Purpose To compare the outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PKP) in the management of medically unresponsive Acanthamoeba keratitis (AK). Methods This retrospective study included 27 eyes of BB-DALK and 24 eyes of PKP from a tertiary ophthalmology care centre. Glucocorticoid eye drops were subsequently added to the treatment plan 2 months postoperatively based on the evaluation using confocal laser scanning microscopy. The clinical presentations, best-corrected visual acuity (BCVA), postoperative refractive outcomes, graft survival, and Acanthamoeba recurrence were analyzed. Results The AK patients included in the study were in stage 2 or stage 3, and the percentage of patients in stage 3 was higher in the PKP group ( P = 0.003). Clinical presentations were mainly corneal ulcers and ring infiltrates, and endothelial plaques, hypopyon, uveitis and glaucoma were more common in the PKP group ( P = 0.007). The BCVA and the graft survival rate showed no statistically significant differences between the two groups at 1 year after surgery. However, 3 years postoperatively, the BCVA of 0.71 ± 0.64 logMAR, the graft survival rate of 89.5%, and the endothelial cell density of 1899 ± 125 cells per square millimeter in the BB-DALK group were significantly better than those of the PKP group ( P = 0.010, 0.046, and 0.032, respectively). 3 eyes (11.1%) in the BB-DALK group and 2 eyes (8.3%) in the PKP group experienced Acanthamoeba recurrence, but the rates showed no statistically significant difference between the two groups ( P = 1.000). In the PKP group, immune rejection and elevated intraocular pressure were observed in 5 and 6 eyes, respectively. Conclusion Corneal transplantation is recommended for AK patients unresponsive to antiamoebic agents. The visual acuity and graft survival can be maintained after BB-DALK surgery. Acanthamoeba recurrence is not related to the surgical approach performed, whereas complete dissection of the infected corneal stroma and delayed prescribing of glucocorticoid eye drops were important to prevent recurrence.

Objective::To analyze the clinical and etiological characteristics of patients with fungal keratitis secondary to infectious endophthalmitis who required evisceration.Methods::In this retrospective case series study, a total of 44 patients (44 eyes) who were diagnosed with fungal keratitis secondary to infectious endophthalmitis and underwent evisceration from January 2012 to December 2021 were collected in Shandong Eye Hospital. The course of the disease and its predisposing factors, ocular and systemic history, clinical manifestations, microbial culture and drug sensitivity test results were analyzed.Results::The 44 patients included accounted for 2.15% of the total cases of fungal keratitis diagnosed by Shandong Eye Hospital in the same period. The median course of the disease was 18.5 days. At admission, 44 eyes had no light perception, and 20 eyes (45%) were complicated with secondary glaucoma. All 44 eyes showed corneal ulcer, involving the whole corneal layer and limbus, and 27 eyes (61%) complicated with anterior chamber empyema. A total of 39 eyes (89%) of microbial culture had fungal growth, including 20 eyes (51%) of Fusarium, 8 eyes (21%) of Aspergillus, 2 eyes (5%) of Alternaria, others including 4 eyes (10%) of Nonsporulating molds, 2 eyes (5%) of Pythium insidiosum, 1 eye (3%) of Scedosporium apiospemum, 1 eye (3%) of Sarocladium, 1 eye (3%) of Phialemoniopsis pluriloculosa. The geometric mean of the minimum inhibitory concentration values of amphotericin B, posaconazole, voriconazole, itraconazole, 5-fluorocytosine, fluconazole, anifensin, micafungin and caspofungin cultivated in this study were 1.597, 1.338, 1.926, 3.291, 64, 189.699, 1.36, 1.16, 1.23 μg/ml.Conclusions::The patients with infectious endophthalmitis secondary to fungal keratitis often present with total corneal ulceration. In addition to the common pathogenic bacteria of Fusarium, Aspergillus and Alternaria, other bacteria with strong pathogenicity and invasiveness such as Nonsporulating molds, Pythium insidiosum and Scedosporium apiospemum are also common.

Age-related macular degeneration (AMD) is a retinal degenerative disease that is the main cause of central vision loss in the elderly.Recent studies have found that inflammation and immune mediation play an important role in the pathogenesis and progression of AMD.The study of inflammatory factors in the process of AMD by inflammation and immune mediation is used to elucidate the pathogenesis of AMD,screen and identify individuals at risk,and guide the prognosis and treatment of AMD.This article reviews the latest research progress of C-reactive protein,NLRP3 inflammasome,and Amyloidβ-protein,in AMD.