bluuebunny/crossref_metadata_2025 huggingface dataset:
Conjunctival Autografts for Ocular Surface Reconstruction after Conjunctival Nevus Excision
Authors: Ucar Fikret
Published: February 2023

Purpose:

The aim of this study was to evaluate the clinical and therapeutic outcomes of the cases where we used conjunctival autografts with and without the Tenon fascia for ocular surface reconstruction after conjunctival nevus excision.

Methods:

This study included 63 eyes of 63 patients who underwent conjunctival nevus excision between January 2013 and December 2020. Although a Tenon-free conjunctival autograft was used in 32 eyes of 32 patients in group 1, a Tenon-containing conjunctival autograft was used in 31 eyes of 31 patients in group 2. The clinical and histopathological characteristics of the nevus, complete graft epithelization, cosmetic outcomes, and postoperative complications were evaluated.

Results:

Conjunctival autografts were harvested from the contralateral eye in 3 eyes (9.3%) in group 1 and 2 eyes (6.4%) in group 2 (P = 0.66). Postoperatively, the mean defect size at the harvest site was 5.3 ± 1.4 mm in group 1 and 5.5 ± 1.5 mm in group 2 (P = 0.47). Graft edema was observed in only 1 case (3.1%) in group 1 and 6 cases (19.3%) in group 2 (P = 0.04). Although a complete graft epithelization was observed in all eyes in group 1, fluorescein staining was present in 2 eyes (6.4%) in group 2 (P = 0.14). Cosmetically, retracting and shrinking grafts were absent in group 1, whereas group 2 had in 4 eyes (12.9%) (P = 0.03). Neither group had conjunctival scarring, symblepharon, eyelid cicatrization, dysmotility, or pannus at the donor site.

Conclusions:

Ocular surface reconstruction with a Tenon-free conjunctival autograft after conjunctival nevus excision provides excellent cosmetic and functional results without significant complications.
Influence of Descemet Membrane Endothelial Keratoplasty Graft Preparation Patterns on Postoperative Clinical Outcome
Authors: Schrittenlocher Silvia , Matthaei Mario , Rokohl Alexander C. , Franklin Jeremy , Bachmann Björn , Cursiefen Claus
Published: February 2023

Purpose:

The aim of this study was to quantify preparation difficulties and complications during DMEK graft preparation and their influence on clinical outcome.

Methods:

A retrospective evaluation of 214 consecutive DMEK surgeries from the prospective Cologne DMEK database was performed between July 2018 and December 2019. Preparation conditions (such as central and peripheral adherences, tissue fragility, and Descemet membrane splitting) were quantified and divided into 3 groups: easy, difficult, and very difficult preparation. At follow-up (3, 6, and 12 months after DMEK), best spectacle-corrected visual acuity, endothelial cell count (ECC), and rebubbling rates were evaluated and compared between groups.

Results:

An easy preparation was possible in 41.6% of cases (group 1, n = 89), a difficult preparation of the DMEK graft occurred in 30.8% (group 2, n = 66), and a very difficult preparation occurred in 27.6% (group 3, n = 59). There was no difference between groups for best spectacle-corrected visual acuity at 3, 6, and 12 months (P = 0.179, P = 0.325, and P = 0.682, respectively) or for ECC at 3 and 6 months (P = 0.537 and P = 0.606, respectively). Only at 12 months, the ECC was slightly significant between groups (P = 0.045). Regarding the rebubbling rate, there was no difference (P = 0.585). 17.9% of eyes from group 1, 25.7% of eyes from group 2, and 23.7% of eyes from group 3 received at least 1 rebubbling.

Conclusions:

These data suggest that difficult preparation conditions do not lead to any worsening of visual acuity or rebubbling rate in the 1-year outcome after DMEK. The endothelial cell density at 12 months showed slightly poorer results in the cases of very difficult preparation.
Healing of Chemical Injury–Related Persistent Corneal Epithelial Defects With Topical Insulin
Authors: Balal Shafi , Din Nizar , Ashton Christopher , Ahmad Sajjad
Published: February 2023

Purpose:

The purpose of this study was to evaluate the effectiveness of insulin eye drops for treating refractory persistent epithelial defects (PEDs).

Methods:

A prospective, single-center, case series was performed from March 2020 to September 2021. All patients were prescribed insulin eye drops for refractory PEDs that failed on maximum standard medical treatment (including serum eye drops). The drops were used 4 times/day. Patients were followed up at 2 weekly intervals with full slitlamp examination and serial anterior segment photography. The primary end point was resolution of the epithelial defect.

Results:

Eleven eyes of 10 patients were treated with insulin eye drops. The mean age of the cohort was 45.4 + 25 years with a mean follow-up of 195.7 + 114.3 days after re-epithelization. The most common causative condition was chemical injury (n = 5, 60%). Mean baseline PED defect was 41.3 + 55.2 mm2. Nine of 11 eyes (82%) fully re-epithelized within a mean time of 62.3 + 34.6 days (range 14–112). In 2 patients who did not achieve re-epithelization, one had a reduction in size from 12.25 mm2 to 4.5 mm2 and the other had no response. No recurrence in defect was observed in the group that had fully re-epithelized.

Conclusions:

This study showed that the use of topical insulin eye drops led to a successful resolution of PED in 9 of 11 cases. We demonstrate the use of insulin for closure of PEDs in chemical eye injury. Larger controlled studies are required to further evaluate this novel therapy.
Novel Map Biopsy Technique to Define the Extent of Infection Before Penetrating Keratoplasty for Acanthamoeba Keratitis
Authors: Simpson Alasdair , Sarode Deep , Lockington David , Ramaesh Kanna
Published: February 2023

Purpose:

The purpose of this study was to report a novel approach of prepenetrating keratoplasty (PKP) corneal map biopsies to define the extent of Acanthamoeba cyst infiltration in recalcitrant Acanthamoeba keratitis.

Methods:

Corneal map biopsies were performed 1 week before PKP. Four biopsies, 1 from each peripheral corneal quadrant, were obtained to delineate the extent of microscopic infection. Histological results of these map biopsies were used to determine the size and location of the subsequent PKP.

Results:

In our first case, map biopsies revealed Acanthamoeba cysts in 2 of the 4 biopsies. This led to an inferotemporally eccentric 8.5-mm PKP. The final histology report indicated that the closest resection margin was 0.08 mm. In our second case, the peripheral map biopsies were clear and an inferiorly eccentric 8.25-mm PKP was performed. The final histology report indicated that the closest resection margin was 2.3 mm. Both grafts have remained clear at 6 months postoperatively.

Conclusions:

Map biopsies of the cornea can achieve total removal of the corneal tissues infested with Acanthamoeba cysts and prevent reinfection of the donor graft.
Keratoplasty in the United States: Trends and Indications From 2015 to 2020
Authors: Xiao Grace , Tsou Brittany C. , Soiberman Uri S. , Prescott Christina R. , Srikumaran Divya , Woreta Fasika A.
Published: February 2023

Purpose:

The aim of this study was to report trends in keratoplasty techniques and indications in the United States from 2015 to 2020.

Methods:

This retrospective review of annual reports from the Eye Bank Association of America assessed domestic corneal graft distribution and surgical indication data for various types of keratoplasty. Trends in procedure volume and indications from 2015 to 2020 were analyzed using the Cochran–Armitage test.

Results:

The total number of corneal transplants increased from 47,903 in 2015 to 49,143 in 2019, with a decline to 42,257 in 2020, most likely due to COVID-19. Penetrating keratoplasty (PK) volume decreased from 2015 to 2020 (19,160–15,402, 40% to 36.4%, P < 0.001), continuing a trend from the previous decade. Descemet membrane endothelial keratoplasty as a percentage of all keratoplasty procedures increased (9.8%–27.8%, P < 0.001), whereas Descemet stripping automated endothelial keratoplasty (47%–33.9%, P < 0.001) and anterior lamellar keratoplasty (ALK) decreased (2.3%–1.2%, P < 0.001).

From 2017 to 2020, repeat corneal transplant was the most common specific indication for PK while ectasias/thinnings decreased in prevalence (15.6%–11.5%, P < 0.001). Ectasias/thinnings and endothelial dystrophy remained the leading indications for ALK and endothelial keratoplasty, respectively.

Conclusions:

From 2015 to 2020, keratoplasty trends in the United States showed a continuation of the decrease in PK and increase in Descemet membrane endothelial keratoplasty observed in the previous decade. The most common domestic indications from 2017 to 2020 have been repeat corneal graft, endothelial dystrophy, and ectasias/thinnings for PK, EK, and ALK, respectively.
Paraproteinemic Keratopathy in a Patient With Previous LASIK Procedure Mimicking Lattice Corneal Dystrophy
Authors: Guerrero-Becerril Jesus , Vigderovich-Cielak Itamar , Neme-Yunes Yvette , Pérez Alejandro Navas , Miranda Arturo Ramírez , Zenteno-Ruiz Juan Carlos , Terrazas-Marín Ricardo , Graue-Hernández Enrique O.
Published: February 2023

Purpose:

The aim of this study was to report a unique clinical presentation of paraproteinemic keratopathy after a myopic uneventful laser in situ keratomileusis (LASIK) procedure that led to the diagnosis of gammopathy of undetermined significance.

Methods:

This was an interventional case report. A 55-year-old woman present with bilateral branching opacities limited to the optical zone of myopic LASIK. The patient's medical history was unremarkable.

Results:

After ruling out a mutation in TGF-β1, a systemic workup was performed, revealing an IgG level of 12.8 mg/dL, lambda-free light chain of 12.8 mg/dL, and M-spike of 0.6 g/dL. Bone marrow aspiration was slightly hypercellular, without evidence of neoplastic infiltration by plasma cells. The patient underwent 3 cycles of systemic chemotherapy, with improvement in best-corrected visual acuity.

Conclusions:

Paraproteinemic keratopathy is a rare clinical presentation that may lead to a systemic diagnosis of hematologic malignancy. To the best of our knowledge, this is the first reported case of paraproteinemic keratopathy after LASIK.
Leukocyte Immunoglobulin-like Receptor A5 Deletion Aggravates the Pathogenesis of Pseudomonas aeruginosa Keratitis by Promoting Proinflammatory Cytokines
Authors: Shang Yuqi , Liu Xi , Wei Liwen , Liang Siping , Zou Zhengyu , Wu Minhao , Xia Jinyu
Published: February 2023

Purpose:

The purpose of this study was to assess the role of leukocyte immunoglobulin-like receptor A5 (LILRA5) in regulating bacterial infection and corneal inflammation.

Methods:

The human corneal tissue microarray data set GSE58291 from Gene Expression Omnibus was downloaded. Then, the differentially expressed genes, Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, Gene Set Enrichment Analysis, and the immune infiltration analysis were conducted. We constructed the Pseudomonas aeruginosa (P. aeruginosa) keratitis mice model using wild-type and LILRA5-deficient mice. The results of the bioinformatics analysis were verified by the cell in vitro and animal in vivo experiments.

Results:

This study revealed that LILRA5 is substantially expressed in human keratitis and regulates the immune response negatively. Neutrophils were identified as the core fraction of immune cells in keratitis. After P. aeruginosa infection, neutrophils lacking LILRA5 induced elevated levels of proinflammatory cytokines and toll-like receptor 4. LILRA5 deficiency exacerbated the severity of the infection and the production of proinflammatory cytokines in mice.

Conclusions:

LILRA5 was discovered as an immunosuppressive regulator in P. aeruginosa keratitis, highlighting its significance in activated immune responses.
Types of Descemet Membrane Detachment After Ocular Surface Burns: The Factor Long Been Ignored
Authors: Li Yuan-Ting , Wu Wen-Yu , Li Jing-Yi , Chan Szy-Yann , Ang Marcus , Feng Yun
Published: February 2023

Purpose:

The aim of this study was to explore types of Descemet membrane detachment (DMD) after ocular surface burns by anterior segment optical coherence tomography.

Methods:

This is a pilot, case series, observational study. Patients with DMD after ocular surface burns were enrolled. Ophthalmologic examinations were performed in all patients including slit-lamp photography and anterior segment optical coherence tomography.

Results:

Three types of DMDs in 9 eyes of 9 patients with ocular surface burns were identified depending on the detachment components involved with the pre-Descemet layer (PDL). Type A was referred as a taut chord that the PDL and Descemet membrane (DM) detached simultaneously but were remained attached to each other, while type B was identified as a wavy line separated from the stroma by a dark slit that demonstrated the detachment of DM from the PDL and stroma. Type C was defined as the DM detached with or without PDL but they were separated from each other. We found that DM and PDL were detached simultaneously in most condition, with type A in 4 cases, type C in 5 cases, and type B in only 1 case.

Conclusions:

Our study demonstrated 3 types of DMDs after ocular surface burns and revealed that the limbal involvement and retrocorneal exudations may give clues to DMD in the corresponding areas. DMDs may be neglected for long in patients with extensive limbal involvement in early stages and also play an important role in unstable ocular surface condition until the late stages of conjunctivalization after ocular surface burns.
Evaluation of Biomechanical Changes After Accelerated Cross-Linking in Progressive Keratoconus: A Prospective Follow-Up Study
Authors: Herber Robert , Francis Mathew , Spoerl Eberhard , Pillunat Lutz E. , Raiskup Frederik , Roy Abhijit Sinha
Published: February 2023

Purpose:

The aim of this study was to analyze the biomechanical effect of accelerated corneal cross-linking (9*10) in progressive keratoconus (KC) in comparison to untreated fellow eyes using Scheimpflug-based tonometry (Corvis ST, CVS).

Methods:

Forty-three eyes of 43 patients with KC showed progressive KC and were treated using accelerated corneal cross-linking. Twenty-five untreated fellow eyes were used as the control group. All eyes were examined biomechanically (CVS) and tomographically (Pentacam) at baseline, after 1-month, 6-month, and 12-month follow-up. Statistical analysis was performed using a linear mixed model. A logistic regression was performed to attribute the effects of changes in each parameter to treatment status (treated or untreated).

Results:

Maximum keratometry values decreased statistically significantly at 12 months by −1.1 D (95 confidence interval: −2.0 to −0.1, P = 0.025) compared with baseline. Thinnest corneal thickness decreased significantly after 1 month (P < 0.001) and recovered to baseline after 12 months (P = 0.752). In the corneal cross-linking (CXL) group, biomechanical changes were observed by an increased bIOP, a shorter A2 time, and a lower integrated radius after 1 month (all P < 0.05). No biomechanical and tomographical changes were observed in the control group (all P > 0.05). Logistic regression pointed out that treated eyes can be separated from untreated eyes by differences in bIOP, corneal thickness, A1 velocity, integrated radius, and Kc mean at 1, 6, and 12 months.

Conclusions:

The alterations in biomechanical parameters indicated a corneal stiffening effect after CXL treatment, which was mostly detectable 1 month after treatment, although corneal thickness was reduced. The logistic regression model showed an adequate separation between CXL-treated and untreated eyes.
Ocular Cicatricial Pemphigoid With IgM-Positive Biopsy
Authors: Philip Andrew M. , Stephenson Andrew , Al-Dabbagh Alaa , Ramezani Koosha , Fernandez-Santos Carla C. , Foster C. Stephen
Published: February 2023

Purpose:

The aim of this study was to investigate the prevalence of IgM along the basement membrane zone (BMZ) of patients with ocular cicatricial pemphigoid (OCP) and the outcomes of these patients with immunomodulatory therapy.

Methods:

This study is a retrospective chart review of patients with conjunctival biopsy-proven OCP. Clinical data, including the presence of linear IgM deposition along the BMZ on either direct immunofluorescence or avidin–biotin complex immunohistochemistry, were recorded. Response to IMT was also recorded.

Results:

A total of 817 patients with documented conjunctival biopsies were identified, with 93 (11.4%) positive for OCP with linear IgM deposition along the BMZ. Forty-six patients with sufficient follow-up were evaluated for clinical outcomes, with 35 (76.1%) able to achieve durable remission an average of 24.3 months after initiation of IMT. Most of these patients, 82.9%, were able to achieve durable remission with first-line antimetabolite therapy. Three patients were identified with solely IgM-positive conjunctival biopsies.

Conclusions:

Our study suggests that IgM positivity is seen in a minority of patients with OCP and that outcomes are comparable for these patients to the general OCP patient population.
Management of Belantamab Mafodotin–Associated Keratopathy With Rigid Gas-Permeable Corneal Contact Lenses
Authors: Keye Philip , Engelhardt Monika , Wäsch Ralph , Böhringer Daniel , Reinhard Thomas
Published: February 2023

Belantamab mafodotin is a relatively new drug used in the treatment of relapsed or refractory multiple myeloma. Clinical studies have shown promising responses, but ocular toxicity remains a major challenge with dose reduction or therapy discontinuation being the only available treatment option. We report a clinical case of a patient with severe keratopathy under therapy with belantamab. The use of rigid gas-permeable corneal contact lenses led to a major visual improvement and enabled therapy continuation at full dose over several months. Although this strategy may not be suitable for all patients, it provides an additional option for the treatment of ocular toxicity of this promising agent.
Anterior Segment Swept Source Optical Coherence Tomography and In Vivo Confocal Microscopy Findings in a Case With Bleb-Like Epithelial Basal Membrane Dystrophy
Authors: Eker Serhat , Oflaz Ayse Bozkurt , Bozkurt Banu
Published: February 2023

Purpose:

The aim of this study was to evaluate the anterior segment swept source optical coherence tomography (SS-OCT) and in vivo confocal microscopy (IVCM) features in a patient with bleb-like epithelial basement membrane dystrophy (EBMD).

Methods:

A 67-year-old man was referred to the hospital for recurrent attacks of severe ocular pain, tearing, and photophobia, typically upon awakening in the right eye. Biomicroscopic examination revealed pebbled glass-like appearance in the corneal epithelium which was remarkable with retroillumination and the patient was suspected to have bleb-like EBMD. The cornea was further evaluated using SS-OCT DRI Triton (Topcon, Tokyo, Japan) and IVCM (Heidelberg Retina Tomograph 3, Rostock Cornea Module).

Results:

Using anterior segment SS-OCT, multiple, hyporeflective, round-oval structures within the size range of 30 to 90 μm were observed at the basal epithelial level. IVCM showed circular or oval hyporeflective areas with a diameter ranging from 30 to 140 μm at the level of the basal epithelium in a depth of 35 to 40 μm from the corneal surface and hyperreflective linear structures extending into the corneal epithelium. The corneal stroma was normal, while a few round hyperreflective deposits and guttae were noted at the endothelial cell layer.

Conclusions:

Anterior segment SS-OCT and IVCM can be used in the diagnosis of bleb-like EBMD and are very helpful in differentiating from other epithelial/subepithelial corneal dystrophies and cystic disorders of the corneal epithelium.
Detecting disease progression in mild, moderate and severe glaucoma
Authors: Liebman Daniel L. , Wen Joanne C. , Shen Lucy Q.
Published: February 2023

Purpose of review

The purpose of this review is to examine contemporary techniques for detecting the progression of glaucoma. We provide a general overview of detection principles and review evidence-based diagnostic strategies and specific considerations for detecting glaucomatous progression in patients with mild, moderate and severe disease.

Recent findings

Diagnostic techniques and technologies for glaucoma have dramatically evolved in recent years, affording clinicians an expansive toolkit with which to detect glaucoma progression. Each stage of glaucoma, however, presents unique diagnostic challenges. In mild disease, either structural or functional changes can develop first in disease progression. In moderate disease, structural or functional changes can occur either in tandem or in isolation. In severe disease, standard techniques may fail to detect further disease progression, but such detection can still be measured using other modalities.

Detecting disease progression is central to the management of glaucoma. Glaucomatous progression has both structural and functional elements, both of which must be carefully monitored at all disease stages to determine when interventions are warranted.
Advances in innovative delivery systems for antiglaucoma drugs
Authors: Chen XinYi , Shen Ting
Published: February 2023

Purpose of review

Currently, glaucoma treatment drugs are facing problems such as low bioavailability, poor patient compliance, discontinuous administration affecting the efficacy of intraocular pressure (IOP) lowering and chronic damage to the eye caused by side effects of drugs. In order to solve these problems and to better meet clinical needs, various new dosage forms have been developed and applied in the clinical setting.

Recent findings

A number of nano formulations and extended-release gels are in successive animal trials, some tear plugs, implants and contact lenses are in clinical trials, and it is believed that more new carrier materials and formulations to improve the bioavailability of drugs are being developed.

Novel delivery systems for antiglaucoma drugs offer patients more and better therapeutic options, and ongoing or completed studies are providing clear directions for subsequent research to improve clinical applications.
Comparison of Lens Extraction Versus Laser Iridotomy on Anterior Segment, Choroid, and Intraocular Pressure in Primary Angle Closure Using Machine Learning
Authors: Kurysheva Natalia Ivanovna , Pomerantsev Alexey Leonidovich , Rodionova Oxana Yevgenievna , Sharova Galina Arkadievna
Published: February 2023

Précis:

Treatment strategy of primary angle closure (PAC) is not clear due to the large number of clinical and anatomic-topographic parameters in PAC, influencing the treatment algorithm. Using the machine learning method DD-SIMCA, we justify the expediency of early lens extraction (LE) in PAC.

Purpose:

To compare the anatomic and functional efficacy of LE and laser peripheral iridotomy (LPI) in patients with PAC using Machine Learning.

Materials and Methods:

This prospective study included 120 patients aged 41–80 years: 60 eyes with PAC, 30 with PAC suspects, and 30 with healthy eyes (control). Thirty PAC eyes with intraocular pressure (IOP) up to 30 mm Hg were treated using LE with intraocular lens implantation and 30 eyes with LPI. All subjects underwent Swept Source optical coherence tomography. We analyzed 35 parameters of each eye including the lens vault, the choroidal thickness, the anterior chamber angle, and iris specifications such as iris curvature. Considering the correlations between them, the machine learning method DD-SIMCA 1-class classification was applied: the proximity of each sample to the target class (control) was characterized by the total distance to it.

Results:

After LE, IOP was significantly lower than after LPI (P=0). Every third eye with PAC after LE reached the target class: specificity according to DD-SIMCA equals 0.67. This was not observed for the eyes after LPI: specificity equals 1.0. After LE, all parameters of the anterior chamber angle did not differ from the control (all P>0.05). After LPI, there was an increase in anterior chamber depth (P=0) and a decrease in lens vault (P=0), but results comparable to the control were achieved only for iris curvature (P=1.000).

Conclusion:

The efficacy of LE in PAC is higher than LPI due to the better postoperative anterior chamber topography and lower IOP. This study lends further clinical and anatomic support to the emerging notion of LE as an effective treatment for PAC.
Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness for Diagnosing Early to Moderate Glaucoma
Authors: Zangalli Camila S. , Jammal Alessandro A. , Reis Alexandre S.C. , Ayub Gabriel , Diniz-Filho Alberto , Paranhos Augusto , Paula Jayter S. , Costa Vital P.
Published: February 2023

Précis:

In a cross-sectional study from a Brazilian multiracial population, minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness measurements from OCT showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes.

Purpose:

The purpose of this study is to compare the ability of MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements in discriminating early to moderate glaucoma from healthy eyes in a Brazilian population.

Methods:

A total of 155 healthy controls and 118 patients with mild to moderate glaucoma (mean deviation >−12 dB) underwent MRW and RNFLT measurements with optical coherence tomography. Only 1 eye per patient was included in the analysis. A receiver operating characteristic (ROC) regression model was used to evaluate the diagnostic accuracy of MRW and RNFLT, whereas adjusting for age and Bruch membrane opening area. Sensitivities at fixed specificities of 95% were calculated for each parameter.

Results:

Global RNFLT and MRW showed comparable area under the ROC curves [0.93 (0.91–0.96) and 0.93 (0.89–0.96), respectively; P=0.973]. Both parameters had similar sensitivities (75% vs. 74%, respectively; P=0.852) at a fixed specificity of 95%. The best sector for diagnosing glaucoma for both parameters was the temporal inferior sector, which showed an area under the ROC curve of 0.93 (0.87–0.96) for RNFLT and 0.91 (0.86–0.95) for MRW (P=0.320). The temporal inferior sector showed similar sensitivities for RNFLT and MRW measurements (83% vs. 77%, respectively) at a fixed specificity of 95% (P=0.230).

Conclusions:

MRW and RNFLT measurements showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes in a Brazilian multiracial population.
Use of Sotrovimab in 14 Children with COVID-19: A Single-center Experience
Authors: Butzer Sarina Kim , Habbig Sandra , Mehler Katrin , Haumann Sophie , Meyer Meike , Jung Norma , Oberthür André
Published: February 2023

Children affected by coronavirus disease 2019 (COVID-19) with preexisting comorbidities are at risk of complications. Monoclonal antibodies prevent severe COVID-19 courses in adults but data on children are scarce. Here we report on the use of Sotrovimab in 14 children at risk of severe disease treated at the University of Cologne Children’s Hospital. Tolerability was good and no infusion-related reactions were seen.
Prolonged SARS-CoV-2 Infection and Intra-Patient Viral Evolution in an Immunodeficient Child
Authors: Filippi Micheli , Ribeiro Amorim Mariene , Soares da Silva Mariana , Schons Gularte Juliana , Demoliner Meriane , Girardi Viviane , de Abreu Goes Pereira Vyctoria Malayhka , Witt Hansen Alana , Fleck Juliane Deise. , Frohlich Júlia , de-Paris Fernanda , Motta Rodrigues Grazielle , Aparecida Risczik Arruda Correa Janaina , Machado Arlindo De Mattos Elissandra , Minuto Paiva Rodrigo , Deutschendorf Caroline , Soares Falcetta Frederico , Proença Modena José Luiz , Rosado Spilki Fernando
Published: February 2023

Background:

With the progression of the Coronavirus disease pandemic, the number of mutations in the viral genome has increased, showing the adaptive evolution of severe acute respiratory syndrome coronavirus 2 in humans and intensification in transmissibility. Long-term infections also allow the development of viral diversity. In this study, we report the case of a child with severe combined immu presenting a prolonged severe acute respiratory syndrome coronavirus 2 infection. We aimed to analyze 3 naso-oropharyngeal swab samples collected between August and December 2021 to describe the amino acid changes present in the sequence reads that may have a role in the emergence of new viral variants.

Methods:

The whole genome from clinical samples was sequenced through high throughput sequencing and analyzed using a workflow to map reads and then find variations/single-nucleotide polymorphisms. In addition, the samples were isolated in cell culture, and a plaque forming units assay was performed, which indicates the presence of viable viral particles.

Results:

The results obtained showed that the virus present in all samples is infectious. Also, there were 20 common mutations among the 3 sequence reads, found in the ORF1ab and ORF10 proteins. As well, a considerable number of uncommon mutations were found.

Conclusions:

In conclusion, we emphasize that genomic surveillance can be a useful tool to assess possible evolution signals in long-term patients.
Conservative Treatment of Parapneumonic Effusion in Children: Experience From a 10-Year Consecutive Case Series
Authors: Lohuis Steven J. , de Groot Eric , Kamps Arvid W. A. , Ottink Mark D. , de Vries Tjalling W. , Bekhof Jolita
Published: February 2023

Background:

In children with parapneumonic effusion (PPE), it remains unclear when conservative treatment with antibiotics suffixes or when pleural drainage is needed. In this study we evaluate clinical features and outcomes of children with PPE.

Methods:

A retrospective, multicentre cohort study at 4 Dutch pediatric departments was performed, including patients 1–18 years treated for PPE between January 2010 and June 2020.

Results:

One hundred thirty-six patients were included (mean age 8.3 years, SD 4.8). 117 patients (86%) were treated conservatively and 19 (14%) underwent pleural drainage. Patients undergoing pleural drainage had mediastinal shift more frequently compared with conservatively treated patients (58 vs. 3%, difference 55%; 95% CI: 32%–77%). The same accounted for pleural septations/pockets (58 vs. 11%, difference 47%; 95% CI: 24%–70%), pleural thickening (47 vs. 4%, difference 43%; 95% CI: 20%–66%) and effusion size (median 5.9 vs. 2.7 cm; P = 0.032). Conservative management was successful in 27% of patients (4 of 15) with mediastinal shift, 54% of patients (13 of 24) with septations/pockets, 36% of patients (5 of 14) with pleural thickening, and 9% of patients (3 of 32) with effusions >3 cm, all radiological signs generally warranting pleural drainage. In patients treated conservatively, median duration of hospitalization was 5 days (IQR 4–112) compared with 19 days (IQR 15–24) in the drainage group (P < 0.001), without significant difference in readmission rate (11 vs. 4%, difference 6%; 95% CI: –8%–21%).

Conclusion:

This study suggests that the greater amount of children with PPE could be treated conservatively with antibiotics only, especially in absence of mediastinal shift, pleural septations/pockets, pleural thickening or extensive effusions.
Interferon Gamma Release Assay Results and Testing Trends Among Patients Younger Than 2 Years Old at Two US Health Centers
Authors: Tabatneck Mary E. , He Wei , Lamb Gabriella S. , Sun Mingwei , Goldmann Don , Sabharwal Vishakha , Sandora Thomas J. , Haberer Jessica E. , Campbell Jeffrey I.
Published: February 2023

Background:

Interferon-gamma release assays (IGRAs) are approved for children ≥2 years old to aid in diagnosis of Mycobacterium tuberculosis (TB) infection and disease. Tuberculin skin tests (TSTs) continue to be the recommended method for diagnosis of TB infection in children <2 years, in part due to limited data and concern for high rates of uninterpretable results.

Methods:

We performed a retrospective cohort study of IGRA use in patients <2 years old in 2 large Boston healthcare systems. The primary outcome was the proportion of valid versus invalid/indeterminate IGRA results. Secondary outcomes included concordance of IGRAs with paired TSTs and trends in IGRA usage over time.

Results:

A total of 321 IGRA results were analyzed; 308 tests (96%) were valid and 13 (4%) were invalid/indeterminate. Thirty-seven IGRAs were obtained in immunocompromised patients; the proportion of invalid/indeterminate results was significantly higher among immunocompromised (27%) compared with immunocompetent (1%) patients (P < 0.001). Paired IGRAs and TSTs had a concordance rate of 64%, with most discordant results in bacille Calmette-Guérin–vaccinated patients. The proportion of total TB tests that were IGRAs increased over the study period (Pearson correlation coefficient 0.85, P < 0.001).

Conclusions:

The high proportion of valid IGRA test results in patients <2 years of age in a low TB prevalence setting in combination with the known logistical and interpretation challenges associated with TSTs support the adoption of IGRAs for this age group in certain clinical scenarios. Interpretation of IGRAs, particularly in immunocompromised patients, should involve consideration of the broader clinical context.
Clinical and Biologic Characteristics of Kingella kingae-Induced Septic Arthritis of the Knee in Young Children
Authors: Ramadani Ardian , Coulin Benoit , De Marco Giacomo , Vazquez Oscar , Tabard-Fougère Anne , Gavira Nathaly , Steiger Christina N. , Dayer Romain , Ceroni Dimitri
Published: February 2023

Background and Objectives:

Septic arthritis of the knee is presumed to be the most frequent form of Kingella kingae-induced osteoarticular infection. This study aimed to report on the clinical course, biological parameters, and results of microbiological investigations among children with K. kingae-induced septic arthritis of the knee. It also assessed the modified Kocher–Caird criteria’s ability to predict K. kingae-induced septic arthritis of the knee.

Methods:

The medical charts of 51 children below 4 years old with confirmed or highly probable K. kingae-induced arthritis of the knee were reviewed. Data were gathered on the five variables in the commonly-used Kocher–Caird prediction algorithm (body temperature, refusal to bear weight, leukocytosis, erythrocyte sedimentation rate, and C-reactive protein level).

Results:

Patients with K. kingae-induced arthritis of the knee usually presented with a mildly abnormal clinical picture and normal or near-normal serum levels of acute-phase reactants. Data on all five variables were available for all the children: 7 children had zero predictors; 8, 20, 12, and 4 children had 1, 2, 3, and 4 predictors, respectively; no children had 5 predictors. This gave an average of 1.96 predictive factors and a subsequent probability of ≤ 62.4% of infectious arthritis in this pediatric cohort.

Conclusions:

Because the clinical features of K. kingae-induced arthritis of the knee overlap with many other conditions affecting this joint, the Kocher–Caird prediction algorithm is not sensitive enough to effectively detect K. kingae-induced septic arthritis of the knee. Excluding K. kingae-induced arthritis of the knee requires performing nucleic acid amplification assays on oropharyngeal swabs and joint fluid from those young children presenting with effusion of the knee, even in the absence of fever, leukocytosis, or a high Kocher–Caird score.
Increase in Invasive Group a Streptococcal Infections in Children in the Netherlands, A Survey Among 7 Hospitals in 2022
Authors: van Kempen Evelien B. , Bruijning-Verhagen Patricia C. J. , Borensztajn Dorine , Vermont Clementien L. , Quaak Marjolijn S. W. , Janson Jo-Anne , Maat Ianthe , Stol Kim , Vlaminckx Bart J. M. , Wieringa Jantien W. , van Sorge Nina M. , Boeddha Navin P. , van Veen Mirjam
Published: February 2023

Following an increase in notifiable invasive group A streptococcal (iGAS) infections in the Netherlands, we conducted a survey among 7 hospitals. Pediatric iGAS case numbers were 2-fold higher between July 2021 and June 2022 versus pre-COVID-19. A sharp increase occurred early 2022, most pronounced in <5 years old and for diagnoses empyema and necrotizing fasciitis. This recent pediatric iGAS surge warrants investigation and vigilance.
Clinical and Health System Impact of Biofire Filmarray Meningitis/Encephalitis Routine Testing of CSF in a Pediatric Hospital: An Observational Study
Authors: Berkhout Angela , Cheng Daryl R. , McNab Sarah , Lee Lai-yang , Daley Andrew J. , Clifford Vanessa
Published: February 2023

Background:

Rapid cartridge-based molecular test panels targeting multiple pathogens are increasingly available, improve pathogen detection and reduce turn-around-time but are more expensive than standard testing. Confirmation that these test panels contribute to improved patient or health service outcomes is required.

Methods:

In March 2021, our pediatric hospital laboratory implemented the BioFire Filmarray™ meningitis/encephalitis (M/E) panel as an additional routine test for all cerebrospinal fluid (CSF) samples collected from infants <90 days or from any patient in the emergency department. A retrospective chart review was done to ascertain changes in clinical outcomes, antimicrobial prescribing practices, and hospital length of stay, comparing two discrete 6-month periods: preimplementation (March–August 2019) and postimplementation (March-August 2021).

Results:

Both pre- and postimplementation groups were similar at baseline, except the preimplementation group had a higher proportion of infants with enterovirus and parechovirus meningitis. There was no significant difference between the groups in terms of median length of stay (2.94 vs 3.47 days, p = 0.41), duration of antibiotic treatment (2.0 vs 2.3 days, p = 0.25), need for central venous access (12.9% vs 17%, p = 0.38) or hospital-in-the-home admission (9.4% vs 9%, p = 0.92). A similar proportion of infants received aciclovir (33% vs 31%), however, a reduction in duration was observed (1.36 vs 0.90 days, p = 0.03) in the postimplementation period.

Conclusions:

Introduction of the Biofire Filmarray™ M/E panel for routine testing of CSF samples reduced the duration of antiviral prescribing but had only a minor impact on antibiotic prescribing practices or health service outcomes in our pediatric hospital. The introduction of new laboratory testing needs to be supported by a comprehensive stewardship program to see optimal outcomes from new testing platforms.
Meningitis Among Neonates with Suspected Sepsis Presenting to Pediatric Emergency
Authors: Soni Prakash Kumar , Kumar Jogender , Angrup Archana , Kumar Praveen , Saini Shiv Sajan , Sundaram Venkataseshan , Mukhopadhyay Kanya , Dutta Sourabh
Published: February 2023

We aimed to assess the risk factors, clinical features and microbial profiles of meningitis in neonates with suspected sepsis referred to a pediatric emergency. Over 13 months, 191 neonates were enrolled, of whom 64 (33.5%) had meningitis. There were no significant differences in risk factors or clinical features between infants with and without meningitis. Ninety-three neonates (49%) had culture-positive sepsis (109 isolates). Candida spp. (n = 29), coagulase-negative staphylococci (n = 28) and Klebsiella pneumoniae (n = 23) were the most common pathogens. Forty-one (53%) bacteria were multidrug resistant.
HIV Viral Load Scale-up Among Children and Adolescents: Trends in Viral Load Suppression, Sample Type and Processing in 7 PEPFAR Countries, 2015–2018
Authors: Hrapcak Susan , Pals Sherri , Itoh Megumi , Peters Natalie , Carpenter Deborah , Hackett Stephanie , Prao Aka K. , Adje-Toure Christiane , Eboi Ehui , Mutisya Immaculate , Nyabiage Omoto Lennah , Ondondo Raphael O. , Bowen Nancy , Nyanya Winifred , Kayira Dumbani , Kaba Muluken D. , Mwenda Rueben , Deus Maria Ines , Almeida Jose , Cuco Rosa Marlene M. , Boylan Ashley , Beard Suzanne , Ashikoto Sylvia , van Rooyen Gerhard , Kindra Gurpreet , Diallo Karidia , Carmona Sergio , Nazziwa Esther , Mwangi Christina , Ntale Jonathan , Ssewanyana Isaac , Nabadda Susan N. , Nabukenya Miriam , Ellenberger Dennis , Rivadeneira Emilia
Published: February 2023

HIV-positive children and adolescents face gaps in viral load (VL) testing. To understand trends in pediatric/adolescent VL testing, 7 countries collected data from Laboratory Information Management Systems. Results showed increasing proportion of VL tests done through dried blood spot (DBS) and decreased sample rejection rates for DBS compared with plasma, supporting use of DBS VL when skilled phlebotomy is unavailable.
Evaluation of Depression and Anxiety in a Diverse Population With Thyroid Eye Disease Using the Nationwide NIH All of Us Database
Authors: Lee Tonya C. , Radha-Saseendrakumar Bharanidharan , Delavar Arash , Ye Gordon Y. , Ting Michelle A. , Topilow Nicole J. , Bass Jeremy , Korn Bobby S. , Kikkawa Don O. , Baxter Sally L. , Liu Catherine Y.
Published: February 2023

Purpose:

To evaluate the prevalence of depression and anxiety among individuals with thyroid eye disease (TED) and identify sociodemographic risk factors using the NIH All of Us database.

Methods:

Three hundred ninety eight cases with TED were compared with 1,592 controls with demographics matching the 2020 US Census. Primary outcomes were diagnosed depression or anxiety; Patient Health Questionnaire-9 (PHQ-9) scores and General Anxiety Disorder-7 (GAD-7) scores were included as secondary outcomes. We performed multivariable logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between TED and depression and anxiety.

Results:

Patients with TED were more likely to have depression (OR 2.72, 95% CI 2.08–3.56, p < 0.001) and anxiety (OR 2.82, 95% CI 2.16–3.70, p < 0.001) than controls. In patients with TED, female gender was an independent risk factor for both depression (OR 1.72; 95% CI 1.00–5.07, p = 0.05) and anxiety (OR 2.17, 95% CI 1.25–3.85, p = 0.006). Unemployment (OR 1.72, 95% CI 1.03–2.94, p = 0.04) and lower income (OR 0.88 for income as a continuous variable, 95% CI 0.79–0.99, p = 0.03) were risk factors for anxiety. Risk factors for more severe depression as assessed by PHQ-9 included lower income (OR 0.70, 95% CI 0.57–0.85, p < 0.001), and protective factors included Black race (OR 0.12, 95% CI 0.02–0.45, p = 0.002). Lower income was associated with more severe anxiety as assessed by GAD-7 (OR 0.77, 95% CI 0.64–0.94, p = 0.009).

Conclusions:

Patients with TED were more likely to develop depression and anxiety compared with controls. This study highlights the psychosocial impact of TED and associated socioeconomic risk factors.
Efficacy of vector thermal pulsation treatment in reducing postcataract surgery dry eye disease in patients affected by meibomian gland dysfunction
Authors: Mencucci Rita , Mercuri Stefano , Cennamo Michela , Morelli Alberto , Favuzza Eleonora
Published: February 2023

Purpose:

To evaluate the effect of a single LipiFlow vector thermal pulsation treatment performed before cataract surgery in reducing signs and symptoms of postoperative dry eye disease (DED) in patients with mild-moderate meibomian gland dysfunction (MGD).

Setting:

Eye Clinic, Careggi Hospital, University of Florence, Florence, Italy.

Design:

Prospective unmasked randomized controlled clinical trial.

Methods:

This study included patients affected by age-related cataract and mild-moderate MGD, who were randomized into 2 groups: (1) a single LipiFlow treatment performed at 5 preoperative weeks and (2) warm compresses and eyelid massages twice a day for 1 preoperative month (control group). Noninvasive break-up time (NI-BUT), Schirmer test, Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, and MG functionality parameters were evaluated at visit 0 (5 preoperative weeks), visit 1 (1 preoperative week), and visit 2 (1 postoperative month). Confocal microscopy of the MG of lower eyelids was performed at visit 0 and visit 2.

Results:

A total of 46 patients (46 eyes) were enrolled. In the LipiFlow group (n = 23), NI-BUT, SPEED questionnaire, and MG functionality parameters significantly improved at visit 1 (P < .05) and visit 2 (P < .05) compared with baseline and remained stable postoperatively. In the control group (n = 23), they did not significantly improve after treatment, while worsened postoperatively. Moreover, the changes in all parameters from baseline were significantly different between the 2 groups. Confocal microscopy imaging highlighted lower postoperative MG alterations in the LipiFlow group.

Conclusions:

A single preoperative LipiFlow treatment was effective in preventing postcataract surgery DED in patients with mild-moderate MGD. Postoperatively, treated patients displayed a better ocular surface status compared with warm compresses.
Indifference or hypersensitivity? Solving the riddle of the pain profile in individuals with autism
Authors: Hoffman Tseela , Bar-Shalita Tami , Granovsky Yelena , Gal Eynat , Kalingel-Levi Merry , Dori Yael , Buxbaum Chen , Yarovinsky Natalya , Weissman-Fogel Irit
Published: February 2023

Excitatory–inhibitory (E/I) imbalance is a mechanism that underlies autism spectrum disorder, but it is not systematically tested for pain processing. We hypothesized that the pain modulation profile (PMP) in autistic individuals is characterized by less efficient inhibitory processes together with a facilitative state, indicative of a pronociceptive PMP. Fifty-two adults diagnosed with autism and 52 healthy subjects, age matched and sex matched, underwent quantitative sensory testing to assess the function of the (1) pain facilitatory responses to phasic, repetitive, and tonic heat pain stimuli and (2) pain inhibitory processes of habituation and conditioned pain modulation. Anxiety, pain catastrophizing, sensory, and pain sensitivity were self-reported. The autistic group reported significantly higher pain ratings of suprathreshold single (P = 0.001), repetitive (46°C- P = 0.018; 49°C- P = 0.003; 52°C- P < 0.001), and tonic (P = 0.013) heat stimuli that were cross correlated (r = 0.48-0.83; P < 0.001) and associated with sensitivity to daily life pain situations (r = 0.39-0.45; P < 0.005) but not with psychological distress levels. Hypersensitivity to experimental pain was attributed to greater autism severity and sensory hypersensitivity to daily stimuli. Subjects with autism efficiently inhibited phasic but not tonic heat stimuli during conditioned pain modulation. In conclusion, in line with the E/I imbalance mechanism, autism is associated with a pronociceptive PMP expressed by hypersensitivity to daily stimuli and experimental pain and less-efficient inhibition of tonic pain. The latter is an experimental pain model resembling clinical pain. These results challenge the widely held belief that individuals with autism are indifferent to pain and should raise caregivers' awareness of pain sensitivity in autism.