Vascular endothelial growth factor in a recipient cornea acts as a prognostic factor for corneal graft reaction development.

PURPOSE: To evaluate whether the vascular endothelial growth factor A (VEGF-A) in the recipient cornea measured at the time of penetrating keratoplasty (PK) can act as a prognostic factor for corneal graft reaction development. METHODS: The study included 25 eyes (of 25 patients) scheduled for PK. According to preoperative clinical finding, patients were divided into three groups: inflammatory with neovascularization (n = 11); inflammatory without neovascularization (n = 7); and non-inflammatory (n = 7). One half of the recipient cornea was analyzed for the levels of VEGF-A protein using a commercial enzyme-linked immunosorbent assay; the other half was analyzed to determine the loci of VEGF-A production by immunohistochemistry. The frequencies of corneal graft reaction and rejection were recorded, together with the improvement of visual acuity. Twenty-five donor corneas obtained from cadaver eyes represented the control group (n = 25). RESULTS: There was a statistically significant difference in the levels of VEGF-A protein between the recipient corneal buttons obtained from eyes with inflammatory changes and neovascularization, and those from the non-inflammatory group and controls (p < 0.01). The level of VEGF-A was 287.74 pg/ml (standard deviation [SD] = 129.181) in the inflammatory with corneal neovascularization group, 227.64 pg/ml (SD = 85.590) in the inflammatory without neovascularization group, 115.37 pg/ml (SD = 105.93) in the non-inflammatory group, and 142.28 pg/ml (SD = 93.081) in the control group. Graft reaction/rejection rate was 54.5%/45.5% in the inflammatory with neovascularization group, 14.3%/0% in the inflammatory without neovascularization group, and 14.3%/14.3% in non-inflammatory group. Patients who developed clinical signs of graft reaction during the postoperative follow-up had a significantly higher level of VEGF-A (307.4 pg/ml, SD = 100.058) compared with those without any signs of graft reaction (182.8 pg/ml, SD = 124.987). CONCLUSION: Our results suggest that both graft reaction and final graft rejection occur more often in patients with increased levels of VEGF-A in a recipient cornea at the time of PK.

[Ocular dirofilariasis: a case report]. / Okularna dirofilarioza--prikaz bolesnice.

A case of ocular dirofilariasis in a female patient is presented. The zoonosis caused by parasites of the genus Dirofilaria is relatively rare in humans, with a higher incidence in south and central Europe, Asia and Africa. In Europe, dirofilariasis is mostly caused by the species Dirofilaria repens. In the past 50 years, the number of individuals involved has been on an increase, with about 780 cases reported in the literature to date. Dirofilaria is a parasite found in the dog, cat, racoon and bear. The parasite replicates in the animal's body and enters circulation in the form of microfilariae. These microfilariae reach the insect's digestive tract and are transmitted to another animal or human with subsequent mosquito bites. When transmitted to humans, the parasite is found in the skin and subcutaneous tissue, mucous membranes, and less frequently visceral organs. Concerning ocular involvement, infections of the eye and adnexa oculi and tumorous noninfectious growth of eyelid or orbit have been described to date. The symptoms of the disease vary and include local pain, proptosis, diplopia, palpebral and conjunctival edema, redness, feeling of foreign body, and impaired vision. The diagnosis is generally made by histologic identification of the parasite micro- and macroscopic characteristics, Dirofilaria DNA analysis by the method of polymerase chain reaction, and serology (ELISA) demonstrating the presence of Dirofilaria antibodies in serum. Treatment includes surgical excision of the parasite as an appropriate and efficient therapeutic procedure. A 76-old-female patient presented to outpatient ophthalmology clinic for occasional sensation of pain, rubbing and redness in her right eye. Initial therapy was introduced, resulting in short-lasting improvement. In two weeks, the patient was re-examined for recurrence of discomforts. Slit lamp examination performed temporally revealed a whitish motile, live parasite under the injected and chemotic bulbar conjunctiva. Upon surgical extirpation of the parasite, the diagnosis of dirofilariasis was verified by microbiologic identification.

[Painful ophthalmoplegia--Tolosa-Hunt syndrome]. / Bolna oftalmoplegija--Tolosa-Huntov sindrom.

Tolosa Hunt syndrome is a rare disorder caused by nonspecific inflammation in the cavernous sinus/superior orbital fissure and/or orbital apex. It is clinically characterized by alternating remissions and exacerbations, and manifested as diplopia associated with unilateral periorbital hemicranial headache. The symptoms include blepharoptosis, which is usually mild if present, bulbomotor paresis involving the pupil, and loss of sensation in the area supplied by the first division of the trigeminal nerve. Therapy for Tolosa-Hunt syndrome are systemic steroids. The course of disease in a 25-year-old man hospitalized for painful ophthalmoplegia and diplopia is presented. The history included severe pain on rightward eye movement and parabulbarly on the right, considerable defect in the area supplied by the first division of the trigeminal nerve, right hemicrania, and diplopia on looking to the left, right, upward and downward that developed after four days. A month before, the patient was observed at neurology department for severe right hemicrania. Current status included severe pain parabulbarly on the right, discrete proptosis with mild ptosis on the right eye, restricted right eye bulbar motoricity on looking nasally, nasally upward and downward, and loss of sensation in the area supplied by the first division of the trigeminal nerve. Pupilar motoricity was normal. Upon admission, neuroradiologic examination (orbit CT) and brain MR were performed, and therapy with systemic corticosteroids was initiated ex iuvantibus, in consultation with a neurologist. At 24 hours of corticosteroid therapy, the pain subsided, whereas diplopia disappeared almost completely after 5 days, now being only occasionally recorded on looking to the left and upward.

[Uveitis caused by Toxocara canis]. / Uveitis uzrokovan Toxocarom canis.

The course of disease in a 64-year-old man with toxocariasis and ocular manifestations of the disease, treated at Departments of Ophthalmology and of Infectious Diseases, Dr. Josip Bencevic General Hospital in Slavonski Brod, Croatia, is presented. The patient was hospitalized for bilateral uveitis of unknown etiology. In several days, the patient developed high fever with respiratory tract involvement and hepatomegaly. Worsening of the patient's general condition and laboratory findings of leukocytosis and eosinophilia indicated clinical examinations for parasitosis, in consultation with a specialist for infectious diseases. Specific serologic testing pointed to toxocariasis. The patient's general condition and ophthalmologic status improved in response to specific therapy with anthelmintics and corticosteorids. Toxocariasis is an acute infectious disease that primarily affects animals and less frequently humans. Clinically, toxocariasis manifests as a systemic disease, and on the eye as parasitic posterior uveitis. The disease is caused by the nematodes Toxocara canis and Toxocara cati, the species parasitic in the intestine of dogs and cats, respectively. When the parasite eggs reach human intestine, larvae are released and migrate via blood and lymphatic system to the liver, lungs, eyes, and other organs. Considering the mechanism of disease transmission, the potential preventive measures should include treatment and appropriate anthelmintic management of infected animals, and due control of public areas such as public gardens, promenades, playgrounds, along with taking pets for exercise to the sites specially intended for this purpose.