Tegument-specific, virus-reactive CD4 T cells localize to the cornea in herpes simplex virus interstitial keratitis in humans.

Herpes stromal keratitis (HSK) is a prevalent and frequently vision-threatening disease associated with herpes simplex virus type 1 (HSV-1) infection. In mice, HSK progression occurs after viral clearance and requires T cells and neutrophils. One model implicates Th1-like CD4 T cells with cross-reactivity between the HSV-1 protein UL6 and a corneal autoantigen. HSK can be prevented by establishing specific immunological tolerance. However, HSK can also occur in T-cell receptor-transgenic X SCID mice lacking HSV-specific T cells. To study the pathogenesis of HSK in the natural host species, we measured local HSV-specific T-cell responses in HSK corneas removed at transplant surgery (n = 5) or control corneas (n = 2). HSV-1 DNA was detected by PCR in two specimens. HSV-specific CD4 T cells were enriched in three of the five HSK specimens and were not detectable in the control specimens. Reactivity with peptide epitopes within the tegument proteins UL21 and UL49 was documented. Responses to HSV-1 UL6 were not detected. Diverse HLA DR and DP alleles restricted these local responses. Most clones secreted gamma interferon, but not interleukin-5, in response to antigen. HSV-specific CD8 cells were also recovered. Some clones had cytotoxic-T-lymphocyte activity. The diverse specificities and HLA-restricting alleles of local virus-specific T cells in HSK are consistent with their contribution to HSK by a proinflammatory effect.

Penetrating keratoplasty after radial keratotomy. A report of six patients.

BACKGROUND: For more than 15 years, radial keratotomy has increased in popularity as an option for treating myopia in the United States. During this period of time, the procedure has been modified to improve results and decrease complications. Despite these changes, complications from radial keratotomy continue to occur. The authors report six cases of penetrating keratoplasty performed to correct significant loss of vision resulting from complications of radial keratotomy. METHODS: The surgical records of one author (WR) were reviewed retrospectively for penetrating keratoplasties performed for complications of radial keratotomy. RESULTS: Six cases of penetrating keratoplasty performed for complications of radial keratotomy were found. Severe loss of vision was the indication for surgery in each case, and was associated with aggressive and repeated incisional refractive attempts to correct astigmatism, hyperopic overcorrection, residual myopia, or refractive errors associated with keratoconus. Glare associated with subepithelial scarring and irregular astigmatism were the primary findings associated with loss of vision. CONCLUSIONS: Despite advances in technique and instrumentation, radial keratotomy is limited in the amount of myopia it can correct. The risk for loss of vision increases with increasing number of incisions, intersecting incisions, very small optical zones, and keratoconus.

Subepithelial infiltrates in Acanthamoeba keratitis.

Six patients had Acanthamoeba keratitis that manifested an unusual type of subepithelial corneal infiltrate late in the course of the disease. These infiltrates occurred in the anterior corneal stroma, often in a location removed from the site of infection. In four of these patients the infiltrates occurred with no other clinical signs of inflammation. Two patients had mild foreign-body sensation that resolved despite the persistence of the subepithelial infiltrates. The infiltrates resolved with topical corticosteroid therapy in three patients; however, in two of these three patients the infiltrates recurred when corticosteroid therapy was tapered or discontinued. The subepithelial infiltrates appeared and behaved similarly to those associated with viral and chlamydial corneal infections. An immunologic mechanism may be responsible for these unusual delayed-in-onset infiltrates.

Indications for penetrating keratoplasty: 1980-1988.

A retrospective analysis was undertaken of the clinical diagnoses of 1594 eyes that underwent penetrating keratoplasty performed in a private-referral corneal practice over a 9-year period, 1980-1988. The seven most common indications for surgery were keratoconus (24.0%), pseudophakic or aphakic bullous keratopathy (21.2%), corneal scarring (13.9%), Fuchs' endothelial dystrophy (12.5%), regraft (8.1%), and herpetic keratitis (5.3%). Keratoconus was the leading indication from 1980 to 1985. From 1985 to 1988, pseudophakic bullous keratopathy became the leading indication and correlates well with known complications associated with closed-loop anterior chamber lenses, which were widely used during the early 1980s. Less frequent indications for penetrating keratoplasty included the following: infectious (nonviral) keratitis (3.5%); acute or chronic ulcerative keratitis (2.7%); interstitial keratitis (1.8%); mechanical trauma (1.5%); other (non-Fuchs') corneal dystrophies (1.4%); congenital opacities (0.8%); and chemical burns (0.5%).

Diagnosis of anterior chamber metastasis by serologic marker found during anterior chamber paracentesis.

A 29-year-old man developed anterior uveitis unresponsive to intensive topical and systemic therapy. He had recently completed a course of chemotherapy with apparent response and resolution of metastasis from a mixed germ cell tumor (embryonal carcinoma and seminoma). Anterior chamber paracentesis was nondiagnostic on two occasions for metastatic cells. At the time of his second paracentesis a tumor marker, human chorionic gonadotropin-beta subunit, was used to confirm the diagnosis of anterior chamber metastasis to the eye.

Filamentary keratitis following penetrating keratoplasty.

Filamentary keratitis is a problem associated with a wide variety of ocular conditions. Of 114 patients receiving penetrating keratoplasty, 31 (27.2%) were noted to have filaments. Those patients receiving transplants for keratoconus were noted to have the highest incidence (12 of 31, 39%), while transplants following herpetic scars were not associated with filaments (0 of 11) in this series. Suturing technique or relation of donor button-to-graft site were not apparently important factors in the development of postoperative filamentary keratitis.