Vogt-Koyanagi-Harada associated with diabetes mellitus and celiac disease in a 3-year-old girl.

PURPOSE: To present a case of Vogt-Koyanagi-Harada (VKH) associated with type I diabetes mellitus and celiac disease in a 3 year old female. METHODS: We studied a three-year old female who presented with clinical manifestation of VKH and type I Diabetes mellitus and celiac disease. RESULTS: Patient was found to have hyperglycemia with type I diabetes mellitus. Duodenal mucosal biopsy specimen confirmed the diagnosis of celiac disease. Patient's ocular inflammation was treated by topical and systemic corticosteroid and immune-suppressive therapy. Her diabetes mellitus was controlled by insulin and her celiac disease was controlled by gluten-free diet. CONCLUSIONS: The association of VKH with two autoimmune diseases (celiac disease and type I diabetes mellitus) is rare. This case is, to our knowledge, the youngest patient reported with VKH.

The presence of cytotoxic autoantibody to lacrimal gland cells in NZB/W mice.

New Zealand Black and White F1 hybrid mice (NZB/W mice) spontaneously develop an autoimmune disease which provides us with a suitable animal model for Sjögren's syndrome. With increasing age, these mice develop foci of mononuclear cell infiltration in the lacrimal and salivary glands, which closely resemble the lesions seen in patients with Sjögren's syndrome. We studied the cell-mediated and antibody-mediated immune responses of NZB/W mice to lacrimal gland cells. Lacrimal gland acinar cells were isolated from 2-month-old NZB/W or BALB/c mice for the target of 51Cr-release assay. There was no statistically significant difference in the spleen cell-mediated cytotoxicity to lacrimal gland cells among NZB/W mice of different ages (2, 5, and 8 months old). With increasing age, on the other hand, we found a statistically significant increase in the titers of autoantibodies to lacrimal gland cells in NZB/W mice, while aged BALB/c mice did not develop such antibodies. Fractionation of pooled positive sera by gel filtration revealed that this cytotoxic activity was mostly recovered in the IgM fraction. The tissue absorption study showed that these antibodies cross-reacted with salivary gland and kidney.

Tear tryptase in vernal keratoconjunctivitis.

OBJECTIVES: To determine the tear level of tryptase (a marker of mast cell activation) in vernal keratoconjunctivitis (VKC) before and after treatment. In addition, eosinophil counts in conjunctival scrapings and ocular surface temperature before and after treatment were studied. PATIENTS AND METHODS: A total of 20 patients, 7 years or older with VKC, were included in this study. Tear samples for tryptase determination were collected before and 2 weeks after treatment with 4% disodium cromoglycate eyedrops and 0.1% fluorometholone eyedrops. In addition, conjunctival scrapings were obtained for microscopic evaluation, and measurement of the ocular surface temperature was performed before and 2 weeks after treatment. One patient was excluded because the patient did not receive topical treatment. Control tear samples were collected from 20 normal control patients for tryptase determination. RESULTS: There were 19 patients with VKC (17 males, 2 females). The age range was 7 to 17 years with a mean age of 9 years. The mean number of eosinophils prior to initiation of therapy was 11.37 eosinophils with a range of 1 to 34 per high-power field. Following treatment, the mean number of eosinophils was 3.42 eosinophils per high-power field with a range of 0 to 11 (P<.01). The mean ocular surface temperature for the right eye before treatment was 35.56 degrees C (range, 34.46 degrees C-36.50 degrees C) and after treatment was 33.53 degrees C (range, 31.13 degrees C-35.40 degrees C). For the left eye, the mean ocular surface temperature before treatment was 35.49 degrees C (range, 34.86 degrees C-36.16 degrees C) and after treatment was 33.88 degrees C (range, 32.40 degrees C-35.53 degrees C). The ocular surface temperature was found to decrease significantly following treatment (P<.001). The levels of tryptase in tears of patients with VKC were determined before and after treatment. The mean level was 16.77 ng/mL (range, <5-115 ng/mL). Following treatment with topical 4% disodium cromoglycate and 0.1% fluorometholone eyedrops, the mean level of tryptase decreased to 7.29 ng/mL (range, <5-44.1 ng/mL) (P<.05). CONCLUSIONS: Patients with severe VKC had high levels of tryptase in tears. Following treatment, the level of tryptase in tears decreased significantly.

Acute promonocytic leukemia with ocular involvement.

A 3-month-old male infant had bilateral redness of the eyes. Large, immature blast cells were noted in material obtained by anterior chamber tap, and the diagnosis of acute promonocytic leukemia was confirmed by bone marrow aspiration and autopsy. Detailed clinical, histopathological, histochemical, and electron microscopic studies were carried out. The case showed forcibly that children with sterile hypopyon should be investigated for malignancy.

Quantitation of tear lysozyme levels in dry-eye disorders.

A simple, rapid, reproducible method of quantifying tear lysozyme levels with a dual-channel spectrophotometer was used to compare normal subjects and those with dry-eye syndrome. The method was sensitive (80%) and specific (85%) and had a predictive value of a positive result of 83%. One patient with clinical manifestations of dry-eye syndrome and paradoxically elevated levels of tear lysozyme was found to have underlying sarcoidosis.

Cromolyn effects on vernal keratoconjunctivitis in children.

A double-masked, coded trial was undertaken to evaluate the effect of the topical administration of 2% cromolyn sodium eye drops on vernal keratoconjunctivitis in 14 children. One eye of each patient was treated for one year with cromoly, the other eye with placebo. Cromolyn reduced the characteristic vernal keratitis, vernal corneal ulcers and plaques, and limbal edema and infiltrates but did not affect the number or size of the giant papillae. The drug's long-term topical use did not have any adverse side effects.

Minocycline levels in tears of patients with active trachoma.

We determined minocycline levels in human tears and plasma samples using high-performance liquid chromatography. In the first study, we determined the trough tear and plasma levels of minocycline in patients with active trachoma 24 hours after an oral dose. After a single dose of minocycline, the mean concentration of the drug in tear samples was 189 +/- 58 ng/mL and corresponding plasma levels were 578 +/- 290 ng/mL. In a second study, we monitored the pharmacokinetics of the drug in tear and plasma samples of healthy nonfasting adults. Tear and plasma samples were collected at 1 through 6, 12, 24, 48, 72, and 96 hours. The pharmacokinetics study revealed that 48 hours following a single 200-mg dose of minocycline, the mean tear level of minocycline was 68 ng/mL, which is above the in vitro minimal inhibitory concentration required for Chlamydia trachomatis and other susceptible organisms.

Ocular tissue absorption of clindamycin phosphate.

Clindamycin phosphate, a new semisynthetic antibiotic that is effective in the treatment of toxoplasmosis and of infections caused by Gram-positive bacteria, was found to be highly concentrated in the choroid, iris, and retina of the pigmented rabbit eye after a single intramuscular injection of 75 mg/kg. Drug levels considered adequate for the control of most ocular infections were detectable in the iris, choroid, and retina 24 hours after injection, at which time serum levels were negligible. Subconjunctival injection of clindamycin phosphate also produced sustained high levels of drug in the choroid, iris, and retina; but when 150 mg was injected in a volume of 1 ml, corneal edema and severe inflammation of the conjunctiva resulted. Lesser amounts (15 to 35 mg) injected subconjunctivally produced adequate ocular tissue levels without damage to the conjunctiva or cornea.

Experimental ocular toxoplasmosis in primates.

The rabbit serves as the only existing experimental model for ocular toxoplasmosis. This model has many deficiencies. Our technique for the production of acute toxoplasmic retinitis in monkeys is described herein. This primate model should be more representative than the rabbit model of human ocular toxoplasmosis.

Ocular tissue absorption of minocycline in the rabbit.

After intramuscular (IM) administration of minocycline hydrochloride, concentrations of the drug that would be adequate for the control of sensitive organisms (greater than 0.5 micrograms/g of tissue) were detectable in the cornea, iris, and retinochoroid 3, 6, and 12 hours after a single injection. The concentration of the drug in the aqueous humor was greater than in the vitreous humor. Following a single IM injection of 40 mg/kg, the drug level was found to be significantly higher in the iris and aqueous humor of pigmented rabbits than in the corresponding tissues of albino rabbits. The drug seems to concentrate in the pigmented layers of the ocular tissue.

Clindamycin in chronic toxoplasmosis. Effect of periocular injections on recoverability of organisms from healed lesions in the rabbit eye.

Bilateral toxoplasmic retinochoroiditic scars were induced in 21 rabbits. Eleven rabbits were treated with clindamycin phosphate and ten rabbits received parallel injections of normal saline solution. All injections were made into Tenon's space. Toxoplasma organisms could be recovered from tissue suspensions of retina and choroid of four (18%) of the clindamycin-treated eyes, compared with recovery from 12(60%) of the 20 control eyes. There were significantly fewer Toxoplasma cysts in the hematoxylin-eosin-stained sections of the treated eyes than in similar sections of the untreated control eyes.

Detection of toxoplasmal antigen and antibody in ocular fluids in experimental ocular toxoplasmosis.

Enzyme-linked immunosorbent assays were used to detect intraocular toxoplasmal antigen and antitoxoplasmal IgG antibodies in a rabbit model of experimental ocular toxoplasmosis. Toxoplasmal antigen could be detected in the vitreous humor of the infected eye at the height of clinical activity of the lesion. Antitoxoplasmal IgG antibodies were detected in the aqueous and vitreous humors of the infected eyes five weeks following the onset of toxoplasmic retinochoroiditis.

Secondary squamous cell carcinoma of the orbit.

OBJECTIVE: To evaluate the origin and biological behavior of secondary orbital squamous cell (SCC) and mucoepidermoid carcinoma. METHODS: A retrospective review of 30 consecutive patients with SCC and mucoepidermoid carcinoma of the orbit seen over a period of 8 years at a large ophthalmic hospital in Saudi Arabia. RESULTS: A total of 51 secondary orbital tumors were seen in the 8-year period from 1983 through 1991; 30 (60%) of the 51 cases were SCC. There were 16 male and 14 female patients, with an age range of 38 to 80 years and a mean age of 65 years. In 28 (93%) of the 30 patients, the tumor originated in the conjunctiva. Orbital involvement by conjunctival SCC was the most common cause of secondary orbital tumors encountered in patients older than 19 years. Four patients had concomitant paranasal sinus involvement, 4 patients exhibited intraocular invasion, and 2 others were found to have intracranial extension of the SCC. Six (20%) of the 28 patients developed regional lymph node metastases during the course of their illness. All patients were treated by orbital exenteration, with or without radiation therapy. Seven (23%) of the 28 patients died of their disease. CONCLUSIONS: Orbital SCC is an aggressive and life-threatening condition. Most cases result from secondary extension of conjunctival SCC, a common disease in Saudi Arabia. Several factors contribute to the aggressiveness of conjunctival SCC in this geographic location, including continual exposure to UV rays, chronic irritation, and genetic factors. Delay in presentation for treatment, inadequate initial resection of conjunctival lesions, and the aggressive mucoepidermoid carcinoma variant of SCC are also factors contributing to orbital invasion.

Ocular levels of azithromycin.

OBJECTIVE: To assess azithromycin levels in human serum, aqueous humor, tear fluid, and conjunctival tissue specimens after administration of a single 1-g oral dose of azithromycin. METHODS: Sixty patients undergoing cataract surgery were included in this analysis. Serum, aqueous, and tear specimens were collected 3, 6, and 12 hours and 1, 2, 3, and 4 days after azithromycin administration. Conjunctival tissue biopsy specimens were collected 1, 2, 3, 4, 6, 8, 10, 12, and 14 days after azithromycin administration. All specimens were subjected to analysis by high-performance liquid chromatography-mass spectrometry. RESULTS: Azithromycin concentration ranges during the specified sampling times were as follows: serum, 21 to 974 ng/mL; tear, 82 to 2892 ng/mL; aqueous, 10 to 69 ng/mL; and conjunctival, 0.7 to 32 micrograms/g. Levels above the 90% minimal inhibitory concentration (MIC90) for Chlamydia trachomatis were detected after 4 days in all tear samples and after 14 days in all conjunctival tissue specimens following oral azithromycin administration. CONCLUSION: We demonstrated prolonged high levels of azithromycin in drug-targeted ocular tissue. Prolonged high concentrations of azithromycin in conjunctival tissue make this drug suitable for treatment of conjunctivitis caused by chlamydiae and other susceptible organisms.

Eyelid laceration sustained in an attack by a rabid desert fox.

PURPOSE/METHODS: Two patients were bitten on the face by a rabid desert fox and sustained eyelid lacerations. The patients were examined and they received the same prophylactic treatment: human rabies immunoglobulin, intramuscularly and at the laceration site, and rabies human-diploid cell vaccine. RESULTS/CONCLUSIONS: One patient survived; the other died. Eyelid laceration sustained by a bite of a rabid animal is a life-threatening condition; patients should receive prompt rabies prophylaxis.

Bacillus licheniformis corneal ulcer.

A 46-year-old woman developed a corneal ulcer after an injury to the right eye. Cultures were positive for Bacillus licheniformis. Although resistant to some antibiotics, the corneal ulcer resolved after treatment with topical, subconjunctival, and intramuscular gentamicin sulfate.

Extracapsular cataract extraction in Fuchs' heterochromic iridocyclitis.

We studied 15 patients with Fuchs' heterochromic iridocyclitis who underwent extracapsular cataract extraction. Ten patients also had capsular-fixated posterior chamber intraocular lens implantation. The patients were followed up for a mean of 23 months (range, six to 48 months). The clinical course and visual outcome were favorable. All patients had a postoperative best-corrected visual acuity of 20/40 or better. There were no major surgical, intraoperative, or postoperative complications.

Laser in situ keratomileusis in eyes with inactive herpetic keratitis.

PURPOSE: To evaluate the safety and outcome of laser in situ keratomileusis in eyes with inactive herpetic keratitis. METHODS: Prospective, interventional case series. In three eyes of three patients with inactive unilateral herpetic keratitis for a minimum period of 1 year, laser in situ keratomileusis was performed. Oral and topical acyclovir were prescribed perioperatively. No topical steroids were prescribed. RESULTS: Preoperatively, all three eyes had corneal stromal scars with induced astigmatism in two eyes and central stromal scar in one eye with best-corrected visual acuity of 20/120, 20/25, and 20/50, respectively. Postoperatively, the three eyes achieved uncorrected visual acuity of 20/20, 20/20, and 20/50, respectively, with decreased corneal scar. None of the patients developed herpetic keratitis reactivation during a minimum follow-up of 6 months. CONCLUSION: Laser in situ keratomileusis was safe and effective in the treatment of refractive errors and corneal scars in three eyes of three patients with inactive herpetic keratitis.

Childhood blindness in Lebanon.

A survey in the Lebanese schools for the blind revealed that 77% of childhood blindness in the country was genetically determined. Two thirds of the hereditary blindness cases were due to autosomal recessive conditions; the high frequency of consanguineous marriages in Lebanon was the underlying cause of this finding. There is marked similarity in the etiology of childhood blindness in Cyprus and Lebanon, for both countries are somewhere between the highly developed countries.

Minocycline in experimental ocular toxoplasmosis in the rabbit.

We studied the effects of minocycline, a semisynthetic tetracycline, on experimentally induced toxoplasmic retinochoroiditis in the rabbit. In two experiments we found that this drug effectively ameliorated the clinical disease and sterilized the ocular tissues from Toxoplasma organisms. Minocycline prevented death from toxoplasmic encephalitis in 75% of the animals, whereas all the control animals died of toxoplasmic encephalitis. Minocycline appears to be a promising agent for ocular toxoplasmosis.