Tuberculosis of the eye in Italy: a forgotten extrapulmonary localization.

PURPOSE: Tuberculosis (TB) of the eye is a well-known extrapulmonary localization in high-incidence countries. Data on its relevance in developed countries are scanty. We aim to study the epidemiological and clinical pattern of ocular TB in a tertiary care institution of a western country. METHODS: From 2007 to 2010, consecutive patients with a diagnosis of isolated ocular TB or associated to extraocular TB were recruited. Patients with ophthalmological and clinical features of TB were treated with standard antitubercular therapy (ATT) and steroids in case of concomitant severe ocular inflammation. RESULTS: Seventeen cases of ocular and extraocular TB and 45 cases of isolated ocular TB were identified. The proportion of patients with ocular and extraocular TB in our local district was 8.1 %, with a proportion of 10.6 % for the isolated cases. In Cohort 1, only one patient was symptomatic for ocular impairment, and uveitis without inflammation was the most common presentation. On the contrary, in Cohort 2, all patients had visual impairment, mainly with bilateral involvement. 77.8 % of the patients showed an inflammatory pattern. ATT was administered for at least 9 months, in four cases with a short course of systemic corticosteroids. Eight cases in Cohort 2 showed recurrence after 1 year from diagnosis. CONCLUSIONS: TB of the eye should not be forgotten, even in geographical areas not considered among endemic countries. Ocular evaluation is advisable in patients with pulmonary and extrapulmonary TB, as early detection may allow ATT to preserve visual acuity.

Intraoperative mitomycin C in the treatment of cicatricial obliterations of conjunctival fornices.

PURPOSE: To investigate whether the intraoperative use of topical mitomycin C improved the postoperative outcome in cases of cicatricial obliteration of conjunctival fornices. METHODS: Ten eyes of five patients were subjected to surgical lysis of the synechiae followed by intraoperative application of 0.4 mg mitomycin C per milliliter of saline for 3 to 5 minutes. RESULTS: After a follow-up period of 12 to 19 months, no recurrence of synechiae was observed, the conjunctival fornices remained open, and conjunctival overgrowths on the cornea did not recur. No adverse effect was observed. CONCLUSION: Intraoperative application of mitomycin C proved useful in the surgical treatment of cicatricial shrinkage of conjunctival fornices.

Topical use of cyclosporine in the treatment of vernal keratoconjunctivitis.

We treated 11 patients with vernal keratoconjunctivitis for four to nine months with topical cyclosporine as a 2% dilution in castor oil. No significant side effects occurred, except for mild and transient burning upon administration. Within the first 15 days, both symptoms and signs of the condition improved significantly, and these results were maintained throughout the entire treatment. Relapses of the disease occurred two to four months after the end of the therapy. A double-masked clinical trial of nine patients (2% cyclosporine in castor oil vs castor oil alone) confirmed the results. Treated eyes improved significantly for both signs and symptoms as compared to control eyes. Topical cyclosporine may, therefore, be considered an effective substitute for corticosteroids, with an excellent anti-inflammatory activity in patients with both corticosteroid-dependent and corticosteroid-resistant vernal keratoconjunctivitis.

A psychosomatic approach to idiopathic recurrences of anterior uveitis.

We examined 60 patients affected by idiopathic recurrent anterior uveitis and studied the relevance of stressful life events and psychological distress in relation to relapses of the disease. The results were statistically insignificant when compared to the control groups. We found that neither life events nor psychological distress played a contributory role in this disease.

Intravitreal and systemic foscarnet in the treatment of AIDS-related CMV retinitis.

Cytomegalovirus retinitis is the most frequent ocular opportunistic infection in AIDS patients. Untreated, it is always a progressive and destructive disease of the retina that results in blindness. Specific treatment is therefore mandatory to halt the progression of the retinal lesions. The authors report their experience in the treatment of CMV retinitis with foscarnet in 25 AIDS patients; the drug is an analog of pyrophosphate, virostatic against all herpes-class viruses including CMV. Foscarnet was successful in halting the progression of CMV retinitis during induction treatment (180 mg/kg/day) by either a TID (three times a day) or a BID (twice a day) regimen, and in healing retinal lesions during maintenance (90 mg/kg/day) in 14 out of 19 patients. Five patients had a relapse of retinitis during maintenance. In these patients a brief course of intravitreal foscarnet, in association with the lowest dosage of the drug administered systematically (90 mg/kg/day), was effective in healing the retinal lesions. The main systemic side effects, such as renal impairment and electrolytic disturbances, were observed only during the induction treatment, and only in one case was it necessary to stop the therapy.

Cyclosporine-A in the treatment of serpiginous choroiditis.

Seven patients affected by bilateral inflammatory serpiginous choroiditis have been treated with Cyclosporine-A for 6-21 months. Nine out of the fourteen eyes showed a significant improvement in their visual acuity; five eyes did not change. Cyclosporine-A may, therefore, be considered effective in the treatment of this disease. Its usefulness seems to be greater when the serpiginous choroiditis is in its 'acute' stage; 'chronic' stages, however, also seem to improve under treatment. Its main indication is, in our opinion, the involvement of the macular region of the 'second' eye, when the 'first' eye is already damaged. We consider Cyclosporine-A, in these situations, to be a first choice treatment.

Intravitreal use of foscarnet: retinotoxicity of repeated injections in the rabbit eye.

Cytomegalovirus retinitis is the most frequent ocular opportunistic infection in AIDS patients. In selected cases intravitreal injections of foscarnet may be the sole therapeutic possibility. The retinal toxicity of the drug, however, has not yet been thoroughly investigated. Our present study in the rabbit eye concerns the retinal toxicity of 2, 4, and 6 intravitreal injections of 3.6 mg of foscarnet, using ophthalmoscopy, histology and electrophysiology to evaluate retinal damage. The results show that foscarnet may be employed intravitreally without substantial damage to the retina, but only in short courses of injections when no other therapeutic possibility may be utilized.

Heterogeneity of lymphocytes from aqueous humor of patients with uveitis.

T lymphocyte subsets from inflammatory aqueous humor (n = 34) have shown one of three different patterns: group 1 = lower CD4+/CD8+ ratio in aqueous as compared to peripheral blood (0.43 +/- 0.25 vs. 1.96 +/- 0.82; n = 9); group 2 = similar CD4+/CD8+ ratio in aqueous and peripheral blood (1.76 +/- 0.60 vs. 1.60 +/- 0.62; n = 22); and group 3 = higher CD4+/CD8+ ratio in aqueous as compared to peripheral blood (7.53 +/- 0.47 vs. 2.13 +/- 0.55; n = 3). DR+ T lymphocytes were significantly higher, and natural killer cells significantly lower, in inflammatory aqueous as compared to peripheral blood.

Acute frosted retinal periphlebitis associated with cytomegalovirus retinitis.

The clinical picture of an acute frosted periphlebitis has been reported in a limited number of otherwise healthy patients, and in one case of human immunodeficiency virus (HIV) infection. The disease is usually bilateral and highly sensitive to steroids. The case of a 26-year-old, HIV-seropositive woman who developed unilateral diffuse perivenous sheathing in the course of recurrent cytomegalovirus retinitis is reported. The appearance of the retinovasculitis was identical to that described as an acute frosted periphlebitis, and the disease proved to be highly sensitive to a combined treatment of steroids and ganciclovir. The clinical findings in this case support the possibility that the appearance of an acute frosted periphlebitis can occur in response to several different stimuli, including cytomegalovirus.