Rose Bengal Electromagnetic Activation with Green Light for Infection Reduction (REAGIR) Study: A randomized, double-masked, sham-controlled clinical trial of rose bengal photodynamic therapy.

Objective: To determine the effect of adjunctive rose-bengal photodynamic therapy (RB-PDT) in the treatment of fungal, Acanthamoeba, and smear/culture negative infectious keratitis.

Study Design: This international, randomized, double-masked, sham controlled clinical trial, randomizes patients with corneal ulcers in a 1:1 fashion to one of two treatment arms: 1) Topical antimicrobial plus sham RB-PDT or 2) Topical antimicrobial plus RB-PDT.

Main Outcome Measures: The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 6 months.

Adjunctive Topical Calcineurin Inhibitors During the Treatment of Fungal Keratitis: Practice Patterns and Opinions.

Purpose: Successful antifungal treatment for fungal keratitis does not always result in a good visual outcome. Both infectious and inflammatory components of the disease result in visually significant corneal opacification. We conducted a survey of cornea specialists to elicit expert opinion on the role topical calcineurin inhibitors may play in the management of fungal keratitis.

Steroids and Cross-Linking for Ulcer Treatment: The SCUT II Randomized Clinical Trial.

Importance: Adjunctive topical corticosteroids and/or corneal cross-linking (CXL) have the potential to improve outcomes in bacterial keratitis.

Objective: To determine the benefit of adjunctive topical difluprednate and CXL with riboflavin in addition to topical antibiotics.

Design, Setting, And Participants: This was a National Institutes of Health (NIH)-funded, sham, placebo-controlled trial randomizing participants to topical moxifloxacin, 0.

Symptoms as an Indicator of Microbial Keratitis Severity and Its Association With Visual Acuity.

Objective: Microbial keratitis (MK) is a vision-threatening and often painful corneal infection. This study aims to quantify severity of symptoms of MK at presentation and investigate their association with visual acuity (VA).

Methods: The Automated Quantitative Ulcer Analysis (AQUA) study recruited MK patients from two sites (University of Michigan and Aravind Eye Care System).

Genome-wide methylation analysis unveils genes and pathways with altered methylation profiles in pterygium.

Pterygium is a highly prevalent ocular surface disease, particularly in equatorial regions, with no pharmaceutical intervention available and surgical excision remaining the only treatment option. Ultraviolet (UV) radiation from sunlight is widely recognized as the primary cause of pterygium. While chronic UV exposure induces epigenetic changes in the skin contributing to skin cancer, comprehensive studies on epigenetic alterations in pterygium remain unpublished, and causal relationships have yet to be established.

Self-knowledge distillation-empowered directional connectivity transformer for microbial keratitis biomarkers segmentation on slit-lamp photography.

The lack of standardized, objective tools for measuring biomarker morphology poses a significant obstacle to managing Microbial Keratitis (MK). Previous studies have demonstrated that robust segmentation benefits MK diagnosis, management, and estimation of visual outcomes. However, despite exciting advances, current methods cannot accurately detect biomarker boundaries and differentiate the overlapped regions in challenging cases.

Genetic implications of CHST6 gene mutations and their corneal microstructural changes in macular corneal dystrophy patients.

Purpose: To collectively investigate the carbohydrate sulfotransferase 6 (CHST6) mutation spectrum and corneal morphological alterations of macular corneal dystrophy (MCD) patients using in vivo confocal microscopy (IVCM), histochemistry, immunohistochemistry, and further ascertaining the immunophenotype using an enzyme-linked immunosorbent assay (ELISA).

Methods: Sanger sequencing-based CHST6 gene screening was performed for 112 study participants (MCD patients, n = 68; family members, n = 44). Twenty-seven MCD patients underwent IVCM analyses, and corneal buttons were analyzed with histochemistry Alcian blue (AB) staining and immunohistochemistry anti-keratan sulfate (KS) monoclonal antibody, 5D4MoAb.

Factors Associated with Vision Outcomes in Microbial Keratitis: A Multisite Prospective Cohort Study.

Purpose: To investigate factors associated with 90-day vision in patients with microbial keratitis (MK).

Design: Multicenter prospective cohort study recruited patients with MK from the United States and India from July 23, 2020, through May 1, 2024, and followed them for 90 days.

Participants: Individuals ≥ 15 years of age with MK of > 2 mm in stromal infiltrate area without prior corneal surgery or gluing, impending corneal perforation or keratoplasty, no light perception vision, current pregnancy, or incarceration.

Multimodal Deep Learning for Differentiating Bacterial and Fungal Keratitis Using Prospective Representative Data.

Objective: This study develops and evaluates multimodal machine learning models for differentiating bacterial and fungal keratitis using a prospective representative dataset from South India.

Design: Machine learning classifier training and validation study.

Participants: Five hundred ninety-nine subjects diagnosed with acute infectious keratitis at Aravind Eye Hospital in Madurai, India.

Inhibition of matrix metalloproteases by a chemical cross-linker to halt the corneal degradation in keratoconus.

The need for better and simpler alternative crosslinking strategies to treat keratoconus (KC) is becoming essential as there is only a single approved way to treat it. Recently, conventional UV-A Riboflavin crosslinking is proven to have some disadvantages such as causing damage to the corneal endothelium and inducing keratocyte apoptosis. A chemical cross-linker (CXL) using carbodiimide chemistry and an octanedioic acid spacer is found effective in stiffening the cornea and has the potential to be developed as an alternative therapy to halt KC progression.

OSSN in South India: Clinical presentation, treatment outcomes, and histopathologic correlations.

Purpose: This study aimed to analyze the clinical presentation, treatment outcomes, and histopathology features of ocular surface squamous neoplasia (OSSN) in a South Indian population and correlate the area of lesions to the histopathological grade/severity of carcinoma in situ (CIN) and squamous cell carcinoma (SqCC) invasive and noninvasive tumors.

Methods: The study was a retrospective cross-sectional study. The study reviewed electronic medical records (EMRs) of 99 eyes of 99 South Indian patients who underwent en bloc excision and biopsy for tumors in the corneal and conjunctival epithelium with suspicion of OSSN over 1 year from January 2019 to December 2019.

Association between in vitro susceptibility and clinical outcomes in fungal keratitis.

Purpose: The purpose of this study was to assess the association between antifungal susceptibility as measured by minimum inhibitory concentration (MIC) and clinical outcomes in fungal keratitis.

Methods: This pre-specified secondary analysis of the Mycotic Ulcer Treatment Trial II (MUTT II) involved patients with filamentous fungal keratitis presenting to Aravind Eye Hospitals in South India. Antifungal susceptibility testing for natamycin and voriconazole was performed on all samples with positive fungal culture results according to Clinical and Laboratory Standards Institute Guidelines.

A double-masked, sham-controlled trial of rose bengal photodynamic therapy for the treatment of fungal and acanthamoeba keratitis: Rose Bengal Electromagnetic Activation with Green Light for Infection Reduction (REAGIR) study.

Background: Infectious keratitis secondary to fungus or acanthamoeba often has a poor outcome despite receiving the best available medical therapy. In vitro rose bengal photodynamic therapy (RB-PDT) appears to be effective against fungal and acanthamoeba isolates (Atalay HT et al., Curr Eye Res 43:1322-5, 2018, Arboleda A et al.

Biomarker Detection and Validation for Corneal Involvement in Patients With Acute Infectious Conjunctivitis.

Importance: Infectious conjunctivitis can lead to corneal involvement and result in ocular morbidity. The identification of biomarkers associated with corneal involvement has the potential to improve patient care.

Objective: To identify biomarkers in patients with acute infectious conjunctivitis.

In vitro and ex vivo models of microbial keratitis: Present and future.

Microbial keratitis (MK) is an infection of the cornea, caused by bacteria, fungi, parasites, or viruses. MK leads to significant morbidity, being the fifth leading cause of blindness worldwide. There is an urgent requirement to better understand pathogenesis in order to develop novel diagnostic and therapeutic approaches to improve patient outcomes.

Assessing the Impact of Image Quality on Deep Learning Classification of Infectious Keratitis.

Objective: To investigate the impact of corneal photograph quality on convolutional neural network (CNN) predictions.

Design: A CNN trained to classify bacterial and fungal keratitis was evaluated using photographs of ulcers labeled according to 5 corneal image quality parameters: eccentric gaze direction, abnormal eyelid position, over/under-exposure, inadequate focus, and malpositioned light reflection.

Participants: All eligible subjects with culture and stain-proven bacterial and/or fungal ulcers presenting to Aravind Eye Hospital in Madurai, India, between January 1, 2021 and December 31, 2021.

Rapid Point-of-Care Identification of Aspergillus Species in Microbial Keratitis.

Importance: Microbial keratitis (MK) is a common cause of unilateral visual impairment, blindness, and eye loss in low-income and middle-income countries. There is an urgent need to develop and implement rapid and simple point-of-care diagnostics for MK to increase the likelihood of good outcomes.

Objective: To evaluate the diagnostic performance of the Aspergillus-specific lateral-flow device (AspLFD) to identify Aspergillus species causing MK in corneal scrape and corneal swab samples of patients presenting with microbial keratitis.

Apollo Rising: Acute Conjunctivitis Outbreak in India, 2022.

Purpose: To identify pathogens associated with the 2022 conjunctivitis outbreak in Tamil Nadu, India.

Methods: This prospective study was conducted in November of 2022. Patients with presumed acute infectious conjunctivitis presenting to the Aravind Eye Clinic in Madurai, India were eligible.

FluoroPi Device With SmartProbes: A Frugal Point-of-Care System for Fluorescent Detection of Bacteria From a Pre-Clinical Model of Microbial Keratitis.

Purpose: Rapid and accurate diagnosis of microbial keratitis (MK) could greatly improve patient outcomes. Here, we present the development of a rapid, accessible multicolour fluorescence imaging device (FluoroPi) and evaluate its performance in combination with fluorescent optical reporters (SmartProbes) to distinguish bacterial Gram status. Furthermore, we show feasibility by imaging samples obtained by corneal scrape and minimally invasive corneal impression membrane (CIM) from ex vivo porcine corneal MK models.

Validation of the C-DU(KE) Calculator as a Predictor of Outcomes in Patients Enrolled in Steroids for Corneal Ulcer and Mycotic Ulcer Treatment Trials.

Purpose: The aim of this study was to validate the C-DU(KE) calculator as a predictor of treatment outcomes on a data set derived from patients with culture-positive ulcers.

Methods: C-DU(KE) criteria were compiled from a data set consisting of 1063 cases of infectious keratitis from the Steroids for Corneal Ulcer Trial (SCUT) and Mycotic Ulcer Treatment Trial (MUTT) studies. These criteria include corticosteroid use after symptoms, visual acuity, ulcer area, fungal etiology, and elapsed time to organism-sensitive therapy.

The effect of social determinants of health on severity of microbial keratitis presentation at a tertiary eye care hospital in Southern India.

Purpose: Understanding the association between social determinants of health (SDoHs) and microbial keratitis (MK) can inform underlying risk for patients and identify risk factors associated with worse disease, such as presenting visual acuity (VA) and time to initial presentation.

Methods: This was a cross-sectional study was conducted with patients presenting with MK to the cornea clinic at a tertiary care hospital in Madurai, India. Patient demographics, SDoH survey responses, geographic pollution, and clinical features at presentation were collected.