SARS-CoV-2 Seen in Swabs of Conjunctiva and Tears

A small preponderance of SARS-CoV-2 (COVID-19) was noted in the conjunctival swabs and tears of 19 post-mortem corneas, reports a recent study in The Ocular Surface.¹

Specifically, out of 132 ocular tissues of 33 donors, 13% were positive for the virus, which has taken the lives of over 500,000 Americans, at press time. Additionally, of the virus-positive donors, 6 had COVID-19-positive post-mortem nasopharyngeal swabs, and 8 showed positive post-mortem anti-SARS-CoV-2 IgG levels. Further, 3 conjunctival, 1 anterior corneal, 5 posterior corneal and 3 vitreous swabs were positive for SARS-CoV-2 RNA, among 20 eyes taken from 10 donors who had COVID-19. Finally, a SARS-CoV-2 spike and envelope proteins were identified in the corneas’ epithelial layer appropriated sans povidone-iodine (PVP–I) disinfection.

As a result of these findings, the study’s researchers say it is critical that post-mortem nasopharyngeal polymerase chain reaction testing and a PVP-I disinfection protocol be employed to eradicate any tissue containing SARS-CoV-2 being used for corneal transplantation.

Reference:

1. Ocular Surf. 2021 Jan;19:322-329.

Alcohol-Based Sanitizer Causing Toxic Keratopathy in Children

Children are experiencing toxic keratopathy from unintentional contact between alcohol-based sanitizer and the eye, according to a recent JAMA Ophthalmology case series.¹

The author notes four steps can be taken to prevent this: (1) Promoting hand washing with soap and water vs. sanitizer, especially at home; (2) teaching and training children how to use hand sanitizers; (3) having separate dispensers at shops and malls for children, preferably at a lower height (i.e., below face level); and (4) placing caution signs next to sanitizer dispensers.

Reference:

1. JAMA Ophthalmol. Published online January 21, 2021.

UV-Emitting Germicidal Lamp Use Linked With Photokeratitis

Patients presented with acute ocular surface pain, post UV-emitting germicidal lamp exposure, that was diagnosed as photokeratitis, reports a recent case series in Ocular Immunology and Inflammation.

Specifically, visual acuity was 20/30 or better, and anterior segment exam showed differing degrees of conjunctival injection and diffusely distributed punctate epithelial erosions.

The study’s authors say patients should “follow manufacturer recommendations when using UV-emitting germicidal lamps, and avoid direct exposure to the ocular surface.”

Reference:

1. Ocul Immunol Inflamm. 2020 Nov 20;1-5.

High Body Mass Index Linked With Keratoconus in Adolescents

Obese and overweight young adults appear more likely to develop keratoconus (KC) vs. their normal weight peers, reports a recent study in the American Journal of Ophthalmology.

Specifically, obese young adults had a greater prevalence (270/100,000) of KC vs. overweight (179/100,000), typical weight (154/100,000), and underweight (141/100,000) young adults. Additionally, the odds ratio for obese adolescents was 1.50 (95% confidence interval [CI] 1.22-1.83; P < .05) compared with the typical weight group, the odds ratio for overweight young adults was 1.42 (95% CI 1.08-1.92; P < .05), and the odds ratio for underweight young adults was 0.84 (95% CI 0.65-1.09; P = .18). This was after adjusting for the confounding factors of age, country of origin, gender, height and socioeconomic status.

The nationwide Israeli, population-based study was comprised of 579,946 males and females between age 16 and 19.9 who attended the draft board as military service candidates between 2006 and 2014, and underwent an eye exam. The participants were divided among four groups based on their adjusted body mass index (BMI) percentiles.

Given the study’s findings, the study’s researchers say, “BMI should be considered a risk factor for keratoconus, and further research should elucidate how obesity is involved in the progress of keratoconus.”

Reference:

1. Am J Ophthalmol. 2020 Dec 9;224:200-206.

Eyebank Pioneer Passes

Frederick N. Griffith, creator of the Medical Eye Bank of Maryland and, subsequently, Tissue Banks International, which has 26 subsidiaries nationwide, has passed away at age 88.

“Frederick was a great visionary and an incredible human being,” says Mahmood Farazdaghi, past president of the International Federation of Eye Banks. “... He organized and revolutionized recovery, distribution and utilization of donated corneas in the United States and then introduced, developed and organized modern eye banking globally.

Mr. Farazdaghi points out the creation of the central national distribution for donated corneas as one of Mr. Griffith’s many contributions to the field.

“Corneas were shipped for scheduled surgery from the eye bank of one state to a hospital of another, so no cornea was expired or wasted, and the patient waiting list for cornea transplantation was eliminated,” he explains.

Mr. Griffith’s efforts have reached South Africa, Sudan, Egypt, Ethiopia, Syria, Lebanon, Israel, Greece, Turkey, Germany, Poland, Czech, Slovak, Bulgaria, Croatia, UK, India, Nepal, Bangladesh, China, Union of Myanmar, Philippines, Singapore and Australia.

“All his tremendous achievements and contributions would not have been possible without the unwavering support and passionate involvement of his wife, partner and travel companion, Ms. Beatrice Griffith,” Mr. Farazdaghi adds.

Mr. Griffith is survived by his wife of 61 years, two sons, a daughter and four grandchildren, reports The Baltimore Sun.

Antibody-Based Dry Eye Disease Treatment Under Development

A broad-spectrum immunomodulatory eye drop for severe dry eye disease (DED) and ocular surface disease, resulting from inflammatory and immune system disorders, is being created by University of Illinois at Chicago (UIC) researchers for severe DED and ocular surface disease, resulting from inflammatory and immune system disorders, according to a UIC press release. The researchers have been given a 5-year, $10.15 million grant for the treatment, which will fund preclinical data that backs a commercial application to the FDA to allow for phased clinical trials.

The treatment will contain pooled human immune globulins as an active ingredient. This is because they have broad-spectrum immunomodulatory actions using anti-idiotypic, molecular and cellular mechanisms.

Sandeep Jain, MD, a UIC College of Medicine professor of Ophthalmology, and principal investigator, received the grant from the NEI for a “Translational Research Program to Develop Novel Therapies and Devices for the Treatment of Visual System Disorders.”

Dr. Jain has experience in discovering the presence of neutrophil extracellular traps on the ocular surface of DED patients, as well as anti-citrullinated proteins and autoantibodies in the tears.

Student and Researcher Creates Video to improve Corneal Infection Diagnosis

Pauline Khoo, a PhD candidate at the University of Sydney, and a researcher at the University’s Save Sight Institute (www.sydney.edu.au/save-sight-institute/ ), has created a video to improve both the identification and treatment of microbial keratitis, according to a Save Sight Institute-issued press release.

Specifically, the video details the best practices for acquiring an infected tissue sample via a corneal scrape. (See: www.youtube.com/watch?v=rNdE4B5zU6s to watch the 2:35 video.)

“The faster the organism causing the infection is identified, the faster a patient can receive the right treatment, reducing the likelihood of complications,” Ms. Khoo told the Save Sight Institute.

Her focus of study for her PhD is dry eye disease, specifically, improving patient outcomes via a web-based tool that enables doctors to analyze, track and report on patient outcomes from various treatments and compare them to discern what treatment is most effective.

Meibomian Gland Findings Common in Patients Presenting for Refractive Surgery Evaluations

Meibomian gland atrophy and tortuosity are a frequent finding in patients who come in for refractive surgery evaluations, according to a recent study in Clinical Ophthalmology.¹

Specifically, roughly 73% of patients had evidence of meibomian gland atrophy, and roughly 70% had indications of tortuosity, with most patients in the atrophy group having the mild form. The study was comprised of 120 patients (49 males) ages 21 to 62.

As a result, of these findings, the study’s researchers say clinicians should consider employing meibography into the refractive surgery evaluation, and, if meibomian gland issues are discovered, proactively treat them, as the condition is associated with unsatisfactory post-operative outcomes.

Reference:

1. Clin Ophthalmol. 2021 Jan 27;15:315-321.

Researchers Create Gene-Editing Technology to Eradicate Herpetic Stromal Keratitis

Shanghai researchers have developed a gene-editing method that rids the eye of keratitis, while eliminating the herpes simplex virus, reports an article in ShanghaiDaily.com . The method has been successful on both mice and donated human corneas.

Specifically, Dr. Hong Jiaxu, of the Shanghai Eye, Ear, Nose and Throat Hospital, and Cai Yujia, a Shanghai Joao Tong University researcher, joined forces to create a virus-like particle mRNA to “infect” the target and deliver HSV-1 Erasing Lentiviral Particles via dripping the technology into the infected patient’s eyes.

Diabetes Mellitus Predisposes Patients to Recurrent Corneal Erosion

Diabetes mellitus (DM) patients are at higher risk for recurrent corneal erosion (RCE), reports a recent study in the BMJ.¹

Specifically, 1,236 DM patients vs. 884 control patients developed the painful condition. Additionally, in adjusting for potential confounders, such as chronic renal disease, hyperlipidemia, hypertension and keratoconjunctivitis sicca, the researchers discovered DM patients were 1.35 times more likely to develop RCE vs. the entire sample cohort.

The study was comprised of 239,854 DM patients who were recruited between 2003 and 2005 from the Longitudinal Cohort of Diabetes Patients database. The control patients were number, age and sex-matched and chosen from the Taiwan Longitudinal Health Insurance Database, 2000.

The study’s researchers say, “…Close collaboration between endocrinologists and ophthalmologists is important in managing RCE following DM.”

Reference:

1. BMJ Open. 2020 Jun 21;10(6):e035933. doi: 10.1136/bmjopen-2019-035933.

Scleral Lens Wear Decreases Risk of Keratoplasty

Keratoconus (KC) patients who wear scleral contact lenses have close to 1/5 of the risk of undergoing keratoplasty, reports a recent study in Cornea.¹

Specifically, out of 2,806 keratoconic eyes, 3.2% underwent keratoplasty, with scleral contact lens wear or rigid gas permeable contact lens wear significantly decreasing the need to undergo keratoplasty (HR = 0.19, 95% confidence interval [CI] 0.09-0.39, P < 0.0001 and HR = 0.30, 95% CI 0.17-0.52, P < 0.0001, respectively) vs. no contact lens wear.

Contact lens wear in each eye was 36.2% no wear, 7.2% soft contact lens wear, 33.9% rigid gas permeable wear and 22.7% scleral wear. Additional factors linked with a higher risk of keratoplasty were black race, younger age and lower socioeconomic status.

Given these findings, the study’s researchers say doctors should maximize the use of scleral or rigid gas permeable contact lenses on KC patients.

Reference:

1. Cornea. 2021 Jan;40(1):39-42.

Atopic Keratoconjunctivitis Linked with Corneal Ulcer Risk

Patients who have atopic keratoconjunctivitis (AKC) are at an increased risk of developing a corneal ulcer, reports a recent British Journal of Opthalmology¹ study.

Specifically, out of 171,019 newly diagnosed AKC patients, 2,018 developed a corneal ulcer, with the age-, potential comorbidities- and sex-matched control group comprised of 171,019 patients sans AKC. Both groups were tracked from January 2004 to December 2013.

Given this finding, the study’s researchers say patients who have AKC should be educated on their increased risk of developing a corneal ulcer.

Reference

1. Br J Ophthalmol. 2020 Oct 3;bjophthalmol-2020-316206. doi: 10.1136/bjophthalmol-2020-316206. Online ahead of print.

Autophagy-Related 5 Potential Biomarker for Sjögren’s Syndrome

Atophagy-related 5 (ATG5) shows a 94.6% sensitivity and a 93.6% specificity (at a cutoff value of >4.0 ng/mL/μg) as an ocular biomarker for the diagnosis and assessment of Sjögren’s syndrome (SS), reports a study in Diagnostics.¹

Specifically, the tear ATG5 concentration, among ocular surface disease index, ocular surface staining score, Schirmer’s test and tear break-up time were evaluated and compared in their ability to aid in differentiating SS from non-SS dry eye disease.

The study’s researchers say “the diagnostic power of tear ATG,” which other studies show is elevated in the conjunctival epithelial cells and tears of SS patients vs. non-SS dry eye disease patients, should be validated.

Reference:

1. Diagnostics (Basel) 2021 2021 Jan 4;11(1):71.