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PubMedDate not supplied

Perinatally acquired Chlamydia trachomatis associated morbidity in young infants.

OBJECTIVE: This study was designed to evaluate the spectrum of morbidity associated with perinatally acquired Chlamydia trachomatis in infants < or =12 weeks of age, and to determine its relationship to maternal Chlamydia trachomatis status. METHODS DESIGN: Retrospective review of maternal and infant records. SETTING: Large inner city teaching hospital. PATIENTS: A cohort of 530 symptomatic infants < or =12 weeks of age who were tested for Chlamydia trachomatis infection in the upper respiratory tract during a 2-year period from January 1993 to December 1994. RESULTS: During the study period, 70/530 (13.2%) patients tested positive for Chlamydia trachomatis from the conjunctiva and/or the nasopharynx. Complete medical records of 66 of these infants were available for review. Forty-eight of 66 (73%) infants had conjunctivitis, 13/66 (20%) had pneumonia, 5/66 (7%) had both conjunctivitis and pneumonia. Thirteen of 66 (20%) infants were hospitalized, 7 for pneumonia and 6 for ophthalmia, accounting for 68 hospital days. In 55/66 (83%), maternal records were available for review. Nineteen of 55 (35%) mothers had documented Chlamydia trachomatis infection at delivery or during pregnancy that had not been treated; 16/55 (29%) mothers tested negative for Chlamydia trachomatis sometime during pregnancy but were not retested at delivery, 8/55 (14%) were treated for Chlamydia trachomatis during pregnancy but status at delivery regarding reinfection was not evaluated. In 12/55 (22%) mothers, no prenatal testing was documented. CONCLUSIONS: This study demonstrates significant morbidity in early infancy associated with perinatally acquired Chlamydia trachomatis infection. There is need for studies evaluating the importance of adequate maternal testing and treatment to reduce perinatal transmission.

Chlamydia Infections↗
PubMed2000

Interventions for treating genital chlamydia trachomatis infection in pregnancy.

BACKGROUND: Chlamydia trachomatis is a sexually transmitted infection. Mother-to-child transmission can occur at the time of birth and may result in ophthalmia neonatorum or pneumonitis in the newborn. OBJECTIVES: The objective of this review was to assess the effects of antibiotics in the treatment of genital infection with Chlamydia trachomatis during pregnancy with respect to neonatal and maternal morbidity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (Cochrane Library issue 1, 1999). SELECTION CRITERIA: Randomised trials of any antibiotic regimen compared with placebo or no treatment or alternative antibiotic regimens in pregnant women with genital Chlamydia trachomatis infection. DATA COLLECTION AND ANALYSIS: Trial quality assessments and data extraction were done independently by two reviewers. Study authors were contacted for additional information. MAIN RESULTS: Eleven trials were included. Trial quality was generally good. Amoxycillin appeared to be as effective as erythromycin in achieving microbiological cure (odds ratio 0.54, 95% confidence interval 0.28 to 1.02). Amoxycillin was better tolerated than erythromycin (odds ratio 0.16, 95% confidence interval 0.09 to 0.30). Clindamycin and azithromycin also appear to be effective, although the numbers of women included in trials are small. REVIEWER'S CONCLUSIONS: Amoxycillin appears to be an acceptable alternative therapy for the treatment of genital chlamydial infections in pregnancy when compared with erythromycin. Clindamycin and azithromycin may be considered if erythromycin and amoxycillin are contra-indicated or not tolerated.

Anti-Bacterial Agents↗
PubMed2000

Interventions for treating gonorrhoea in pregnancy.

BACKGROUND: Neisseria gonorrhoeae can be transmitted from the mother's genital tract to the newborn during birth and can cause gonococcal opthalmia neonatorum. OBJECTIVES: The objective of this review was to assess the effects of antibiotic regimens in the treatment of genital infection with gonorrhoea during pregnancy with respect to neonatal and maternal morbidity. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: October 1998. SELECTION CRITERIA: Randomised trials of one regimen of antibiotic versus another in pregnant women with culture confirmed genital gonococcal infection. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by one reviewer. MAIN RESULTS: Two trials involving 329 women were included. Amoxycillin with probenicid or spectinomycin or ceftriaxone have a similar effect on microbiological cure, defined by negative gonococcal culture. REVIEWER'S CONCLUSIONS: Any of the antibiotic regimens tested in these trials appear to be effective for the treatment of gonorrhoea in pregnancy in terms of their effect on microbiological cure. For women who are allergic to penicillin, this review provides reassurance that treatment with ceftriaxone or spectinomycin appears to be at least as equally effective in producing microbiological cure.

Anti-Bacterial Agents↗
PubMed1993

Chloroquine embryotoxicity in the postimplantation rat conceptus in vitro.

The embryotoxicity of the antimalarial drug chloroquine (CQ) was evaluated in vitro using the rat whole embryo culture system. CQ was found to be embryotoxic and dysmorphogenic when added directly to the culture media containing gestational day (GD) 10 rat conceptuses. Twenty-six-hr exposure to CQ elicited dose-related decreases in embryonic crown-rump length, protein and DNA contents and increases in the incidence of morphologically abnormal embryos. At 30 microM CQ, embryonic protein content was decreased to 67% and DNA content to 58% of control while the incidence of morphological abnormalities rose to 100%. Abnormal axial rotation, micro-ophthalmia, and selective cephalic hypoplasia were the most common developmental abnormalities observed. Visceral yolk sac (VYS) vasculature and blood pigmentation were also decreased in a dose-dependent manner, as was VYS DNA content (80% of control at 30 microM). VYS protein content, however, showed an alternate pattern of response, decreasing to 87% of control at 10 microM CQ but increasing to 125% of control at 30 microM. Histologic evaluation revealed that the cytoplasm of the VYS endoderm epithelium was distended due to vacuolization produced by CQ exposure. In the embryo proper, CQ inhibited cranial neural tube development and altered the morphology of cranial neural crest cells. These observations document the in vitro embryotoxicity of CQ and suggest altered VYS histiotrophic nutrition as well as direct embryonic effects as possible mechanisms of CQ embryotoxicity.

Abnormalities, Multiple↗
PubMed1988

Trachoma through history.

History of 'ophthalmia' is as old as history itself; no race or community is immune to it. There were times when blinding trachoma took a form of disastrous epidemics. The historical and recent literature are reviewed in this paper.

Europe↗
PubMedDate not supplied

The first German textbook of ophthalmology "Augendienst" by G. Bartisch, 1583.

This book contains various illustrations, portraits and an exact index, testimonials proving the author's professional successes as well as an accurate list of the qualities that should be demanded from any ophthalmologist. The anatomy of the head and eye is described according to Galen's ideas and Vesalius' book. Many remedies, prescriptions and medical treatments are discussed, partly showing the mystic influences of the Middle Ages. Bartisch reports several diseases for the first time: Allergic reactions, sympathetic ophthalmia, hemeralopia, photoelectric keratoconjunctivitis, amaurosis due to toxemia of pregnancy. But most important is the part on surgery. A careful pre- and postoperative treatment is demanded in cases of cataract operations. Bartisch describes the removal of eyelashes to cure trichiasis, the operations of ptosis, blepharochalasis and the exenteration of the orbit. This book was appreciated for a long time so that in 1686 a nearly identical reprint was published.

Books↗
PubMed1994

Didymus the blind: an unknown precursor of Louis Braille and Helen Keller.

The present study presents the case of Didymus the Blind, worthy author, philosopher and theologian of the 4th century AD. Blinded by ophthalmia at the age of four years, Didymus succeeded in achieving great learning in the philosophical and natural sciences. He began his education by using a system which was remarkably like Braille, that is reading letters engraved into the surface of wood by touch and subsequently furthering his knowledge by listening. This learning process of Didymus the Blind appears as the precursor of Louis Braille who invented the educational system of reading embossed dots by touch. Like Didymus, Braille lost his vision in infancy (at three years of age). Another parallel of Didymus' career and written works is found in the example and achievements of Helen Keller.

Blindness↗
PubMed1982

The phlycten, a come-back?

In February 1980 acute keratoconjunctivitis was seen in a girls' class in a school in Rotterdam. Bacteriological and virological examination was performed on 20 girls. The agent causing this epidemic could not be demonstrated. Three patients had phlyctens at the limbus. In the year following this observation (March 1980 till March 1981) 42 cases of phlyctenular keratoconjunctivitis were examined prospectively. The condition was most commonly seen in 13- to 18-year old girls. The phlycten can be considered as an elementary form of inflammation in the conjunctiva and cornea, based on an immune reaction of the delayed type (Gell and Coombs' type IV). The hypersensitivity to tuberculin, which was formerly an important feature of this inflammation ('scrofulous ophthalmia'), is of little importance in the Netherlands at the present day. However, in every case of phlyctenular keratoconjunctivitis tuberculosis should still be excluded by the medical history, and if necessary by a Mantoux reaction.

Adolescent↗
PubMed1989

Immune response to intraocular injection of retinal S-antigen in adjuvant.

It has been proposed that the introduction of foreign material into the eye at the moment of a penetrating trauma provides an adjuvant effect which, coupled with the release of antigen, might be responsible for sensitizing the immune system to produce a contralateral "sympathetic ophthalmia." We addressed that hypothesis by injecting S-antigen with complete Freund's adjuvant (CFA) into the anterior chamber (AC) of the eye of Lewis rats. The injection of an identical dose of antigen (30 micrograms S-Ag in CFA in a total volume of 10 microliters) via the foodpad (FP) or under the conjunctiva (SC) could induce typical experimental autoimmune uveitis (EAU). By immunizing via the AC route, we could demonstrate a positive sensitization of the immune system, manifested by serum antibody production against S-Ag and by the presence of S-Ag-specific, responsive T-lymphocytes in the spleen. However, immunization via the AC route did not induce contralateral uveitis, and the animals did not produce a DTH skin response when challenged intradermally with S-Ag as they did after FP immunization. In the light of these results, we evaluated the possibility that a DTH suppressive response was elicited by intracameral (IC) injection as seen in anterior chamber-associated immune deviation (ACAID): we tested the effect of splenectomy and cyclophosphamide pretreatment before IC immunization and the effect of secondary footpad immunization as well as T-helper cell transfer after IC immunization. The results given by these approaches argue against the induction of suppressor cells by IC immunization.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

Devastating endophthalmitis following penetrating ocular injury during night sleep from orthodontic headgear: case report and literature review.

BACKGROUND: Complications associated with the use of extra-oral traction devices (orthodontic headgear or facebow) including facial and ocular injuries, are considered infrequent. METHODS: We describe the case of a 12-year-old boy who was inadvertently injured by the metallic bow of orthodontic headgear during sleep and developed blinding intra-ocular infection (endophthalmitis). RESULTS: The injury resulted in corneal perforation. Visual acuity at presentation was 20/60 but deteriorated rapidly to light perception despite prompt medical and surgical treatment for endophathalmitis. Sympathetic ophthalmia developed and was controlled with systemic corticosteroids and imuran. Bacterial cultures showed mixed infection by gram-negative bacilli and Streptococcus viridans. In 10 (91%) out of the 11 eyes that were reported including our case, the visual acuity was hand movement perception or less. CONCLUSIONS: The increase in case reports of such injuries should prompt the establishment of a standard policy regarding the use of orthodontic headgear and increase awareness of orthodontists and ophthalmologists to the blinding potential of even trivial and minor ocular injuries by orthodontic headgear. Intervention should be one step ahead compared with ocular injuries from other foreign bodies.

Adolescent↗
PubMedDate not supplied

Ultrastructural changes in rat eyes with experimental Vogt-Koyanagi-Harada disease.

PURPOSE: To determine whether the ultrastructural changes in the eyes of an animal model of Vogt-Koyanagi-Harada (VKH) disease are similar to those in human eyes with VKH disease. METHODS: Pigmented rats derived by crossing brown Norway and Lewis rats were immunized with tyrosinase-family proteins, and the eyes were enucleated after different postinoculation times. The eyes were fixed in glutaraldehyde or formaldehyde and prepared for light or electron microscopy (EM). RESULTS: EM showed that thickening of the choroid resulted from the invasion of many lymphocytes and epithelioid-like cells. The melanocytes were surrounded by lymphocytes and lost their normal spindle shape. Neutrophils and eosinophils were also present in the choroid. These findings are very similar to the changes reported in eyes from patients with VKH disease or sympathetic ophthalmia. CONCLUSIONS: The similarity of the ultrastructural changes in this model to those in human VKH disease indicate that this animal model can serve as a histopathological model of human VKH disease.

Animals↗
PubMed1992

Experimental autoimmune posterior uveitis accompanied by epitheloid cell accumulations (EAPU). A new type of experimental ocular disease induced by immunization with PEP-65, a pigment epithelial polypeptide preparation.

Purified retinal pigment epithelial cells of bovine eyes have been fractionated by a series of buffer and detergent extractions. The electropherogram of the buffer-insoluble, Triton X-100-soluble fraction (RPE-TS) exhibits a major polypeptide band of M(r) 65 kDa and a variety of minor components. Electrophoretically purified 65 kDa-band protein (PEP-65) is immunologically unrelated to the known uveitogenic photoreceptor proteins, to other neural retina proteins, and to PEP-X, the RPE-melanin-bound uveitogenic antigen. An immunocytochemical study of eye tissues suggests that it is exclusively located in the RPE. Immunization of Lewis rats with PEP-65 or affinity-purified RPE-TS induces a new type of ocular disease: experimental autoimmune posterior uveitis accompanied by epitheloid cell accumulations (monocytes) adjacent to the RPE (EAPU). The disease starts 9 days after immunization, provided that pertussis toxin is used as co-adjuvant. The first clinical signs are transient flare and cells in the anterior chamber. Choroiditis develops, and epitheloid cells accumulate focally along one or both sides of the Bruch's membrane-RPE layer. Such foci resemble, in some respects, Dálen-Fuchs nodules which occur in human sympathetic ophthalmia. Areas of inflammation are frequently localized in the chorioretinal periphery adjacent to the pars plana. Vitreous cell infiltration is the most prominent clinical feature of EAPU. During at least 2 months, extending chorioretinal areas containing epitheloid cell collections remain while the adjacent photoreceptor cells sometimes disappear without being invaded by these cells. Retinal vasculitis is seldomly observed and pinealitis is absent. EAPU has the latter feature in common with PEP-X-induced experimental autoimmune anterior uveitis (EAAU). The two diseases differ from the various photoreceptor antigen-induced forms of EAU where pinealitis and inflammation of the neural retina are prominent features. However, just as in EAU and EAAU, EAPU can be adoptively transferred, and is inhibited by cyclosporin treatment suggesting T-cell dependency.

Animals↗
PubMedDate not supplied

Immunology of multisystem ocular disease.

In this review based on Prof. James' 1983 George Nelms Wise Lecture, the authors summarize proven and speculated relationships involved in the immunology of multisystem ocular disease. Extensive tables elucidate the mechanisms underlying such conditions as, systemic lupus erythematosus, polyarteritis nodosa, Sjögren's syndrome, Wegener's granulomatosis, scleritis, sarcoidosis, Behcet's disease, idiopathic retinal vasculitis, sympathetic ophthalmia, Vogt-Koyanagi-Harada syndrome, and dysthyroid eye disease.

Antigen-Antibody Complex↗
PubMed2005

Intravitreal triamcinolone acetonide for treatment of intraocular proliferative, exudative, and neovascular diseases.

Within the last three years, triamcinolone acetonide has increasingly been applied intravitreally as treatment option for various intraocular neovascular edematous and proliferative disorders. The best response in terms of gain in visual acuity after the intravitreal injection of triamcinolone acetonide was found in eyes with intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. Visual acuity increased and degree of intraocular inflammation decreased in eyes with various types of non-infectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischemic retinopathies. Possibly, intravitreal triamcinolone may be helpful as adjunct therapy for exudative age-related macular degeneration, possibly in combination with photodynamic therapy. In eyes with chronic, therapy resistant, ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected, cataractogenesis, postoperative infectious and non-infectious endophthalmitis, and pseudo-endophthalmitis. Intravitreal triamcinolone injection can be combined with other intraocular surgeries including cataract surgery. Cataract surgery performed some months after the injection does not show a markedly elevated rate of complications. If vision increases and eventually decreases again after an intravitreal triamcinolone acetonide injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone depended on the dosage given. Given in a dosage of about 20mg to non-vitrectomized eyes, the duration of the effect and of the side-effects was 6-9 months. Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular edematous and neovascular disorders. One has to take into account the side-effects and the lack of long-term follow-up observations.

Exudates and Transudates↗
PubMed1991

Detection of antibodies against Borrelia burgdorferi in patients with uveitis.

We determined the antibody response against Borrelia burgdorferi strains isolated from Japanese Ixodes ovatus and Ixodes persulcatus ticks by enzyme-linked immunosorbent assay and indirect immunofluorescence assay of serum specimens from 127 patients with uveitis. We examined samples of serum from Japanese patients with unclassified uveitis, iridocyclitis caused by herpes zoster virus, Behçet's disease, Vogt-Koyanagi-Harada syndrome, sarcoidosis, or other conditions (sympathetic ophthalmia, Posner-Schlossman syndrome and acute anterior uveitis with ankylosing spondylitis). Serum from healthy individuals and patients with Lyme disease served as negative and positive control samples, respectively. Significantly higher antibody titers were demonstrated in patients with uveitis than in control subjects. Of 29 patients with unclassified uveitis, nine (31) had significantly increased antibody titers against B. burgdorferi strain H014 by ELISA testing. Five patients also showed higher IgG and IgM responses than in three control subjects with Lyme disease. All positive controls showed joint problems characteristic of rheumatoid arthritis. One of three patients had uveitis. The patients were diagnosed as having Lyme disease on the basis of their history and serologic tests. A positive antibody response was recognized in several patients with Behçet's disease, Vogt-Koyanagi-Harada syndrome, sarcoidosis, and other conditions (acute anterior uveitis with ankylosing spondylitis), but not in control subjects.

Antibodies, Bacterial↗
PubMed1990

Cellular immune responses of patients with uveitis to retinal antigens and their fragments.

Of two patient populations totaling 82 patients, one in the United States and the other in Japan, we studied the cellular immune responses against S-antigen and interphotoreceptor retinoid binding protein as well as to fragments of each antigen. Behçet's disease, birdshot retinochoroidopathy, pars planitis, ocular sarcoid, sympathetic ophthalmia, and the Vogt-Koyanagi-Harada syndrome were diagnosed in these patients. The response profile of both antigens paralleled each other. This profile was more commonly seen in patients suffering from diseases affecting the retina. Responders reacting to both antigens or to several fragments of an antigen were present. This pattern of response was seen in 26 of the patients tested. Patients with uveitis appeared able to recognize several autoantigens. This might be a consequence of the breakdown of the blood-retinal barrier and may help perpetuate the inflammatory process. Several patients were capable of responding to more than one epitope of the same antigen, which indicates that there are major differences between the experimental model and human autoimmune diseases in the response to autoantigens. Both of these findings may to help develop new immunotherapeutic strategies in the treatment of uveitis.

Adolescent↗
PubMedDate not supplied

Immunopathology of the noninfectious posterior and intermediate uveitides.

The posterior and intermediate uveitides share an underlying immune etiology; however, they can be clinically and immunopathologically distinguished. Although the initiating stimuli for posterior and intermediate uveities are not known, it is believed that an exogenous agent (such as a bacterium or a virus) or an endogenous molecule may induce disease. In either case, T-helper lymphocytes in conjunction with human leukocyte antigens are likely to be involved. This review examines the epidemiology, histology, immunopathology, and theories of pathogenesis of several posterior and intermediate uveitides, including sympathetic ophthalmia, Vogt-Koyanagi-Harada syndrome, Behçet's disease, sarcoidosis, intermediate uveitis, white dot syndromes, and birdshot retinochoroidopathy.

Cytokines↗
PubMedDate not supplied

Eye injuries in twentieth century warfare: a historical perspective.

With successive wars in the twentieth century, there has been a relative increase in injuries to the eye compared to injuries of other parts of the body. The main causes of eye injury have changed with advances in techniques and weaponry of warfare, with blast fragmentation injuries accounting for 50-80% of cases. Penetrating and perforating injuries are most common, and injuries associated with intraocular foreign bodies pose special diagnostic and management problems. Injuries are bilateral in 15-25% of cases. Injuries associated with chemical, nuclear, and laser weapons have distinct characteristics and epidemiology. Enucleation was commonly performed at the turn of the century, but incidence has declined with better understanding of the pathophysiology of ocular trauma, improved surgical techniques and sepsis control with antibiotics. Sympathetic ophthalmia appears to be uncommon and earlier fears of this complication seem to have been exaggerated. Timely evacuation to a surgical facility is important for a good visual prognosis and preservation of the globe. However, prevention of injuries with eye armor is ultimately the best management, and the need for a comprehensive eye protection program in the military cannot be overemphasized, especially since eye injuries pose important socioeconomic, as well as medical, problems.

Eye Injuries↗