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Biomedical subjects

M Zierhut

Publications and source records attributed to M Zierhut.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Allergic granuloma of the conjunctiva (Splendore-Hoeppli phenomenon)].

A 35-year-old woman from Georgia presented with multiple bilateral yellow nodules of the upper bulbar conjunctiva, accompanied by a severe injection of conjunctival vessels. The histologic examination of excisional biopsies showed the characteristic morphology of the Splendore-Hoeppli-phenomenon, which describes granulomas with a necrotized eosinophilic center, surrounded by a ring of epitheloid cells, giant cells and eosinophils. Although nematodes could be identified in only a few lesions, they should always be kept in mind as the causing agent of this condition. No cause of the lesions was found in our patient. The nodules may regress spontaneously. Topical application of corticosteroid eye drops, however, may give relief of symptoms, and sometimes excision of the granulomas will be necessary.

Adult↗
PubMed1995

Behçet's disease: epidemiology and eye manifestations in German and Mediterranian patients.

Behçet's disease (BD) is a systemic disease of unknown etiology, characterized by multiple organ involvement. Although its incidence is high in the Mediterranean countries and in Japan, BD is not often found in German patients. We therefore compared the epidemiological and clinical involvement of BD in 39 patients of German and of Mediterranean origin. The first manifestation was oral aphthosis in 72% of patients, followed by eye involvement (62%), skin lesions (25%), and arthritic problems (23%). Eventually, all our patients developed oral aphthosis. Whereas Germans had eye involvement in only 55% of cases (Mediterraneans, 71%), they came up with venous thrombosis or thrombophlebitis more often (64%) as compared with Mediterraneans (29%). The first ocular symptom was anterior uveitis in 87.5% of patients; the visual prognosis was poor due to occlusive retinopathy. Among 22 eyes of 12 patients, 16 had a visual acuity of 0.1 or less after 5 years of disease. We found a similar association with human leukocyte antigen B5 (HLA-B5) in the German patients (66.7%) and in the Mediterranean group (54.4%). There was no significantly higher HLA-B5 association with the uveitis or arthritis type. These results demonstrate a few differences between the two ethnic groups but illustrate that in Germans the disease also has a poor prognosis.

Adolescent↗
PubMed1995

[Erythema exsudativum multiforme major].

UNLABELLED: Erythema exudativum multiforme major (EEMM), also know as Stevens-Johnson syndrome, may cause severe conjunctival and corneal alterations. The etiology remains unknown. The aim of are study was to evaluate the clinical course, therapy and prognosis of ocular involvement. PATIENTS AND METHODS: In a retrospective study, we evaluated ten patients with EEMM who were treated between 1986 and 1994 at the University Eye Clinic Tübingen. RESULTS: The age of the four female and six male patients varied between 5 and 70 years. Drugs as a possible precipitating factor were found in all cases (acetylsalicylicacid, sulfonamide, erythromycin, cotrimoxazole, Valproinicacid, paracetamol). Eight patients experienced an infection at the same time. Clinically, we were able to differentiate two groups regarding severity of the disease. Seven patients were characterized by ocular alterations that only involved the conjunctiva, leading to conjunctival scars. In those cases local treatment with antibiotics and corticosteroids was effective. In the second group severe ocular damage occurred, with symblephara, keratinization and consecutive perforating keratoplasty. Secondary infections became evident in a total of six cases from the two groups. SUMMARY: Drugs as a possible precipitating factor could be identified in all cases. In eight of ten patients previous infection was known. This agrees with literatures reports of viral infections (e.g. herpes simplex) as cofactors causing EEMM, especially for the aggressive form, remains unresolved. The danger of possible superinfection should always be taken into consideration.

Adolescent↗
PubMed1995

[Severe eye involvement in pemphigus vulgaris].

Pemphigus vulgaris (PV) is an immune-mediated vesiculobullous disease of the skin and mucous membranes. Generally, patients with PV present first with oral lesions, which may precede the cutaneous lesions, such as bullae and erosions, by several months. An ocular manifestation is unusual. The most common ophthalmologic involvement in pemphigus is conjunctivitis, but without progressive scarring such as occurs in ocular cictricial pemphigoid. Corneal involvement is very rare. CASE REPORT. We report on severe ocular involvement in a 56-year-old male Turkish patient with PV. Ophthalmologic findings included conjunctival cicatrization, corneal ulceration and corneal perforation, despite immunosuppressive therapy with azathioprine and corticosteroids. A penetrating keratoplasty was performed, but rapidly failed because of corneal vascularization. CONCLUSION. If a chronic bullous dermatosis leads to severe eye involvement, PV should be considered in the differential diagnosis besides ocular cicatricial pemphigoid. Pemphigus vulgaris can be differentiated on the basis of clinical findings and histopathological and immunohistological features. Generally, PV can be treated with steroids or with a combination of an immunosuppressant and steroids. However, the combination of prednisone and azathioprine could not prevent corneal perforation in our patient.

Conjunctiva↗
PubMed1994

Neuroendocrine alterations in uveitis patients.

Experimental models of autoimmune uveitis are consistently associated with pinealitis. To investigate the interaction between the neuroendocrine and immune systems in humans with uveitis, we measured serum levels of the predominant pineal hormone melatonin (MEL), prolactin (PRL) and interleukin-2 (IL-2). A total of 100 patients with different forms of uveitis and 30 age-matched, healthy blood donors were evaluated retrospectively. The day-time MEL was reduced significantly (P < or = 0.01) in patients with iritis and iridocyclitis, and highly significantly (P < or = 0.001) in patients with intermediate uveitis, chorioretinitis and panuveitis. In 38% of patients day-time MEL levels in plasma were below the limit of detection. PRL was significantly reduced (P < 0.01) in patients with intermediate uveitis. IL-2 was reduced to about 50% of control values in all groups of patients. The results suggest a possible neuroendocrine-immune interaction in uveitis patients.

Adolescent↗
PubMed1994

Immunology of the eye and the joint.

It is well known that polyarticular joint diseases such as rheumatoid arthritis, HLA-B27-associated arthritis and Borreliosis can be associated with eye diseases, such as uveitis, scleritis and keratitis. However, the mechanisms underlying the involvement of these tissues remain unclear. A recent meeting examined the immunoregulation of the eye and the joint in an attempt to determine their similarities and differences.

Animals↗
PubMed1994

Herpes simplex virus type 2 induced retinal necrosis in BALB/c mice.

We injected herpes simplex virus type 2 of MS- or G-strain into the anterior chamber of BALB/c mice. In the contralateral eye inflammatory cell infiltration began in the ciliary body; focal retinitis, detected by day 8, led to total destruction of the retina by day 10. Contralateral disease was observed in 75% of mice inoculated with 8 x 10(3) pfu herpes simplex virus type 2, but in only 20% of mice receiving 80 pfu herpes simplex virus type 2. Still this low concentration, however, produced a suppressed delayed-type hypersensitivity response. Anti-herpes simplex virus type 2 antibody, first detected on day 8, reached high titers on day 10; by then, most of the mice had died of encephalitis. The G-strain of herpes simplex virus type 2 was more neurotoxic than the MS-strain, but produced the same incidence of contralateral retinitis. Herpes simplex virus type 2 products contralateral necrotizing retinitis comparable to that produced by herpes simplex virus type 1. These findings, like those of other authors, suggest a role for herpes simplex virus type 2 in some cases of acute retinal necrosis in humans.

Animals↗
PubMed1994

[Retinal vasculitis and antiphospholipid antibodies].

Antiphospholipid antibodies (APAb) are often found in systemic lupus erythematosus (LE) (secondary antiphospholipid syndrome), leading to arterial or venous thrombosis. In primary antiphospholipid syndrome other LE-associated symptoms are not detectable. We present the clinical course and therapy of three patients with this rarely reported disease, discussing immunopathology and therapy. Three young patients (28, 29 and 31 years) were seen at the university eye clinic, presenting severe occlusive vasculitis with vitreal haemorrhages and/or thrombosis. The first patient did not respond to any therapy (various immunosuppressives, plasma-pheresis, laser coagulation) and ended up with defective light perception in both eyes. The second patient also had light perception as final outcome in spite of acetylsalicylic acid, steroids and immunosuppression. The third patient established complete reperfusion on an arteriovenous occlusion after haemodilution and acetylsalicylic acid. Antibodies directed against phospholipids interfere with the blood clotting system in many ways (activation and aggregation of thrombocytes, endothelial function, coagulation cascade). The optimal therapy of this severe disease is unclear, suggesting that acetylsalicylic acid seems to be important, while the effect of immunosuppression or steroids is uncertain.

Adult↗
PubMed1992

[Clinical aspects, follow-up and results of cataract extraction in uveitis].

Over a 5-year period, a consecutive series of 52 eyes in 46 patients with uveitis underwent extracapsular cataract extraction. Twenty-eight of these cases received a posterior chamber intraocular lens (IOL). During an average follow-up of 25 months (range 7 to 58 months) 71% of eyes receiving an IOL achieved postoperatively a visual acuity of 0.5 or better; 54% of aphakic eyes reached this level. Persistent cystoid macular edema limited the visual improvement to 20/200 in 6 patients; none of the patients developed cystoid macular edema postoperatively on clinical observation. Intraocular hypertension occurred postoperatively in 12 eyes, but was limited to a 4-week postoperative period in 9 cases. YAG laser capsulotomy was performed in 2 eyes with opacification of the posterior lens capsule without any further complications. The results suggest that uveitis patients benefit from cataract extraction and in selected cases can tolerate IOL implantation without major complications.

Adolescent↗
PubMed1992

Depletion of T-lymphocyte subsets in murine herpes-simplex-virus retinitis.

Uniocular injection of herpes-simplex virus type 1 into the anterior chamber of BALB/c mice induced contralateral retinitis with relative preservation of the ipsilateral retina. Overall 95% of T-cell deficient nude mice developed ipsi- and contralateral retinitis, suggesting the importance of T-cells in this model. We then depleted lymphocyte subsets in susceptible BALB/c and resistant CB-17 and C57BL/6J mice using anti-CD4 (helper/inducer cells) or anti-CD8 (suppressor/cytotoxic cells) monoclonal antibody. 85% of CD8-depleted, 58% of CD4-depleted and 50% of untreated BALB/c mice developed contralateral retinitis. All CD4- and CD8-depleted animals developed severe ipsilateral retinitis. These results suggest that CD8 cells (but not CD4 cells) are protective for the contralateral retina in BALB/c mice and that both subsets are important for the ipsilateral protection. In CB-17 and C57BL/6J mice, depletion produced no change in the contralateral retina but resulted in ipsilateral retinitis, suggesting different mechanisms for ipsi- and contralateral protection. The possible role of the anterior-chamber-associated immune deviation is discussed.

Animals↗
PubMed1991

Elevated prolactin levels in human aqueous humor of patients with anterior uveitis.

Evidence is accumulating that prolactin (PRL) may play a physiological role in the regulation of humoral and cell-mediated immune responses. On the basis of these observations, we measured levels in the serum and aqueous humor of 28 patients with cataract or anterior uveitis with concomitant cataract. Intraocular concentrations were measured in a range from 0.1 to 3.4 ng/ml. Whereas serum PRL levels failed to show significant differences between the two groups (P = 0.39), intraocular concentrations were significantly higher in uveitis patients (P less than 0.001). The level in aqueous humor did not reflect the serum concentration in either group. To the best of our knowledge, this is the first study measuring PRL concentrations in human aqueous humor.

Adolescent↗
PubMed1991

[Significance of autoimmunity in various forms of uveitis].

Autoimmune diseases are the result of a false recognition by the immune system of the own tissue as foreign. Suppressor cells serve to inhibit these mechanisms, however, their influence can be bypassed by other cells. Many antigen structures have been isolated in the uvea. With them it is possible to induce a model of autoimmune uveitis. The diagnostic value of eye specific and non-specific autoantibodies in uveitis patients was studied. In this report are show indications of autoimmune phenomena in the following diseases: sympathetic uveitis, Behçet's disease, Vogt-Koyanagi-Harada syndrome and birdshot retinopathy.

Animals↗
PubMed1991

[Herpes simplex virus retinitis. Role of the immune system in the animal experiment].

Herpes simplex virus (HSV) can induce severe inflammation in the retina. Von Szily described a model in which anterior chamber injection of HSV results in anterior uveitis with relative protection of the retina, but contralateral retinitis. The role of the immune system in the von Szily mouse model was investigated in our experiments. Earlier experiments demonstrated resistance to contralateral retinitis in some mouse strains. Our results suggest that natural killer (NK) cells do not play an important role in this phenomenon. In the next step the role of NK cells and T cells in the retinitis was investigated. After depletion of NK cells with anti-NK antibody, sensitive BALB/c and resistant CB17 mice did not have a higher incidence of retinitis. CB-17 mice developed more encephalitis after depletion, demonstrating an important role of NK cells against generalization of HSV. The role of T cells was investigated using T-cell-deficient nude mice. These mice had bilateral retinitis in about 95% of cases, demonstrating the role of T cells in protection of the retina in this model. Anti-HSV-1 serum transfer provided protection for the contralateral retina.

Animals↗