We report a case of scleral keratitis caused by Phomopsis phoenicicola. Pterygium surgery was a predisposing factor, and the patient was treated with natamycin and fluconazole eye drops and oral fluconazole. The fungus was identified by sequencing of the internal transcribed spacer (ITS) region of the fungal ribosomal DNA (rDNA) locus and confirmed on the basis of its typical pycnidia and conidia. CASE REPORTA 48-year-old postman presented with a history of pain, redness, and watering in his right eye since 6 weeks previously. He had undergone pterygium surgery in the same eye 6 weeks ago. The details of the surgical technique and the use of mitomycin C were not available. On examination, his uncorrected visual acuity was just light perception and projection in the right eye and 6/9 in the left eye. Slit lamp examination of the right eye showed a significant area of infiltration (3 to 5 mm) involving the peripheral cornea from the nasal side and extending toward the limbus temporally and superiorly. There was stromal infiltrate surrounding the descemetocele, blood pigments on the endothelium, and a corneal abscess with central thinning. Scleral necrosis and thinning nasally in the area of the pterygium excision were also seen. Diffused stromal haze and significant anterior chamber inflammation with 2-mm hypopyon were evident (Fig. 1A).Corneal scraping material obtained from the infected area was viewed microscopically using a potassium hydroxide (10% KOH)-calcofluor white preparation and Gram staining. It was inoculated on blood agar, potato dextrose agar (PDA), and tryptone soy broth (Himedia Labs Ltd., Mumbai, India) and incubated under appropriate atmospheric conditions. Examination of 10% KOH mounts showed numerous septate and branched hyphae (Fig. 1B).Antifungal treatment was initiated with topical natamycin eye drops (Natamet; 5% suspension; Sun Pharmaceuticals Ind Ltd., Halol, India), moxifloxacin eye drops (Vigamox; 0.5% suspension; Alcon Laboratories Inc., Texas), and fluconazole eye drops (Zocon; 0.3% suspension; FDC Ltd., Aurangabad, India) hourly and atropine eye drops (0.1% suspension; Taj Pharma Ltd., Mumbai, India) three times a day. The patient was also prescribed Iopar tablets (250 mg to reduce intraocular pressure [IOP]) and an antifungal tablet (fluconazole; 150 mg) once daily.The corneal scrapings inoculated onto the PDA and blood agar showed the presence of several colonies of a single fungus within 2 days. Fourteen days later, the lesion improved with a decrease in hypopyon. The natamycin and fluconazole therapy was reduced to every 2 h, and tablet fluconazole was continued. Further improvements were noted, and after 1 month the lesion had healed. The infection subsided in 2 months, following which all the medications were discontinued. The patient was left with a scar on the cornea and a best-corrected vision of 6/12.Mycologic studies. The isolate (ICIRC-CC58) was subcultured on PDA and Sabouraud dextrose agar (SDA) (Himedia Labs Ltd., Mumbai, India) and incubated at 25°C and 37°C. Growth ...

Dideoxyosones (DDOs) are intermediates in the synthesis of advanced glycation end products (AGEs), such as pentosidine and glucosepane. Although the formation of pentosidine and glucosepane in the human lens has been firmly established, the formation of DDOs has not been demonstrated. The aim of this study was to develop a reliable method to detect DDOs in lens proteins. A specific DDO trapping agent, biotinyl-diaminobenzene (3,4-diamino-N-(3-{[5-(2-oxohexahydro-1H-thieno[3,4-d]imidazol-4-yl)pentanoyl]aminopropyl) benzamide) (BDAB) was added during in vitro protein glycation or during protein extraction from human lenses. In vitro glycated human lens protein showed strong reaction in monomeric and polymeric crosslinked proteins by western blot and ELISA. Glycation of BSA in the presence of BDAB resulted in covalent binding of BDAB to the protein and inhibited pentosidine formation. Mass spectrometric analysis of lysozyme glycated in the presence of BDAB showed the presence of quinoxalines at lysine residues at positions K1, K33, K96, and K116. The ELISA results indicated that cataractous lens proteins contain significantly higher levels of DDO than non-cataractous lenses (101.9±67.8 AU/mg protein vs. 31.7±19.5 AU/mg protein, p<0.0001). This study provides first direct evidence of DDO presence in human tissue proteins and establishes that AGE crosslink synthesis in the human lens occurs via DDO intermediates.

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