The roles of toll like receptor 3, 7 and 8 in allergic rhinitis pathogenesis

Allergic rhinitis, as an allergic and nasal hypersensitivity disease, is associated with the inflammation of nasal mucosa. It appears that innate immune receptors are the important risk factors in the pathogenesis of the inflammatory disease. Toll-like receptors (TLRs) are the most important receptors of innate immunity; their crucial roles in the recognition of allergens and subsequently pathogenesis of allergic diseases have been evaluated recently. TLR3, 7 and 8 are the intracellular members of the innate immune receptors and recognize intracellular single and double strand RNAs. This review article collected the investigations regarding the roles of TLR3, 7 and 8 in the allergic rhinitis pathogenesis

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The roles of toll like receptor 3, 7 and 8 in allergic rhinitis pathogenesis.

Allergic rhinitis, as an allergic and nasal hypersensitivity disease, is associated with the inflammation of nasal mucosa. It appears that innate immune receptors are the important risk factors in the pathogenesis of the inflammatory disease. Toll-like receptors (TLRs) are the most important receptors of innate immunity; their crucial roles in the recognition of allergens and subsequently pathogenesis of allergic diseases have been evaluated recently. TLR3, 7 and 8 are the intracellular members of the innate immune receptors and recognize intracellular single and double strand RNAs. This review article collected the investigations regarding the roles of TLR3, 7 and 8 in the allergic rhinitis pathogenesis.

1H, 13C, NH, HH, CH COSY, HH NOESY NMR and UV-vis studies of Solophenyl red 3BL dye azo-hydrazone tautomerism in various solvents.

Azo-hydrazone tautomeric behavior of polyazo Solophenyl red 3BL (C.I. Direct 80) dye in different solvents (water, methanol and DMSO) was investigated using 1H, 13C, NH, HH, CH COSY, HH NOESY NMR techniques and UV-vis spectroscopy. Two-dimensional NMR experiments were used to assign 1H, 13C and 15N NMR lines unambiguously. Results showed that the hydrazone-form proton NMR signal appeared in the weakest field with respect to tetramethylsilane, in comparison with the amide and phenolic proton NMR signals. UV-vis absorption spectroscopic evidences showed that azo-hydrazone mixture exists in water and DMSO solvents, but in methanol, only azo tautomer was dominant, which was in a good agreement with NMR spectroscopic results.

Clear lens extraction with intraocular lens implantation for hyperopia.

PURPOSE: Current surgical options for the correction of moderate to severe hyperopia include hyperopic laser in situ keratomileusis (LASIK), phakic intraocular lens implantation and clear lens extraction with intraocular lens (IOL) implantation. We investigate the safety and efficacy of clear lens extraction with IOL implantation to correct hyperopia. METHODS: Phacoemulsification and IOL implantation was performed on 18 eyes of 10 patients. In 16 eyes, the Hoffer-Q formula was used for IOL power calculation and a single IOL was inserted; in the remaining 2 nanophthalmic eyes, the Holladay-II formula was used and two piggy-back IOLs were inserted. RESULTS: Mean preoperative spherical equivalent for distance was +6.17 D (range, +4.25 to +9.62 D). Patients were followed postoperatively for a mean of 10.5 months (range, 4 to 27 mo). Uncorrected visual acuity in all eyes was 20/50 or better with a median uncorrected visual acuity of 20/40 (range, 20/30 to 20/50). Two patients lost 2 lines of spectacle-corrected visual acuity; both of these patients achieved spectacle-corrected visual acuity of 20/30. CONCLUSIONS: Clear lens extraction with IOL implantation is a safe and effective procedure for the correction of moderate to severe hyperopia in the presbyopic age range.

Refractive keratotomy after photorefractive keratectomy.

BACKGROUND: The current surgical procedures available for the treatment of residual myopia and/or astigmatism after photorefractive keratectomy (PRK) include refractive keratotomy, laser in situ keratomileusis (LASIK), repeat PRK, or photorefractive astigmatic keratectomy (PARK). In this study, we investigate the safety and efficacy of refractive keratotomy for the correction of residual myopia and/or astigmatism after PRK. METHODS: Ten eyes of 9 patients underwent refractive keratotomy after excimer laser photorefractive keratectomy using the Lindstrom nomogram. PRK procedures were performed using the VISX 20/20 system by one surgeon. RESULTS: All eyes except one obtained an uncorrected visual acuity of 20/40 or better. One eye developed significant haze following PRK with myopic astigmatic regression and underwent refractive keratotomy to correct the residual refractive error. This patient was also the only patient who lost 2 lines of spectacle-corrected visual acuity secondary to corneal haze. CONCLUSION: This study demonstrates that refractive keratotomy can reduce residual astigmatism and myopia that may be present following excimer laser photorefractive keratectomy. Our results suggest there is no need to change the refractive keratotomy nomograms for eyes that have previously undergone PRK.

Photorefractive keratectomy in African Americans including those with known dermatologic keloid formation.

PURPOSE: To report the outcome of photorefractive keratectomy in African Americans, including those with a known history of dermatologic keloid formation. METHODS: A retrospective analysis of African American patients who had photorefractive keratectomy at either of our institutions was undertaken to identify all patients who were at least 3 months status-post refractive surgery. The presence or absence of a history of keloid formation, as well as preoperative and postoperative measurements of uncorrected visual acuity, best-corrected visual acuity, manifest refraction, and the presence and magnitude of any postoperative corneal haze were analyzed. RESULTS: Twelve patients (19 eyes) met the inclusion criteria and three of these patients (six eyes) had a history of keloid formation. Mean uncorrected visual acuity +/- SD for the entire study group improved from 20/369 +/- 20/270 preoperatively to 20/19.4 +/- 20/7.1 postoperatively (average follow-up, 13.8 months). All eyes had postoperative uncorrected visual acuity of 20/40 or better; 14 (74%) achieved 20/20 or better. Mean best spectacle corrected visual acuity went from 20/14.8 +/- 20/2.8 preoperatively to 20/15.5 +/- 20/3.2 postoperatively (not statistically significant). Mean manifest spherical equivalent was -4.9 +/- 3.4 diopters preoperatively and +0.03 +/- 0.55 diopters postoperatively. Eight eyes (42%) had trace to 1+ corneal haze following photorefractive surgery. A comparison of postoperative uncorrected and best-corrected visual acuities of known keloid formers with nonkeloid formers revealed no significant statistical difference. CONCLUSIONS: African Americans may have excellent visual outcomes following photorefractive keratectomy. History of keloid formation does not appear to have an adverse effect on the outcome. These results question whether known dermatologic keloid formation should be a contraindication to photorefractive keratectomy.

Effects of gamma-interferon on keratocyte-induced collagen gel contraction and keratocyte proliferation.

PURPOSE: Gamma-interferon has been shown to be an effective immunoregulatory polypeptide that can modulate fibroblastic response. We investigated the effects of gamma-interferon on keratocyte proliferation and keratocyte-induced collagen gel contraction. METHODS: Gamma-interferon in concentrations of 0.01, 1, 100, and 1000 U/ml of media was added to keratocytes embedded in polymerized type I collagen and the gel area was measured after 5 days with an image analysis system. The rate of keratocyte proliferation within and outside the collagen gel under the influence of gamma-interferon was also investigated. RESULTS: Keratocyte-induced collagen gel contraction was significantly inhibited at all concentrations above 0.01 U/ml. The keratocyte proliferation was not affected by low and moderate concentrations and was significantly stimulated at concentration of 1000 U/ml. CONCLUSION: Keratocyte-induced collagen gel contraction is inhibited by gamma-interferon and the mechanism of this effect is not inhibition of keratocyte proliferation by gamma-interferon.

Open globe injuries in children.

PURPOSE: A retrospective review of open globe injuries in children was performed to identify the common types of injury and to correlate features of the injuries and surgical management with visual prognosis. METHODS: The hospital records of 70 patients were reviewed to determine demographic data, the nature and location of the injuries, the anatomic and functional status of the injured eye before the initial repair, the details of all primary and subsequent surgical procedures, and the final visual outcome. RESULTS: Fifty of the patients studied (71%) were male and 20 (29%) were female. The average age of the patients was 5 years. Sharp objects caused the majority of injuries (67%). Most of the injuries happened at home (72%). The cornea was involved in a majority of the injuries (92%). Thirty-two eyes (46%) required only primary repair; 15 eyes (21%) required primary repair with anterior vitrectomy and primary lensectomy; 17 eyes (24%) underwent secondary lensectomy or vitreoretinal surgeries, and 5 eyes (7%) were enucleated. Visual acuity of 20/40 or better was achieved by 45% of those patients who required only primary repair. Of those patients requiring a second procedure, 19% had a visual acuity of 20/40 or better. Initial clinical findings associated with an unfavorable visual outcome were retinal detachment, relative afferent pupillary defect, vitreous hemorrhage, and hyphema. CONCLUSION: The prognosis after an open globe injury in children is strongly influenced by the nature of the injury and the extent of the initial damage. Visual outcome is better in eyes that require only primary repair.

Presumed multifocal cryptococcol choroidopathy prior to specific systemic manifestation.

PURPOSE: Disseminated cryptococcosis is a major cause of morbidity and mortality in immunocompromised individuals, especially those with the acquired immunodeficiency syndrome (AIDS). Early diagnosis and treatment greatly improves the outcome, so clinical clues that lead to prompt diagnosis are important. METHODS: Three patients with AIDS in whom multifocal choroiditis and choroidal lesions were the initial signs of disseminated cryptococcosis were treated with systemic amphotericin B and flucytosine. All of the patients had a systemic work-up that included evaluation of the cerebral spinal fluid (CSF). RESULTS: All three patients who were seen with the choroidal lesions as the presenting sign were noted to have either positive titers for cryptococcus or cultures that grew cryptococcus in the CSF. The choroidal lesions are presumed to be due to cryptococcus as no histopathologic or microscopic studies were available for ocular tissues. The choroidal lesions started to resolve one to three months after systemic treatment with amphotericin B and flucytosine. CONCLUSION: Primary choroidal lesions in patients with AIDS may herald severe systemic disseminated disease. Funduscopic examination, however, may detect disseminated cryptococcal disease before other overt clinical manifestations, thereby allowing prompt institution of effective therapy.

The role of smears, cultures, and antibiotic sensitivity testing in the management of suspected infectious keratitis.

PURPOSE: To examine the role of routine smears, cultures, and antibiotic sensitivity testing in the treatment of suspected infectious keratitis. METHODS: A retrospective chart and laboratory data review was performed for 81 consecutive patients seen in the Los Angeles County/University of Southern California Department of Ophthalmology between June 1991 and December 1993 with a primary diagnosis of community-acquired infectious keratitis. No patients were treated with antibiotics before evaluation in the author's department, and all underwent corneal scrapings for gram-stain and bacterial, fungal, and mycobacterium cultures. Ulcers were classified as moderate or severe. All initially were treated as inpatients with a regimen including fortified cefazolin and a fortified aminoglycoside. RESULTS: Of 81 patients, 74 ulcers were either culture- negative (n=18) or grew bacteria (n=56). Fungal infection was suggested in seven patients. Of the nonfungal ulcers, 33 were classified as moderate, and 41 as severe; all moderate ulcers improved without requiring a modification in antibiotic treatment, whereas 3 severe ulcers required a change in treatment. CONCLUSION: Most community-acquired bacterial ulcers resolve with broad spectrum empiric therapy. Alternatives to universal culture and sensitivity testing that might be considered include selectively performing cultures for more severe or suspected non-bacterial ulcers or routinely obtaining cultures in all cases, but pursuing identification and sensitivity studies only when those data are required for therapy modification.

Retrospective comparison of simultaneous and non-simultaneous bilateral radial keratotomy.

PURPOSE: Many radial keratotomy surgeons advocate bilateral simultaneous surgery, in which there is an inherent, although rare, risk of bilateral sight-threatening complications such as microbial keratitis. This study was designed to evaluate the refractive outcomes of simultaneous and non-simultaneous radial keratotomy performed by a single surgeon. METHODS: We retrospectively compared the results of radial keratotomy performed simultaneously (both eyes operated on the same day, 20 patients) versus non-simultaneously (right and left eyes operated on different days, 71 patients) by a single surgeon. Both eyes had the same surgical procedure, including clear zone diameter and number of incisions. RESULTS: The refractive results of bilateral simultaneous and non-simultaneous surgery were largely equivalent for all parameters analyzed except one. The variability of the difference in postoperative refractive error between right and left eyes was less for those patients undergoing simultaneous surgery (p = .0008). CONCLUSION: Our data suggest that performing radial keratotomy as a bilateral simultaneous procedure increases the symmetry of the refractive effect. In view of recent reports of sight-threatening risks such as bilateral microbial keratitis following bilateral keratotomy, however, the potential risks and benefits of bilateral surgery should be carefully considered before operating on both eyes on the same day.

In situ collagen gel mold as an aid in excimer laser superficial keratectomy.

PURPOSE: The aim of this study is to evaluate the potential use of bovine type I collagen as an adjuvant to excimer laser keratectomy. METHOD: A suspension of collagen with the capability to polymerize into a gel was applied to the anterior corneal surface of freshly enucleated porcine eyes, using 35.0 diopter (D), 45.5 D, or 52.0 D contact lenses as molds. Keratometry, photokeratoscopy, slit-lamp photography, scanning electron microscopy, and light microscopy were performed on the new surfaces. Furthermore, an irregular corneal surface was created and a suspension of collagen was applied to mask protruding irregularities, therefore creating a smooth surface that was subjected to excimer laser keratectomy. Ablation rates for both collagen and cornea were measured. RESULTS: Collagen suspension placed on a cornea and molded with contact lenses created a smooth-surfaced gel that conformed to the shape of the contact lens and adhered to the anterior cornea; it was optically smooth and regular as shown by photokeratoscopy, keratometry, and scanning electron microscopy. The corneal curvature was altered in accordance with the base curvature of the contact lens used. Results of keratometry showed resolution of pre-existing astigmatism without induction of new astigmatism. The ablation rate of the gel was not measurably different than that of cornea; hence, when applied to an irregular corneal surface, a smooth surface was created after excimer laser ablation. CONCLUSION: This study supports the potential value of collagen gel as an adjuvant to excimer laser keratectomy for removal of corneal irregularities as well as for correction of myopia or hyperopia with or without astigmatism.