Strabismus in patients with cortical visual impairment: outcomes of surgery and observations of spontaneous resolution.

PURPOSE: To investigate the rate of spontaneous resolution of strabismus in patients with cortical visual impairment (CVI) at a single center over a 10-year period and to evaluate the success rate of strabismus surgery. METHODS: The medical records of patients with CVI and strabismus seen between October 2003 and October 2013 were reviewed retrospectively. Patients were classified into 4 outcome groups: (1) those who experienced spontaneous resolution of strabismus, (2) those with persistent strabismus who did not undergo surgery, (3) those who achieved postoperative alignment of ≤10(Δ); and (4) those whose final postoperative alignment was 11(Δ)-25(Δ) or >25(Δ). RESULTS: A total of 70 patients were included. Of these, 11 patients (16%) experienced spontaneous resolution of strabismus, 27 (38%) were observed without receiving surgery, and 32 (46%) underwent strabismus surgery. Of these 32, 18 (56%) achieved alignment of ≤10(Δ); 9 (28%), alignment of 11(Δ)-25(Δ); and 5 (16%), alignment >25(Δ). The patients who did not undergo surgery were significantly older at presentation (36 months vs 12-15 months; P = 0.03); otherwise, there were no significant differences between groups in age at surgery or spontaneous resolution, type of strabismus, or underlying cause of CVI. CONCLUSIONS: In our study cohort, a minority of patients with CVI and strabismus (16%) experienced spontaneous resolution of strabismus. Only 16% of patients undergoing surgery had poor final alignment (>25(Δ)). Strabismus surgery can be reasonably successful in properly selected patients with CVI and strabismus. These patients show considerable rates of resolution of their strabismus, either spontaneously or through surgery.

Metastasis of squamous cell cervical carcinoma to the orbit of the eye.

► We compare characteristics of our case with five previously reported cases. ► We discuss possible mechanisms of dissemination and metastasis to the distant site. ► We discuss treatment options, but poor outcome was noted in all six cases.

Nasolacrimal duct closure modulates ocular mucosal and systemic CD4(+) T-cell responses induced following topical ocular or intranasal immunization.

Both topical ocular and topical intranasal immunizations have been reported to stimulate the ocular mucosal immune system (OMIS) and the systemic immune system. Nasolacrimal ducts (NLDs) are the connecting bridges between the OMIS and nasal cavity-associated lymphoid tissue (NALT). These ducts drain topical ocularly administrated solutions into the inferior meatus of the nose to reach the NALT. Inversely, NLDs also drain intranasally administrated solutions to the mucosal surface of the eye and thus the OMIS. This unique anatomical connection between the OMIS and NALT systems provoked us to test whether the OMIS and NALT are immunologically interdependent. In this report, we show that both topical ocular administration and topical intranasal administration of a mixture of immunodominant CD4(+) T-cell epitope peptides from herpes simplex virus type 1 (HSV-1) glycoprotein D (gD) emulsified with the CpG(2007) mucosal adjuvant are capable of inducing local (in conjunctiva) as well as systemic (in spleen) HSV-peptide-specific CD4(+) T-cell responses. Interestingly, surgical closure of NLDs did not significantly alter local ocular mucosal CD4(+) T-cell responses induced following topical ocular immunization but did significantly enhance systemic CD4(+) T-cell responses (as measured by both T-cell proliferation and gamma interferon (IFN-gamma) production; P < 0.005). In contrast, NLD closure significantly decreased ocular mucosal, but not systemic, CD4(+) T-cell responses following intranasal administration of the same vaccine solution (P < 0.001). The study suggests that NALT and the OMIS are immunologically interconnected.

Asymptomatic human CD4+ cytotoxic T-cell epitopes identified from herpes simplex virus glycoprotein B.

The identification of "asymptomatic" (i.e., protective) epitopes recognized by T cells from herpes simplex virus (HSV)-seropositive healthy individuals is a prerequisite for an effective vaccine. Using the PepScan epitope mapping strategy, a library of 179 potential peptide epitopes (15-mers overlapping by 10 amino acids) was identified from HSV type 1 (HSV-1) glycoprotein B (gB), an antigen that induces protective immunity in both animal models and humans. Eighteen groups (G1 to G18) of 10 adjacent peptides each were first screened for T-cell antigenicity in 38 HSV-1-seropositive but HSV-2-seronegative individuals. Individual peptides within the two immunodominant groups (i.e., G4 and G14) were further screened with T cells from HLA-DR-genotyped and clinically defined symptomatic (n = 10) and asymptomatic (n = 10) HSV-1-seropositive healthy individuals. Peptides gB(161-175) and gB(166-180) within G4 and gB(661-675) within G14 recalled the strongest HLA-DR-dependent CD4(+) T-cell proliferation and gamma interferon production. gB(166-180), gB(661-675), and gB(666-680) elicited ex vivo CD4(+) cytotoxic T cells (CTLs) that lysed autologous HSV-1- and vaccinia virus (expressing gB)-infected lymphoblastoid cell lines. Interestingly, gB(166-180) and gB(666-680) peptide epitopes were strongly recognized by CD4(+) T cells from 10 of 10 asymptomatic patients but not by CD4(+) T cells from 10 of 10 symptomatic patients (P < 0.0001; analysis of variance posttest). Inversely, CD4(+) T cells from symptomatic patients preferentially recognized gB(661-675) (P < 0.0001). Thus, we identified three previously unrecognized CD4(+) CTL peptide epitopes in HSV-1 gB. Among these, gB(166-180) and gB(666-680) appear to be "asymptomatic" peptide epitopes and therefore should be considered in the design of future herpes vaccines.

Herpes zoster ophthalmicus in an otherwise-healthy child.

Herpes zoster ophthalmicus, although not uncommon in adults, is rarely found in children. Herein we present a case of pediatric herpes zoster ophthalmicus that is unique in 2 ways. First, the child had been vaccinated against varicella and otherwise had no known exposure to varicella-zoster virus. Second, the initial presentation of herpes zoster ophthalmicus was a painful and diffuse subconjunctival hemorrhage that appeared before any of its classic signs were observed. We report this case to document the possible occurrence of herpes zoster ophthalmicus in children who have been vaccinated against varicella and the possibility of a diffuse, painful subconjunctival hemorrhage as a presenting sign.