Does immunosuppressive treatment ameliorate morphology changes in encapsulating peritoneal sclerosis?

Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome associated with ileus symptoms and irreversible sclerosis of the peritoneal membrane. Inflammation, fibrosis, and neoangiogenesis are the main features of the pathophysiology. No evidence-based therapy is currently available for EPS. In recent years, anti-inflammatory and immunosuppressive (IS) treatment modalities have become more popular. The aim of the present study was to investigate the effects of various IS treatment strategies-glucocorticosteroid (GC), azathiopurine (AZT), and cyclosporin (CsA)- on regression of EPS. We divided 52 nonuremic Wistar albino rats into six groups: Control group-2 mL isotonic saline injected intraperitoneally (IP) daily for 3 weeks; CG group-2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for 3 weeks; Resting group-CG (weeks 1 - 3), plus peritoneal rest (weeks 4 - 6); Corticosteroid (GC) group-CG (weeks 1 - 3), plus 10 mg/L prednisolone in drinking water (weeks 4 - 6); AZT group- CG (weeks 1 - 3), plus 100 mg/L azathioprine in drinking water (weeks 4 - 6); and CsA group-CG (weeks 1 - 3), plus cyclosporin 7.5 mg/kg by subcutaneous injection daily (weeks 4 - 6). At the end of the study, under ketamine HCl anesthesia, the rats were humanely killed by bleeding. Parietal peritoneal samples were then taken from same location (away from the injection site) and changes of parietal peritoneum morphology were examined by a single pathologist. The CG severely disturbed parameters of peritoneal morphology, increasing peritoneal thickness, inflammatory activity, vascularity, and fibrosis score as compared with the Control group (p < 0.05). No benefit was observed for any parameter in the Resting group as compared withthose parameters in the CG group (p < 0.05). We observed a lower fibrosis score and less peritoneal thickness in the GC group as compared with the Resting group (p < 0.05). No beneficial effects of AZT on peritoneal morphology were observed as compared with the effects of peritoneal rest or corticosteroid therapy. Treatment with cyclosporin resulted in more fibrosis, vascularity, and inflammation than was seen with corticosteroid therapy (p < 0.05). Immunosuppressive therapies, especially those that are corticosteroid-based, may have therapeutic value in the management of EPS. Patients treated with cyclosporin may have a risk for developing EPS.

Repair of anterior staphyloma with dehydrated dura mater patch graft.

A case of postoperative large anterior staphyloma of the sclera was treated with a dehydrated cadaveric dura mater patch graft. Structural integrity of the globe and a good cosmetic result were obtained after the surgery. During the follow-up of 2 years, no recurrence of staphyloma developed.

Evaluation of serum resistin levels in patients with ocular and non-ocular Behçet's disease.

BACKGROUND: Resistin, a recently identified adipocytokine, has been found to play an important role in inflammation and the processes of inflammation-related diseases. Serum resistin levels in patients with Behçet's disease (BD) have not yet been investigated. We aimed to evaluate the relation between resistin and interleukin-6 (IL-6) in Behçet patients with or without ocular involvement and in normal controls. METHODS: Twenty-two patients with BD and 19 healthy control subjects were included in this study. While 14 patients had posterior segment involvement of the eye, the other 8 did not have ocular disease. Serum resistin and interleukin-6 (IL-6), levels were measured in all samples. Data from all groups were tested for statistical significance. RESULTS: The mean resistin and IL-6 concentrations were significantly higher in patients with BD than the control subjects (p = 0.011 and p = 0.0001, respectively). There was a significant difference in resistin and IL-6 levels between the patients with non-ocular BD and controls (p = 0.013 and p = 0.0001, respectively), as well as resistin and IL-6 levels between the ocular BD group and the control group (p = 0.05 and p = 0.0001, respectively). However, there was no significant difference between patients with ocular versus non-ocular BD. INTERPRETATION: Resistin levels were found to be raised in Behçet patients with or without ocular involvement compared with the control subjects.

Soluble endothelial protein C receptor levels in Behçet patients with and without ocular involvement.

BACKGROUND: The protein C system is an important natural anticoagulant mechanism. Endothelial cell-activated protein C receptor (EPCR), which was discovered at the surface of endothelial cells, binds protein C and enhances its activation. The soluble form of EPCR (sEPCR) has been detected in plasma. Behçet's disease is a chronic inflammatory disorder affecting multiple organs. Arterial and venous thrombosis is a common clinical manifestation of Behçet's disease and the pathogenic mechanism of thrombotic tendency in the disease is not well known. The aim of this study is to determine sEPCR concentrations in Behçet patients with and without ocular involvement as well as to investigate the association between sEPCR levels and clinical manifestations of Behçet's disease. METHODS: Sixty patients with Behçet's disease and 67 healthy control subjects were included in this study. A complete ophthalmic examination was performed by ophthalmologists with an interest in Behçet's disease. Sixty patients with Behçet's disease were divided into two groups. Group 1 consisted of 30 patients with ocular involvement and Group 2 consisted of 30 patients without ocular involvement. Soluble EPCR levels were determined in plasma by using sEPCR Asserachrom enzyme-linked immunosorbent assay (ELISA) kits according to the manufacturer's instructions. Differences of the mean sEPCR levels between groups were evaluated using Mann-Whitney U-test. Pearson's correlation analysis was used for evaluating the correlation between sEPCR levels and age, gender, duration of the disease as well as different clinical manifestations of Behçet's disease. RESULTS: Age and gender ratio were not different between patients and controls. Plasma sEPCR concentrations were significantly higher in patients with Behçet's disease than those in controls (p<0.05). There was no statistically significant difference in serum sEPCR levels between the patients with versus the ones without ocular involvement. There were no statistically significant correlations between sEPCR levels and age, gender, duration of the disease or clinical manifestations. CONCLUSIONS: Our data suggests a possible role of soluble EPCR in the pathogenesis of Behçet's disease. Further studies by possible mutations and polymorphisms in EPCR gene in patients with Behçet's disease would be useful to bring to light the pathogenic mechanism of ocular and systemic vascular complications of the disease.

Effectiveness of tacrolimus in high-risk limbal allo-graft transplantation.

We evaluated the efficacy and safety of tacrolimus in prevention of allograft rejection in high-risk allo-limbal grafts. Six eyes of six patients with severe limbal stem cell deficiency were included. All patients were started 0.1 mg x kg 1 x day(-1) tacrolimus orally 3 days before the surgery. Limbal allo-graft transplantation for ocular surface reconstruction had a successful outcome with using systemic tacrolimus for immunosuppression.

Intravenous methylprednisolone pulse therapy for acute posterior segment uveitis attacks in Behçet's disease.

We evaluated the efficacy and safety of high-dose intravenous methylprednisolone (1 g x 3 days) pulse therapy followed in the management of acute posterior segment uveitis attacks in 25 patients with Behçet's disease. High-dose intravenous methylprednisolone pulse therapy may be beneficial in the prompt control of severe ocular inflammation and in preventing visual loss.

Penetration of topically applied tacrolimus into the aqueous humor in Behçet's disease.

We investigated the concentration of tacrolimus in aqueous humor, and serum of patients with ocular Behçet's disease after topical application in 11 patients. All received 1 drop of isotonic tacrolimus solution 0.3% every 6 hours for 3 days. The mean tacrolimus concentration in the aqueous and serum, as measured by microparticle enzyme immunoassay, were 12.49 and 0.76 ng/mL, respectively. Tacrolimus may be a promising treatment modality in anterior uveitis in Behçet's disease by topical application.

Serum leptin levels in patients with ocular and nonocular Behçet's disease.

AIMS: To investigate serum leptin levels in Behçet's patients with or without ocular involvement compared with healthy subjects and the relationship between serum leptin and uveitis activity in patients with ocular involvement. METHODS: Fifty-seven patients with Behçet's disease and 20 healthy control subjects were included in this study. While 27 patients had ocular involvement (18 had acute uveitis, 9 had inactive ocular involvement), 30 did not have ocular disease. C-reactive protein, alpha 1-antitrypsin, and serum leptin levels were measured in all samples. RESULTS: There was a significant difference between the patients with Behçet's disease and control group for both logarithm of leptin (P = .000) and logarithm of CRP (P = .031). Logarithm of leptin in non-ocular Behçet's patients was significantly higher compared to its level in ocular Behçet's disease and controls (P = .009). There was a significant difference between the patients with active ocular disease and control group (P = .03). CONCLUSIONS: Leptin might have a possible role in the pathogenesis of Behçet's disease.

Intravitreal triamcinolone acetonide in the management of cystoid macular edema in Behçet's disease.

PURPOSE: To determine the efficacy of intravitreal triamcinolone acetonide (ivTA) injection in the management of cystoid macular edema (CME) due to uveitis in patients with Behçet's disease. METHODS: Ten eyes of seven patients with CME associated with Behçet's disease were included in the study. A quantity of 4 mg of triamcinolone acetonide was injected intravitreally in all of the eyes. The maculas of the patients were evaluated with optical coherence tomography (OCT) and fluorescein angiography (FA). The change in visual acuity, fluorescein leakage, macular thickness, and potential complications were assessed. RESULTS: The mean follow-up was 15.6 months (range 7-19 months). There was an increase of more than two Snellen lines in the visual acuity in seven of the ten eyes (70%) at the last examination. Macular edema regressed completely in eight of the ten eyes (80%) at the last visit on OCT and FA. The mean central macular thickness assessed by OCT was 406 mum before treatment and 186.9 mum at the last visit. The intraocular pressure (IOP) exceeded 21 mmHg in six eyes of five patients (60%) during the follow-up. At the last visit, the IOP was less than 21 mmHg in five eyes with medication. One eye underwent glaucoma filtration surgery. Four eyes of three patients had cataract progression. In four eyes of four patients (40%), a second ivTA injection was given due to relapsing CME. CONCLUSION: Intravitreal triamcinolone acetonide (ivTA) may be beneficial in the management of CME in patients with Behçet's disease. Repeated ivTA injections might be required if CME reoccurs.

Aqueous humor and serum penetration of tacrolimus after topical and oral administration in rats: an absorption study.

PURPOSE: To investigate the penetration of tacrolimus to the aqueous and serum after topical and oral administration. METHODS: Thirty Wistar rats were divided into three groups. In the first group (n = 12), a single dose of 0.3 % isotonic tacrolimus solution was applied topically to the rat eyes. The second group (n = 12), received 0.1 mg/kg/day tacrolimus for three days. In control group (n = 6), the rats were administered a single drop of 0.3% salin solution topically. Following collection of samples, the amounts of tacrolimus in aqueous and serum samples were compared with each other. RESULTS: In group I, the mean concentration of tacrolimus was 35.16 ng/ml in aqueous and 2.22 ng/ml in serum. In group II, the mean concentration of tacrolimus was 13.08 ng/ml in aqueous and 13.45 ng/ml in serum. There was no significant difference in the serum concentration levels of tacrolimus between group I and control group. However there was a significant difference of the drug concentrations in aqueous between the groups (p < 0.001). The mean aqueous and serum concentrations of tacrolimus in group II, differed significantly from the mean concentrations in group I (p < 0.001) and the control group (p < 0.001). CONCLUSION: Tacrolimus may be a promising treatment modality in intraocular inflammation by topical application besides systemic administration.

Contact lens fitting for keratoconus after Intacs placement.

PURPOSE: To describe a patient with keratoconus who underwent Intacs surgery to one eye with an unsatisfactory result and refused to undergo an Intacs removal procedure. METHODS: Case report. RESULTS: The patient's eye was fitted with a soft contact lens for visual rehabilitation 5 months after Intacs placement. CONCLUSIONS: Intacs, with the help of secondary refractive procedures or contact lenses, may still be considered as effective in postponing penetrating keratoplasty, even in patients with advanced keratoconus.