术前、术后分别测定最佳矫正视力、施墨试验,并对术后主观满意度、人工泪液使用频率、主观症状评分进行评价。结果术后随访时间12个月,自体唇腺黏膜瓣全部存活,下唇创面愈合良好。术后不同时间段所有患者移植侧泪液分泌量均较术前明显增加(P<0.05),主观症状评分和人工泪液使用频率也明显低于术前(P<0.05)。2例患者术后最佳矫正视力有不同程度提高,其余患者未见明显提高。14例患者对术后效果满意,2例满意度一般。结论自体唇腺移植可以增加重症角结膜干燥症患者唾液泪液分泌,明显缓解患者干眼症状。该术式可作为治疗重症角结膜干燥症的一种有效方法。

他克莫司治疗春季卡他性角结膜炎的疗效分析

目的:评价免疫抑制剂——他克莫司滴眼液治疗春季卡他性角结膜炎(vernal keratoconjunctivitis,VKC)的治疗效果。方法:随机双盲试验,安慰剂对照。收集四川大学华西医院眼科16例门诊患者,将16例患者按就诊顺序随机分为治疗组与对照组。治疗组使用他克莫司滴眼液,对照组使用他克莫司滴眼液基础液,观察期为28d。对研究眼眼部体征和自觉症状分别进行单项评分,以治疗前后眼部体征总分变化量为主要疗效指标,主观症状为次要疗效指标。结果:(1)组内比较:两组症状和体征在用药前后的差异具有统计学意义,治疗组用药后各个时期的自觉症状评分均低于用药前,且随着时间推移,症状评分逐渐降低,差异有统计学意义,对照组用药后不同时期之间的差异无统计学意义。(2)组间比较:两组患者的主观症状和体征在用药前和用药后第一次复查时差异无统计学意义,之后两次复查差异均具有统计学意义。评分变化量(用药前评分-用药后评分)在用药后第一次复查时差异无统计学意义,之后两次复查差异均具有统计学意义。结论:他克莫司滴眼液能改善VKC患者的体征与症状,对于使用抗过敏滴眼液无明显改善的VKC,具有迅速、优良的改善效果,可应用于临床。