Ocular complications of the acquired immunodeficiency syndrome. Focus on the treatment of cytomegalovirus retinitis with ganciclovir and foscarnet.

The most common ocular complication in patients with the acquired immunodeficiency syndrome (AIDS) is cytomegalovirus retinitis. Incidence figures vary from 20 to 76%. Patients with cytomegalovirus may suffer from mild visual impairment of one or both eyes, but as the disease progresses the retinitis will almost certainly lead to blindness. Although cytomegalovirus retinitis is not a life-threatening infection, it can largely diminish the patient's quality of life. Clinical trials for the treatment of cytomegalovirus retinitis with a number of antiviral drugs have resulted in two drugs of choice, ganciclovir and foscarnet. Both drugs have an initial efficacy with induction therapy of 80-90%, but maintenance therapy is always needed to prevent a relapse. To exclude systemic side-effects of ganciclovir, intravitreal administration has been investigated with good results. Combination therapy of foscarnet and ganciclovir may be worthwhile in resistant cytomegalovirus retinitis.

Antibodies to a 15 kD nuclear antigen in patients with juvenile chronic arthritis and uveitis.

Young girls with a pauciarticular onset of juvenile chronic arthritis and circulating antinuclear antibodies are at risk for chronic uveitis. The actual nuclear antigen for these antinuclear antibodies has not been defined. Conventional laboratory techniques, such as counter immunoelectrophoresis, have shown that antibodies to well defined "extractable nuclear antigens" (eg, RNP, Sm, SS-A, and SS-B) are not present in patients with juvenile chronic arthritis. Therefore, other, previously unknown nuclear antigens may be involved. Sera of 64 patients with juvenile chronic arthritis, including 22 patients with chronic anterior uveitis, were studied using the immunoblotting technique to characterize the nuclear antigens. Antinuclear antibodies were present in 12 (55%) of the 22 patients with uveitis, and only in six (14%) of the 42 patients without chronic anterior uveitis. With the immunoblotting technique, antibodies to a 15 kD nuclear antigen were found in 10 (45%) of the 22 patients with chronic anterior uveitis, whereas only two (5%) of the 42 patients without chronic anterior uveitis showed these antibodies (P less than 0.001). Only clearly visible and reproducible lines in the immunoblotting patterns were studied. This may provide a diagnostic tool for the early detection of uveitis and means for further pathogenetic studies.

Endophthalmitis after Nd:YAG laser capsulotomy.

A 63-year-old patient underwent a Nd:YAG laser capsulotomy, 5 months after an extracapsular cataract extraction. One day later endophthalmitis had developed. Staphylococcus epidermidis was cultured from the vitreous. We assume that this micro-organism, a pathogen of low virulence, had been sequestered in the capsular bag and was released into the vitreous after Nd:YAG capsulotomy.

Autoimmunity against corneal antigens. II. Accessibility of the 54 kD corneal antigen for circulating antibodies.

Autoantibodies against corneal epithelium antigens are frequently found in patients with corneal diseases, but also in patients with uveitis. To investigate whether these autoantibodies play a primary role in the pathogenesis of corneal disease we studied the distribution of a 54 kD corneal antigen (isolated in a previous study) within the eye. Animal experiments were performed to determine the accessibility of this antigen by its corresponding antibody. Immunohistochemistry showed that the 54 kD corneal antigen was abundantly present in the rat corneal and conjunctival epithelium. A high concentration of this antigen was seen just above the nuclei in the basal cell layer of the corneal epithelium. The antigen could also be detected in the keratocytes of the corneal stroma, the corneal endothelium and the lens epithelium. The 54 kD corneal antigen was not detected in other parts of the eye, nor could it be found in the rat liver, kidney, spleen, lung or skeletal muscle. Incubation of intact rat eyes with antiserum against the 54 kD corneal antigen in vitro, resulted in a weak binding of immunoglobulins to the corneal surface epithelium cells. Passive transfer experiments, whereby rats received an intravenous injection of antiserum against the 54 kD corneal antigen resulted in a weak deposition of immunoglobulins in the corneal stroma and sclera. However, no antibodies were bound to the corneal epithelium. These observations show that although antibody production to corneal epithelium antigens is easily triggered, these antibodies do not reach the corneal epithelium.