Limbal and bulbar inflammatory nodules in a patient with pityriasis lichenoides et varioliformis acuta.

CLINICAL REPORT: We report a case of a 42-year old lady with recurrent bilateral nodular conjunctival inflammation following a diffuse papulo-vesicular rash, mainly over her trunk and scalp. Slitlamp examination revealed limbal and bulbar inflammatory nodules with secondary corneal involvement. DISCUSSION: Pityriasis lichenoides is considered to be a spectrum of uncommon, acquired maculo-papular skin eruptions. The diagnosis is made by the combination of a typical clinical picture and matching histopathology. In severe cases, there may be associated with mucous membrane involvement. CONCLUSION: Although ocular involvement has been reported in pityriasis lichenoides, this is the first report of conjunctival inflammatory nodules with secondary corneal ulceration as a part of the manifestations of the pityriasis lichenoides spectrum. Treatment with topical steroid drops was required to bring this condition under control.

The effect of pars plana vitrectomy on cystoid macular oedema associated with chronic uveitis: a randomised, controlled pilot study.

AIM: To evaluate the efficacy of pars plana vitrectomy (PPV) in the management of chronic uveitic cystoid macular oedema (CMO). METHODS: A prospective, interventional, randomised, controlled, pilot study. 23 eyes of 23 patients with CMO secondary to chronic intermediate or posterior uveitis unresponsive to medical treatment were randomised into a surgical (group S) or medical group (group M). 12 patients in group S underwent PPV as opposed to 11 patients in group M who received systemic corticosteroid and/or immunosuppressive treatment during the study period. The primary outcome measures of the study were change in visual acuity and angiographic appearance of CMO at 6 months. RESULTS: Mean visual acuity in group S improved significantly from 1.0 (0.62) at baseline to 0.55 (0.29) at 6 months following vitrectomy (p = 0.011), with five (42%) eyes reaching vision of 20/40 or better. Conversely, mean visual acuity in group M improved only marginally by 0.03 (0.27) (p = 0.785). CMO after vitrectomy was angiographically improved in four (33%) eyes, remained unchanged in seven (58%) eyes, and deteriorated in one (8%) eye. In the medical group, fluorescein leakage decreased in one eye, did not alter in four eyes, and deteriorated in two eyes. CONCLUSION: PPV for macular oedema secondary to chronic uveitis despite angiographic improvement in only one third of the patients, seems to have a significant beneficial effect on visual function. This study provides enough evidence to justify a large scale trial which would define the role of vitrectomy in uveitic macular oedema.

Chronic granulomatous disease and peripheral ulcerative keratitis: a rare case of recurrent external ocular disease.

CLINICAL REPORT: We report a case of a 29-year-old lady, with known Chronic Granulomatous Disease, who presented with an acneiform scarring facial and trunk eruption and sore red eyes. Slitlamp examination showed limbal granulomas and adjacent peripheral ulcerative keratitis. DISCUSSION: The authors are considering the possible causes of the keratitis. As there were no signs of blepharitis at the time of initial presentation, the keratitis was most likely mediated by the adjacent limbal granuloma, and not due to Staphylococcal hypersensitivity. CONCLUSION: Although ocular involvement in CGD has been described before, this is the first article that describes limbal granulomata and peripheral ulcerative keratitis. Multidisciplinary management with longstanding oral antibiotic treatment, and topical combined antibiotic-steroid treatment were required to bring the condition under control.

Never forget the risks of immunosuppression.

It has been widely reported in the literature that malignant neoplasms are a recognised complication of immunosuppression following organ transplantation. These days, immunosuppressive drugs are being used for many conditions outside the transplant setting. A case of a de novo astrocytoma in a patient on long-term immunosuppression for psoriatic arthritis is described.

Interstitial keratitis and deafness in a patient with cutaneous sarcoidosis.

We report a case of interstitial keratitis and progressive hearing loss in a young female patient with biopsy proven cutaneous sarcoidosis. This rare sequence of ophthalmological and auditory signs in sarcoidosis mimicks Cogan's syndrome.

Masquerade syndrome: T-cell prolymphocytic leukemia presenting as panuveitis.

PURPOSE: To report a case of T-cell prolymphocytic leukemia with panuveitis as the primary presenting feature. METHODS: Case report. RESULTS: A 46-year-old woman presented with pain and blurred vision in the right eye. She was found to have signs of panuveitis with a central exudative retinal detachment. Further investigations revealed that she was suffering from the rare T-cell prolymphocytic leukemia. Both systemic and ocular manifestations of the disease resolved after chemotherapy with Campath-IH antigen and as she went into complete remission. The exudative detachment settled, and visual acuity recovered to 20/20. CONCLUSION: This case illustrates that leukemias can present with primarily ocular findings, and the sudden appearance of a serous retinal detachment with inflammatory signs in an otherwise healthy person warrants a thorough systemic screening for an underlying malignancy.

Macrophages during fibrosis following scleral fistulising surgery in a rat model.

PURPOSE: Glaucoma filtration surgery can fail in a minority of patients as a result of fibrosis in the subconjunctival bleb space and closure of the scleral fistula. In this study, the rat eye has been used as an experimental model for fistulising surgery in order to evaluate the clinical manifestation of bleb failure with the morphological events of the wound healing process. METHODS: A conjunctival bleb was successfully formed in 25 rats and was examined daily using slit lamp microscopy to evaluate postoperative inflammation and the presence of a bleb. At defined post-operative time points, serial frozen sections of eyes were stained immunohistochemically using a panel of monoclonal antibodies directed against known surface markers on rat immune/inflammatory cells. Positively stained cells were counted (a) in the bleb site, (b) at the sclerostomy and (c) at the suture site. RESULTS: Following an initial post-operative inflammation, a surgically formed sclerostomy and conjunctival bleb underwent a granulation and scarring response so that by 7-19 days the bleb had disappeared. Using the monoclonal antibodies applied in this study, it was possible to show that macrophages most likely play a major and pivotal role throughout the sequence of events that lead to repair of the fistula and closure of the bleb. It was also noted that the presence of an otherwise inert nylon suture used to close the incised conjunctiva can serve as a focus for macrophages. CONCLUSION: The rat has been successfully used as an experimental model of fistulising surgery and its subsequent failure. The use of a panel of monoclonal antibodies directed against specific surface markers on immune-inflammatory cells, highlighted macrophages to be prominent in all stages of this wound healing process.

Relapsing acute myeloid leukemia manifesting as hypopyon uveitis.

PURPOSE: Although acute lymphoblastic leukemia may masquerade as hypopyon uveitis, acute myeloid leukemia has only rarely been reported to cause this complication, and ocular relapse generally has been associated with evidence of malignant cells at other sites. We studied a patient with acute myeloid leukemia whose only sign of relapse was bilateral anterior uveitis with pseudohypopyon that was refractory to topical and systemic corticosteroids. METHODS: A 26-year-old woman with acute myeloid leukemia in remission, who had bilateral anterior uveitis and increased intraocular pressure at initial examination, was studied clinically. Blood films, bone marrow smears, and preparations were examined by using immunoperoxidase staining. RESULTS: Although there was no evidence of leukemia in the blood or bone marrow samples, the cells obtained from the anterior chamber showed myeloblastic leukemic cells with morphologic characteristics similar to those present in the original bone marrow biopsy obtained 14 months previously. Irradiation and chemotherapy were used to kill the malignant cells in the eye and central nervous system. The persisting glaucoma resolved after anterior chamber washout of necrotic tumor cells. CONCLUSIONS: Unusual features of uveitis in this patient indicated that she had a masquerade syndrome, despite normal results of bone marrow and blood film tests. Aspiration of intraocular cellular infiltrate for cytopathologic examination was required to obtain the correct diagnosis and enable treatment to commence without delay.

The humoral response to an allograft.

Antibodies are known to damage grafted tissues by a variety of means, so it is important to know how the humoral response is initiated. In this paper we summarise the cellular events in B cell activation, the mechanisms of antibody-mediated rejection and the evidence that antibody apparently does not contribute to early corneal graft rejection. The role of antibodies in chronic graft loss is discussed.

Prolongation of rat corneal graft survival by treatment with anti-CD4 monoclonal antibody.

A rat model of orthotopic corneal graft rejection was used to investigate the effect of depletion of subpopulations of immune cells by treatment with monoclonal antibodies. Though CD4+ cells were not eliminated completely by anti-CD4 monoclonal antibodies there was a profound delay in the rejection times of orthotopic corneal allografts. Furthermore a third of the CD4+ depleted animals failed to reject corneal allografts by 100 days post grafting. Despite an almost complete depletion of circulating CD8+ cells, the anti-CD8 antibody treated animals rejected corneal allografts in a similar time course to allografted controls treated with a non-reactive control antibody OX21. These results demonstrate that CD8+ T-cells are not required for rejection of corneal allografts whereas CD4+ T-cells play a critical role in the rejection response. Treatment with anti-CD4 antibodies may have a useful clinical application.