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Purpose: To ascertain the incidence of Acanthamoeba keratitis and the coexistence of Acanthamoeba and fungi in microbial keratitis., Design: Prospective cross-sectional study., Methods: Patients presenting with stromal keratitis were additionally tested for Acanthamoeba irrespective of the clinical diagnosis. Culture positivity was the gold standard., Results: Of the 401 cases included in the study, 40 were positive for Acanthamoeba (10%); of these 40, 16 were positive for both Acanthamoeba and fungi (4.5% of the study group was Acanthamoeba and fungal keratitis positive); 5 were positive for Acanthamoeba and bacteria; and 2 had triple infection with Acanthamoeba, fungi, and bacteria. Ring infiltrates and stromal edema are frequently associated with Acanthamoeba keratitis, as well as in Acanthamoeba coinfections. Ring infiltrates in particular were more frequently seen in the Acanthamoeba and fungal keratitis group (8/16) and they were often yellowish with hyphate edges (vs ring infiltrates only, which are seen in the patients with Acanthamoeba alone). Only 2 patients were contact lens wearers: however, they presented with history of trauma., Conclusions: Acanthamoeba coinfections are much more frequent and are not restricted to contact lens users. Anticipating coinfections is necessary for establishing a diagnosis as well as for appropriate and timely therapeutic interventions., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Intraocular gnathostomiasis is a rare parasitic infection caused by the third-stage larvae of spiruroid nematode Gnanthostoma spp. seen mostly in tropical and subtropical regions. It is a food-borne zoonosis caused by ingestion of raw or undercooked freshwater fish, amphibians, reptiles, birds, and mammals, all of which are known to harbor advanced third-stage larvae of Gnanthostoma spp. To date, 74 cases of intraocular gnathostomiasis have been reported from 12 different countries. Only four countries have reported more than 10 cases each, and India shares the rare distinction of being one of them, with 14 cases. Surprisingly, not a single case of cutaneous gnanthostomiasis has ever been reported from India. We present one such case of intraocular gnathostomiasis in a 41-year-old male who presented with an actively motile worm attached to the iris, and we review the pertinent literature of all such cases reported from India.

Background: Ophthalmomyiasis in humans is a rare phenomenon., Objectives: To create awareness among the ophthalmologists regarding larval conjunctivitis., Cases: We report two cases of ophthalmomyiasis, which came to a tertiary care centre with features of unilateral acute catarrhal conjunctivitis., Observations: Fly larvae were detected on slit-lamp examination and removed after immobilizing them with topical 4 % lignocaine. Topical antibiotics and steroid drops were prescribed for 2 weeks. The samples were identified as Oestrous ovis by the entomology department of the Institute of Tropical Medicine, Kolkata. The signs and symptoms regressed within 48 hours., Conclusion: The ocular myiasis can manifest as a unilateral catarrhal conjunctivitis., (© NEPjOPH.)

Purpose: To report a case of DUSN from the Indian subcontinent and emphasize the importance of immediate photocoagulation., Method: Review of case record., Result: The referring ophthalmologist had photographed the subretinal worm but had not undertaken laser photocoagulation. On presentation to us the patient had features typical of DUSN but no worm could be detected despite repeated examinations. Failure to localize the worm at subsequent examinations resulted in only partial recovery of vision., Conclusion: Whenever the nematode is detected, immediate laser photocoagulation of the worm is necessary as the migratory worm may be difficult to identify later on. This is necessary to prevent the otherwise natural decline in vision.