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ObjectivesTo investigate the clinical characteristics of acute retinal necrosis (ARN) with ultra-wide-field imaging (UWFI) and analyse their visual significance.MethodsClinical and UWFI records of patients diagnosed with ARN at a single centre over 2 years were reviewed.ResultsIn 38 eyes of 35 patients, the clinical manifestations of ARN on UWFI included patchy (12 eyes) or fan-shaped necrotic lesions (26 eyes), retinal arterial obliteration (38 eyes), vitritis (38 eyes), retinal venous haemorrhage (19 eyes), and vitreous haemorrhage (6 eyes). Retinal detachment was associated with the number of retinal quadrants involved (β = 2.145, P = 0.005). LogMAR BCVA at last follow-up was associated with logMAR BCVA at presentation (β = 0.473, P = 0.004) and retinal detachment (β = 0.367, P = 0.020).ConclusionUWFI is useful for detecting retinal lesions in ARN, especially peripheral lesions or through opaque media, and provides valuable information concerning visual prognosis.

Acute retinal necrosis (ARN) caused by varicella-zoster virus (VZV) is associated with changes in specific proteins in the eye's fluid, particularly matrix metalloproteinase-3 (MMP-3), an enzyme that breaks down tissue structures, and tissue inhibitor of metalloproteinase-1 (TIMP-1), which regulates MMP activity. This study aims to investigate how these proteins correlate with the progression of ARN. We analyzed aqueous humor samples from 33 patients with ARN and 23 control patients with virus-negative uveitis. MMP-3 levels were measured using immunoturbidimetry, and TIMP-1 levels were determined using an enzyme-linked immunosorbent assay. We examined the relationships between these protein levels and clinical findings using statistical correlation methods. MMP-3, TIMP-1 were significantly higher in the aqueous humor of ARN patients compared to the controls (P<0.0001). Correlation analysis revealed a significant correlation between MMP-3 levels and TIMP-1 (r = 0.460, P = 0.007). The upregulation of MMP-3 and TIMP-1 was found to parallel VZV DNA load and IL-6 levels. Additionally, they exhibited negative correlation with best corrected visual acuity (BCVA) and positive correlation with the percentage of active retinal necrosis area.MMP-3 was markedly enhanced in all 14 cases of retinal detachment (RD), whereas TIMP-1 levels were significantly reduced in the same cohort of eyes. Patients with initial higher TIMP-1 levels have a significantly increased risk of developing RD, with a hazard ratio (HR) of 3.152 (95% CI, 1.082-9.18). The imbalance between MMP-3 and TIMP-1 may play a critical role in the development and severity of ARN. Measuring these proteins in the eye's aqueous humor could be valuable for assessing disease progression and guiding treatment strategies, potentially improving outcomes for patients with virus-induced retinal diseases.

The Posner–Schlossman syndrome (PSS) is a disease with clinically recurrent unilateral anterior uveitis with markedly elevated intraocular pressure (IOP) and subsequent progression to optic neuropathy. Retrospective studies have reported increased annual incidence of PSS, especially in China. While currently, the clinical management of PSS is still challenging. Metabolomics is considered to be a sensitive approach for the development of novel targeted therapeutics because of its direct elucidation of pathophysiological mechanisms. Therefore, we adopted gas chromatography time-of-flight mass spectrometry (GC-TOF-MS) technology-based non-targeted metabolomics approach to measure comprehensive metabolic profiles of aqueous humor (AH) samples obtained from patients with PSS, with an aim to demonstrate the underlying pathophysiology, identify potential biomarkers specific to PSS, and develop effective treatment strategies. A comparative analysis was used to indicate the distinct metabolites of PSS. Pathway analysis was conducted using MetaboAnalyst 4.0 to explore the metabolic reprogramming pathways involved in PSS. Logistic regression and receiver-operating characteristic (ROC) analyses were employed to evaluate the diagnostic capability of selected metabolites. Comparative analysis revealed a clear separation between PSS and control groups. Fourteen novel differentiating metabolites from AH samples obtained from patients with PSS were highlighted. Pathway analysis identified 11 carbohydrate, amino acid metabolism and energy metabolism pathways as the major disturbed pathways associated with PSS. The abnormal lysine degradation metabolism, valine–leucine–isoleucine biosynthesis, and citrate circle were considered to weigh the most in the development of PSS. The ROC analysis implied that the combination of glycine and homogentisic acid could serve as potential biomarkers for the discrimination of control and PSS groups. In conclusion, these results revealed for the first time the identity of important metabolites and pathways contributing to the development/progression of PSS, enabled the better understanding of the mechanism of PSS, and might lead to the development of metabolic biomarkers and novel therapeutic strategies to restrict the development/progression of PSS.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viruses is mainly transmitted through respiratory droplets. Notably, some coronavirus disease 2019 (COVID-19) patients have ocular manifestations, including conjunctival hyperaemia, chemosis, epiphora, and increased secretions. However, the association between SARS-CoV-2 and ocular surface diseases is poorly described. Between May 2020 and March 2021, a total of 2, 0157 participants from six districts of China were enrolled. Serum samples were tested for immunoglobulin G and M (IgG and IgM) antibodies against the SARS-CoV-2 spike protein and nucleoprotein using magnetic chemiluminescence enzyme immunoassays. Throat swabs were tested for SARS-CoV-2 RNA using RT-PCR assays in a designated virology laboratory. Fisher exact, χ 2 test, and logistic regression analysis were performed. Of 2, 0157 serum samples tested, 1, 755 (8.71%) were from ocular surface diseases, 1, 2550 (62.26%) from no-ocular surface diseases (ocular diseases except ocular surface diseases), 5, 852 (29.03%) from no-ocular diseases. SARS-CoV-2 prevalence for the combined measure was 0.90% (182/2, 0157). Seroprevalence of SARS-CoV-2 was significantly (p<0.05) higher in the population with ocular surface diseases (2.28%, 40/1755) compared with no-ocular surface diseases (0.70%, 88/1, 2550), and no-ocular diseases (0.92%, 54/5, 852). Similar results were also observed with respect to sex, age, time, and districts. Logistic regression analyses revealed that ocular surface diseases [ocular surface diseases vs. no-ocular diseases (p=0.001, OR =1.467, 95% CI=1.174-1.834); ocular surface diseases vs. no-ocular surface diseases (p<0.001, OR =2.170, 95% CI=1.434-3.284)] were associated with increased risk of susceptible to SARS-CoV-2 infection. In a word, there was a significant association between ocular surface disease and SARS-CoV-2 infection. Therefore, increasing awareness of eye protection during the pandemic is necessary, especially for individuals with ocular surface diseases.

Purpose To assess the differential diagnostic values for stromal herpes simplex keratitis (HSK) by using tear HSV-sIgA, tear HSV-DNA, and the combination. Methods Tear samples for both eyes and the paired serum were collected from 187 stromal HSK and 56 controls. Enzyme-linked immune sorbent assay (ELISA) was used to analyze the tear HSV-sIgA and serum IgG/IgM/IgA. The levels of tear HSV-DNA were measured by polymerase chain reaction (PCR). Results The positive rates for tear HSV-sIgA and HSV-DNA were 36.90% and 10.96% respectively in stromal HSK patients. Twelve showed positivity for both sIgA and DNA, while 46 cases were positive for sIgA or DNA. The sensitivity, specificity, PPV, and NPV for simultaneous measurement were 39.73%, 98.21%, 98.31%, and 38.46%. The total negative conversion rate of sIgA was 95.71%. Conclusions The diagnostic efficiency of HSV-sIgA only is nearly equal to the combination of HSV-sIgA and HSV-DNA, and the positive result is optimum to achieve a reliable diagnosis of stromal HSK even in atypical or unsuspected cases.

Background Interleukin detection is helpful in screening vitreoretinal lymphoma (VRL). However, the levels of interleukin in aqueous humor (AqH) can be abnormally low in some cases, leading to underdiagnosis of VRL merely dependent on AqH. The purpose of this study was to investigate the correlation of interleukins between paired AqH and vitreous humor (VH) samples in VRL cases, and to explore potential factors affecting interleukin levels and diagnostic parameters. Methods This was a case series study. Reviewed were consecutive biopsy-proven B-cell VRL cases of which adequate paired AqH and VH samples were obtained for the measurement of interleukin 10 (IL-10) and interleukin 6 (IL-6). The correlations of IL-10 and IL-6 between AqH and VH were analyzed. Influences of clinical manifestations on IL levels and positive rates of IL-related parameters in AqH and VH were evaluated, which included AqH IL-10 > 30 pg/mL, VH IL-10 > 65 pg/mL, IL-10/IL-6 ratio > 1, and Interleukin Score for Intraocular Lymphoma Diagnosis (ISOLD) > 0 in both the AqH and VH. Results Seventy-four eyes of 64 patients with VRL were included. IL-10 in VH was significantly higher than in AqH (median: 1159.77 vs. 225.74 pg/mL, P  < 0.001). For both IL-10 and IL-6, the AqH concentrations were positively correlated with VH concentrations in the form of power functions ( P  < 0.001 and P  < 0.001, respectively). The positive rate of AqH IL-10/IL-6 > 1 (77%) was lower than that of VH IL-10 > 65 pg/mL (91%), VH IL-10/IL-6 > 1 (89%) and VH ISOLD > 0 (91%). Eyes without intraretinal infiltration tended to have lower IL-10 levels in the AqH and VH (median: 141.08 pg/mL vs. 449.10 pg/mL, 825.48 pg/mL vs. 2285.77 pg/mL; P  = 0.001 and P  < 0.001, respectively), and lower positive rates of AqH IL-10 > 30 pg/mL (78% vs. 97%, P  = 0.018) and AqH ISOLD > 0 (76% vs. 97%, P  = 0.033). Conclusions IL-10/IL-6 in AqH may not be as sensitive as the parameters (including IL-10, IL-10/IL-6 and ISOLD) in VH for VRL screening. Cases without intraretinal involvement were less likely to be positive for IL-10 > 30 pg/mL and ISOLD > 0 in AqH; the possibility of VRL should be ruled out more cautiously in these cases.

Purpose. The objective of this study was to evaluate the microbiological spectrum and antibiotic susceptibilities of isolates in posttraumatic endophthalmitis over a 15-year period. Methods. A retrospective study of 3,163 posttraumatic endophthalmitis cases was conducted between July 2004 and July 2019. The outcome measures included the microbiological spectrum and antibiotic susceptibilities. Chi-squared tests were conducted to detect trends in changes in antibiotic sensitivity over the 15-year period. P values of <0.05 were considered statistically significant. Results. Of the 3,163 cases of posttraumatic endophthalmitis, 1,003 culture-positive isolates were identified. Among these, there were 848 (84.5%) Gram-positive isolates, 109 (10.9%) Gram-negative isolates, and 46 (4.6%) fungal isolates. The most common isolates were Staphylococcal species. There was a significant increase in the percentage of fungal isolates over the 15-year period (P=0.02). Gram-positive organisms showed the greatest level of susceptibility to vancomycin (99.6%). The susceptibilities of the 109 Gram-negative isolated organisms were as follows: levofloxacin (95.8%), meropenem (95.7%), ciprofloxacin (93.5%), tobramycin (90.8%), imipenem (88.9%), trimethoprim-sulfamethoxazole (TMP-SMX) (87.7%), ertapenem (80%), and ceftazidime (79.1%). The susceptibility of Gram-positive organisms to several antibiotics, including levofloxacin (P=0.004), ciprofloxacin (P<0.001), and chloramphenicol (P=0.001) decreased over time, whereas the susceptibility to TMP-SMX increased over time (P<0.001). The susceptibility of Gram-negative bacilli to ceftazidime decreased over time (P=0.03). Conclusions. Over the 15-year study period, most isolates were Gram-positive cocci, especially coagulase-negative staphylococci (CNS). Vancomycin seemed to be the most effective antibiotic for Gram-positive bacteria. Gram-negative bacteria appeared to be most susceptible to fluoroquinolones. A number of antibiotics showed an increasing trend of microbial resistance.

AimsThe aim of this observational study was to report the distribution of glycoprotein B (gB) genotypes in the eyes of cytomegalovirus (CMV) positive patients with Posner-Schlossman syndrome (PSS), and to investigate their clinical characteristics and outcomes.MethodsWe collected aqueous humour samples from 165 patients clinically diagnosed with PSS between 2017 and 2019. PCR was performed to analyse the CMV DNA and identify the gB genotypes in the samples. Clinical characteristics and responses to antiviral treatment were compared among patients with different gB genotypes.ResultsCMV DNA was detected in 94 (56.97%) of the 165 aqueous humour specimens analysed. Owing to the quantity requirement for CMV gB genotype analysis, results could be obtained from only 14 specimens. CMV gB type 1 was detected in 11 samples (78.6%), whereas CMV gB type 3 was detected in three samples (21.4%). No other gB genotypes or mixed genotypes were detected. Overall, 9.1% (1/11) of the patients in the gB type 1 group and 66.7% (2/3) of the patients in the gB type 3 group had bilateral attacks (p=0.093). The concentration of anti-CMV immunoglobulin G (IgG) in the type 1 group was 0.94±0.79 s/co (ratio of aqueous humour CMV IgG/serum CMV IgG to aqueous humour albumin concentration/serum albumin concentration), whereas that in the type 3 group was 0.67±0.71 s/co.ConclusionGenotype 1 was the most prevalent genotype in the aqueous humour of CMV-infected patients with PSS. Bilateral attack was predominant among patients with gB genotype 3. CMV gB gene may be related to the pathogenicity of CMV virus strain in patients with PSS.

ObjectivesTo observe the changes of viral load in aqueous humour samples and visual outcomes in varicella zoster virus (VZV)-induced acute retinal necrosis (ARN).MethodsObservational retrospective study. Medical records and viral load measured by real-time quantitative polymerase chain reaction (qPCR) of 20 eyes with VZV-induced ARN were reviewed.ResultsThe mean viral load at presentation was 5.7 × 107 ± 9.7 × 107 copies/mL. An initial plateau phase for viral load lasting up to 2 weeks occurred in most eyes (18 eyes, 90%). In the following logarithmic reduction phase, the mean slope of the decline in viral load was −0.103 ± 0.029 log/day, and the expected time for half reduction of the initial viral load was 3.2 ± 1.0 days. At the end of the first 8-week’s antiviral treatment, the viral load was below detection threshold in all 20 eyes (100.0%). The mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 1.1 ± 0.7 (Snellen equivalent 20/250) to 0.7 ± 0.6 (Snellen equivalent 20/100) after a follow-up of 8.6 ± 2.0 months. Thirteen of the 20 eyes (65.0%) suffered retinal detachment and underwent vitrectomy. The initial viral load was the independent predictive factor of logMAR BCVA at the last follow-up (β = 0.745, P < 0.001).ConclusionsThe observation of viral load changes by qPCR was useful for better monitoring of therapeutic efficacy and deciding needed antiviral duration in VZV-induced ARN patients.

To report antibiotic resistance rates and trends of common ocular isolates collected over a 15-year period. We collected 3533 isolates from July 1, 2005 to July 31, 2020. Antibiotic sensitivity was determined according to the guidelines of the Clinical and Laboratory Standards Institute. Chi-squared ( ) test was used to analyze changes in antibiotic susceptibility over 15 years. Among the 3533 isolates, the predominant pathogens were the staphylococcal species. Methicillin resistance was observed in 381 ( ) isolates (46.4%) and 1888 coagulase-negative staphylococci (CoNS) isolates (61.1%), and methicillin-resistant (MR) isolates had a high probability of concurrent resistance to fluoroquinolones and aminoglycosides. The mean percentage of resistance in staphylococcal isolates did not reach statistical significance across patient age groups ( = 0.87). Methicillin resistance did not increase in the CoNS ( = 0.546) isolates, and resistance to methicillin slightly decreased among ( = 0.04) isolates over 15 years. Additional exploratory analysis revealed a small decrease in resistance to tobramycin ( = 0.01) and chloramphenicol ( < 0.001) among the CoNS isolates. All staphylococcal isolates were susceptible to vancomycin. Staphylococci were the most common microorganisms responsible for causing ocular infections. Antibiotic resistance was high among staphylococci, with nearly half of these isolates were resistant to methicillin and these had a high probability of concurrent resistance among MR staphylococci to other antibiotics. Overall, ocular resistance did not significantly change during the 15-year study period. We conclude that continued surveillance of antibiotic resistance provides critical data to guide antibiotic selection.