Human pythiosis is an infectious condition with high morbidity and mortality. The causative agent is the oomycete microorganismPythium insidiosum. The pathogen inhabits ubiquitously in a wet environment, and direct exposure to the pathogen initiates the infection. Most patients with pythiosis require surgical removal of the affected organ, and many patients die from the disease. Awareness of pythiosis among healthcare personnel is increasing. In this review, we summarized and updated information on the diagnosis and treatment of human pythiosis. Vascular and ocular pythiosis are common clinical manifestations. Recognition of the typical clinical features of pythiosis is essential for early diagnosis. The definitive diagnosis of the disease requires laboratory testing, such as microbiological, serological, molecular, and proteomic assays. In vascular pythiosis, surgical intervention to achieve the organism-free margin of the affected tissue, in combination with the use of antifungal drugs andP. insidiosumimmunotherapy, remains the recommended treatment. Ocular pythiosis is a serious condition and earliest therapeutic penetrating keratoplasty with wide surgical margin is the mainstay treatment. Thorough clinical assessment is essential in all patients to evaluate the treatment response and detect an early sign of the disease recurrence. In conclusion, early diagnosis and proper management are the keys to an optimal outcome of the patients with pythiosis.

The purpose of this study was to investigate the efficacy and safety of topical 100% serum eye drops for corneal epithelial defect after ocular surgery. A total of 181 patients who received topical 100% serum therapy for the treatment of corneal epithelial defect following several different types of ocular surgery were recruited into this study. Each patient already failed conventional medical therapy before being prescribed 100% serum eye drops. Slit-lamp biomicroscopic examination with fluorescein staining was performed at baseline and all follow-up visits. The main outcome measures were the rate of complete healing of the corneal epithelial defect and incidence of adverse events. One hundred and seventy-eight eyes (98.34%) received autologous serum eye drops, and 3 (1.66%) received allogeneic serum eye drops. The overall success rate of treating persistent postoperative epithelial defect using 100% serum eye drops was 93.92% (95% CI 0.88–0.98). The median time to complete corneal epithelialization was 4 days (95% CI 4-5). Adverse reactions were observed in 3 patients (1.66%), including sticky sensation with minimal eye discomfort and asymptomatic trace corneal subepithelial infiltration. No serious complications were reported. In conclusion, 100% serum eye drops are effective, safe, and tolerable for treating postoperative corneal epithelial defect following ocular surgeries.

To investigate the efficacy and safety of subconjunctival bevacizumab injection for the treatment of impending recurrent pterygium. A prospective, randomized, single-masked, controlled trial was conducted in 80 patients with impending recurrent pterygium. Patients were randomized into 4 groups using random tables: 20 patients served as a control and treatment groups received a single intralesional injection of 1.25 mg (20 patients, group 1), 2.5 mg (20 patients, group 2), or 3.75 mg (20 patients, group 3) of bevacizumab. Topical 0.1% fluorometholone and ocular lubricant were administered 4 times daily for 1 month in all groups. Severity of impending recurrent pterygium graded by photographic assessment (at baseline, 3 days, 1 week, and 2, 4, 8, and 12 weeks after treatment) and true recurrence were the main outcome measures. At 3 days, the conjunctival injection significantly decreased in all treatment groups (P < 0.01). A significant decrease in the conjunctival injection was still observed until 2 and 4 weeks in only groups 2 and 3, respectively (P < 0.05). The conjunctival hyperemia appeared to increase back to baseline at later time points. No significant difference in the mean severity score among the groups was observed. True recurrence was found in 62 patients with no statistically significant difference among the groups. No serious ocular or systemic adverse events were seen. A single subconjunctival bevacizumab injection seems to only partially and transiently decrease conjunctival vascularization in impending recurrent pterygium in a dose-dependent manner. This treatment does not cause regression or reduce the recurrent rate of impending recurrent pterygium.

To report the clinical presentation and the role of intrastromal and intracameral voriconazole injection in the management of rare cases of fungal keratitis caused by Lasiodiplodia theobromae.Two eyes of 2 patients with Lasiodiplodia keratitis unresponsive to topical and oral antifungal medications were included in this study. Diagnosis of Lasiodiplodia keratitis was confirmed by microbiological analysis, including culture-based (case 1 and 2) and DNA sequencing techniques (case 2 only).The first patient presented with multiple satellite lesions and one of these infiltrates spread deeply into the cornea, forming a stromal abscess. Another patient had a large full-thickness corneal infiltrates with several fungal balls in the anterior chamber, requiring a limbus-to-limbus therapeutic penetrating keratoplasty. Despite aggressive topical therapy, the stromal abscess continued to worsen in the first case and recurrent keratitis was observed postoperatively in the second case. Voriconazole 50 μg/0.1 mL was administered intracamerally and intrastromally around the fungal abscess as adjuncts to topical antimycotics in the first case. The second patient who needed therapeutic keratoplasty was treated with an intracameral injection of 50 μg/0.1 mL voriconazole at the end of surgery. Postoperatively, 100 μg/0.1 mL voriconazole was also injected intracamerally after the recurrence of infection was noted in the graft. Reinjections were given 48 hours apart in both cases. After the injections, all corneal and anterior chamber lesions were reduced in size and density and completely resolved within 4 weeks.Intrastromal and intracameral voriconazole injections may offer safe and effective treatment options for L theobromae keratitis.

Purpose: The aim of this study was to investigate the medium-term outcomes after Boston type 1 keratoprosthesis surgery in patients with poor prognosis for standard keratoplasty. Methods: A prospective study of a case series was conducted at a university-based referral center from 2006 to 2013. Forty-two eyes of 40 patients with a minimum follow-up of 4 years were recruited. The main outcome measures included best spectacle-corrected visual acuity (BSCVA), keratoprosthesis retention, and complications. Results: The mean follow-up was 64.9 ± 15.2 months (range, 48–88 months). At 1 week, 90.5% had an improvement in BSCVA by ≥2 lines compared with that in preoperative BSCVA. The best-ever vision was reached by the end of 6 months. Nevertheless, 39.5% (15/38) could not maintain the improved vision. The major etiology of visual deterioration after initial gains was glaucoma (60%). The initial keratoprosthesis retention rate was 80.9%, corresponding to a failure rate of 4 per 100 eye-years or 0.04/eye-year. Autoimmune diagnosis was the independent risk factor for keratoprosthesis failure (hazard ratio, 5.68; 95% confidence interval, 1.41–22.85; P = 0.014). The common postoperative complications were glaucoma, retroprosthetic membrane, corneal melting, infectious keratitis, and endophthalmitis. Conclusions: Boston type 1 keratoprosthesis is an alternative for patients who are not candidates for corneal transplants. However, there was a trend toward visual loss over time most commonly because of progressive glaucoma. Therefore, appropriate patient selection, lifelong follow-up, and early aggressive treatment of complications are recommended.

Several studies found that 50–100% serum eye drops provided greater benefits without inducing detrimental effects on the corneal epithelial healing. This study assessed the efficacy of undiluted serum eye drops for the treatment of persistent corneal epithelial defects (PED). A total of 109 eyes received 100% serum eye drops for PED were recruited into this study. The data were compared with an historical control group of 79 eyes with PED who received conventional treatments from 2006–2011 at the same institution. Main outcome measures were complete healing of PED and incidence of adverse events. No significant difference in demographics between the 2 groups was noted. The success rate of the treatment and control groups were 87.16% (95% CI 0.79–0.93) and 69.62% (95% CI 0.59–0.80) (P = 0.001), respectively. The median time to complete epithelialization was 14 days (95% CI 12–21) in the treatment group and 28 days (95% CI 21–59) in the control group (P = 0.001). Serum treatment, primary diagnosis of non-limbal stem cell deficiency etiology, and prior contact lens wear significantly correlated with the corneal re-epithelialization. There were no serious side effects encountered during the study period. In conclusion, undiluted serum therapy is effective and safe for treating PED.