Corneoscleral laceration and ocular burns caused by electronic cigarette explosions

PURPOSE: To report cases of acute globe rupture and bilateral corneal burns from electronic cigarette (EC) explosions. METHODS: Case series. RESULTS: We describe a series of patients with corneal injury caused by EC explosions. Both patients suffered bilateral corneal burns and decreased visual acuity, and one patient sustained a unilateral corneoscleral laceration with prolapsed iris tissue and hyphema. A review of the scientific literature revealed no prior reported cases of ocular injury secondary to EC explosions; however, multiple media and government agency articles describe fires and explosions involving ECs, including at least 4 with ocular injuries. CONCLUSIONS: Given these cases and the number of recent media reports, ECs pose a significant public health risk. Users should be warned regarding the possibility of severe injury, including sight-threatening ocular injuries ranging from corneal burns to full-thickness corneoscleral laceration

Immunology and Microbiology An Investigative Peptide-Acyclovir Combination to Control Herpes Simplex Virus Type 1 Ocular Infection

PURPOSE. To investigate the efficacy of a combination treatment composed of the cationic, membrane-penetrating peptide G2, and acyclovir (ACV) in both in vitro and ex vivo models of herpes simplex virus 1 (HSV-1) ocular infection. METHODS. The antiviral activity of a combined G2 peptide and ACV therapy (G2-ACV) was assessed in various treatment models. Viral entry, spread, and plaque assays were performed in vitro to assess the prophylactic efficacy of G2, G2-ACV, and ACV treatments. In the ex vivo model of HSV-1 infection, the level of viral inhibition was also compared among the three treatment groups via Western blot analysis and immunohistochemistry. The potential change in expression of the target receptor for G2 was also assessed using immunohistochemistry and RT-PCR. RESULTS. Statistically significant effects against HSV-1 infection were seen in all treatment groups in the viral entry, spread, and plaque assays. The greatest effects against HSV-1 infection in vitro were seen in the G2-ACV group. In the ex vivo model, statistically significant anti-HSV-1 effects were also noted in all control groups. At 24 hours, the greatest inhibitory effect against HSV-1 infection was seen in the ACV group. At 48 hours, however, the G2-ACVtreated group demonstrated the greatest antiviral activity. Syndecan-1, a target of G2, was found to be upregulated at 12-hours postinfection. CONCLUSIONS. This study shows that G2-ACV may be an effective antiviral against HSV-1 (KOS) strain when applied as single prophylactic applications with or without continuous doses postinfection. Keywords: herpes simplex keratitis, heparan sulfate, acyclovir H erpes simplex virus is an enveloped, double-stranded DNA virus and a member of Alphaherpesvirinae, a subfamily of Herpesviridae. Of the three members of this subfamily, which include herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2), and varicella zoster virus (VZV), HSV-1 has the greatest association with ocular infection. 1 With approximately 8.4 to 13.2 new cases per 100,000 people per year, HSV-1 is actually the main cause of infectious blindness in developed countries. 2 In the United States, approximately 500,000 individuals are afflicted with HSV ocular infection, with treatment costs rising to US$ 17.7 million annually for initial onset and recurring cases. 2,3 Ocular manifestations of HSV-1 include iridocyclitis, acute retinal necrosis, conjunctivitis, and keratitis. 1 Current mainstay treatment options against ocular HSV-1 infection include a dual regimen consisting of topical antivirals and topical corticosteroids. Prior work in our laboratory has yielded two 12-mer peptides with antiviral activity against HSV-1. The mechanism of action of these peptides rely on binding specifically to heparan sulfate (HS) and a modified form of HS, 3-O-sulfated HS (3-OS HS), both of which serve as entry receptors for HSV-1 on many different cell lines, including human corneal epithelial (HCE) cells. The peptides G1 (LRSRTKIIRIRH) and G2 (MPRRRRIRRRQK) both have high positive charge densities, and specific arginine and lysine residues are necessary to inhibit virus-cell binding and virus-induced membrane fusion. 7 In addition to inhibitory effects on HSV-1 entry into primary cultures of human corneal fibroblasts, both peptides have been demonstrated to effectively serve as prophylactic eye drops in an in vivo murine corneal model

Corneal perforation in ocular graft-versus-host disease

PURPOSE: Corneal perforation is a rare, vision-threatening complication of ocular graft-versus-host disease (GVHD) and is not well understood. Our objective was to examine the clinical disease course and histopathologic correlation in patients who progressed to this outcome. METHODS: This study is a retrospective case series from four academic centers in the United States. All patients received a hematopoietic stem cell transplant (HSCT) prior to developing ocular GVHD. Variables of interest included patient demographics, time interval between HSCT and ocular events, visual acuity throughout clinical course, corticosteroid and infection prophylaxis regimens at time of corneal perforation, medical/surgical interventions, and histopathology. RESULTS: Fourteen eyes from 14 patients were analyzed. Most patients were male (86%) and Caucasian (86%), and average age at time of hematopoietic stem cell transplant was 47 years. The mean interval between hematopoietic stem cell transplant and diagnosis of ocular graft-versus-host disease was 9.5 months, and between hematopoietic stem cell transplant and corneal perforation was 37 months. Initial best-corrected visual acuity was 20/40 or better in 9 eyes, and all eyes had moderate or poor visual outcomes despite aggressive management, including corneal gluing in all patients followed by keratoplasty in 8 patients. The mean follow-up after perforation was 34 months (range 2-140 months). Oral prednisone was used prior to perforation in 11 patients (79%). On histopathology, representative specimens in the acute phase demonstrated ulcerative keratitis with perforation but minimal inflammatory cells and no microorganisms, consistent with sterile corneal melt in the setting of immunosuppression; and in the healed phase, filling in of the perforation site with fibrous scar. CONCLUSIONS: In these patients, an extended time interval was identified between the diagnosis of ocular graft-versus-host disease and corneal perforation. This represents a critical window to potentially prevent this devastating outcome. Further study is required to identify those patients at greatest risk as well as to optimize prevention strategies

Challenges in Diagnosing Microspherophakia in a Pediatric Patient

Microspherophakia (MSP) is a rare condition of the crystalline lens characterized by increased anteroposterior diameter and reduced equatorial diameter [1]. It is theorized that underdeveloped zonules of Zinn do not exert enough force on the lens to form the typical oval shape [1,2]. Although classically present in Weill-Marchesani (WMS) syndrome [3], microspherophakia can be associated with a number of other systemic or ocular conditions including Marfan’s syndrome [2,4], iridocorneal endothelial syndrome [5] and Axenfeld-Rieger syndrome [6] (Table 1). Non-syndromic cases of MSP are rare. Both autosomal recessive and autosomal dominant heredity have been reported [7–9]. Since 1901, isolated MSP disease was described in different ethnic groups, mostly in the Asian continent and North Africa [10]. Here we describe an unusual case of isolated microspherophakia in a pediatric patient that presented for esotropia and required ultrasound biomicroscopy (UBM) to aid in diagnosis

Idiopathic bilateral neuroretinitis in a child

PPT case describing idiopathic bilateral neuroretinitis in a child

Leukemic and Lymphomatous Optic Neuropathy: A Case Series

Optic neuropathy in the context of leukemia and lymphoma raises concern for central nervous system involvement or relapse and warrants prompt evaluation and treatment. To date, a gold standard for the diagnosis and management of leukemic optic neuropathy has yet to be established

Biomarkers of Pediatric Cataracts: A Proteomics Analysis of Aqueous Fluid

Cataracts are among the most common causes of childhood vision loss worldwide. This study seeks to identify differentially expressed proteins in the aqueous humor of pediatric cataract patients. Samples of aqueous humor were collected from pediatric and adult cataract patients and subjected to mass spectrometry-based proteomic analysis. Samples of pediatric cataracts were grouped by subtype and compared to adult samples. Differentially expressed proteins in each subtype were identified. Gene ontology analysis was performed using WikiPaths for each cataract subtype. Seven pediatric patients and ten adult patients were included in the study. Of the pediatric samples, all seven (100%) were male, three (43%) had traumatic cataracts, two (29%) had congenital cataracts, and two (29%) had posterior polar cataracts. Of the adult patients, seven (70%) were female and seven (70%) had predominantly nuclear sclerotic cataracts. A total of 128 proteins were upregulated in the pediatric samples, and 127 proteins were upregulated in the adult samples, with 75 proteins shared by both groups. Gene ontology analysis identified inflammatory and oxidative stress pathways as upregulated in pediatric cataracts. Inflammatory and oxidative stress mechanisms may be involved in pediatric cataract formation and warrant further investigation