The Effect of Candida albicans and Dexamethasone on the Secretion of Tumor Necrosis Factor-alpha from Cultured Human Keratocytes

PURPOSE: To measure the secretion of TNF-alpha from cultured human keratocytes after inoculation of Candida albicans, and to evaluate the change of secretion of TNF-alpha following application of dexamethasone. METHODS: Human corneal keratocytes were cultured independently in vitro. The specimens were divided into 4 groups: Group I with only pure culture as control, Group II with C. albicans, Group III with C. albicans and dexamethasone, and Group IV with only dexamethasone. RESULTS: As a whole, Group II showed the highest secretion of TNF-alpha, followed by Group III, Group I, and Group IV respectively (P< 0.05). CONCLUSION: Keratocytes with the addition of both C. albicans and dexamethasone, secreted much lower level of TNF-alpha , but showed more proliferation in comparison to keratocytes with addition of C. albicans alone. Therefore, the author may conclude that in fungal keratitis, the early administration of dexamethasone may be beneficial in reducing inflammatory responses induced by increased TNF-alpha secretion. However, because steroids may stimulate the proliferation of fungus leading to tissue damages, more cautious use might be needed.

Clinical Characteristic of Lacrimal Ductal Cyst

PURPOSE: Through 13 cases of lacrimal ductal cysts which were diagnosed by clinical or histopathological findings, we investigated the clinical characteristic and the effect of cyst excision on lacrimal secretion. METHODS: As a primary treatment, cyst excisions(6 cases), marsupialzations(4 cases), and needle aspirations(3 cases) were performed and their results were compared. Pre-and postoperative lacrimal secretion tests(Schirmer I & BST) were performed on 10 cases which underwent cyst excision either primarily or secondarily(due to recurrences). A biochemical analysis of cyst fluid and serum IgA level was also done on 7 cases. RESULT: There were no recurrences on 6 surgically excised cases, but 1 out of 4 cases with marsupia-lizations and all 3 cases with needle aspirations recurred and underwent cyst excisions secondarily. Two out of 10 surgically excised cases showed reduced value of postoperative lacrimal secretion tests. Cyst fluid IgA levels were higher than that of serum in all 7 cases. CONCLUSION: The higher cyst IgA level may signify the presence of an active secretory precess within cyst walls. A complete cyst excision seems to be the best treatment choice for the prevention of recurren-ces and marsupialization is also considered as an alternative treatment modality. The cyst excision itself does not seem to affect lacrimal secretion.

Primary Lid Tuberculosis Occuring at Preaponeurotic Portion after upper Lid Blepharo plasty

Tuberculosis of the lid is a rare disease that usually extends directly from surrounding tissues such as paranasal sinuses and lacrimal glands, or occurs possibly as a result of hematogenous spread. Primary tuberculous infection of lid also rarely occurs. The earliest lesion is a brownish red, soft papule that develops into an indurated nodule or plaque that may ulcerate. There is usually prominent lymphadenopathy. The diagnosis is established through tuberculin skin testing, stains for acid-fast organisms, and cultures. If diagnosis is delayed, complications including extensive orbital tissue damages, cold abscess, cutaneous fistula, and cicatricial ectropion may ensue. Lid tuberculosis should be differentiated from other granulomatous lesions of eyelid and also from other more commonly occuring orbital tumors. The combination therapy of Isoniazid, Rifampin, and Pyrazinamide is recommended for lid tuberculosis. We experienced a patient presenting with painless upper eyelid nodule that occurred about 3 weeks following upper lid blapharoplasty and treated her with anti-tuberculous medications after histological diagnosis of lid tuberculosis has been made. So, we report this rare case of lid tuberculosis with literature.