[Recalcitrant cicatrizing conjunctivitis. Treatment of nine patients with rituximab]. / Conjuntivitis cicatrizal recalcitrante. Tratamiento de nueve pacientes con rituximab.

Cicatrizing conjunctivitis is the final consequence of several diseases. The most severe among them are cicatricial pemphigoid and chronic Stevens-Johnson syndrome. Systemic immunosuppressive drugs and steroids are usually an effective approach to these diseases. However, a few patients follow a recalcitrant course unremitting to usual therapy. We describe the treatment with rituximab of seven patients with cicatricial pemphigoid and two with chronic Stevens-Johnson syndrome. Eight of them also received gammaglobulin and all achieved clinical remission. Three relapsed and required two or three new courses of rituximab with good control of disease activity. Rituximab proved to be an efficacious drug for chronic recalcitrant cicatrizing conjunctivitis.

La conjuntivitis cicatrizal es la consecuencia de distintas enfermedades oculares. Entre ellas, las más graves son el penfigoide cicatrizal y el síndrome de Stevens-Johnson crónico. El tratamiento de estas enfermedades con corticoides e inmunosupresores es habitualmente exitoso, pero unos pocos pacientes siguen un curso recalcitrante. En los últimos años se introdujo el uso de rituximab, asociado o no a gammaglobulina endovenosa, en forma abierta, para el control de la inflamación conjuntival. Describimos aquí el tratamiento de siete pacientes con penfigoide y dos con Stevens-Johnson recalcitrante, con rituximab. Ocho recibieron también gammaglobulina y todos alcanzaron la remisión de la actividad. Tres recayeron y recibieron dos o tres nuevos cursos de la medicación con mejoría sintomática. El rituximab probó ser una droga efectiva para el tratamiento de la conjuntivitis cicatrizal crónica recalcitrante.

Conjuntivitis cicatrizal recalcitrante: Tratamiento de nueve pacientes con rituximab / Recalcitrant cicatrizing conjunctivitis. Treatment of nine patients with rituximab

La conjuntivitis cicatrizal es la consecuencia de distintas enfermedades oculares. Entre ellas, las más graves son el penfigoide cicatrizal y el síndrome de Stevens-Johnson crónico. El tratamiento de estas enfermedades con corticoides e inmunosupresores es habitualmente exitoso, pero unos pocos pacientes siguen un curso recalcitrante. En los últimos años se introdujo el uso de rituximab, asociado o no a gammaglobulina endovenosa, en forma abierta, para el control de la inflamación conjuntival. Describimos aquí el tratamiento de siete pacientes con penfigoide y dos con Stevens-Johnson recalcitrante, con rituximab. Ocho recibieron también gammaglobulina y todos alcanzaron la remisión de la actividad. Tres recayeron y recibieron dos o tres nuevos cursos de la medicación con mejoría sintomática. El rituximab probó ser una droga efectiva para el tratamiento de la conjuntivitis cicatrizal crónica recalcitrante.

Cicatrizing conjunctivitis is the final consequence of several diseases. The most severe among them are cicatricial pemphigoid and chronic Stevens-Johnson syndrome. Systemic immunosuppressive drugs and steroids are usually an effective approach to these diseases. However, a few patients follow a recalcitrant course unremitting to usual therapy. We describe the treatment with rituximab of seven patients with cicatricial pemphigoid and two with chronic Stevens-Johnson syndrome. Eight of them also received gammaglobulin and all achieved clinical remission. Three relapsed and required two or three new courses of rituximab with good control of disease activity. Rituximab proved to be an efficacious drug for chronic recalcitrant cicatrizing conjunctivitis.

Brain antioxidant status in a high pressure-induced rat model of glaucoma.

PURPOSE: The goal of the present study is to establish the antioxidant status in the brain of a high pressure-induced rat model. METHODS: Ocular hypertension was induced in rats (n = 12) cauterizing two episcleral veins under a surgical microscope. A sham procedure (n = 12) was performed in the control group. The markers evaluated in the brain 7 days after surgery were as follows: spontaneous chemiluminescence, protein carbonylation, nitrite concentration, total reactive antioxidant potential (TRAP), ascorbic acid, glutathione, vitamin E and activities of superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase. RESULTS: Chemiluminescence in glaucoma was 55% higher than in controls (393 ± 20 cpm/mg protein, p < 0.001). Protein carbonylation in glaucoma was 93% higher than in controls (1.15 ± 0.18 nmol/mg protein, p < 0.001). Nitrite concentration was 5.30 ± 0.25 µM for glaucoma (controls 4.41 ± 0.24 µM, p < 0.05). Total reactive antioxidant potential decreased by 42% in glaucoma (controls 153 ± 14 µM Trolox, p < 0.001). Ascorbic acid was 67 ± 26 µM for glaucoma (controls 275 ± 22 µM, p < 0.001). Vitamin E was 0.58 ± 0.05 µmol/g organ for glaucoma (controls 1.10 ± 0.06 µmol/g organ, p < 0.01). Glutathione was 1.98 ± 0.13 µmol/g organ for glaucoma (controls 8.19 ± 0.71 µmol/g organ, p < 0.001). Superoxide dismutase and GPx were increased in glaucoma by 42 and 59%, respectively (p < 0.05). CONCLUSIONS: Reactive oxygen and nitrogen species were increased in glaucoma, the increase in chemiluminescence, protein carbonylation and nitrite levels could be evidenced by this situation. The decrease in nonenzymatic antioxidants and a compensatory increase in SOD and GPx activity may have been a consequence of an increase in oxidative processes.

Time course changes of oxidative stress markers in a rat experimental glaucoma model.

PURPOSE: To evaluate the relationship between oxidative stress markers and increased intraocular pressure in experimental glaucoma. METHODS: In vivo chemiluminescence (CL), total antioxidant capacity (TRAP), nitrite concentration (NC), and lipid peroxidation markers (TBARS) were evaluated. Wistar rats (n=18 for each time point) underwent operation, and two episcleral veins were cauterized. RESULTS: Decreases of 22%, 35%, and 27% at 7, 15, and 30 days and an increase of 22% at 60 days in CL were observed in glaucomatous eyes. In optic nerve, TBARS values were 6.9+/-0.5 nmol/mg protein (7 days), 9.4+/-0.4 nmol/mg protein (15 days), 18.0+/-1.2 nmol/mg protein (30 days), and 43.1+/-5.3 nmol/mg protein (60 days) (control, 6.2+/-0.4 nmol/mg protein; P<0.001). NC was 37.0+/-1.8 microM (7 days), 31.4+/-1.2 microM (15 days), 39.6+/-1.3 microM (30 days), and 40.0+/-1.3 microM (60 days) (control, 21.1+/-1.7 microM; P<0.001). In glaucomatous vitreous humor, TRAP decreased by 42% at 15 days and 78% at 60 days (control, 414+/-29 microM; P<0.001). In glaucomatous aqueous humor, TRAP values were 75+/-7 microM (7 days), 54+/-4 microM (15 days), 25+/-4 microM (30 days), and 50+/-3 microM (60 days) (control, 90+/-10 microM; P<0.001). CONCLUSIONS: Reactive species were increased in glaucoma, as evidenced by the increases in CL, TBARS, and NC. The decrease in the antioxidant levels may be a consequence of an increase in oxidative processes.

Disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess.

Mycobacteria other than tuberculosis (MOTT) have a low incidence as pathogens in human pathology. The most frequent clinical expression is the disseminated disease in subjects with compromised cellular immunity. Bacteriological characteristics in culture can generate confusion with other pathogens, which delays the appropriate diagnosis and treatment. We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit induced by therapeutic drugs. The antibiotic scheme of twenty-one weeks, during the follow-up period, controlled the infection, however, the optimum duration of treatment has not been established.

Disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess

Mycobacteria other than tuberculosis (MOTT) have a low incidence as pathogens in human pathology. The most frequent clinical expression is the disseminated disease in subjects with compromised cellular immunity. Bacteriological characteristics in culture can generate confusion with other pathogens, which delays the appropriate diagnosis and treatment. We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit induced by therapeutic drugs. The antibiotic scheme of twenty-one weeks, during the follow-up period, controlled the infection, however, the optimum duration of treatment has not been established.

Infectious keratitis in the corneal graft: treatment with partial conjunctival flaps.

BACKGROUND AND OBJECTIVE: The infection of the corneal graft is one of the most serious complications following keratoplasty. In many instances, it can be treated successfully with intensive topical and subconjunctival antibiotics. However, when this therapy is ineffective, a surgical approach must be considered. The usefulness of partial conjunctival flaps that spare the visual axis for managing corneal graft infections is reported. PATIENTS AND METHODS: Retrospective review of four cases. All patients were males between 12 and 85 years old. The four abscesses developed in the penetrating corneal graft during the first year after keratoplasty. The organisms found were Propionibacterium acnes, Candida albicans, Staphylococcus aureus, and Streptococcus pneumoniae. After failure of medical therapy, they were operated on using the partial, thick conjunctival flap technique. RESULTS: Resolution of the infection and maintenance of a clear graft was achieved in all patients. The follow-up ranged from 5 to 8 years. CONCLUSION: The partial conjunctival flap is an effective surgical procedure for the treatment of abscesses in penetrating keratoplasties when medical treatment has failed.

Resultados obtenidos en endoftalmítis postquirúrgicas agudas en relación al tiempo de inicio terapéutico / Results obtained in acute postsurgical endophthalmitis in relation to the time of therapeutic beginning

Objetivo: analizar diversos factores pronósticos relacionados con los resultados obtenidos en el tratamiento de las endoftalmitis post-quirúrgicas agudas, secundarias a cirugía de catarata mediante punción vítrea y/ovitrectomía. Métodos: el presente estudio se realiza en forma restrospectiva sobre 20 casos de endoftalmitis postquirúrgicas agudas secundarias a cirugía de catarata, en los que se practicó punción vítrea y/o vitrectomía según el caso; más inyecciones intravítreas de antibióticos (vancomicina/ceftazidima o amikacina), antibióticos y corticoides, sistémicos y tópicos. Resultados: los gérmenes aislados fueron: Staphilococcus epidermidis 7 casos (35 porciento), Streptococo 3 casos (15 porciento), Clostridium 1 caso (5 porciento), Pseudomona 2 casos (10 porciento), Cultivos negativos 7 casos (35 porciento). De los veinte casos tratados la agudeza visual a los 120 días fue igual o superior a 0,5 en 5 pacientes (25 porciento). Dos casos requirieron evisceración luego de una segunda vitrectomía. Conclusiones: el conocimiento actual, en relación a la prevención, diagnóstico y tratamiento de las endoftalmitis postquirúrgicas ha hecho que el pronóstico de esta complicación devastadora haya mejorado sustancialmente en la última década. La puesta en marcha de las medidas tendientes a la profilaxis, deben ser exhaustivas y una vez instaurado el cuadro deberá tenerse en cuenta que si bien la vitrectomía y la punción vítrea constituyen armas terapéuticas de gran importancia, no son curativas por sí solas y peor aún no son utilizadas con la celeridad que el cuadro requiere

Evolución de la endoftalmitis post-cirugía de cataratas / Enophthalmites evolution in catarats post-operative period

Objetivos: Evaluar los resltados port-tratamiento d la endoftalmitis post-cirugía de cataratas. Materal y Métodos: Se estudiaron en forma retrospectiva 35 pacientes con diagnóstico de endoftalmitis post-cirugía de catarata que recibieron tratamiento entre 1989 y 1999. Resultados: Todos los pacientes recibieron tratamiento con antibióticos; 60 porciento recibió también tratamiento quirúrgico. Se utilizaron corticoides en 71 porciento de los casos. En menor proporción se utilizó ciclopéjicos, beta-bloqueantes, antiinflamatorios no esteroides, diuréticos (Acetazolamida). Los gérmenes más frecuentes hallados fueron cocos gram + (57 porciento). La agudeza visual post-tratamiento fue 20/200 o mejor en 48,5 porciento de los casos, 20/400 en el 26 porciento y de cero en 25,5 porciento de los casos. Conclusión: El tratamiento de la endoftalmitis requiere diagnóstico y decisión terapéutica inmediata.