Endophthalmitis by Aspergillus fumigatus after retina detachment

A fungal infection in the right eye after retina detachment on an immunocompetent patient is reported. After surgery, she developed an infection that was empirically treated with antibiotics and corticoids. Later the patient developed another retina and choroid detachment. The infection evolved to endophthalmitis and a sample was sent to the microbiology laboratory, where Aspergillus fumigatus was isolated. In spite of treatment with intravenous and intravitreous amphotericin B, the eye was eventually removed by enucleation.     

Importancia de la vigilancia oftalmológica durante el tratamiento de la enfermedad invasora por Candida

BackgroundInvasive Candida disease (ICD) is the most common cause of endogenous endophthalmitis. There are two characteristic ocular signs: Candida chorioretinitis defined as retina and choroid lesions without vitreal involvement, and Candida endophthalmitis defined as chorioretinitis with extension into the vitreous with characteristic fluffy balls. The most common visual symptoms are blurred vision and floaters.AimsTo define in which patients with ICD a surveillance ophthalmoscopic examination should be done.MethodsWe searched the PubMed/Medline data base Candida endophthalmitis in adult and paediatric patients with ICD.Results and conclusionsThe need of ophthalmoscopic examination in patients with ICD is controversial, partly due to the fact that early antifungal treatment leads to a significant decrease of endogenous Candida endophthalmitis. Routine ophthalmoscopic examination seems of little value in patients with positive blood culture, with early implementation of antifungal treatment, without symptoms of ocular infection and without impairment of the level of consciousness during the episode. However, ophthalmoscopic examination should be performed in children with candidemia and critically ill patients with documented ICD, in the second week of treatment, especially in echinocandin treatment.     

Anidulafungin versus fluconazole in the treatment of Candida albicans chorioretinitis

BackgroundCandida albicans chorioretinitis is the most common cause of endogenous fungal endophthalmitis. Echinocandins are recommended as first-line therapy in the treatment of invasive candidiasis (IC), but in clinically stable patients with IC and endophthalmitis caused by Candida species susceptible to azole compounds these are the first-line treatment due to their better intraocular penetration.Case reportA 42-year-old woman admitted to hospital for duodenal perforation after gastrointestinal surgery and treated with broad-spectrum antibiotics developed C. albicans candidemia. According to protocol, an antifungal treatment with anidulafungin was given. The patient presented no visual symptoms but on routinary ophthalmoscopic examination multiple bilateral chorioretinal lesions were observed. Systemic therapy was changed to fluconazole, with good systemic and ocular results.ConclusionsAzole compounds are the first-line therapy for endophthalmitis associated with candidemia. However, clinical guidelines often propose echinocandins as the first option for IC. In some cases, C. albicans chorioretinitis will require a change in the systemic treatment to assure better intraocular penetration. According to the current evidence and our own experience, routine funduscopy is not necessary in all IC patients. However, we do recommend fundus examination in patients with visual symptoms or those unable to report them (paediatric patients and patients with an altered level of consciousness), and in those who are being treated with echinocandins in monotherapy.     

Endogenous <Emphasis Type="Italic">Aspergillus versicolor</Emphasis> Endophthalmitis in an Immuno-competent HIV-positive Patient

A 25-year-old white, HIV-positive, immuno-competent man was referred to us because of a progressive blurred vision in his right eye. Clinical characteristics were suggestive for an unilateral fungal endophthalmitis, and thereby fluconazole firstly, followed by conventional amphotericin B were intravenously administered, without any significant improvement. Thus, a pars plana vitrectomy was performed. Aspergillus versicolor was isolated from the cultures of the vitreous sample and intravenous liposomal amphotericin B was administered. An increase of visual acuity together with a reduction of vitreous inflammation occurred. This case of ours represents the first report describing an endogenous endophthalmitis induced by Aspergillus versicolor.     

Ocular prosthesis: a brief review and fabrication of an ocular prosthesis for a geriatric patient

Objective: A review of literature for ocular prosthesis is presented along with a case report of a geriatric patient. Review of literature: The evolution of ocular prosthesis, materials and methods, fabrication techniques for custom and stock eye prosthesis, delivery and after care for the ocular prosthesis are reviewed. Case report: A 74‐year‐old female patient who had undergone enucleation of her right eye was restored with a stock ocular prosthesis. Conclusion: The use of stock ocular prosthesis of appropriate contour, size and colour can provide an acceptable aesthetic result.     

白内障术后感染性眼内炎的致病菌分析及影响因素研究

目的:分析白内障术后感染性眼内炎的致病菌分布情况,并对其影响因素进行分析。方法:选取2016年8月~2019年3月期间于我院行白内障手术的患者2936例,统计白内障术后感染性眼内炎的发生情况。分析术后感染性眼内炎患者的病原菌分布情况及病原菌耐药情况。单因素及多因素Logistic回归分析术后感染性眼内炎发生的影响因素。结果:本研究中,共发放2936份调查问卷,回收2931份,回收率为99.83%(2931/2936)。其中53例患者患有感染性眼内炎,发生率为1.81%(53/2931),根据患者是否患有感染性眼内炎分为感染组(n=53)和未感染组(n=2878)。感染性眼内炎的病原菌检出41株,其中革兰阳性菌37株,占90.24%;共检出4株真菌,为白色假丝酵母菌,占比9.76%。37株革兰阳性菌中,头状葡萄球菌、表皮葡萄球菌以及腐生葡萄球菌对利福平、利奈唑胺以及万古霉素的敏感度达100.00%。感染组和未感染组在性别、住院时间、玻璃体溢出方面比较差异均无统计学意义(P>0.05);两组在麻醉药时间、年龄、手术切口、手术时间、高血压、糖尿病方面比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:年龄≥66岁、手术切口为透明角膜、手术时间≥15 min、合并糖尿病均是发生感染性眼内炎的危险因素(OR=2.759、2.676、1.601、1.261,P<0.05)。结论:白内障术后感染性眼内炎的致病菌较多,以革兰阳性菌为主,革兰阳性菌对利福平、利奈唑胺、万古霉素的敏感度较高,年龄≥66岁、手术切口为透明角膜、手术时间≥15 min、合并糖尿病均会增加术后感染性眼内炎发生的风险。     

Endogenous Fusarium Endophthalmitis During Treatment for Acute Myeloid Leukemia,Successfully Treated with 25-Gauge Vitrectomy and Antifungal Medications

Endogenous fungal endophthalmitis (EFE) caused by disseminated fusariosis is a rare condition that generally has a poor outcome, even with intensive therapy. Here, we describe a case in which this type of EFE was diagnosed with vitreous sampling and was successfully treated with 25-gauge vitrectomy and antifungals, including liposomal amphotericin B and voriconazole. A 16-year-old male patient undergoing treatment for acute myeloid leukemia complained of eye pain and blurred vision in his right eye. Treatment was initiated for a vitreous opacity, possibly associated with herpetic retinitis, but the patient worsened and he was referred to us. Right-eye visual acuity was limited to light perception. We suspected endogenous endophthalmitis and performed 25-gauge vitrectomy with antibiotic perfusion of ceftazidime, vancomycin, and voriconazole. Vitreous culturing revealed the presence of Fusarium solani species complex, and enhanced computed tomography revealed disseminated fusariosis lesions in the lung, spleen, and the soft tissue of the left upper arm. The patient received antifungal treatment with liposomal amphotericin B and voriconazole, and these conditions were eliminated. Visual acuity recovered to 20/400 after additional vitrectomy for tractional retinal detachment and was maintained at this level during the 6-month follow-up period. The success of our treatment allowed the capture of optical coherence tomography images of the retina during fusarium-associated endogenous endophthalmitis and the follow-up period. Furthermore, this case showed that immediate vitrectomy for suspected EFE and intensive treatment can lead to a good clinical outcome.     

Perioperative Antibiotics to Prevent Acute Endophthalmitis after Ophthalmic Surgery: A Systematic Review and Meta-Analysis

BackgroundPost-operative endophthalmitis is a rare and dreaded complication in ophthalmic operations because it often induces irreparable vision loss. Although many ophthalmological studies aimed at reducing the rate of endophthalmitis have been performed around the world, controversy continues to surround some issues, including the choice of antimicrobials and their route of administration, duration and timing. The aim of this study is to investigate some of these unresolved issues.MethodsA systematic review and meta-analysis of randomized controlled trials and observational studies was performed. The PubMed, EMBASE, Cochrane Library and Clinical Trials databases were searched to identify studies published until Feb. 2016. The relative risk (RR) for each clinical outcome data is presented with 95% confidence intervals (CIs). Pooled estimates of effects were calculated using random-effect models.ResultsThirty-four studies from twenty-four reports involving 1264797 eyes were included in this analysis. Endophthalmitis occurred, on average, in one out of 6177 eyes when intracameral vancomycin/moxifloxacin were used and in one out of 1517 eyes when intracameral vancomycin/moxifloxacin were not used. The relative risk (95% CI) of endophthalmitis was reduced to 0.20 (0.10, 0.42) when intracameral antibiotics were used (p<0.0001). The subconjunctival injection of antibiotics was not superior to other administration routes included in this study (RR = 1.67, 95% CI (0.55, 5.05), p = 0.36). A statistically significant difference was found in the rate of endophthalmitis between the use and lack of use of topical antibiotics (RR = 0.65, 95% CI (0.43, 0.99), p = 0.04). However, no statistically significant difference was found in microbial isolation rates between these groups (RR = 0.77, 95% CI (0.34, 1.75), p = 0.53). When long-term and short-term use of topical antibiotics before surgery were compared, a statistically significant difference was found in microbial isolation rates (RR = 0.57, 95% CI (0.44, 0.74), p<0.0001).ConclusionsThis meta-analysis concluded intracameral antibiotics are effective at preventing endophthalmitis in ocular surgery. A randomized controlled trial confirms the efficacy of cefuroxime but recent large cohort studies support the efficacy of vancomycin/moxifloxacin intracamerally. Intracameral antibitoics are superior to subconjunctival injections but that irrigation antibitoic data are not of enough quality to make a comparison. Different results were found in two clinical outcomes between the use or lack of use of topical antibiotic therapy, we did not find sufficient evidence to conclude that its use prevents endophthalmitis.     

Ocular prosthesis for a geriatric patient with customised iris: a report of two cases

doi:10.1111/j.1741‐2358.2009.00327.x
Ocular prosthesis for a geriatric patient with customised iris: a report of two cases Objective: An ocular prosthesis is given when trauma or disease may lead to enucleation or evisceration of the eye and the combined efforts of the ophthalmologists and the maxillofacial prosthetist can provide a cosmetically acceptable ocular prosthesis. Methods: An ocular prosthesis is either pre‐fabricated or custom‐made. One of the important factors for achieving a cosmetic result is accurate colour matching of the iris with the contralateral iris. Results: A knowledge of the anatomy of the eye facilitates hand painting of iris and sclera to produce a satisfactory result. Conclusion: The custom‐made ocular prosthesis allows infinite variations during the fabrication.     

室性早搏患者射频消融术预后与起源部位的相关性

目的:探讨室性早搏(PVCs)患者射频消融术(RFCA)预后与起源部位的相关性。方法:回顾性分析2016年12月～2017年12月第二军医大学第一附属医院长海医院心血管内科收治并接受RFCA治疗的PVCs患者的临床资料,根据起源部位分为右心室组(n=58),左心室组(n=24)。记录两组RFCA手术时间、X线曝光时间及手术成功率等指标,术后随访6个月,比较两组术后心功能指标的改善情况,记录24h PVCs总数及复发情况。结果:与左心室组比较,右心室组手术时间、X线曝光时间明显延长,手术成功率明显下降(P0.05)。术后3个月,右心室组LVESD、LVEDD均明显减小,LVEF明显升高(P0.05);术后6个月,两组24h PVCs数均较术前显著降低,且右心室组下降幅度更为显著(P0.05)。术后6个月,两组各心功能指标均较术前明显改善,右心室组较术后3个月进一步改善,且明显优于左心室组(P0.05)。结论:射频消融术治疗PVCs的预后与起源部位存在一定相关性,右心室起源相对左心室起源的PVCs手术成功率更高,更有利于抑制心室重构、改善心功能。     

Molecular and Phenotypic Characterization of Staphylococcus epidermidis Isolates from Healthy Conjunctiva and a Comparative Analysis with Isolates from Ocular Infection

Staphylococcus epidermidis is a common commensal of healthy conjunctiva and it can cause endophthalmitis, however its presence in conjunctivitis, keratitis and blepharitis is unknown. Molecular genotyping of S. epidermidis from healthy conjunctiva could provide information about the origin of the strains that infect the eye. In this paper two collections of S. epidermidis were used: one from ocular infection (n = 62), and another from healthy conjunctiva (n = 45). All isolates were genotyped by pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec), detection of the genes icaA, icaD, IS256 and polymorphism type of agr locus. The phenotypic data included biofilm production and antibiotic resistance. The results displayed 61 PFGE types from 107 isolates and they were highly discriminatory. MLST analysis generated a total of 25 STs, of which 11 STs were distributed among the ocular infection isolates and lineage ST2 was the most frequent (48.4%), while 14 STs were present in the healthy conjunctiva isolates and lineage ST5 was the most abundant (24.4%). By means of a principal coordinates analysis (PCoA) and a discriminant analysis (DA) it was found that ocular infection isolates had as discriminant markers agr III or agr II, SCCmec V or SCCmec I, mecA gene, resistance to tobramycin, positive biofilm, and IS256⁺. In contrast to the healthy conjunctiva isolates, the discriminating markers were agr I, and resistance to chloramphenicol, ciprofloxacin, gatifloxacin and oxacillin. The discriminant biomarkers of ocular infection were examined in healthy conjunctiva isolates, and it was found that 3 healthy conjunctiva isolates [two with ST2 and another with ST9] (3/45, 6.66%) had similar genotypic and phenotypic characteristics to ocular infection isolates, therefore a small population from healthy conjunctiva could cause an ocular infection. These data suggest that the healthy conjunctiva isolates do not, in almost all cases, infect the eye due to their large genotypic and phenotypic difference with the ocular infection isolates.     

Orbital Inflammatory Disease in A Patient Treated with Zoledronate

ObjectiveTo increase awareness of orbital inflammatory disease as a rare adverse effect of bisphosphonates.MethodsWe present a case report and a review of the relevant literature.ResultsA 57-year-old woman with history of esophageal, breast, and lung cancers was diagnosed with postmenopausal osteoporosis. She initially received intravenous ibandronate for a total of 6 infusions. Later, she was changed to zoledronate infusion because of its yearly dosing schedule. Several hours after her initial infusion of zoledronate, she developed a painfully swollen left eye with photophobia. Ophthalmologic exam showed edema of the left upper lid. No exophthalmos was noted. Slitlamp exam showed conjunctival injection in the left eye with an elevated intraocular pressure. An orbital computed tomographic scan showed inflammation of the left orbital, preseptal, and retroseptal spaces. She was started on 2 methylprednisolone dose packs and the swelling and erythema disappeared completely in 2 weeks. Subsequent orbital magnetic resonance imaging showed no mass within either the left or right orbit, and no abnormal enhancement following contrast administration.ConclusionPhysicians should be aware of this rare complication of zoledronate. It should be used with caution in patients with a history of inflammatory eye disease or mild ocular symptoms following use of a bisphosphonate. (Endocr Pract. 2011;17:e101-e103)     

Human Pythiosis: Emergence of Fungal-Like Organism

Pythiosis is an emerging infectious disease caused by the aquatic oomycete Pythium insidiosum, a fungal-like organism. It is believed that P. insidiosum’s zoospores, its infected form, play major role in pathogenesis. Vascular and ocular infections are the most common clinical manifestation in humans. It is difficult to establish the diagnosis given its relatively rarity and difficulty to distinguish P. insidiosum from other molds. Delay in diagnosis and treatment has been associated with poor outcomes. High index of suspicion is the key, particularly in thalassemia patients with arterial insufficiency and patients with fungal keratitis/endophthalmitis without improvement on antifungal therapy. Tissue culture and zoospore induction remain gold standard for diagnosis; however, DNA-based method should be performed simultaneously. The combination of radical surgery, antifungal agents, and immunotherapy has been recommended. It was previously believed that surgery with negative surgical margins was the essential to survive in vascular pythiosis; however, it was recently found that patients could have residual disease despite documented negative surgical margins as infected clot may be dislodged to proximal arterial sites prior to surgery. Serum β-d-glucan (BG) has been used to monitor disease response after treatment initiation in vascular pythiosis. A significant decrease in BG levels within 2 weeks after surgery is indicative of the absence of residual infection. Unfortunately, monitoring tools for ocular pythiosis are not yet available. Itraconazole plus terbinafine have generally been used in P. insidiosum-infected patients; however, antibacterial agents, including azithromycin and linezolid, have also been used with favorable outcomes in ocular disease. Recently, azithromycin or clarithromycin plus doxycyclin were used in two relapsed vascular pythiosis patients with good outcomes.

     

不同角膜表面处理方式在全飞秒SMILE手术中的应用效果分析

摘要 目的：探讨不同角膜表面处理方式在全飞秒SMILE手术中的应用效果。方法：选择2021年10月至2022年9月来我院择期行全飞秒SMILE手术的患者50例,根据先右后左手术原则,观察眼与对照眼没有固定左右眼,观察眼25例选择右眼,25例选择左眼,对照眼反之选择另一眼,观察眼使用开睑器开睑后用三角海绵擦拭清洁角膜表。对照眼眼自净（眨眼）后使用开睑器开眼睑。对比观察眼与对照眼的角膜光密度、角膜表面颗粒物质计数、角膜表面湿度、术中负压吸引完成时间、失吸比例、OBL发生率,分析50例患者的舒适度。结果：观察眼的角膜光密度为16.33±2.12,对照组为16.85±2.58,组间对比无统计学意义（t=-1.101,P=0.274）。对照眼的表面颗粒物质计数明显较观察眼低,角膜表面湿度明显较观察眼高（P<0.05）。对照眼与观察组术中负压吸引完成时间、失吸比例对比无统计学意义（P>0.05）。观察眼中OBL发生率为6.00 %,对照眼中OBL发生率为2.00 %,组间对比无统计学意义（P=0.617>0.05）。50例患者中对三角海绵擦拭角膜感觉恐惧者占比32.00%（16/50）,三角海绵擦拭角膜后对注视绿点存在影响者占比20.00 %（10/50）,手术中选择三角海绵擦拭角膜者20例,占比40.00 %（20/50）,选择眼自净（眨眼）者30例,占比60.00 %（30/50）。结论：眼自净（眨眼）可以代替三角海绵擦拭角膜,用于全飞秒SMILE手术,提高患者舒适度。     

腹腔镜下子宫血管阻断术联合子宫肌瘤剜除术治疗子宫肌瘤的回顾性研究

摘要 目的：回顾性分析子宫肌瘤剜除术联合腹腔镜下子宫血管阻断术治疗子宫肌瘤的临床疗效。方法：分析2017年6月~2019年7月期间我院收治的子宫肌瘤患者的临床资料（n=150）。根据手术方法的不同将患者分为A组（腹腔镜下子宫肌瘤剜除术治疗,73例）和B组（腹腔镜下子宫血管阻断术联合子宫肌瘤剜除术治疗,77例）,对比两组术中、内分泌激素、术后恢复指标、妊娠情况、并发症发生率及复发率。结果：两组患者手术时间对比无统计学差异（P>0.05）,B组的术中出血量少于A组,术后排气时间、住院天数、下床活动时间短于A组（P<0.05）。A组术前、术后3个月、术后6个月黄体生成素(LH) 、卵泡刺激素(FSH) 、雌二醇(E₂) 水平组内对比无统计学差异（P>0.05）。B组术前、术后3个月、术后6个月E₂水平呈降低后升高趋势,LH、FSH水平呈升高后降低趋势（P<0.05）。B组术后3个月LH、FSH水平高于A组,E2水平低于A组（P<0.05）。与A组相比,B组的并发症发生率明显下降,组间对比有差异（P<0.05）。B组的妊娠率高于A组,子宫肌瘤复发率低于A组（P<0.05）。两组流产率组间对比无统计学差异（P>0.05）。结论：与单纯子宫肌瘤剜除术相比,结合腹腔镜下子宫血管阻断术治疗子宫肌瘤患者可减少术中出血量,促进患者术后恢复,降低并发症发生率及复发率,虽然其对卵巢功能有轻微、短暂性影响,但可逐步恢复,且有利于提高妊娠率。     

Artritis séptica por Scedosporium apiospermum de lenta instauración tras infiltración periarticular

BackgroundFungal arthritis is usually of haematogenous origin, and mainly affects patients with impaired cellular immunity or users of intravenous drugs. The infection in immunocompetent patients is generally caused by direct inoculation of the microorganism through an invasive device. The experience of azole therapy in these patients is limited.Case reportWe report a case of arthritis caused by Scedosporium apiospermum characterized by its slow onset, lack of response to posaconazole and caspofungin, and its successful resolution after surgical debridement and treatment with voriconazole.ConclusionsTreatment with voriconazole and surgical debridement is an effective therapy for arthritis due to S. apiospermum.     

Changes in the Motor Asymmetry and Structure of Mauthner Neurons of the Goldfish Resulting from Unilateral Visual Deprivation

We studied the effects of unilateral enucleation of the eye on the motor asymmetry of goldfish fries and morphometric characteristics of their Mauthner neurons, MNs (data of 3D reconstruction using serial slices). Enucleation of the right or left eye in ambidextral fishes resulted in stable preference of turnings during swimming toward the side of visual deafferentation and in a shift of the initial motor asymmetry coefficient (MAC) by 25%, on average. Ipsilateral enucleation of the eye in dextral and sinistral fishes intensified the initial motor asymmetry by 20%. Contralateral enucleation of the eye in dextral and sinistral fishes induced inversion of the motor asymmetry with a decrease in the MAC by 50%, on average. All operated fishes stably (within 3 months or more) preferred to turn toward the side of the enucleated eye. Morphological measurements showed that the size of the ventral dendrite of the MN contralateral with respect to the side of enucleation noticeably decreased. At the same time, this neuron (according to a shift in the motor asymmetry of the fish) became the functionally dominant unit. These data agree with the earlier supposition on a reciprocal relation between the level of functional activity of the MN and the size of its ventral dendrite. Selective changes in the dimension of the ventral dendrite of the MN receiving visual inputs probably resulted from the action of some endogenous trophic factor. The effect of this factor was enhanced after enucleation of the eye and the corresponding dysfunction of the contralateral visual input. A specific local change in the balance of neurotransmitter influences upon the MN ventral dendrite can play the role of such a factor. From the neurophysiological aspect, a decrease in the size of the ventral MN dendrite is a primary link in the chain of events resulting in modification of behavior; it leads to intensification of the integral functional activity of the MN and a shift of the motor asymmetry of the fish compensating, in such a way, the effect of unilateral visual deprivation.     

Outbreak of Fungal Endophthalmitis Due to Fusarium oxysporum Following Cataract Surgery

Outbreak of exogenous Fusarium endophthalmitis after cataract surgery was evaluated. Twenty patients developed postoperative endophthalmitis. In 19 eyes, pars plana vitrectomy (PPV) was performed, in 14 cases (74 %) with primary intraocular lens explantation. In one case, the PPV was not performed because of poor general condition of the patient. Symptoms of endophthalmitis (damaged vision, iritis, tyndallization in anterior chamber, hypopyon) occurred at intervals of 16–79 days (mean 31.3 days). Fungal etiology was documented in 12 eyes (60 %). Fusarium oxysporum was evidenced by culture and/or microscopy and confirmed by PCR and sequencing analysis. Eighteen (90 %) patients were treated with oral voriconazole (400 mg/day) for a period of 4–6 weeks. The final visual acuity was 6/15 in 1 case (5 %), 6/60 and worse in 17 eyes (85 %), and in 2 cases (10 %), enucleation had to be performed. Viscoelastic filling material was suggested the most likely source of infection. Endophthalmitis caused by Fusarium spp. are a potentially big threat for patients with serious impact on vision. Successful management of the infection is highly dependent on early diagnosis including species identification and antifungal susceptibility testing, and on aggressive and long-term treatment.     

Retinoic acid signaling in perioptic mesenchyme represses Wnt signaling via induction of Pitx2 and Dkk2

Morphogenesis during eye development requires retinoic acid (RA) receptors plus RA-synthesizing enzymes, and loss of RA signaling leads to ocular disorders associated with loss of Pitx2 expression in perioptic mesenchyme. Several Wnt signaling components are expressed in ocular tissues during eye development including Dkk2, encoding an inhibitor of Wnt/β-catenin signaling, which was previously shown to be induced by Pitx2 in the perioptic mesenchyme. Here, we investigated potential cross-talk between RA and Wnt signaling during ocular development. Genetic studies using Raldh1/Raldh3 double null mice deficient for ocular RA synthesis demonstrated that Pitx2 and Dkk2 were both down-regulated in perioptic mesenchyme. Chromatin immunoprecipitation and gel mobility shift studies demonstrated the existence of a DR5 RA response element upstream of Pitx2 that binds all three RA receptors in embryonic eye. Axin2, an endogenous readout of Wnt/β-catenin signaling, was up-regulated in cornea and perioptic mesenchyme of RA deficient embryos. Also, expression of Wnt5a was expanded in perioptic mesenchyme of RA deficient eyes. Our findings demonstrate excessive activation of Wnt signaling in the perioptic mesenchyme of RA deficient mice which may be responsible for abnormal development leading to defective optic cup, cornea, and eyelid morphogenesis.     

Immunology of Staphylococcal biofilm infections in the eye: new tools to study biofilm endophthalmitis

Endophthalmitis is an important disease of the eye that is most frequently caused by postoperative and post-traumatic introduction of bacteria into the posterior segment of the eye. In the case of severe infections, visual acuity is greatly damaged or completely lost. Much work has focused on the ability of planktonic bacteria to cause infection and ocular damage while little work has focused on chronic infections in endophthalmitis mediated by the formation of bacterial biofilms on the surface of the lens. This review focuses on the interaction of Staphylococcus aureus and Staphylococcus epidermidis lens-associated biofilms in endophthalmitis. Additionally, this review highlights some relevant biofilm-immune system interactions and outlines a new in vivo mouse model to explore biofilm-related infections in endophthalmitis.