Tear and serum eosinophil cationic protein levels in seasonal allergic conjunctivitis.

PURPOSE: Eosinophil cationic protein (ECP) levels in tear fluid and sera of patients with seasonal allergic conjunctivitis (SAC) were measured to assess local and systemic eosinophilic activity in SAC. The correlation between ECP levels and disease activity was evaluated. METHODS: Tears and sera were collected from 21 patients with SAC and 13 healthy control subjects. ECP levels in tears and sera were measured before and 4 weeks after treatment with 0.1% lodoxamide eyedrops. Clinical signs and symptoms of SAC were scored and the correlation of ECP levels with the clinical scores was evaluated. RESULTS: Tear and serum levels of ECP were significantly increased (p = 0.01, p = 0.02, respectively) in patients with SAC compared with the control subjects, but ECP levels were not correlated with the severity of the disease. Following treatment with topical 0.1% lodoxamide eyedrops, the mean level of ECP in tears decreased significantly (p = 0.02), whereas no significant change was observed in serum ECP levels. Furthermore, a significant decrease in clinical signs and symptoms scores was found after treatment (both p < 0.0001). CONCLUSIONS: Increased serum and tear ECP levels in patients with SAC confirms that both local and systemic eosinophil activation occurs in SAC. However, clinical signs and symptoms of SAC were not found to be correlated with the degree of eosinophilic activity. Thus ECP does not seem to have an important role in clinical manifestations of SAC.

High dose intravenous steroid therapy for severe posterior segment uveitis in Behçet's disease.

AIM: To evaluate the safety and effectiveness of high dose intravenous steroid therapy (HDIST) in Behçet's disease patients with severe posterior segment uveitis attacks. METHODS: Five patients with ocular Behçet's disease were treated with HDIST for severe posterior segment attacks. Two patients had vasculitis, one patient had papillitis, and the other two had retinitis; four patients also had accompanying severe vitritis. The visual acuities and improvement in ocular signs after HDIST were evaluated. RESULTS: During HDIST, patients had no systemic complications caused by treatment. All patients responded to HDIST with evidence of a decrease in intraocular inflammatory activity and improved visual acuities within a mean time of 7 (1-15) days of commencing treatment. During follow up three out of five patients had new posterior segment attacks. CONCLUSION: HDIST is effective in controlling severe, vision threatening acute posterior segment Behçet's uveitis attacks and in improving visual function in a short period of time

Anti-MHC autoimmunity in Behçet's disease: T cell responses to an HLA-B-derived peptide cross-reactive with retinal-S antigen in patients with uveitis.

Immune response to retinal autoantigens plays a central role in the pathogenesis of uveitis. A synthetic peptide (B27PD) from a common sequence of various HLA-B molecules associated with uveitis, such as HLA-B27 and 51, which shares amino acid homologies with a retinal-S antigen (S-Ag)-derived peptide (PDSAg), was shown to be immunogenic in human and experimental uveitis in the rat. In this study we investigated T cell responses to B27PD and PDSAg in patients with Behçet's disease and posterior uveitis (BD-posterior uveitis; n = 33) in comparison with non-Behçet anterior uveitis (AU, n = 14), Behçet's patients without uveitis (BD, n = 15) and healthy controls (HC, n = 32) in a 6-day proliferation assay. Patients with BD and posterior uveitis had significantly higher responses (stimulation index (SI) 2.8 +/- 1.3) than those with AU (SI 1.5 +/- 0.4), BD without uveitis (SI 1.1 +/- 0.4) and HC (SI 1.1 +/- 0.6) for B27PD (P < 0.0001). Responses to PDSAg were also higher in BD with posterior uveitis patients (SI 3.3 +/- 1.6) than AU (SI 1.5 +/- 0.4), BD without uveitis (SI 1.2 +/- 0.3) and HC (SI 1.1 +/- 0.6) (P < 0. 0001). A significant correlation between the responses to PDSAg and B27PD (r = 0.56, P < 0.001) was observed. Elevated levels of IL-2 and tumour necrosis factor-alpha were also observed in culture supernatants obtained from peripheral blood mononuclear cells after stimulation with the peptides, but no correlation was found between the proliferative responses and cytokine levels. These results suggest that cellular immunity to cross-reactive HLA-B and S-Ag-derived peptides might play a role in the pathogenesis of posterior uveitis in BD.

Hereditary pigmented paravenous chorioretinal atrophy.

Pigmented paravenous chorioretinal atrophy (PPCRA) is a rare disorder which is diagnosed primarily because of the typical fundoscopic appearance of retinal pigment epithelial (RPE) atrophy and clumping in a paravenous distribution. A mildly affected and asymptomatic 54-year-old mother and her mildly affected daughter and severely affected son presented with pigmented paravenous chorioretinal atrophy. The severely affected (proband) 28-year-old man manifested the characteristic paravenous chorioretinal atrophy with pigment clusters in both eyes with macular involvement. Besides the characteristic fundus picture, he also had chronic angle closure glaucoma. His 23-year-old sister presented with unilateral involvement. Her right eye showed focal perivenular retinal pigment epithelial hyperplasia at the 2 o'clock position and dilated, tortuous retinal veins, while her left eye had only dilated and tortuous retinal veins. Both patients were hyperopic. Their mother had an area of chorioretinal atrophy in one eye near a retinal vein. The scotopic ERG responses were markedly abnormal in the male patient, while his sister had a mild decrease in amplitude of both a and b waves in both eyes. One of the children of an unaffected family member was found to have dilated and tortuous retinal veins and hyperopia (III-12). To our knowledge, this is the fourth report of familial occurrence of pigmented paravenous chorioretinal atrophy. The present pedigree is compatible with X-linked recessive or dominant inheritance.

Cell adhesion molecules in subretinal fluid: soluble forms of VCAM-1 (vascular cell adhesion molecule-1) and L-selectin.

PURPOSE: In this study we investigated the presence of soluble VCAM-1 and soluble L-selectin-1 in subretinal fluids (SRF) of patients suffering from rhegmatogenous retinal detachment . METHOD: Subretinal fluids were collected from drainage sclerotomies during surgery from 27 patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy (PVR) or uncomplicated retinal detachment. Levels of sVCAM-1 and sL-selectin-1 were quantified with ELISA. RESULTS: The mean +/- SEM values of sVCAM-1 and sL-selectin-1 were 222.2 +/- 81 ng/ml and 171.7 +/- 42.1 ng/ml, respectively. The concentrations of sVCAM-1 in patients with Grade C PVR (498.2 +/- 1703 ng/ml) were significantly different from those with Grade B PVR (45.6 +/- 16.5 ng/ml) and uncomplicated retinal detachments (19.4 +/- 12.3 ng/ml). SVCAM-1 concentration in detachments which had been present for more than 8 weeks was 738.8 +/- 431 ng/ml, significantly higher than the levels in detachments of shorter duration (132.4 +/- 47.7 ng/ml). sL-selectin-1 level in Grade C PVR (291.6 +/- 92.8 ng/ml) was higher than in uncomplicated retinal detachments (72.8 +/- 13.5 ng/ml). Significantly elevated levels of sL-selectin-1 were observed in detachments lasting more than 8 weeks (605 +/- 151.1 ng/ml) compared to those of shorter duration (96.3 +/- 13.1 ng/ml). CONCLUSION: The present study supports growing evidence that these cell adhesion molecules are involved in the inflammatory process during the development and progression of PVR.

Effects and side effects of mydriatic eyedrops in neonates.

The pupils of neonates and premature infants often need to be dilated for retinal examination. The drops used for this purpose have some known side effects. This study investigated the effects and side effects of these drops. In this prospective randomized study, 80 healthy neonates were randomly assigned to eight groups. In Group A 1% cyclopentolate was used; in Group B 1% tropicamide; in Group C 2.5% phenylephrine; in Group D 1% cyclopentolate and 1% tropicamide; in Group E 2.5% phenylephrine and 1% tropicamide; in Group F 0.5% cyclopentolate, 0.5% tropicamide and 2.5% phenylephrine; in Group G 1% cyclopentolate and 2.5% phenylephrine and in Group H 0.9% NaCl. Heart rate, systolic and diastolic blood pressures were recorded before, and 5, 10, 15, 30, 45, 60 minutes after instillation of the drops. Pupillary size was measured at baseline, 30 and 60 minutes. To stimulate the conditions of indirect ophthalmoscopic examination, the pupil sizes were measured under the intense beam of a halogen light. The results were analyzed statistically. Maximum side effects were seen in group C; the safest was group B and maximum mydriasis was achieved in group F.

Merkel cell tumour of the eyelid and reconstruction with the Cutler-Beard technique: a clinicopathologic case report.

A case of Merkel cell tumour that developed on the left upper lid of a 76-year-old white man is reported. The diagnosis was ultrastructurally made by demonstrating characteristic light microscopic features of Merkel cell carcinoma; such as large, round nuclei and frequent mitoses. Immunohistochemically, the tumour cells were shown to possess simple epithelia-type keratin intermediate filaments. Merkel cell tumour probably develops from precursor cells which give rise to keratinocytes and Merkel cells, and nearly one out of 10 Merkel cell tumours occur in the eyelid and periocular region. They tend to be bulging lesions near the lid margin of elderly patients. The condition can be misdiagnosed as lymphoma, oat cell carcinoma, malignant melanoma, sweat gland tumours, neuroblastoma and Ewing's sarcoma, and frequently invades lymphatic vessels. Nearly one out of three Merkel cell tumours recur and two thirds cause regional lymph node metastases. Wide surgical resection and reconstructive procedures, should be followed by routine postoperative irradiation. This patient was treated with wide resection and the Cutler-Beard technique, then scheduled for radiotherapy.

Hypotonic maculopathy after trabeculectomy with postoperative use of 5-fluorouracil.

We evaluated two patients who developed hypotonic maculopathy following trabeculectomy and adjunctive 5-fluorouracil injections. Both patients had ocular hypotony and decreased visual acuity following these injections. The first case showed marked choroidal foldings, retinal striae, increased retinal vascular tortuosity, engorgement and optic disc oedema. The second case had radial perifoveal retinal striae, increased retinal vascular tortuosity and engorgement. The first patient regained pre-operative visual acuity while the second case had a visual acuity of 20/25 without any intervention. Fundus changes were less marked 12 months after initial evaluation in both cases. Hypotonic maculopathy is a reversible complication of trabeculectomies with adjunctive use of 5-fluorouracil.

Assessment of tear drainage by fluorescein dye disappearance test after experimental canalicular obstruction.

Controversy exists about the role of upper and lower canaliculi in tear drainage. Fluorescein dye disappearance test was used to evaluate tear drainage after experimental obstruction of upper, lower, neither or both canaliculi in 18 subjects by hydroxypropil cellulose rods. When both canaliculi were occluded marked impairment was noted in all subjects (p < 0.05). Monocanalicular obstruction (either upper or lower) generally resulted in minimal impairment in most of the cases. Only 11% of upper canalicular obstruction and 20% of lower canalicular obstruction resulted in marked impairment. There was no significant difference between upper and lower canalicular obstruction (p < 0.05). In this study it is concluded that both upper and lower canaliculus have equal importance in tear drainage.

Congenital lens coloboma and associated pathologies.

Coloboma of the lens is characterized by notching of the equator of the lens. The cause of the condition is faulty development of the zonule. The lens deprived of its normal pull in the defective region is thicker and more spherical as if there were no loss of its substance. We report five cases of lens coloboma and localized zonular defect without any associated systemic anomalies. One case included retinal detachment; another included an iris coloboma; and a third included iris, choroid and optic disk colobomas and retinal detachment with lens coloboma. The remaining two cases were without associated ocular anomalies. The pathogenic mechanisms and relationship of this defect with the differentiation of the tertiary vitreous and development of the zonule is discussed. The defect most likely occurs in the third to fourth months of gestation during differentiation of the tertiary vitreous in response to toxic, inflammatory or genetic factors.

Effect of the application of acetazolamide soaked contact lenses on intraocular pressure of rabbits.

Topical application of acetazolamide has no known effect on intraocular pressure (IOP). We tried to detect the hypotensive effect on IOP of acetazolamide soaked onto soft contact lenses (CL). We applied CLs soaked in either 1%, 3%, or 5% acetazolamide solution onto one eye of 29 rabbits while the contralateral eye served as a control. There was an average 32% reduction of IOP amongst all acetazolamide applied eyes, and an average 19% reduction of IOP amongst all control eyes. Amongst the 1% acetazolamide-CL applied eyes there was a mean 37% reduction of IOP, amongst the 3% acetazolamide-CL applied eyes a mean 36% reduction, amongst the 5% acetazolamide-CL applied a mean 30% reduction, and a mean 19% reduction in control eyes. The longest period of IOP reduction followed the application of 1% acetazolamide-CLs, probably owing to improved drug corneal penetration at this concentration. Our results reveal that the application of acetazolamide soaked soft CLs has a significant hypotensive effect on IOP in both the applied and contralateral control eyes of rabbits.

Tear lysozyme levels in contact lens wearers.

Tear lysozyme levels in various types of asymptomatic contact lens wearers were compared with those in age- and sex-matched healthy control subjects. We used a radial immunodiffusion technique, and the lysozyme levels were in the normal range in controls and contact lens wearers. A comparison of the tear lysozyme levels of 27 contact lens wearers (mean, 1.05 +/- 0.45 g/L) with 22 control subjects (mean, 0.84 +/- 0.39 g/L) was statistically significant (P less than .05). The mean tear lysozyme levels of rigid (1.12 +/- 0.54 g/L, P less than .05) and high water-content (1.20 +/- 0.43 g/L, P less than .03) contact lens wearers were increased in comparison with the control group. The tear lysozyme difference was significant (P less than .03) between high and low water-content (0.82 +/- 0.20 g/L) contact lens users. Our study revealed that, although most of the contact lens wearers were asymptomatic and there was no pathologic sign of external ocular inflammation, a change in tear lysozymes was observed. Contact lens wear is irritating to the cornea and conjunctiva, and tear lysozyme physiology is disturbed most by high water-content contact lenses.

Long-term effects of cyclophosphamide and colchicine treatment in Behçet's disease.

We assessed the long-term effects of cyclophosphamide and colchicine on visual prognosis and attack frequency in 64 patients with Behcet's disease who were studied in two separate groups between the years of 1976 and 1989. No statistically significant positive changes in visual acuity or attack frequency which might be attributed to the treatment could be shown when the period of treatment was compared with the period after treatment.

Intraocular pressure variations during extracorporeal circulation and some influencing factors.

Intraocular pressure (IOP) variations during extracorporeal circulation (ECC) and some influencing factors were studied prospectively in 38 patients undergoing cardiovascular surgery. IOPs were measured preoperatively, during EEC after 5 min, 10 min, and then every 15 min and on the first, second and third postoperative days. IOP, haematocrit, arterial perfusion pressure, partial O2 pressure, partial CO2 pressure, pH, and blood bicarbonate levels were measured simultaneously. After beginning ECC, arterial perfusion pressure and haematocrit values decreased suddenly while IOP was raised immediately. The sudden increase of blood volume at the start of ECC is the probable cause of IOP elevation. Afterwards IOP levels decreased to pre-ECC levels. We think that the drop is due to the effect of mannitol in the priming solution and hyposecretion of aqueous humor due to insufficient nutrition-oxygenation of the corpus ciliaris after the haemodynamics have stabilised.

Low-vision aids in Stargardt's disease.

The use of low-vision-aids (LVAs) to improve distance and near visual acuity was evaluated in 27 patients. Most of the patients had a useful distance vision with or without glasses, and 24 patients (89%) were prescribed a near visual aid successfully. The high success rate was attributed to young age, strong motivation and myopic refractive error of these patients. We recommend the trial of LVAs to patients with Stargardt's disease who have visual difficulties.

The effect of contact lens wear on tear immunoglobulins.

We assayed tear immunoglobulins (IgA, IgG, and IgM) by radial immunodiffusion in 24 contact lens wearers and 22 healthy control subjects. IgA level was found to be increased (P less than or equal to 0.02) in rigid contact lens wearers (mean: 0.14 +/- 0.07 g/L) compared to control subjects (mean: 0008 +/- 0.06 g/L). IgA levels of both of PMMA contact lens wearers (mean: 0.14 +/- 0.08 g/L; P less than or equal to 0.05) and rigid gas permeable contact lens wearers (mean: 0.13 +/- 0.07 g/L; P less than or equal to 0.05) were increased in comparison with the control group. No statistically significant differences were found in IgA levels of various types of soft contact lens wearers or in IgG or IgM levels between wearers and controls. The mean duration of lens wear was 6.4 years (range: 1-20 years), and an increase in IgG level was found, related length of lens wear (P less than or equal to 0.03). We believe that the continuous mechanical stimulation of conjunctiva alters the level of tear immunoglobulins, especially the IgA type.

Intraocular foreign bodies: results of 27 cases.

Twenty-seven consecutive cases of various kinds of perforating injuries with foreign bodies, referred to the Ophthalmology Department of Hacettepe Medical School between January 1984 and April 1988, were evaluated retrospectively. Whenever technically possible magnetic extraction was the preferred method of removing the foreign body. Thirteen (48%) eyes developed endophthalmitis, 18 (66.6%) eyes developed traumatic cataract, and eight (29.6%) eyes developed retinal detachment after the trauma. Twelve (44.5%) eyes had a visual acuity of 1/10 or better after the appropriate medical and surgical treatment.