Faezeh Molaei

Purpose: To report a child with severe treatment resistant juvenile idiopathic arthritis associated uveitis (JIAU), a condition that typically presents as chronic anterior uveitis, although severe panuveitis with retinal vasculitis may rarely occur.Methods: We describe the clinical course, treatment response, and challenge, dechallenge, and rechallenge sequence in a child with severe refractory JIAU treated with combined infliximab and tofacitinib therapy.Results: The patient showed marked improvement in ocular inflammation, macular edema, and visual acuity following addition of tofacitinib to ongoing infliximab therapy. Inflammation recurred after holding infliximab despite continuation of tofacitinib and improved again following reintroduction of infliximab.Conclusion: This challenge, dechallenge, and rechallenge sequence suggests that neither infliximab nor tofacitinib alone provided adequate disease control, whereas their combination was associated with sustained suppression of ocular inflammation. Combined tumor necrosis factor alpha and Janus kinase inhibition may represent a rescue therapeutic option for carefully selected patients with severe refractory JIAU, although its long term safety and efficacy require further evaluation.

Purpose To evaluate the microbial spectrum and management of contact lens-associated infectious keratitis (CL-AIK), with an emphasis on behavioral risk factors. Methods This retrospective study was conducted between 2021 and 2023 and involved seventy-four eyes of 70 consecutive diagnosed with CL-AIK at a tertiary care eye hospital. The hygiene practices, clinical and diagnostic findings, including corneal smear and culture, in vivo confocal microscopy (IVCM), and polymerase chain reaction (PCR), were analyzed. The associations between risk behaviors and clinical outcomes were examined. Results A total of 74 eyes from 70 patients (47 females, 63.5%; mean age: 31.24 ± 10.08 years) were reviewed for cases of CL-AIK. The initial best-corrected visual acuity (BCVA) was 1.28 ± 1.27 LogMAR. Diagnostic confirmation was obtained using multiple methods: chocolate agar culture (97.3% usage, 37 (51.4%) positivity), non-nutrient agar with Escherichia coli culture (79.7% usage, 7(11.86%) positivity), PCR testing (79.7% usage, 15 (25.4%) positivity), and IVCM (81.1% usage,18 (29.3%) positivity for Acanthamoeba spp.). Among the 70 patients, 24 (32.4%) rinsed their lenses with tap water, 22 (29.7%) wore lenses overnight, and 14 (18.9%) had exposed to water during showering or swimming. Exposure to water while wearing contact lenses was significantly more common in patients with fungal keratitis (3/4,75%, p = 0.002). The use of expired lenses (3/23, 13.04%; p = 0.008) and prolonged wear (> 12 h; 14/23, 60.8%; p = 0.04) were significantly higher in Acanthamoeba keratitis (AK). Conclusion Although many individuals reported good hygiene practices, high-risk behaviors such as swimming or showering while wearing contact lenses and prolonged daily use (> 12 h) remain important contributors to ocular complications. Prevention strategies should focus not only on general hygiene practices but also on addressing these high-risk behaviors. Additionally, the routine use of multimodal diagnostic techniques has dramatically improved the detection of atypical microorganisms, particularly Acanthamoeba spp.