The Francis I. Proctor Foundation: the first fifty years.

September 15, 1997 marked the golden anniversary of the Francis I. Proctor Foundation, which was established in affiliation with the University of California in San Francisco. Over 50 years, 182 fellows from 27 countries have been trained in programs focusing on the study of infectious and inflammatory eye disease, and the prevention of blindness worldwide. Many of the people and events that have contributed to the success of the Proctor Foundation are presented in this brief essay.

Long-term clinical, microbiological, and immunological observations of a volunteer repeatedly infected with Chlamydia trachomatis.

A blind volunteer was inoculated in one eye with an isolate of Chlamydia trachomatis in 1961 and followed for 20 years. During this time, many observations were made of his clinical responses to the first inoculation and several subsequent inoculations with the same and other strains, chlamydial shedding, and antibody and cell-mediated immune responses. Evidence is presented that partial resistance to chlamydial eye infection developed during repeated infections and that antibodies, cell-mediated immune reactions, and specific antigen in conjunctival cells persisted for many years after the last infection. The antibody response was directed mainly against the original infecting immunotype, regardless of whether the response was restimulated by infection with the same immunotype or with other immunotypes. The lymphocyte stimulation response appeared to be species specific.

Opportunistic ocular infections.

Since corticosteroids were introduced, a steadily increasing number of opportunistic pathogens have been causing major disease in both systemically and locally compromised hosts. In ocular disease, the most common cause of compromise (and of infection with such opportunistic pathogens as the herpeviruses, many gram-negative bacteria, numerous fungi and Toxoplasma) is the topical use of corticosteroids and antibiotic-corticosteroid preparations. To avoid the damaging and sometimes blinding results of opportunistic infection, the use of these preparations should be carefully restricted.

Historical observations on herpetic keratitis.

The history of herpetic keratitis is presented. The similarities and differences between dendritic keratitis and herpes labialis are enumerated, with the suggestion that the similarities (in onset, pathology, and clinical course) far outweigh the differences. The principal difference seems to be that the avascalarity of the cornea retards the immunologic responses. Important points in the history of herpetic keratitis include (1) the close association of herpetic disease with malaria around the turn of the century; (2) the relatively benign nature of the disease, in contrast to herpes zoster keratitis; (3) the unfavorable response of the disease to immunosuppressive measures and diseases; (4) the failure of chemotherapy to influence favorably the natural history of the disease; and (5) the increasing visual damage caused by the disease since 1952 when corticosteroids were introduced into ocular therapy. Mention is made of the increasing problem of venereal herpes, with resultant neonatal herpetic keratitis, retinitis, and encephalitis.

The ocular manifestations of herpes zoster, varicella, infectious mononucleosis, and cytomegalovirus disease.

Herpes zoster, caused by varicella-zoster (V-Z) virus which also causes varicella (chickenpox), is usually a benign self-limited disease. However, when the ophthalmic division of the trigeminal nerve is affected, the ocular disease (ophthalmic zoster), although also usually mild and self-limited, may have severe complications (corneal scarring, glaucoma, iris atrophy, posterior synechiae, scleritis, motor disturbances, optic neuritis, retinitis, anterior segment necrosis, and phthisis bulbi and servere postherpetic neuralgia). Varicella affects the eye rarely (except for the typical lid lesions), but associated conjunctival and corneal lesions, iridocyclitis, glaucoma, chorioretinitis, and optic nerve lesions have been described. Infectious mononucleosis may involve the eye either by direct involvement or from a remote focus such as the central nervous system. Ocular manifestations of cytomegalovirus disease is usually limited to the choroid and retina unless involvement of the developing embryo occurs prior to the development of the eye.