Modulation of HLA antigen expression on corneal epithelial and stromal cells.

Human corneal epithelial cells and stromal fibroblasts in culture were incubated with gamma interferon or with medium conditioned by phytohemagglutinin (PHA)-stimulated mononuclear cells. The corneal cells were placed into suspension, assayed for class I (HLA-A,B,C) and class II (HLA-DR) antigens by indirect immunofluorescence, and analyzed with flow cytometry. Epithelial cells treated for 5 days with conditioned medium (CND-M) did not exhibit an increase in class I or an induction of class II antigen expression, although a trend toward increased class I antigen expression was present. Epithelial cells treated for 5 days with 250-500 U/ml of gamma interferon did not demonstrate an increase in class I but did show an induction of class II antigen expression; again, however, a trend toward increased class I antigen expression was present. Stromal fibroblasts treated for 3-5 days with CND-M exhibited an increase in class I antigen expression, but stromal fibroblasts treated for 1-5 days with CND-M did not show an induction of class II antigen expression. Stromal fibroblasts incubated for 1-5 days with 250-750 U/ml of gamma interferon demonstrated both an increase in class I and an induction of class II antigen expression. These data suggest that host lymphokines may intensify the process of corneal graft rejection by augmenting class I antigen expression on allogeneic cells. Moreover, the induction of class II antigen expression by host lymphokines on cells in transplanted corneal tissue may lead to host sensitization and subsequent allograft rejection.

Laser densitometric analysis of class I HLA antigen expression by corneal epithelium.

Laser densitometric analysis of immunoperoxidase stained tissue was used to quantitate class I HLA (HLA-A,B,C) antigen expression by human corneal epithelium. Frozen sections of human donor corneas stored in modified McCarey-Kaufman medium for less than 24 hr were evaluated for class I HLA antigen by an indirect immunoperoxidase technique using a monoclonal antibody reactive against a class I HLA antigen determinant. Photomicrographs of stained epithelium taken under standardized conditions were evaluated by laser densitometry. Measurements from peripheral and central corneal epithelium on the same tissue section were compared. Total stain, stain density, and stain intensity were higher for peripheral than for central corneal epithelium, indicating that class I HLA antigen expression is greater for peripheral than for central epithelium.

Sinus histiocytosis presenting as an epibulbar mass. A clinicopathologic case report.

Sinus histiocytosis is a well-recognized condition that mainly affects children in the first decade of life. Although this usually benign disease often features massive cervical lymphadenopathy, numerous extranodal sites of involvement can be seen. We describe a new presenting manifestation for sinus histiocytosis. A 13-month-old infant developed a rapidly growing unilateral epibulbar tumor that involved the cornea. A complete physical examination revealed only mild inguinal lymphadenopathy. A diagnosis of sinus histiocytosis was made by histologic examination of the lesion after surgical excision.

Role of débridement and trifluridine (trifluorothymidine) in herpes simplex dendritic keratitis.

Thirty-four patients with herpes simplex dendritic keratitis were randomized into three treatment categories: Group A had débridement alone; group B, trifluridine (trifluorothymidine) alone; and group C, débridement and trifluridine. Patients treated with débridement alone had a statistically higher failure rate than did the other two groups. No statistically significant difference was observed between trifluridine treatment alone and débridement combined with trifluridine treatment, with regard to healing time. Our results suggest that débridement alone is suboptimal therapy for herpes simplex dendritic keratitis and that débridement combined with trifluridine appears to offer no advantage over trifluridine alone.

Epibulbar osseous choristoma.

A 14-year-old girl presented with a firm, movable, epibulbar mass of the right eye. The clinical appearance was characteristic of an epibulbar osseous choristoma, and the diagnosis was substantiated radiographically and confirmed histopathologically. The clinical features, management, and histopathology of epibulbar osseous choristomas are reviewed.

Atypical cases of sinus histiocytosis (Rosai-Dorfman disease) with ophthalmological manifestations.

Sinus histiocytosis with massive lymphadenopathy is a non-neoplastic disease of unknown cause observed mainly in children with markedly enlarged cervical or other lymph nodes. We have reported two very atypical cases with extranodal manifestations that required ophthalmological consultation. Neither patient had significant lymphadenopathy. One patient, who had tumors of all four eyelids as well as lesions of the nose and larynx, was 68 years old when first examined, and 70 at the time of his last surgical procedure. The other patient, a 13-month-old child, had a unique corneoscleral lesion as his only clinical manifestation. The excised tissues obtained from the eyelids and larynx in case 1 and from the corneoscleral lesion in case 2 revealed characteristic histopathologic features of sinus histiocytosis (Rosai-Dorfman disease), including strongly positive immunoperoxidase staining for S-100 protein in the cytoplasm of most of the histiocytes.

Survival of corneal grafts from donors supported by mechanical ventilation.

Eighty-five patients undergoing penetrating keratoplasty with tissue from donors supported by mechanical ventilation (Ventilator group) were compared to a surgeon- and diagnosis-matched group (Control group). Age at surgery, duration of follow-up, and sex of recipient patients were similar in the two groups. The mean donor age in the Ventilator group (26.4 years) was significantly less than in the Control group (45.8 years, P less than 0.0001). Mean time on the ventilator was 99.4 hours (range, 4 hours to 21 days). Overall graft survival rates in the Ventilator and Control groups were similar (P greater than or equal to 0.72). Time on the ventilator did not affect graft survival. Cultures of corneoscleral donor rims were positive more often in the Ventilator group than in Controls (39.7 versus 23.1%), but the difference was not significant (P = 0.09). Prolonged ventilator time was not associated with a higher rate of positive corneoscleral rim cultures, nor did positive cultures affect graft survival. The most common cause of graft failure in both groups was allograft rejection. In no case could postoperative bacterial infection be attributed to contamination of the donor material. One case of primary donor failure occurred in the Ventilator group, but the incidence (1.2%) is similar to that of previously reported studies. The data indicate that corneal tissue from ventilator-supported donors should be considered for use in penetrating keratoplasty.

Penetrating keratoplasty for herpes simplex keratitis and keratoconus. Allograft rejection and survival.

To determine the relationship between corneal allograft rejection and failure, we studied patients who underwent penetrating keratoplasty for herpes simplex keratitis (n = 82) and keratoconus (n = 345), two frequent indications for keratoplasty in young patients, using survival analysis. For first grafts for herpes, the probability of survival was significantly less than it was for keratoconus (P less than 0.0001). For second grafts, this difference was less pronounced, and for three or more grafts, the difference in survival was not significant. The incidence of rejection episodes was similar in first grafts for herpes (16.6%) and keratoconus (18.5%) (P greater than 0.05). However, the incidence of rejection episodes in regrafts for herpes was significantly greater than in keratoconus (23.7 versus 17%, P less than 0.01). The incidence of failure after rejection episodes (first grafts and regrafts combined) was significantly greater in grafts for herpes (52.4 versus 16.2%, P less than 0.001). Because survival after multiple regrafts in both groups is poor, additional measures, such as tissue matching, may be necessary to improve the likelihood of success in these high-risk cases.