3 research outputs found
Corneal Densitometry and In Vivo Confocal Microscopy in Patients with Monoclonal Gammopathy—Analysis of 130 Eyes of 65 Subjects
Background: Corneal imaging may support an early diagnosis of monoclonal gammopathy.
The goal of our study was to analyze corneal stromal properties using Pentacam and in vivo confocal
cornea microscopy (IVCM) in subjects with monoclonal gammopathy. Patients and methods: In our
cross-sectional study, patients with monoclonal gammopathy (130 eyes of 65 patients (40.0% males;
age 67.65 ± 9.74 years)) and randomly selected individuals of the same age group, without hematological disease (100 eyes of 50 control subjects (40.0% males; age 60.67 ± 15.06 years)) were included.
Using Pentacam (Pentacam HR; Oculus GmbH, Wetzlar, Germany), corneal stromal light scattering
values were obtained (1) centrally 0–2 mm zone; (2) 2–6 mm zone; (3) 6–10 mm zone; (4) 10–12 mm
zone. Using IVCM with Heidelberg Retina Tomograph with Rostock Cornea Module (Heidelberg
Engineering, Heidelberg, Germany), the density of hyperreflective keratocytes and the number
of hyperreflective spikes per image were manually analyzed, in the stroma. Results: In the first,
second and third annular zone, light scattering was significantly higher in subjects with monoclonal
gammopathy, than in controls (p ≤ 0.04). The number of hyperreflective keratocytes and hyperreflective spikes per image was significantly higher in stroma of subjects with monoclonal gammopathy
(p ≤ 0.012). Conclusions: Our study confirms that increased corneal light scattering in the central
10 mm annular zone and increased keratocyte hyperreflectivity may give rise to suspicion of monoclonal gammopathy. As corneal light scattering is not increased at the limbal 10–12 mm annular
zone in monoclonal gammopathy subjects, our spatial analysis provides evidence against the limbal
origin of corneal paraprotein deposition. Using IVCM, stromal hyperreflective spikes may represent
specific signs of monoclonal gammopathy
Fusarium és Sarocladium okozta fertőzések szemészeti vonatkozásai és azok kezelése
Absztrakt:
A Fusarium-, Acremonium- és
Sarocladium-gombafajok nevezéktana 2017-ben megváltozott. A
morfológiailag homogén, de filogenetikailag heterogén fajokat, illetve
fajkomplexeket ma már nukleinsav-összetételük szerint a MALDI–TOF MS-vizsgálat
segítségével el lehet különíteni. Ez indokolta a taxonómiai besorolás
módosítását. Közleményünkben a Fusarium- és
Sarocladium-fajok okozta szaruhártya-gyulladás (keratitis)
klinikai lefolyását ismertetjük, összefoglaljuk a diagnosztikus és kezelési
lehetőségeket. Mindezek jelentős kihívást jelentenek a szemorvos számára. Súlyos
szövődményekhez vezet a késői felismerés és kezelés, a folyamat gyors
progressziója, a kórokozó átjutása a Descemet-membránon, a gombaellenes terápia
korlátozott hozzáférhetősége és penetrációja, valamint a gyakori
terápiarezisztencia. A diagnózis felállításához az anamnézisben szereplő trauma
vagy kontaktlencse-viselés, PCR és MALDI–TOF MS-vizsgálat, konfokális
mikroszkópia, a minta mikrobiológiai tenyésztése és a gyulladás területéből vett
citológiai minta mikroszkópos vizsgálata vezet. A primeren választandó
konzervatív terápia a lokálisan alkalmazott 5%-os natamicin, illetve esetenként
érzékenység meghatározását követően az 1%-os vorikonazol vagy 0,15–0,25%-os
amfotericin B szemcsepp, ezenkívül a 0,02%-os polihexametilén-biguanid (PHMB)
szemcsepp használatának sikeréről is beszámoltak. Fusarium
okozta keratitisben napi 2 × 200 mg vorikonazol tabletta adása is javasolt
lehet. Terápiarezisztens esetekben korai, széles átmérőjű perforáló
keratoplasztika (PKP) végzendő, épben történő trepanációval. Megkésett diagnózis
és specifikus kezelés esetén a gombafonalaknak a Descemet-membránon történt
átjutásával az esetek mintegy negyedében a látás elvesztése és a szemgolyó
eltávolítása következik be. Jelen közleményünk öt, Fusarium- és
Sarocladium-fajok okozta keratitis klinikai lefolyásának
változatosságát is bemutatja. Orv Hetil. 2019; 160(1): 2–11.
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Abstract:
Since 2017, the nomenclature of Fusarium, Acremonium and
Sarocladium species have changed, as these morphologically
homogeneous, but phylogenetically heterogeneous species and species complexes
may be differentiated using MALDI–TOF MS examination, analyzing nucleotic
sequences. This resulted in taxonomical changes. We summarize the clinical
course, diagnostic and therapeutic options of keratitis caused by
Fusarium and Sarocladium. The challenge of
Fusarium and Sarocladium keratitis
management for an ophthalmologist lies in delayed diagnosis and therapy,
fulminant progression and penetration of the Descemet’s membrane, restricted
availability, poor penetration of antifungal agents and therapy resistance. The
diagnosis is based on the clinical history of corneal trauma or contact lens
wear, PCR and MALDI–TOF MS, confocal microscopic examination, microbiological
culture and light-microscopic analysis of corneal scrapings. As primary
conservative treatment, 5% natamycin eye drops have to be used and with results
of an antimycogram, topical 1% voriconazole or 0.15–0.25% amphotericin B, in
some cases 0.02% polyhexamethylene-biguanide (PHMB) may be applied.
Fusarium keratitis may benefit from additional 2 × 200 mg
oral voriconazole treatment, daily. In therapy resistant cases, early, large
diameter penetrating keratoplasty (PKP) has to be performed, with complete
removal of the infected area. With late diagnosis, delayed specific treatment
and surgery, mycotic hyphae may penetrate the Descemet’s membrane, leading to
the loss of vision and enucleation in about every fourth patient. In our paper,
we also present the heterogeneous clinical history of five
Fusarium and Sarocladium keratitis cases.
Orv Hetil. 2019; 160(1): 2–11
Corneal Densitometry and In Vivo Confocal Microscopy in Patients with Monoclonal Gammopathy—Analysis of 130 Eyes of 65 Subjects
Background: Corneal imaging may support an early diagnosis of monoclonal gammopathy. The goal of our study was to analyze corneal stromal properties using Pentacam and in vivo confocal cornea microscopy (IVCM) in subjects with monoclonal gammopathy. Patients and methods: In our cross-sectional study, patients with monoclonal gammopathy (130 eyes of 65 patients (40.0% males; age 67.65 ± 9.74 years)) and randomly selected individuals of the same age group, without hematological disease (100 eyes of 50 control subjects (40.0% males; age 60.67 ± 15.06 years)) were included. Using Pentacam (Pentacam HR; Oculus GmbH, Wetzlar, Germany), corneal stromal light scattering values were obtained (1) centrally 0–2 mm zone; (2) 2–6 mm zone; (3) 6–10 mm zone; (4) 10–12 mm zone. Using IVCM with Heidelberg Retina Tomograph with Rostock Cornea Module (Heidelberg Engineering, Heidelberg, Germany), the density of hyperreflective keratocytes and the number of hyperreflective spikes per image were manually analyzed, in the stroma. Results: In the first, second and third annular zone, light scattering was significantly higher in subjects with monoclonal gammopathy, than in controls (p ≤ 0.04). The number of hyperreflective keratocytes and hyperreflective spikes per image was significantly higher in stroma of subjects with monoclonal gammopathy (p ≤ 0.012). Conclusions: Our study confirms that increased corneal light scattering in the central 10 mm annular zone and increased keratocyte hyperreflectivity may give rise to suspicion of monoclonal gammopathy. As corneal light scattering is not increased at the limbal 10–12 mm annular zone in monoclonal gammopathy subjects, our spatial analysis provides evidence against the limbal origin of corneal paraprotein deposition. Using IVCM, stromal hyperreflective spikes may represent specific signs of monoclonal gammopathy