Case Series of Rare Fungal Keratitides: Experiences from a Quaternary Eye Hospital in Sydney, Australia.

The present article reports on the management of six different and rare cases of fungal keratitides, two of which have never been documented in previous literature. This is a case series of six patients with rare fungal keratitides managed at a quaternary eye referral unit, Sydney Eye Hospital, Australia over a period of 7 months (May to December, 2022). The order of occurrence of fungi isolated was Scedosporium apiospermum, Lomenstospora prolificans, Cladosporium spp., Paecilomyces, Syncephalastrum racemosum and Quambalaria spp. A combination of medical and surgical interventions was employed, including topical and systemic anti-fungal therapy, with one requiring therapeutic penetrating keratoplasty and another eventuating in evisceration. Two patients were successfully treated with corneal debridement and two others required pars plana vitrectomy with anterior chamber washout. It is important to remain vigilant with monitoring patient symptoms and correlating with clinical signs to guide antifungal therapy even in the context of confirmed culture and sensitivity results.

Prevalence of tear film hyperosmolarity in 1150 patients presenting for refractive surgery assessment.

PURPOSE: To present an analysis of tear film hyperosmolarity in a large, consecutive population and evaluate the correlation of ocular and systemic conditions with tear film osmolarity (TFO). SETTING: Private practice, Sydney, Australia. DESIGN: Single-center, retrospective, consecutive cohort. METHOD: Patients undergoing screening for laser refractive surgery from October 2017 to October 2020 were retrospectively reviewed. 1404 patients (n = 1357 standard, n = 47 postrefractive) undergoing screening for laser refractive surgery from October 2017 to October 2020 were reviewed. Routine examination included TFO and Ocular Surface Disease Index (OSDI) questionnaire. TFO was conducted prior to further tests, and patients refrained from topical eyedrops minimum 2 hours before the appointment. RESULTS: 1404 patients (n = 1357 standards, n = 47 postrefractive) patients were reviewed. Mean highest TFO in the standard population was 299.12 ± 11.94 mOsm/L, with 82.3% of eyes <308 mOsm/L indicating normal tear film homeostasis. The mean intereye TFO difference was 8.17 ± 8.60 mOsm/L, with 65.2% of eyes ≤8 mOsm/L. Mean highest TFO in the postrefractive subgroup was 299.72 ± 11.00 mOsm/L, with a mean intereye difference of 9.02 ± 6.92 mOsm/L. Postrefractive surgery patients indicated higher mean OSDI values of 15.28 ± 14.46 compared with the remainder of the population 9.69 ± 10.56 (P = .012). Significant correlation was demonstrated between TFO scores and OSDI normal classification in the standard population only (P = .005, r = 0.077). The use of contact lens correlated inversely with TFO and OSDI scores (P = .000, r = -0.136, and P = .000, r = -0.152, respectively). CONCLUSIONS: To the authors' knowledge, this study represents the largest available cohort of TFO scores in a standard population presenting for refractive surgery. Although most patients were found to fall within normal ranges, a reasonable percentage were diagnosed with tear hyperosmolarity and therefore at risk for dry eye disease.

A new indirect immunofluorescence BIOCHIP method for the serological diagnosis of bullous pemphigoid: A review of literature.

The BIOCHIP (Dermatology Mosaic 7, EUROIMMUN, Lubeck, Germany) is a novel multiplex indirect immunofluorescence technique used in the serological diagnosis of bullous pemphigoid. The BIOCHIP method combines the screening of several autoantibodies and target antigen-specific substrates in a single miniature incubation field to allow for simultaneous processing of the most common autoimmune bullous diseases autoantibodies using a single investigation. This manuscript reviews the literature on the validity of the BIOCHIP in the diagnosis of bullous pemphigoid. A systematic search for journal articles comparing the sensitivity and specificity of diagnostic tests for bullous pemphigoid patients was conducted in online databases via the Ovid SP search interfaces. The literature search generated 745 articles of which 189 were deemed relevant. Among the relevant articles, seven studies investigated the validity of the BIOCHIP indirect immunofluorescent test in the diagnosis of bullous pemphigoid. The BIOCHIP has demonstrated itself to be a specific test for BP180 (96.5-100%) and BP230 (98.3-100%), with a high sensitivity for BP180 (83.3-100%) but poor sensitivity for BP230 (24.3-66.7%). The BIOCHIP mosaic-based immunofluorescence test is potentially a simple, time- and effort-saving test that can aid in the diagnosis and screening of bullous pemphigoid. Further studies should report on the inter-rater reliability of the BIOCHIP to further validate the tool.

New biochip immunofluorescence test for the serological diagnosis of pemphigus vulgaris and foliaceus: A review of the literature.

The immunoassays that are available for the serological diagnosis of the more common subtypes of autoimmune blistering diseases such as pemphigus vulgaris (PV) and pemphigus foliaceus (PF) include enzyme-linked immunosorbent assay (ELISA) testing to specific antigens desmoglein (Dsg)1 and Dsg3, direct immunofluorescence (DIF), indirect immunofluorescence (IIF), and immunoblotting. A review of the literature on the biochip assay was conducted. Six studies investigated the validity of a new biochip, mosaic-based, IIF test in patients with pemphigus and demonstrated its relatively high sensitivity and specificity (Dsg3: 97.62-100%, 99.6-100%; Dsg1: 90%, 100%) in comparison with ELISA (Dsg3: 81-100%, 94-100%; Dsg1: 69-100%, 61.1-100%), and/or IIF (PV: 75-100%, 91.8-100%; PF: 67-100%) using suitable substrates. So far, validation studies of the biochip have been conducted in four countries (Germany, Italy, Turkey, and Poland) but none in the southern hemisphere. Caucasian patients were recruited as normal controls for these studies; thus, the diagnostic value of the biochip remains uncertain in population groups of other ethnicities. A range of disease control patients were recruited including patients with linear immunoglobulin A dermatosis, psoriasis, discoid lupus erythematosus, lichen planus, and noninflammatory skin diseases (e.g., squamous cell carcinoma, basal cell carcinoma, and vascular leg ulcers). Prospective studies with control patients from a diverse range of ethnicities are needed to better validate the biochip.