Astigmatism associated with Fuchs' heterochromic iridocyclitis.

PURPOSE: To determine whether there is inherent corneal astigmatism in patients with Fuchs' heterochromic iridocyclitis (FHI). PATIENTS AND METHODS: A case-controlled study of 48 patients with unilateral FHI was conducted. These patients had no history of previous surgery or previous diagnosis of glaucoma or cataract. The controls were the fellow eyes of the patients, and the cases were the FHI eyes. All eyes were refracted, and the results were analyzed with descriptive and parametric statistics. RESULTS: Twenty-one women and 27 men were studied. The mean age was 39.5 years. The mean keratometric value for the astigmatism in the FHI eye was 2.2 diopters (D) (standard deviation +/-1.19) and 0.96 D (+/- 0.64) in the controls (p= 0.000). Refractive astigmatism was 1.44 D (+/-1.45) in FHI eyes and 0.38 D (+/-0.62) in the controls (p= 0.000). CONCLUSIONS: Patients with unilateral FHI have inherent corneal astigmatism in the disease eye.

Effect of chloroquine on experimental melanin-protein-induced uveitis in Lewis rats.

PURPOSE: To evaluate the effect of chloroquine on experimental recurrent autoimmune melanin-protein-induced uveitis in Lewis rats. METHODS: Five Lewis rats were immunized with melanin to induce uveitis (group I); another six were immunized and treated with 5 mg/kg/day of chloroquine (group II). To reinduce uveitis, they received two booster injections of melanin. They were killed when uveitis was present after the last booster injection; every eye was evaluated by means of clinical and histopathological examination. A control group of four rats received the same chloroquine dose to evaluate retinal toxicity (group III). RESULTS: Rats in group I showed more severe uveitis episodes than rats in group II. The second uveitis episode was more severe in group I than in group I. Rats in group III showed no clinical or histopathological abnormalities. CONCLUSIONS: Chloroquine decreased the severity and duration of uveitis, and in two rats it prevented recurrences. Thus, chloroquine can be considered an effective treatment for chronic, recurrent experimental uveitis.

HLA-DR is strongly associated with Vogt-Koyanagi-Harada disease in Mexican Mestizo patients.

PURPOSE: To analyze the genetic background of human leukocyte antigens (HLA) of Vogt-Koyanagi-Harada (VKH) disease in Mexican Mestizo patients in order to establish whether the pathogenesis is related to the same genes or sequences described in other populations. PATIENTS AND METHODS: In 48 VKH patients, we performed HLA class I and class II typing using the standard microlymphocytotoxicity tests; a group of 100 nonrelated healthy subjects were analyzed for comparison. Antigen and gene frequencies were calculated for every antigen tested in patients and in controls. RESULTS: The frequency of HLA-DR4 was significantly increased in VKH Mexican patients (x2Y = 19.95; p = 0.00001; pc = 0.0002; RR = 5.3; EF = 0.52); a discrete increase in DR1 was also found (p = 0.02). HLA-DQ8 also showed a significant association with the disease with a lower RR (3.2) and EF (0.41) than DR4. CONCLUSION: The strong association found with HLA-DR4 and the slight DR1 increase shown in Mexican patients with VKH suggest that a common shared sequence present in the third hypervariable region of DRB1 genes is relevant for the expression of the disease. The stronger association with DR4 than the one with DQ8 suggests that the DR locus carries the primary susceptibility genes involved in the pathogenesis of VKH.

Chorioretinitis secondary to mycobacterium tuberculosis in acquired immune deficiency syndrome.

BACKGROUND: Several opportunistic intraocular infections have been described in patients with the human immunodeficiency virus, among them infections caused by Mycobacterium tuberculosis. In most cases, the diagnosis is based on clinical findings. Recent reports have described the usefulness of polymerase chain reaction techniques in the diagnosis of bacterial infections. METHODS: The authors observed a 29-year-old woman with acquired immune deficiency syndrome in whom unilateral chorioretinitis developed. The chorioretinitis appeared after cessation of treatment for pulmonary tuberculosis. We obtained aqueous humor by paracentesis and tested it by polymerase chain reaction to detect M. tuberculosis DNA. RESULTS: The polymerase chain reaction of the aqueous humor was positive for M. tuberculosis DNA. CONCLUSION: Polymerase chain reaction was useful in identifying M. tuberculosis in aqueous from a patient with chorioretinitis, pulmonary tuberculosis, and acquired immune deficiency syndrome.

Nonprogressive CMV retinitis in AIDS patients with protease inhibitors therapy for AIDS.

Cytomegalovirus (CMV) retinitis is the most common opportunistic viral infection in acquired immunodeficiency syndrome (AIDS) patients with a low CD4+ count. Without specific treatment, the disease is an important cause of blindness. We report two cases of AIDS with nonprogressive CMV retinitis after undergoing a combined antiHIV treatment schedule including at least one protease inhibitor. The treatment was associated with an increase in circulating CD4+ lymphocytes. This newly available antiviral combination may well prevent the recurrence of CMV disease and decrease the morbidity of CMV retinitis.

Clinicopathologic study of retinal and choroidal biopsies in intraocular inflammation.

PURPOSE: We reviewed the clinical and histopathologic features of 33 intraocular tissue biopsy specimens from 32 patients and assessed the value of retinal and chorioretinal biopsies performed in patients with intraocular inflammation. METHODS: Twenty-four endoretinal biopsies and nine chorioretinal or choroidal biopsies were performed. On the basis of clinical indications, the specimens were processed for light microscopy, electron microscopy, immunohistochemical staining, in situ DNA hybridization, and polymerase chain reaction. RESULTS: Of the 24 endoretinal biopsy specimens, 19 were from patients with clinical signs suggestive of viral retinitis. Overall, the diagnosis of viral retinitis was suggested by electron microscopy, immunohistochemical staining, in situ DNA hybridization, or polymerase chain reaction in 53% (ten of 19) biopsies. The preoperative diagnosis was confirmed in seven of ten biopsies in cases of suspected cytomegalovirus retinitis, in one of seven biopsies in cases of suspected acute retinal necrosis, and in two of two biopsies in cases of progressive outer retinal necrosis. The remaining five endoretinal biopsies disclosed Candida in one specimen, subretinal fibrosis in one, and chronic inflammation in three. Histologic examination of the nine chorioretinal or choroidal biopsies disclosed lymphoma in two specimens, a subretinal neovascular membrane in one, uveal melanocytic proliferation in one, toxoplasmic retinochoroiditis in one, viral retinitis in one, and long-standing inflammation in three. CONCLUSION: In select cases of intraocular inflammation, intraocular tissue biopsies may provide clinically useful information.

Simultaneous onset of Vogt-Koyanagi-Harada syndrome in monozygotic twins.

PURPOSE/METHODS: We examined monozygotic twins of Vietnamese ancestry in whom the Vogt-Koyanagi-Harada syndrome developed. RESULTS/CONCLUSIONS: Both patients demonstrated typical clinical findings of the Vogt-Koyanagi-Harada syndrome, and HLA typing disclosed HLA-DR4, an antigen that is present in a disproportionate number of patients with the Vogt-Koyanagi-Harada syndrome. Although familial cases of the Vogt-Koyanagi-Harada syndrome are rare, associations with HLA antigens may indicate that genetic factors play a role in this disease.

Macular edema in chronic Vogt-Koyanagi-Harada syndrome.

BACKGROUND: Macular edema is relatively rare in the Vogt-Koyanagi-Harada (VKH) syndrome, in contrast to many other syndromes of chronic intraocular inflammation, in which macular edema is relatively common. Five eyes of three patients with chronic VKH syndrome and macular edema are described. METHODS: The authors retrospectively reviewed the clinical and fluorescein angiographic records of 27 patients with chronic VKH syndrome (duration of disease more than 3 months) and identified three patients (five eyes) who had macular edema. Fluorescein angiography was performed using a scanning laser ophthalmoscope. RESULTS: These patients had either unusually severe and protracted inflammation (3 eyes) of the presence of an epiretinal membrane (2 eyes). Fluorescein angiography demonstrated prominent perifoveal fluorescein leakage with pooling of fluorescein within perifoveal cystoid spaces. Treatment with sub-Tenon's triamcinolone injections resulted in improvement of visual acuity by two or more Snellen lines in four of the five eyes. CONCLUSION: Macular edema is an uncommon but treatable cause of late loss of vision in patients with the VKH syndrome, and may be the result of leakage from perifoveal retinal capillaries or leakage of fluid at the level of the retinal pigment epithelium.

Pars planitis: epidemiology and clinical outcome in a large community hospital in Mexico City.

Medical records of 51 patients with a diagnosis of pars planitis (97 eyes) were reviewed. Based upon the severity of vitreous inflammation, in 34 eyes (35%) the condition was classified as mild, in 38 (39%) as moderate, and in 25 eyes (26%) as severe. Vascular sheathing was present in 51 eyes (53%), snowballs in 42 (43%), snowbanks in 29 (30%), cataract in 19 (20%), cystoid macular edema in 26 (27%), retinal detachment in 4 (4%) and glaucoma in 3 (3%) eyes. Treatment consisted of prednisone and periocular injections of deposteroids or immunosuppressive agents; 13 patients required surgery for retinal repair, glaucoma, vitreous opacities or cataract. After treatment the visual acuity improved in 58% of the eyes, did not change in 33%, and worsened in 9%.