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Purpose: The aim of this study was to determine the predisposing risk factors, clinical characteristics, microbiological profile, and visual and functional treatment outcome of microbial keratitis including viral keratitis in children. Methods: A prospective study was carried out in a tertiary care institute over a period of 18 months on 73 pediatric patients. Data collected was analyzed for demographics of the patient population, causative organisms, and management outcome in terms of visual and functional outcome. Results: Patients in the age group from 1 month to 16 years were included, with a mean age of 10.81 years. Trauma was the commonest risk factor (40.9%), with unidentified foreign body fall being the most common (32.3%). No predisposing factors were identified in 50% of cases. Also, 36.8% of eyes were culture positive, with bacterial isolates in 17.9% and fungus in 82.1%. Moreover, 7.1% eyes were culture positive for Streptococcus pneumoniae and Pseudomonas aeruginosa each. Fusarium species (67.8%) was the commonest fungal pathogen, followed by Aspergillus species (10.7%). Also, 11.8% were clinically diagnosed as viral keratitis. No growth was found in 63.2% of patients. Treatment with broad?spectrum antibiotics/antifungals was administered in all cases. At the final follow?up, 87.8% achieved a best corrected visual acuity (BCVA) of 6/12 or better. Therapeutic penetrating keratoplasty (TPK) was required by 2.6% of eyes. Conclusion: Trauma was the major cause for pediatric keratitis. Majority of the eyes responded well to medical treatment, with only two eyes needing TPK. Early diagnosis and prompt management helped majority of the eyes to achieve a good visual acuity after the resolution of keratitis.
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Purpose: Infectious keratitis, especially viral keratitis (VK), in resource?limited settings, can be a challenge to diagnose and carries a high risk of misdiagnosis contributing to significant ocular morbidity. We aimed to employ and study the application of artificial intelligence?based deep learning (DL) algorithms to diagnose VK. Methods: A single?center retrospective study was conducted in a tertiary care center from January 2017 to December 2019 employing DL algorithm to diagnose VK from slit?lamp (SL) photographs. Three hundred and seven diffusely illuminated SL photographs from 285 eyes with polymerase chain reaction–proven herpes simplex viral stromal necrotizing keratitis (HSVNK) and culture?proven nonviral keratitis (NVK) were included. Patients having only HSV epithelial dendrites, endothelitis, mixed infection, and those with no SL photographs were excluded. DenseNet is a convolutional neural network, and the two main image datasets were divided into two subsets, one for training and the other for testing the algorithm. The performance of DenseNet was also compared with ResNet and Inception. Sensitivity, specificity, receiver operating characteristic (ROC) curve, and the area under the curve (AUC) were calculated. Results: The accuracy of DenseNet on the test dataset was 72%, and it performed better than ResNet and Inception in the given task. The AUC for HSVNK was 0.73 with a sensitivity of 69.6% and specificity of 76.5%. The results were also validated using gradient?weighted class activation mapping (Grad?CAM), which successfully visualized the regions of input, which are significant for accurate predictions from these DL?based models. Conclusion: DL algorithm can be a positive aid to diagnose VK, especially in primary care centers where appropriate laboratory facilities or expert manpower are not available
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@#Innate immunity plays an important role in viral keratitis. Recently, it has been found that surfactant proteins(SP)A and D in the innate immune system are essential in viral keratitis. SP can inhibit virus adhesion to host cells and further promote phagocytosis of virus through high affinity for virus ligands. In order to ensure the normal function of tissues in the early stage of virus infection, SP regulates immune cells to maintain a non-inflammatory state. However, when pathogen invasion increases, SP promoted inflammation and increased the immune cells to kill the pathogens. SP-A and SP-D could be expressed in cornea, conjunctiva. To play the role of anti-adenovirus, herpes simplex virus, cytomegalovirus and other major eye pathogenic viruses, SP-A and SP-D combine with the virus to prevent entry into cells, promote phagocytosis, and directly kill the virus. SP-A and SP-D may be used as clinical diagnostic tools for viral infection. In the future, recombinant SP is expected to be used as an important means for the treatment of viral keratitis. Here, we review the innate immune function of SP-A and SP-D in ocular viral infection.
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@#AIM:To study the effect of biological keratoconjunctivitis combined with Ganciclovir Pellicles in patients with infectious keratitis and the effect on serum levels of inflammatory factors.<p>METHODS: In this study, 54 patients with 54 eyes were selected as the research object and divided into the observation group and the control group according to the random number table method. All patients were treated with bioartificial corneal transplantation. The patients in the observation group were treated with Ganciclovir eye drops, and the control group was treated with Aciclovir eye drops. The changes of LogMAR visual acuity, corneal transparency, serum inflammatory factors and cytokines were analyzed.<p>RESULTS: The rates of getting rid of blindness in the observation group and the study group were 93% and 89% respectively(<i>P</i>=0.642). The LogMAR visual acuity of two groups were significantly improved in 1wk and 6mo after operation compared with that before operation(<i>P</i><0.05). At 7d after operation, the levels of IL-6, TNF-α, INF- γ, SOD, NO and MDA in the two groups were significantly improved, and the improvement of the indexes in the observation group was better than that of the control group(<i>P</i><0.05). The rate of adverse reaction rate between two groups showed no significant difference(<i>P</i>=0.556).<p>CONCLUSION: Biological keratoconus combined with Ganciclovir has a good effect on viral keratitis, which can improve vision, inflammation and reduce the level of MDA.
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We describe a case of 55-year-old male farmer presented with recurrent corneal abrasions with a spastic entropion in the left eye. Superior cornea showed typical nummular opacities suggestive resolved herpetic eye diseases. On further enquiry, he had similar episodes in the past. Contralateral eye was essentially normal. Following the botulinum toxin injection for the management of spastic entropion, subject developed reactivation of herpetic necrotizing stromal keratitis. Diagnostic corneal scrapings were negative for herpes simplex virus-1 antigen by immunofluorescence assay and for DNA by molecular techniques. The case was successfully managed with topical steroids and antiviral medications.
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AlM:To study and investigate the change situation of trace elements and body comprehensive immune state of patients with viral keratitis.METHODS:Sixty-two patients with viral keratitis in our hospital from December 2011 to February 2014 were selected as observation group, 62 healthy persons with health education at the same time were the control group, then the serum and tear Zn, Cu, cellular immunity and erythrocyte immunity of two groups were compared, and the detection results of observation group with different types and severity degree were compared.RESULTS:The serum and tear Zn of observation group was all lower than that in control group, serum and tear Cu was higher than that in control group, cellular immunity and erythrocyte immunity indexes were all worse than that in control group, the detection results of observation group with mild, moderate and severe infection had significant differences (P0. 05).CONCLUSlON: The change of trace elements and body comprehensive immune state of patients with viral keratitis are obvious, and the severity degree for the detection levels of keratitis are greater.