Crystallization after intravitreal ganciclovir injection

Pitipol Choopong, Nattaporn Tesavibul, Nattawut RodanantDepartment of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok, ThailandPurpose: To report crystal formation as a complication of intravitreal ganciclovir injection.Patients and methods: A 73-year-old female patient with unilateral cytomegalovirus retinitis was treated with intravitreous ganciclovir (4 mg/0.04 mL).Results: After the intravitreal injection, sudden crystallization was observed in the vitreous. The patient experienced marked reduction in visual acuity and increased intraocular pressure. Despite aqueous paracenthesis and pars plana vitrectomy, optic atrophy was observed and her visual acuity remained unimproved after 12 months.Conclusion: Crystal formation can occur as a complication of intravitreal ganciclovir injection. Associated retinal and optic nerve damage was found which results in permanent visual morbidity.Keywords: ganciclovir, intravitreal injection, intraocular, CMV, toxicit

Ocular Manifestations in Acute Herpes Zoster Ophthalmicus

Objective: To determine the prevalence and clinical predictors of ocular involvement in acute herpes zoster ophthalmicus. Methods: A retrospective chart review of 167 patients presenting with acute herpes zoster ophthalmicus at the Outpatient Department of Ophthalmology, Siriraj Hospital, was performed. All skin lesions along the ophthalmic branch of the trigeminal nerve (CN V1) and ocular inflammatory signs were observed and documented. Results: A total of 160 cases were analyzed. The prevalence of ocular inflammation in acute herpes zoster ophthalmicus was 73.1% (117/160). The types of ocular inflammations included conjunctival injection (99.1%), keratitis (51.3%), and iridocyclitis (21.4%). Nasociliary skin lesions (Hutchinson’s sign) were the best predictor of ocular inflammation in acute herpes zoster ophthalmicus (p = 0.006, OR = 3.6, 95% CI: 1.5-9.1). Other factors associated with ocular inflammation were a period of longer than 4 days from the onset of rash to an eye examination (p = 0.007, OR = 3.2, 95% CI: 1.4-7.5), and the initiation of systemic acyclovir treatment after 3 days from rash onset (p = 0.037, OR = 2.3, 95% CI: 1.05-4.96). Conclusion: There is a high prevalence of ocular inflammation in acute herpes zoster ophthalmicus, especially among individuals with Hutchinson’s sign and delayed systemic acyclovir treatment. General practitioners should be aware of ocular involvement and refer high-risk patients for a complete ophthalmologic assessment

Genomes of trombidid mites reveal novel predicted allergens and laterally-transferred genes associated with secondary metabolism

Trombidid mites have a unique lifecycle in which only the larval stage is ectoparasitic. In the superfamily Trombiculoidea (“chiggers”), the larvae feed preferentially on vertebrates, including humans. Species in the genus Leptotrombidium are vectors of a potentially fatal bacterial infection, scrub typhus, which affects 1 million people annually. Moreover, chiggers can cause pruritic dermatitis (trombiculiasis) in humans and domesticated animals. In the Trombidioidea (velvet mites), the larvae feed on other arthropods and are potential biological control agents for agricultural pests. Here, we present the first trombidid mites genomes, obtained both for a chigger, Leptotrombidium deliense, and for a velvet mite, Dinothrombium tinctorium

Quality of Life after Total Knee Replacement at Siriraj Hospital, Thailand

Objective: Total knee replacement (TKR) is reportedly a safe and effective approach to treating osteoarthritis of the knee. However, there is no published data from Thailand about benefit in terms of long-term quality of life (QoL). Our aims were to assess long-term QoL after TKR and identify its associated factors. Methods: This was a prospective, cross-sectional, analytical study of patients who had undergone TKR between 2008 and 2013. Questionnaires were sent to 560 randomly selected patients. Relevant clinical variables, surgical and anesthetic data, and duration of hospital and ICU stays were extracted from hospital records. QoL was evaluated using the Thai version of the WHOQOL-BREF questionnaire. Scores range from 0 to 100, with 100 indicating the best state. The primary outcome was long-term QoL after TKR and secondary outcomes were factors associated with QoL. Results: The mean score within each domain was used to calculate the overall score (mean 64.6, SD 10.2), which indicated medium QoL. Educational level and length of hospital stay were the only factors significantly associated with QoL (p<0.05). Conclusion: Long-term QoL after TKR at Siriraj Hospital was assessed as medium. Educational level and length of hospital stay were the only factors associated with long-term QoL

Rare presentation of intractable tuberculous panophthalmitis with intraocular and intraorbital abscesses: a case report

Abstract Background We report a rare presentation of extrapulmonary tuberculosis. Case presentation A 29-year-old Burmese woman with human immunodeficiency virus infection and known pulmonary tuberculosis who had been treated for 5 months presented to our hospital with unilateral progressive painful visual loss of 1 month’s duration. She was diagnosed with tuberculous panophthalmitis with subretinal and intraorbital abscesses, conjunctival abscess, and extraocular muscle tuberculoma. The diagnosis was confirmed by a conjunctival pus swab with a positive result for acid-fast bacilli and a positive result for a mycobacterial culture. There was high suspicion of multidrug-resistant tuberculosis. Despite receiving ongoing aggressive treatment with conventional antituberculous medications, this patient required subtotal orbital exenteration to control her infection and prevent further progression. Second-line antituberculous medications were added to the first-line therapy, with satisfactory results achieved. Conclusions Tuberculous panophthalmitis with intraocular and intraorbital abscesses is a rare presentation of extrapulmonary tuberculosis. Patients who do not respond to first-line antituberculous therapy might be infected with either single-drug or multidrug-resistant Mycobacterium tuberculosis. Patient compliance is one of the key factors that can alter the course of treatment. Careful patient monitoring can improve disease progression, outcome, and prognosis

Triggering factors associated with a new episode of recurrent acute anterior uveitis

Abstract To identify triggering factors for the next inflammatory episode of recurrent acute anterior uveitis (RAAU), a 1:1 case–control study was conducted. We interviewed RAAU patients with recent acute anterior uveitis attack and quiescent controls for their information during a previous month using Srithanya Stress Test (ST-5) and questionnaires about potential triggering factors. Asymptomatic controls were matched for age (± 5 years), sex, and HLA-B27. There were 39 pairs of cases and controls. Patients who recently experienced a uveitis attack demonstrated higher mean ST-5 scores (3.7 ± 2.9 vs 0.7 ± 1.1) and shorter sleep time (6.3 ± 1.4 vs 7.4 ± 0.7 h per day) compared with their controls. In the multivariate conditional logistic regression analysis, ST-5 score ≥ 3 (OR 9.07, 95% CI 1.14–72.16, p = 0.037) and sleep time < 7 h per day (OR 12.12, 95% CI 1.37–107.17, p = 0.025) were more likely to trigger a uveitis attack in RAAU accounted for patients’ age, sex, HLA- B27 positivity, and presence of concurrent anti-inflammatory drugs for co-existing diseases. Other suspected triggering factors were not found to have any significant association. In short, stress and inadequate sleep may lead to the future episode of acute anterior uveitis in RAAU. Both physical and emotional stress management should be advised to RAAU patients to minimize recurrences and further complications

Late-onset postoperative Mycobacterium haemophilum endophthalmitis masquerading as inflammatory uveitis: a case report

Abstract Background Although atypical mycobacteria had been increasingly found in various ocular infections in the past decades, a slow-growing Mycobacterium haemophilum (M. haemophilum) was scarcely reported. Similar to tuberculous infection, the presentation can masquerade as low-grade granulomatous intraocular inflammation with partial response to corticosteroids. Besides, the special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical presentation and notify the awareness of NTM endophthalmitis among clinicians. This is the first case report of late-onset, postoperative M. haemophilum endophthalmitis in the literature. Case presentation A 66-year-old man with non-insulin-dependent diabetes mellitus (NIDDM) manifested chronic granulomatous inflammation in the left eye after multiple glaucoma surgeries. With a diagnosis of noninfectious panuveitis, he was treated with systemic corticosteroids. The inflammation initially responded to therapy although it subsequently worsened and became purulent endophthalmitis. The vitreous cultures grew M. haemophilum. Intraocular and systemic antimicrobial treatments were administered early, but the patient eventually turned blind. Conclusions M. haemophilum endophthalmitis is a rare but serious intraocular complication leading to loss of vision or eyeball. Awareness of atypical mycobacterial infections is necessary especially in patients with impaired immune function, previous intraocular surgery, and corticosteroid resistance. Proper laboratory investigations and treatments should be performed. However, due to the rarity of the disease, the development of guidelines for its investigation and therapy is still challenging

Non-Infectious Scleritis and Systemic Collagen Vascular Disease Association

Objective: To evaluate scleritis type in association with a systemic collagen vascular disease and the clinical characteristics of patients presenting with non-infectious scleritis. Methods: A retrospective chart review of 95 patients who presented with non-infectious scleritis was conducted. A comparison of the clinical differences between patients who had an associated systemic collagen vascular disease and idiopathic scleritis was performed. Results: Of the 95 patients (123 eyes), 72.6% was female with mean age of 47 years. Diffuse anterior scleritis was the most predominant type (57.9%). The first and the second most frequent complications were anterior uveitis and scleral thinning. Almost twenty percent of the patients had a systemic collagen vascular disease involvement; rheumatoid arthritis and non-specific anti-neutrophil cytoplasmic antibodies-related scleritis were the two most common at 4.2% each. Most of patients who had a concurrent systemic collagen vascular disease presented with diffuse anterior scleritis, and it was statistically significant compared with the idiopathic group. The presence of scleral thinning during follow-up periods was a statistically significant difference between the groups with and without systemic collagen vascular disease. Conclusion: Diffuse anterior scleritis was the most common scleritis found. The association between diffuse anterior scleritis and a systemic collagen vascular disease was higher than those for nodular anterior scleritis and posterior scleritis. The possibility of a systemic collagen vascular disease association and the potential for devastating sight- and life-threatening complications need to be considered for any patient who has scleritis

Efficacy of golimumab in patients with refractory non-infectious panuveitis

Abstract This study investigated the efficacy of golimumab in the management of refractory non-infectious panuveitis. Nineteen patients (38 eyes; mean age, 31 years) were retrospectively reviewed between June 2016 and June 2022. All patients had bilateral eye involvement and Behçet’s disease was the most common diagnosis (57.9%). Compared to the period before golimumab treatment, the rate of uveitis relapses after golimumab treatment significantly decreased from 1.73 to 0.62 events per person-years (incidence ratio 0.33, 95% confidence interval 0.19–0.57, P < 0.001). After golimumab therapy, 12 patients (63.2%) were able to reduce the number or dosage of immunosuppressive drugs, and the median dosage of systemic corticosteroids was reduced from 15.0 to 7.5 mg/d (P = 0.013) compared to baseline. The median logMAR visual acuity improved from 0.9 at baseline to 0.6 at the last visit (P = 0.006). Golimumab demonstrated efficacy against refractory non-infectious panuveitis in terms of a corticosteroid-sparing effect and reduced the rate of uveitis relapses to approximately one-third