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Diagnostics
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Diagnosis and Management of Eye Infections
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Diagnosis and Management of Eye Infections

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Diagnostic Microbiology and Infectious Disease".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 12853

Special Issue Editor

Dr. Darren Shu Jeng Ting

E-Mail Website
Guest Editor
1. Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
2. Birmingham and Midland Eye Centre, Birmingham, UK
Interests: antimicrobial therapy; antimicrobial resistance; artificial intelligence; corneal disease; drug discovery and development; host defense peptide; infectious keratitis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Infectious keratitis (IK) is the leading cause of corneal blindness globally, affecting around 6 million people worldwide. A wide array of organisms, including bacteria, fungi, viruses, and parasites, have been implicated in the manifestation of IK. Currently, microscopy, culture, and sensitivity testing represent the most common diagnostic approach for IK, but this approach is challenged by several factors, including long diagnostic turnaround time, variably low culture positivity rate, and polymicrobial infection. Clinical metagenomic next-generation sequencing and artificial-intelligence-assisted technologies have demonstrated their potential in augmenting the diagnostic performance and accuracy for IK.

In addition, the efficacy of topical antimicrobial treatment is being increasingly challenged by the emergence of antimicrobial resistance and polymicrobial infection. Surgical interventions such as corneal gluing, conjunctival hooding, therapeutic corneal cross-linking (PACK-CXL), amniotic membrane transplantation, and therapeutic keratoplasty are often required to manage the associated complications and to achieve complete eradication of the infection. Emerging antimicrobial therapies such as antimicrobial peptides/host defense peptides, bacteriophage and innovative drug delivery of antimicrobial therapy have recently demonstrated promise.

The overarching aim of this Special Issue is to highlight various emerging diagnostic and therapeutic modalities for IK. All types of articles are welcome for submission, including systematic reviews, narrative reviews, clinical trials, prospective/retrospective studies, and case series.

Dr. Darren Shu Jeng Ting
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acanthamoeba keratitis
  • amniotic membrane transplantation
  • antimicrobial therapy
  • antimicrobial resistance
  • artificial intelligence
  • bacterial keratitis
  • bacteriophage
  • contact lens
  • corneal cross-linking
  • corneal infection
  • fungal keratitis
  • host defense peptide
  • infectious keratitis
  • keratoplasty
  • microbial keratitis
  • next-generation sequencing
  • ocular surface
  • viral keratitis

Published Papers (7 papers)

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Research

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18 pages, 1093 KiB  
Article
Susceptibility of Ocular Surface Bacteria to Various Antibiotic Agents in a Romanian Ophthalmology Clinic
by Aurelian Mihai Ghita, Daniela Adriana Iliescu, Ana Cristina Ghita and Larisa Adriana Ilie
Diagnostics 2023, 13(22), 3409; https://doi.org/10.3390/diagnostics13223409 - 9 Nov 2023
Viewed by 932
Abstract
Periodic assessment of bacterial contamination is necessary as it allows proper guidance in cases of eye infections through the use of appropriate antibiotics. Due to the extensive use of antibiotic treatment, many strains of the microbiota that cause infections are resistant to the [...] Read more.
Periodic assessment of bacterial contamination is necessary as it allows proper guidance in cases of eye infections through the use of appropriate antibiotics. Due to the extensive use of antibiotic treatment, many strains of the microbiota that cause infections are resistant to the usual ophthalmic antibiotics. The present study provides an updated assessment of the susceptibility of Gram-positive and Gram-negative bacteria found on the ocular surface to the most commonly used antibiotic agents in patients undergoing cataract surgery. A total of 993 patients were included in the study with ages between 44 and 98 years old. Conjunctival cultures were collected 7 days before cataract surgery. The response of Gram-positive and Gram-negative bacteria to various antibiotic classes, such as glycopeptides, cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, phenicols, tetracyclines, rifamycins, macrolides and penicillins, was assessed. From the tested antibiotics, vancomycin had 97.8% efficacy on Gram-positive bacteria. In the cephalosporin category, we observed a high level of resistance of the cefuroxime for both Gram-positive and negative bacteria. Antibiotics that have more than 90% efficacy on Gram-positive bacteria are meropenem, imipenem, netilmicin, amikacin and rifampicin. On Gram-negative bacteria, we found 100% efficacy of all tested fluoroquinolones, i.e., aminoglycosides (except for tobramycin), doxycycline, azithromycin, clarithromycin and chloramphenicol. The current study illustrates patterns of increased resistance in certain bacteria present on the ocular surface to some of the commonly used antibiotics in ophthalmological clinical practice. One such revealing example is cefuroxime, which has been highly used as an intracameral antibiotic for the prevention of bacterial endophthalmitis after cataract surgery. Full article
(This article belongs to the Special Issue Diagnosis and Management of Eye Infections)
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12 pages, 1179 KiB  
Article
Clinical Characterization and Outcomes of Culture- and Polymerase Chain Reaction-Negative Cases of Infectious Keratitis
by Sarah Atta, Rohan Bir Singh, Keerthana Samanthapudi, Chandrashan Perera, Mahmoud Omar, Shannon Nayyar, Regis P. Kowalski and Vishal Jhanji
Diagnostics 2023, 13(15), 2528; https://doi.org/10.3390/diagnostics13152528 - 29 Jul 2023
Cited by 1 | Viewed by 976
Abstract
Purpose: To examine the clinical presentation, management, and outcomes of culture and polymerase chain reaction (PCR) negative cases of infectious keratitis. Methods: In this retrospective case series, we evaluated the laboratory and medical records of culture- and PCR-negative cases (2016–2020) reported to a [...] Read more.
Purpose: To examine the clinical presentation, management, and outcomes of culture and polymerase chain reaction (PCR) negative cases of infectious keratitis. Methods: In this retrospective case series, we evaluated the laboratory and medical records of culture- and PCR-negative cases (2016–2020) reported to a tertiary care center, which were presumed to be infectious keratitis on the basis of clinical history and presentation. Results: A total of 121 cases with culture-negative keratitis were included in this study. The mean age of the patients was 48.42 ± 1.89 years, and 53.72% were female. At presentation, the presumed etiology was viral in 38.01%, bacterial in 27.27%, fungal in 8.26%, Acanthamoeba in 6.61%, and unlisted in 28.92% of cases. The most common risk factors were a previous history of ocular surface diseases (96.69%) and contact lens use (37.19%). In total, 61.98% of the patients were already on antimicrobial medication at presentation. The initial management was altered in 79 cases (65.29%) during the treatment course. Average presenting and final (post-treatment) visual acuities (VA) were 0.98 ± 0.04 (LogMAR) and 0.42 ± 0.03 (LogMAR), respectively. A significantly higher frequency of patients with a final VA worse than 20/40 (Snellen) had worse VA at initial presentation (p < 0.0001). A history of ocular surface disease, cold sores, and recurrent infection (p < 0.05) were more commonly associated with a presumed diagnosis of viral keratitis. The patients with presumed bacterial etiology were younger and had a history of poor contact lens hygiene (p < 0.05). Conclusions: We observed a distinct difference in clinical features among patients with culture-negative and PCR-negative keratitis managed for presumed viral and bacterial infections. Although there was significant variability in presentation and management duration in this cohort, the visual outcomes were generally favorable. Full article
(This article belongs to the Special Issue Diagnosis and Management of Eye Infections)
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13 pages, 977 KiB  
Article
Trends in Infectious Keratitis in Taiwan: An Update on Predisposing Factors, Microbiological and Antibiotic Susceptibility Patterns
by Jin-Jhe Wang, Chien-Hsiung Lai, Chau-Yin Chen, Chia-Yen Liu, Meng-Hung Lin, Yao-Hsu Yang and Pei-Lun Wu
Diagnostics 2022, 12(9), 2095; https://doi.org/10.3390/diagnostics12092095 - 29 Aug 2022
Cited by 3 | Viewed by 1656
Abstract
Infectious keratitis (IK) represents a major cause of corneal blindness. This study aims to investigate the demographics, risk factors, microbiological characteristics and antibiotic susceptibility patterns of IK in Taiwan over the past 15 years. A retrospective population-based study was conducted using the Chang [...] Read more.
Infectious keratitis (IK) represents a major cause of corneal blindness. This study aims to investigate the demographics, risk factors, microbiological characteristics and antibiotic susceptibility patterns of IK in Taiwan over the past 15 years. A retrospective population-based study was conducted using the Chang Gung Research Database. Patients with IK were identified by diagnostic codes for corneal ulcer from 2004 to 2019. Of 7807 included subjects, 45.2% of patients had positive corneal cultures. The proportion of contact lens-related IK declined, while that of IK related to systemic diseases grew. The percentage of isolated gram-positive bacteria surpassed that of gram-negative bacteria in the 15-year period. The prevalence of Pseudomonas aeruginosa showed a decreasing trend (p = 0.004), whereas coagulase-negative Staphylococcus (CNS) and Propionibacterium species were increasingly detected (p < 0.001). Overall, the trend of antibiotic susceptibility of both gram-positive and gram-negative bacteria did not change throughout the study period. The susceptibility to the test antibiotics maintained over 90% in gram-negative isolates over 15 years. Vancomycin preserved 100% susceptibility to all gram-positive isolates. Since most tested antibiotics exhibited stable susceptibility over decades, this study reinforced that fluoroquinolones and fortified vancomycin continue to be good empiric therapies for treating bacterial keratitis in Taiwan. Full article
(This article belongs to the Special Issue Diagnosis and Management of Eye Infections)
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Review

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24 pages, 6330 KiB  
Review
Updates in Diagnostic Imaging for Infectious Keratitis: A Review
by Maria Cabrera-Aguas and Stephanie L Watson
Diagnostics 2023, 13(21), 3358; https://doi.org/10.3390/diagnostics13213358 - 31 Oct 2023
Viewed by 1456
Abstract
Infectious keratitis (IK) is among the top five leading causes of blindness globally. Early diagnosis is needed to guide appropriate therapy to avoid complications such as vision impairment and blindness. Slit lamp microscopy and culture of corneal scrapes are key to diagnosing IK. [...] Read more.
Infectious keratitis (IK) is among the top five leading causes of blindness globally. Early diagnosis is needed to guide appropriate therapy to avoid complications such as vision impairment and blindness. Slit lamp microscopy and culture of corneal scrapes are key to diagnosing IK. Slit lamp photography was transformed when digital cameras and smartphones were invented. The digital camera or smartphone camera sensor’s resolution, the resolution of the slit lamp and the focal length of the smartphone camera system are key to a high-quality slit lamp image. Alternative diagnostic tools include imaging, such as optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM). OCT’s advantage is its ability to accurately determine the depth and extent of the corneal ulceration, infiltrates and haze, therefore characterizing the severity and progression of the infection. However, OCT is not a preferred choice in the diagnostic tool package for infectious keratitis. Rather, IVCM is a great aid in the diagnosis of fungal and Acanthamoeba keratitis with overall sensitivities of 66–74% and 80–100% and specificity of 78–100% and 84–100%, respectively. Recently, deep learning (DL) models have been shown to be promising aids for the diagnosis of IK via image recognition. Most of the studies that have developed DL models to diagnose the different types of IK have utilised slit lamp photographs. Some studies have used extremely efficient single convolutional neural network algorithms to train their models, and others used ensemble approaches with variable results. Limitations of DL models include the need for large image datasets to train the models, the difficulty in finding special features of the different types of IK, the imbalance of training models, the lack of image protocols and misclassification bias, which need to be overcome to apply these models into real-world settings. Newer artificial intelligence technology that generates synthetic data, such as generative adversarial networks, may assist in overcoming some of these limitations of CNN models. Full article
(This article belongs to the Special Issue Diagnosis and Management of Eye Infections)
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20 pages, 1988 KiB  
Review
Diagnosis of Acanthamoeba Keratitis: Past, Present and Future
by Matthew Azzopardi, Yu Jeat Chong, Benjamin Ng, Alberto Recchioni, Abison Logeswaran and Darren S. J. Ting
Diagnostics 2023, 13(16), 2655; https://doi.org/10.3390/diagnostics13162655 - 11 Aug 2023
Cited by 3 | Viewed by 2367
Abstract
Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis [...] Read more.
Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis is primarily achieved through a combination of clinical suspicion, microbiological investigations and corneal imaging. Historically, corneal scraping for microbiological culture has been considered to be the gold standard. Despite its technical ease, accessibility and cost-effectiveness, the long diagnostic turnaround time and variably low sensitivity of microbiological culture limit its use as a sole diagnostic test for AK in clinical practice. In this review, we aim to provide a comprehensive overview of the diagnostic modalities that are currently used to diagnose AK, including microscopy with staining, culture, corneal biopsy, in vivo confocal microscopy, polymerase chain reaction and anterior segment optical coherence tomography. We also highlight emerging techniques, such as next-generation sequencing and artificial intelligence-assisted models, which have the potential to transform the diagnostic landscape of AK. Full article
(This article belongs to the Special Issue Diagnosis and Management of Eye Infections)
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14 pages, 332 KiB  
Review
Clinical Management of Herpes Simplex Virus Keratitis
by Bisant A. Labib and DeGaulle I. Chigbu
Diagnostics 2022, 12(10), 2368; https://doi.org/10.3390/diagnostics12102368 - 29 Sep 2022
Cited by 10 | Viewed by 3180
Abstract
Herpes simplex virus (HSV) keratitis is one of the leading causes of blindness worldwide. Additionally, up to 90% of the population in some countries is seropositive for HSV. HSV can cause a wide spectrum of ocular disease ranging from blepharitis to retinitis. Although [...] Read more.
Herpes simplex virus (HSV) keratitis is one of the leading causes of blindness worldwide. Additionally, up to 90% of the population in some countries is seropositive for HSV. HSV can cause a wide spectrum of ocular disease ranging from blepharitis to retinitis. Although the initial clinical expressions of HSV-1 and HSV-2 are similar, HSV-2 has been reported more frequently in association with recurrent HSV disease. Besides irreversible vision loss from keratitis, HSV also causes encephalitis and genital forms of the disease. Despite these statistics, there remains no vaccine against HSV. Current treatment therapies for related ocular diseases include the use of oral and topical antivirals and topical corticosteroids. While effective in many cases, they fail to address the latency and elimination of the virus, making it ineffective in addressing recurrences, a factor which increases the risk of vision loss. As such, there is a need for continued research of other potential therapeutic targets. This review utilized several published articles regarding the manifestations of HSV keratitis, antiviral immune responses to HSV infection, and clinical management of HSV keratitis. This review will summarize the current knowledge on the host–virus interaction in HSV infections, as well as highlighting the current and potential antiviral therapeutics. Full article
(This article belongs to the Special Issue Diagnosis and Management of Eye Infections)
14 pages, 303 KiB  
Review
A Review on Pathogens and Necessary Diagnostic Work for Bleb-Related Infections (BRIs)
by Stylianos A. Kandarakis, Leonidas Doumazos, Dimitra Mitsopoulou, Mario A. Economou, Ioanna Mylona, Chrysostomos Dimitriou, Petros Petrou and Ilias Georgalas
Diagnostics 2022, 12(9), 2075; https://doi.org/10.3390/diagnostics12092075 - 27 Aug 2022
Cited by 2 | Viewed by 1357
Abstract
At the present time, as newer techniques and minimally invasive procedures gain popularity among anterior segment surgeons for regulating intraocular pressure, trabeculectomy still has a leading role in glaucoma surgery. Trabeculectomy retains a highly successful and safe profile; however, one of the major [...] Read more.
At the present time, as newer techniques and minimally invasive procedures gain popularity among anterior segment surgeons for regulating intraocular pressure, trabeculectomy still has a leading role in glaucoma surgery. Trabeculectomy retains a highly successful and safe profile; however, one of the major complications includes bleb-related infections (BRIs). To date, the most common pathogens remain Gram-positive cocci, but the list of pathogens that have been identified in the literature includes more than 100 microorganisms. Because antibiotic use is more widespread than ever before and our ability to identify pathogens has improved, the pathogen spectrum will broaden in the future and more pathogens causing BRIs will be described as atypical presentations. The scope of this review was to identify all pathogens that have been described to cause bleb-related infections to date, as well as focus on the risk factors, clinical presentation, and various available diagnostic tools used for an appropriate diagnostic workup. Full article
(This article belongs to the Special Issue Diagnosis and Management of Eye Infections)
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