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Purpose: To study the risk factors, clinical presentation, management options, and outcomes in cases of culture?proven Acremonium keratitis. Methods: Medical and microbiology records of culture?proven Acremonium keratitis from Jan 2007 to Dec 2019 at a tertiary eye care center were reviewed. Details of clinical findings on each visit and operating notes were reviewed from the medical records. All cases were subjected to corneal scraping at the first visit for microbiological investigation consisting of direct smear examination and culture. Topical natamycin 5% was the mainstay of medical treatment. Surgical treatment was considered for nonresponding patients. Results: During the 13?year study period, 65 cases of culture?proven Acremonium keratitis were identified out of 1605 cases of fungal keratitis. Trauma was the most common predisposing factor in 32 cases (49.2%). The average area of the corneal stromal infiltrate was 24.8 mm2 at the initial presentation. Hypopyon at the time of presentation was evident in 28 (43.1%) cases. Staphylococcus spp. was the most common (n = 22, 33.8%) organism coexistent with Acremonium. Direct microscopy of corneal scraping was positive for fungal filaments in 57/65 (87.6%) cases. Medical management alone was given in 44 patients (67.6%). Age (>50 years) and treatment delay (>15 days) were found to be independent risk factors for the poor final visual outcome (VA <20/60). Conclusion: When treated early, Acremonium keratitis responds well to medical therapy with currently available topical antifungals. However, advanced and nonresponding cases require surgical intervention for resolution of the infection
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Purpose: To analyze the weekly rate of retinal vascular growth in treatment?na飗e babies with various stages of retinopathy of prematurity (ROP) and validate if this could be a predictor of treatment need. Methods: Retrospective review of medical charts and retinal images of babies with various stages of ROP. The images were enhanced using red?green image enhancement software. Using the length of the horizontal disc diameter (DD) of each eye, the vessel growth was measured from the disc margin up to the vessel tip in fixed quadrants. The rate of vessel growth was the ratio of vessel length to the number of weeks it took to reach this length. The babies were divided into treatment warranting ROP (group 1), low?risk pre?threshold (type II) ROP (group 2,), and no?ROP (group 3) for analysis. The 搉o?ROP� group acted as normal control. Group 1 was further subdivided into 1A (threshold ROP), IB (aggressive posterior ROP), 1C (hybrid ROP), and ID (high?risk pre?threshold ROP). Results: Out of 436 eyes, groups 1, 2, and 3 had 238, 108, and 90 eyes, respectively. The mean rate of vascular outgrowth along with 95% confidence interval (CI) was 0.490 [0.487,0.520], 0.612 [0.599, 0.638], and 0.719 [0.703, 0.740] DD/week, respectively, for babies with 搕reatment warranting,� 搇ow risk pre?threshold� and 搉o ROP� groups, respectively. In our estimate, more than 80% of eyes with a vessel growth rate of 0.54 DD/week or less required treatment. Conclusion: A rate of retinal vascular growth less than 0.54 DD/week can be used to determine treatment requirements in babies with ROP
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Purpose: This study aimed to investigate the efficacy of human?derived umbilical cord mesenchymal stem cells (HDUMSC) and human?derived umbilical cord mesenchymal stem cells expressing erythropoietin (HDUMSC?EPO) to rescue total degenerated retina in a rat model. Methods: The study included four treatment groups, namely negative control using normal saline (HBSS) injection, positive control using sodium iodide 60 mg/kg (SI), SI treated with HDUMSC, and SI treated with HDUMSC?EPO given via subretinal and intravenous routes, to test the efficacy of retinal regeneration following SI?induced retinal degeneration. Retinal function in both phases was tested via electroretinography (ERG) and histological staining examining the outer nuclear layer (ONL). Results: There was a statistically significant result (P < 0.05) in the SI treated with HDUMSC?EPO only when comparing day 11 (mean = 23.6 ?v), day 18 (mean = 25.2 ?v), day 26 (mean = 26.3 ?v), and day 32 (mean = 28.2 ?v) to the b?wave ERG on day 4 rescue injection day (mean = 12.5 ?v). The SI treated with HDUMSC?EPO showed significant improvement in b?wave ERG readings in the Sprague–Dawley (SD) rat but did not restore baseline readings prior to degeneration (day 0). Both treated groups’ ONL thicknesses did not show significant changes compared to the negative control group (HBSS) following rescue therapy. Conclusion: Total retinal degeneration following intravenous SI injection was observed at 60 mg/kg. SI treated with HDUMSC and HDUMSC?EPO showed no regenerative potential compared to baseline in SI?induced total retina degeneration on ERG or histology, whereas SI treated with HDUMSC?EPO group showed a substantial increase in b?wave ERG amplitude over time
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Purpose: To analyze the early changes in host and donor lenticule thickness after Descemet Stripping Endothelial Keratoplasty (DSEK). Methods: DSEK was performed on 32 eyes of 31 patients. Pre? and post? operative slit lamp examination and anterior segment Optical Coherence Tomography (OCT) was done on day?1, day?7, 1 month, and 3 months. Results: There were significant changes in host, lenticule, and total corneal thicknesses between day?1 and day?7, and day?7 and 1 month. There were significant changes in host thickness and total corneal thickness between 1 month and 3 months. Thickness changes were significant between day?1 and day?7, and 1 month and 3 months for thick and thin host, respectively, whereas these changes were observed both for thick and thin host between day?7 and 1 month. Similarly, significant changes were observed between day?7 and 1 month, and day?7 and 1 month in thin lenticule whereas in case of thick lenticule, it was observed till the 3 months follow?up period. There was a significant improvement in visual acuity till the 3 months follow?up period. No significant correlation was observed between visual acuity and host and lenticule thickness. Conclusion: The thicknesses of host and lenticule decrease continuously. Lenticule thickness stabilizes before host. Thinner cornea stabilizes earlier compared to thicker cornea