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Pharmacologic modulation of acute ocular inflammation with quercetin.

Anti-inflammatory potentials of a safe, common dietary component, quercetin, were investigated in suppression of intraocular inflammation induced by retinal S antigen. Lewis rats sensitized to S antigen were treated daily with intraperitoneal injections of quercetin. Control rats with S-antigen-induced uveitis were similarly treated with diluent. When compared with controls the treated group showed marked reduction in uveal and retinal inflammation and in vasculitis and perivasculitis. Morphometric analysis revealed a significant reduction (p less than 0.005) in choroidal thickness when compared with that of control animals. These results clearly show the antiphlogistic effects of quercetin in experimental uveitis.

Animals↗

Immune-complex deposition in the eye in systemic lupus erythematosus.

A patient with systemic lupus erythematosus (SLE) and lupus retinopathy showed resolution of subretinal edema documented with fluorescein angiography. Subsequently at autopsy, immunofluorescence studies disclosed ocular deposition of immunoglobulins in the vascular layer of choroid capillaries and basement membranes of ciliary processes and bulbar conjunctivas. To our knowledge, these findings represent the first reported documentation of probable immune-complex ocular vasculitis in lupus retinopathy using immunofluorescent techniques, and they support the hypothesis that lupus retinopathy is caused by immune complex deposition as are other manifestations of SLE.

Adolescent↗

Anti-inflammatory effect of glutathione peroxidase on experimental lens-induced uveitis.

An acute lens-induced necrotizing intraocular inflammation was produced in Lewis rats. Treatment of these animals by intraperitoneal injection of glutathione peroxidase resulted in marked decrease in uveal inflammation, retinal edema, hemorrhage and vasculitis. Intraperitoneal injection of glutathione peroxidase resulted in increased levels of this enzyme in ocular tissue. These findings suggest that glutathione peroxidase can modulate acute lens-induced ocular inflammation by serving as a potent anti-inflammatory agent.

Animals↗

Bilateral acute retinal necrosis in a 12-year-old girl.

Acute retinal necrosis (ARN) is a severe ocular syndrome consisting of a moderate-to-severe anterior uveitis, vasculitis, and vaso-occlusive retinal necrosis. It can occur in healthy individuals at any age, but reports of this condition in children are rare.

Acyclovir↗

The raccoon ascarid. A probable cause of human ocular larva migrans.

The ability of raccoon roundworm larvae, Baylisascaris procyonis, to produce ocular larva migrans (OLM) was studied in various experimental animals. In addition, the clinical and pathologic lesions were compared to those in suspected cases of human ocular baylisascariasis, in patients with diffuse unilateral subacute neuroretinitis (DUSN). Ocular larva migrans was produced in squirrel monkeys, cynomolgus monkeys, mice, hamsters, grey squirrels, and woodchucks orally infected with B. procyonis eggs. The clinical and histologic lesions were primarily those of retinitis, retinal hemorrhages, retinal tracks, disruption, and vasculitis; pigment migration; choroiditis; vitritis; and free or encysted larvae in ocular and extraocular tissues. The lesions of experimental OLM correlated well with those of suspected cases of human ocular baylisascariasis and DUSN. Based on these studies, B. procyonis of raccoons should be considered as a probable cause of OLM and DUSN in humans.

Adult↗

Arteriolar occlusive diseases of the macula.

Occlusion of retinal precapillary arterioles may be related to vascular endothelial damage, embolization, vasculitis, and other factors. Following acute retinal precapillary arteriolar occlusion in the macular area, inhibition of axoplasmic transport results in the formation of cotton-wool patches. A variable loss of retinal function occurs. During the subacute phase, reperfusion of the vascular bed is usually seen with a gradual fading of the cotton-wool patch. In the chronic phase, the only sign of the infarction may be a loss of inner retinal substance with an irregularity of the light reflex from the internal limiting membrane, the retinal depression sign. The characteristics of retinal precapillary arteriolar occlusions are reviewed and specific features of hypertensive retinopathy, talc retinopathy, and sickle cell retinopathy are discussed.

Anemia, Sickle Cell↗

Two cases of uveitis with tubulointerstitial nephritis in HTLV-1 carriers.

BACKGROUND: Although the tubulointerstitial nephritis and uveitis (TINU) syndrome has been reported, there are only a few reports in the ophthalmological literature. The ocular findings usually appear later than the renal findings, and a renal biopsy is required for a definitive diagnosis. CASES: Case 1 was a 15-year-old Japanese girl who was a carrier of the human T lymphotropic virus, type 1 (HTLV-1). She had tubulointerstitial nephritis, anterior uveitis, posterior retinal edema in the right eye, and peripheral vasculitis OU. Case 2 was a 56-year-old Japanese woman who was also a carrier of HTLV-1. Previously she had been diagnosed with Graves' disease, anterior uveitis, and vitreous opacity. Several years later tubulointerstitial nephritis was diagnosed. OBSERVATIONS: In both patients interstitial nephritis was diagnosed and systemic steroid therapy was effective. CONCLUSIONS: It is difficult for ophthalmologists to diagnose the TINU syndrome because the renal biopsy is performed by a pediatrician or an internist. This may be why ophthalmologic descriptions are rare in cases of TINU syndrome, even though the ocular findings reported in the literature are characteristic. This is the first case report of TINU syndrome in patients with HTLV-1. Ophthalmologists should pay more attention to the uveitis in the TINU syndrome.

Adolescent↗

[Vascular endothelium-related factors and atherosclerosis/arteriosclerosis: serum hepatocyte growth factor as a possible indicator of vascular lesions].

To investigate the possible involvement of hepatocyte growth factor (HGF) with vascular lesions, we studied the relationship between serum HGF concentrations and the grades of retinal arteriosclerosis, coronary atherosclerosis proliferative changes in the retina of diabetic subjects, and activities of systemic vasculitis. Individuals with more advanced grades of retinal arteriosclerotic change showed higher serum HGF values (grade 0, 0.053 +/- 0.005 ng/ml ; grade 1, 0.144 +/- 0.022 ng/ml ; grade 2, 0.338 +/- 0.36 ng/ml ; grade 3, 0.526 +/- 0.051 ng/ml). The serum HGF concentration was increased in subjects with single- (0.200 +/- 0.012 ng/ml, double- (0.334 +/- 0.018 ng/ml) or triple- (0.379 +/- 0.022 ng/ml) vessel coronary heart diseases, compared with that in subjects with intact coronary arteries (0.112 +/- 0.008 ng/ml). Serum HGF in diabetes without retinopathy was lower than that in nondiabetic subjects (0.041 +/- 0.003 ng/ml vs 0.080 +/- 0.010 ng/ml, p < 0.05), but did not differ from that in other diabetic subjects with background retinopathy (0.058 +/- 0.007 ng/ml) or preproliferative retinopathy (0.048 +/- 0.010 ng/ml). Serum HGF was increased in patients with proliferative retinopathy without photocoagulation (0.213 +/- 0.025 ng/ml, p < 0.01), but not in those with photocoagulation (0.040 +/- 0.008 ng/ml). Serum HGF concentration was increased (p < 0.01) during the acute phase of Schönlein-Henoch purpura (0.31 +/- 0.15 ng/ml), a systemic vasculitis, but it returned to control levels during the remission phase (0.11 +/- 0.10 ng/ml). Increased serum HGF may be involved in the pathogenesis of arteriosclerosis/atherosclerosis, retinal neovascularization, or vasculitis, and measurement of serum HGF may be a useful test for predicting these vascular lesions.

Aged↗

Manifestations of Whipple's disease in the posterior segment of the eye.

Ocular manifestations of Whipple's disease result from CNS involvement, direct intraocular involvement, or both. Ocular signs caused by CNS involvement occurred in 30 of the 34 patients with ocular manifestations described in the literature. In only four of the 34 cases were ocular manifestations due solely to intraocular involvement. Two cases reported herein had unique intraocular involvement, manifested as diffuse chorioretinal inflammation. Fluorescein angiography showed diffuse vasculitis, with hemorrhages, exudates, retinal capillary occlusion in the perifoveal and midperipheral areas, capillary dilation at the optic disc, and choroidal folds. Proper antibiotic treatment resulted in ocular and systemic recovery. Follow-up is mandatory because of possible recurrences, which may start with intraocular signs, followed by systemic manifestations. Some cases progress to fetal CNS involvement. Therefore, when intraocular signs recur in treated patients, antibiotic therapy should be restarted or dose should be increased.

Adult↗

Isolation of the human T-cell leukemia/lymphotropic virus type III from aqueous humor in two patients with perivasculitis of the retinal vessels.

The human T-cell leukemia/lymphotropic virus type III (HTLV-III) has been isolated from aqueous humor in two patients with perivasculitis of the peripheral retinal vessels, an AIDS-related ocular manifestation. Both patients had antibodies to HTLV-III and although they presented with herpes zoster ophthalmicus, they did not present other symptoms known to be associated with HTLV-III infection. The isolation of HTLV-III from aqueous humor in these two patients with retinal perivasculitis suggests that the virus itself may play a role in the etiology of this ocular sign. The presence of infectious HTLV-III in the anterior chamber further emphasises the necessity to discard corneas from HTLV-III infected donors.

Acquired Immunodeficiency Syndrome↗

Perfluorooctylbromide (PFOB) as a vitreous substitute in non-human primates.

We evaluated the toxicity of perfluorooctylbromide in the primate eye as a short-term postoperative vitreous substitute. Four eyes of 4 African green monkeys underwent complete vitrectomy and vitreous replacement with 1.5-2.0 ml of PFOB. One additional animal received BSS as a control vitreous substitute in one eye. Animals were examined twice weekly for clarity and consistency of the vitreous replacement substance. Anterior segment and lenses remained clear in all eyes, although in the immediate postoperative period one eye became inflamed and had a culture-negative vitritis. The other eyes showed a minimal anticipated postoperative vitreous inflammation. Emulsification of the PFOB began within 3 days of injection and progressed up to 3 weeks, precluding fundus examination and fluorescein angiography after 2 weeks. Eyes were enucleated and light microscopy performed at 2 days, 10 days, 33 days, and 45 days. No toxic effects to the retinal cells were detectable by histological examination, but perivasculitis of retinal vessels was noted at 45 days. Indirect examination was normal up to 10 days; thereafter, the fundus view was obscured by the emulsified PFOB. Because of cellular migration into the vitreous cavity and retinal perivasculitis, observed histologically, PFOB seems most suitable for intraoperative rather than postoperative use.

Animals↗

Multifocal electroretinographic changes in patients receiving hydroxychloroquine therapy.

PURPOSE: To evaluate the longitudinal changes in multifocal electroretinography (mfERG) in patients receiving hydroxychloroquine and to assess the effects of cumulative hydroxychloroquine dose on mfERG. DESIGN: Prospective cohort study. METHODS: Twenty-four eyes in 12 patients receiving hydroxychloroquine underwent mfERG recordings at baseline and 1 to 2 years later. The first negative (N1) and first positive (P1) response amplitudes and peak latencies were compared with normal controls. Serial changes in the pattern of mfERG abnormalities and in response amplitudes and peak latencies were also compared between eyes in which hydroxychloroquine therapy was continued or stopped. Correlation analyses were performed to assess the effects of a cumulative dose of hydroxychloroquine on mfERG. RESULTS: At baseline, reductions in N1 and P1 response amplitudes were observed in patients receiving hydroxychloroquine compared with controls. At follow-up, in addition to the reductions in N1 and P1 response amplitudes, increases in P1 peak latencies compared with controls were observed. In patients who stopped hydroxychloroquine therapy, there were significant increases in N1 and P1 response amplitudes at follow-up mfERG. CONCLUSIONS: Patients receiving hydroxychloroquine showed a longitudinal decline in retinal function; patients who stopped hydroxychloroquine therapy showed improvement. Although these data are insufficient to demonstrate the sensitivity of mfERG for evaluating early hydroxychloroquine toxicity, the results suggest that serial mfERG assessment may help detect early retinal changes associated with hydroxychloroquine therapy. Further studies with long-term results will be useful in clarifying the value of mfERG in evaluating early retinal toxicity due to hydroxychloroquine.

Adult↗

Frosted branch angiitis in a child with HIV infection.

PURPOSE: In adults with human immunodeficiency virus (HIV) infection, frosted branch angiitis is commonly associated with cytomegalovirus retinitis and responds to anti-cytomegalovirus therapy. We describe the first pediatric case of HIV-associated frosted branch angiitis. METHODS: Case report. RESULTS: A 7-year-old HIV-infected male with frosted branch angiitis was refractory to induction doses of intravenous ganciclovir and foscarnet over a 2-month period. Although cytomegalovirus antigenemia resolved, the angiitis only improved after subsequent treatment with systemic corticosteroids. CONCLUSION: Frosted branch angiitis in this patient was not attributed to cytomegalovirus. The pathogenesis of HIV-associated frosted branch angiitis may differ between children and adults.

Antiviral Agents↗