Leishmaniose cutânea disseminada - iridociclite bilateral näo granulomatosa: isolamento de leishmania no humor aquoso / Disseminated cutaneous leishmaniasis - nongranulomatous bilateral iridocyclitis: detection of leischmania in aqueous humor

Descriçäo de um quadro de iridociclite bilateral, näo granulomatosa, num paciente portador de leishmaniose cutânea disseminada. O acometimento ocular ocorreu por via hematogênica, visto que os anexos oculares, córnea e conjuntiva, estavam íntegros. Pela primeira vez conseguiu-se isolar leihmania no humor aquoso, através de pesquisa direta e cultura. O paciente foi medicado inicialmente com N-metil-glutamina, sem resposta. Substituído pela Anfotericina-B, com bom resultado

[Tonography and fluorophotometry in the clinical study of aqueous humor dynamics]. / Tonographie und Fluorophotometrie zur klinischen Untersuchung der Kammerwasserdynamik.

We used Grant's tonography and fluorophotometry (the Jones and Maurice method) to study the aqueous humor dynamics in normal and glaucomatous eyes. The results of the two methods were compared. The mean facility and rate of aqueous flow in normal eyes were similar. In glaucomatous eyes the tonographic outflow facility (C-value) varied greatly, and the calculated rate of aqueous flow (F-value) also had a large standard deviation. To study the inflow rate, fluorophotometry is a more accurate method. Further calculation of uveoscleral flow and the "pseudofacility" from the tonographic F-value and fluorophotometric C-value was therefore of only limited accuracy.

Chemotactic activity of aqueous humor. A cause of failure of trabeculectomies?

The chemoattractant activity for ocular fibroblasts of the aqueous humor of patients undergoing glaucoma surgery was evaluated in 48-well microchemotaxis chambers and compared with control specimens from patients undergoing cataract extractions. All specimens were chemoattractant, but those from patients who had previously undergone glaucoma surgery that had failed were of significantly greater activity than the controls'. This chemoattractant activity is primarily chemotactic. It consists of heat-stable and heat-labile components. The predisposition of a patient to sustain failed glaucoma drainage surgery may be related to the chemoattractant activity of his aqueous humor, since strongly chemoattractant aqueous humor may encourage fibrosis at the operation site.

A platelet-activating factor antagonist inhibits interleukin 1-induced inflammation.

Treatment with a platelet-activating factor receptor antagonist, SRI 63-441, inhibited interleukin 1-induced increases in vascular permeability and leukocyte infiltration in the rabbit eye following the intravitreal injection of human interleukin 1-alpha. Treatment with the prostaglandin-synthetase inhibitor, flurbiprofen, or the corticosteroid, prednisolone, resulted in comparable attenuation of the increase in vascular permeability. In contrast to the effect of flurbiprofen, SRI 63-441 did not reduce interleukin 1-induced increases in prostaglandin E2 levels. Combined treatment with the platelet-activating factor antagonist and inhibitors of prostaglandin synthesis nearly prevented interleukin 1-induced increases in vascular permeability or cellular infiltration. These findings suggest a role for platelet-activating factor in interleukin 1-induced inflammation. Platelet-activating factor and prostaglandins may act synergistically as mediators of interleukin 1-induced vascular permeability.

The treatment of aqueous-deficient dry eye with removable punctal plugs. A clinical and impression-cytologic study.

Punctal plugs were placed in 18 dry eye patients of the aqueous-deficiency type who were on maximally tolerable medical therapy and who had Schirmer testing with topical anesthetic measuring less than 6 mm. Pretreatment and posttreatment evaluations included rose Bengal and fluorescein staining, Schirmer testing, and conjunctival impression cytology. Six weeks after plug placement, 11 of 18 patients had subjective improvement and were able to decrease dependency on tear supplements; all of these patients have successfully worn plugs for at least 8 months. Although these 11 patients improved clinically, impression cytologic abnormalities persisted 6 weeks after plug placement. Three patients did not improve clinically after punctal plug therapy, and four patients improved subjectively but extruded plugs within 2 weeks of placement. Three of the patients who extruded plugs had marked lid laxity and dilated puncta before placement. Reversible punctal occlusion by plugs may significantly decrease dependency on tear supplements in selected patients.

The effect of corticosteroids or nitrogen mustard on aqueous humor chemotactic activity induced by intravitreal endotoxin.

In rabbits intravitreal injection of endotoxin induces potent chemotactic activity for monocytes in aqueous humor. We have assessed the effect of methylprednisolone (30 mg/kg intramuscularly) or nitrogen mustard (1.75 mg/kg intravenously) on the generation of this chemotactic activity. Histologic changes, anterior chamber protein extravasation, and aqueous humor cellular infiltration were reduced by corticosteroids to a variable degree. However, even in animals with a marked reduction in protein extravasation or histologic change, chemotactic activity was substantially preserved. Similarly, nitrogen mustard induced a leukopenia without affecting the ability of endotoxin to generate chemotactic activity in aqueous humor. In contrast, corticosteroids reduced both protein extravasation and the generation of chemotactic activity induced by intravenously injected endotoxin. The results suggest that the chemotactic activity induced in the eye by intravitreal endotoxin may be locally synthesized and may be present without a substantial leukocytic infiltrate.

Endothelial guttata and facility of aqueous outflow.

Thirty-eight eyes of 22 patients with corneal endothelial guttata were examined by slit lamp, tonometry, tonography, and wide-field specular microscopy. The mean value for facility of outflow (C55) was 0.23, and it was not statistically different from reported values for a normal population. Also, there was no correlation between extent of guttata as seen with wide-field specular microscopy and facility of outflow. Thus, contrary to a previous report, endothelial guttata does not seem to predispose to impaired facility of outflow.

Capillary endothelial cell migration: stimulating activity of aqueous humor from patients with ocular cancers.

In double-masked studies, various concentrations of aqueous humor (AH) from 157 patients (208 samples) with ocular cancers, nonmalignant ocular lesions, and normal eyes were added to bovine capillary endothelial (BCE) cells plated onto gold-coated cover slips. The phagokinetic tracks made by 100 cells at each concentration were traced, and the mean area of migration plus or minus the standard error of the mean was determined. Data are expressed as the percentages of increase in mean track area made by 100 cells incubated in medium that contained AH samples beyond the mean area of 100 cells incubated in medium alone. The percentage increases in migration-stimulating activity were as follows: a) malignant ocular disease--retinoblastoma (30 samples), 34 +/- 2; malignant melanoma (55 samples), 37 +/- 3; b) nonmalignant ocular disease--cataracts, glaucoma, pseudoglioma, and diabetic retinopathy (36 samples), 14 +/- 2; c) control AH--no ocular disease (51 samples), 9 +/- 1; normal eyes and systemic cancer (36 samples), 38 +/- 6. The percentage increase in endothelial cell migration was as great in cases of systemic cancer as it was in cases of ocular cancer. The endothelial cell migration-stimulating activity in AH from patients with intraocular cancers was significantly higher than the levels in the other groups of patients having no systemic cancer (P much less than .001). In addition, when the results were compared in the control group and the group with benign ocular disease, no significant differences were detected (P greater than .01).

Changes in outflow facility in experimental hyphema.

To characterize the pathophysiology of hyphema clearance, we studied changes in the facility of outflow in experimental hyphema in freshly enucleated rabbit eyes. Hyphemas, with washed normal or sickled red cells (RBCs) (suspended in isotonic phosphate buffer to obtain a hematocrit value comparable to that of whole blood) and occupying 50% to 100% of the anterior chamber volume, caused a marked cell "crowding" in the chamber angle and an increase in the outflow resistance; the facility stabilized at a value 60% lower than the control (p = < 0.001). No significant change in outflow facility was observed in hyphemas of either RBC type occupying 25% of the anterior chamber volume (p = N.S.). Whole blood hyphema occupying 50% of the anterior chamber volume reduced the facility of outflow by 80% of the control mock aqueous value (p = < 0.001); a comparison with 50% hyphema produced by washed RBCs indicated a significant contribution by the plasma (fibrin) component (p = 0.0025) in increasing the resistance to outflow.

Iridocycloretraction in closed-angle glaucoma.

A small series of patients who underwent iridocycloretraction between 1969 and 1976 is analysed. All patients had previously undergone peripheral iridectomy for primary angle-closure glaucoma, and all had 360 degrees of peripheral anterior synechiae, as seen with the gonioscope. It was found that iridocycloretraction was successful in an unacceptably low percentage of cases, and its success was related to whether subconjunctival drainage was established. There was no clinical evidence to support the theory that its main mode of action was to permit access of aqueous to the trabecular meshwork. Therefore it has no practical advantages over other procedures which establish subconjunctival filtration.

Correlation of aqueous humor ascorbate with intraocular pressure and outflow facility in hereditary buphthalmic rabbits.

The hypotensive effect of ascorbate on intraocular pressure has been reported following topical application, oral administration, or anterior chamber infusion in animals. The present report describes the correlation of aqueous humor ascorbate concentration with intraocular pressure as well as outflow facility in vivo. Low aqueous ascorbate level was seen in buphthalmic eyes with high intraocular pressure and low outflow facility. The opposite correlation was observed in normal eyes. Ascorbate concentration in the anterior chamber of the rabbit eye is apparently related to the alteration of outflow facility and the movement of fluid in the anterior chamber.

Progressive bilateral essential iris atrophy.

A case of bilateral progressive essential iris atrophy, more advanced in one eye than the other, has been studied. Histopathologic examination of the iris from the eye with the more advanced iris atrophy failed to find any vascular abnormalities in that the vessels were patent and appeared normal except for accumulated perivascular connective tissue. Fluorescein angiographic examination of the right eye which was undergoing the earliest changes of iris atrophy failed to show any vascular abnormalities. However, tonographic examination indicated a markedly decreased outflow facility. There does not appear to be any vascular abnormality involved in the pathogenesis of this case.

Upper eyelid retraction after glaucoma filtering procedures.

After glaucoma filtration surgery, 2 patients developed overaction of Müller's muscle with resultant upper eyelid retraction. We theorize that stimulation of Müller's muscle is caused by a sympathomimetic chemical in the aqueous that travels from the bleb, under the bulbar and palpebral conjunctiva, to Muüller's muscle. In one case excision of Muüller's muscle relieved the retraction. In the other case, preventing aqueous from reaching Müller's muscle reduced the retraction.

Investigations into the aqueous humour dynamics in primary pigmentary degeneration of the retina.

40 patients with primary pigmentary degeneration of the retina were investigated for the possible coexistence with glaucoma. 12.5% established primary glaucoma cases and 7.5% suspicious glaucoma cases were found. In primary pigmentary degeneration of the retina with no glaucoma the intraocular pressure and the parameters of Leydhecker's test showed the same distribution as that of the controls selected at random. The intraocular pressure and the tonographic parameters except for CL3-7 were slightly lower on the average in the group with retinitis pigmentosa than in the controls.