The Investigation of HCV RNA in Tear Fluid and Aqueous Humor in Patients with Anti-HCV Antibody Positive Who Underwent Cataract Surgery

Purpose: To obtain aqueous humor and tear fluid samples during cataract surgery of the hepatitis C virus (HCV)-antibody-positive patients in order to analyze them for HCV RNA and compare these measurements with serum HCV RNA levels.

Methods: Twenty-nine anti-HCV-positive patients were included this study. HCV RNA viral load levels were determined by commercial real-time polymerase chain reaction system. Antibodies to HCV were screened with the enzyme-linked immunosorbent assay (ELISA) using anti-HCV test kit.

Results: Log₁₀ HCV RNA levels were found to be 6.00?±?1.06?IU/mL in serum, 2.76?±?0.36?IU/mL in the aqueous humor, and 1.91?±?0.93?IU/mL in tear fluid. No correlation was detected between samples for HCV RNA positivity (p?=?.390, κ?=?.102). We have observed that, viral RNA was detected in the aqueous humor, while not in serum in one case, whereas viral RNA was detected in tear fluid but not in serum in another case.

Conclusions: Although viral load detected in aqueous humor and tear fluid samples was considerably lower compared to the serum samples, it can still be important in terms of infectivity.     

Mumps-induced corneal endotheliitis

OBJECTIVE: To report two cases of corneal endotheliitis following mumps parotitis. METHODS: Observational case reports of two patients presenting with sudden unilateral diminution of vision while they were in the resolution phase of mumps parotitis. RESULTS: Central corneal edema with no associated epithelial involvement or iridocyclitis was confirmed on slit-lamp biomicroscopy. Specular microscopy confirmed an increased corneal thickness with corneal endothelial abnormalities. The diagnosis of mumps virus infection was established through detection of IgM antibody in serum samples of the patients using enzyme-linked immunosorbent assay (ELISA). The routine investigations for other systemic diseases were negative. CONCLUSIONS: Corneal endotheliitis as a sequela to mumps is a new reported association. Timely treatment with topical steroids led to resolution of the disease with full visual recovery without any residual symptoms or signs.     

Intraocular antibody production in intraocular inflammation

Background: The production of intraocular antibodies is considered a specific marker for active infectious uveitis. The aim of our study was to evaluate the diagnostic value of aqueous humor analysis in consecutive patients referred to a tertiary clinical center.  Methods: We analyzed 91 paired aqueous humor/serum samples from 89 patients with intraocular inflammation. In 71 patients aqueous humor analysis was used as a positive or negative confirmation of the suspected cause, whereas in 18 patients the clinical diagnosis was completely uncertain. A modified micro-ELISA technique was used to detect intraocular IgG production against Toxoplasma gondii, varicella zoster virus, herpes simplex virus and cytomegalovirus. Statistical analysis was performed using the ”Cohen’s kappa” test.Results: Specific intra-ocular antibody production could be detected in 12 (66.7%) of 18 patients with uncertain diagnosis. Subsequently initiated therapy led to clinical improvement in 10 patients, whereas 2 patients remained unchanged. In 2 (2.8%) of 71 patients aqueous humor analysis led to revision of the initially suspected etiology and to a change of therapy. Statistical analysis showed a significant accordance of diagnosis and aqueous humor analysis (P<0.01).  Conclusion: In patients with infectious uveitis, analysis of intraocular synthesis of specific antibodies is a valuable tool to establish the etiology rapidly and allows initiation of targeted antimicrobial treatment. Received: 3 February 1999 Revised: 26 August 1999 Accepted: 29 September 1999     

Oxidative Stress Levels in Aqueous Humor from High Myopic Patients

PurposeTo compare oxidative stress status in the aqueous humor of highly myopic eyes and control eyes.MethodsAqueous humor samples were collected from 15 highly myopic eyes (high myopia group) and 23 cataractous eyes (control group) during cataract surgery. Central corneal thickness, corneal endothelial cell density, hexagonality of corneal endothelial cells, and cell area of corneal endothelial cells were measured using specular microscopy. Axial length was measured using ultrasound biometry. 8-Hydroxydeoxyguanosine (8-OHdG) and malondialdehyde levels were measured using enzyme-linked immunosorbent assay.Results8-OHdG level was lower in the aqueous humor of myopic patients than in that of control group (p = 0.014) and was positively correlated with central corneal thickness and negatively correlated with axial length (r = 0.511, p = 0.02; r = -0.382, p < 0.001). There was no correlation between 8-OHdG level and corneal endothelial cell density, hexagonality, or cell area. Malondialdehyde level did not show any correlation with any parameters evaluated.Conclusions8-OHdG might be a sensitive biomarker for evaluating oxidative stress status in the eye. Oxidative stress level was lower in the aqueous humor of highly myopic eyes compared to that in control eyes, which indicates lower metabolic activity in these eyes.     

Corneal endotheliitis and idiopathic sudden sensorineural hearing loss

PURPOSE: To report a case with corneal endotheliitis and idiopathic sudden sensorineural hearing loss, in which herpes simplex virus type 1 DNA was demonstrated in the trabeculum and the aqueous humor by polymerase chain reaction. DESIGN: Interventional case report. METHODS: A 60-year-old man presented with corneal stromal edema in the right eye and sudden bilateral sensorineural hearing loss. The trabeculum excised during trabeculectomy and the aqueous humor were examined for the presence of herpes simplex virus type 1 DNA by polymerase chain reaction. RESULTS: Polymerase chain reaction demonstrated herpes simplex virus type 1 DNA in the aqueous humor and the trabeculum. CONCLUSION: Herpes simplex virus type 1 may cause corneal endotheliitis and idiopathic sudden sensorineural hearing loss simultaneously.     

Cytomegalovirus in aqueous humor from an eye with corneal endotheliitis

PURPOSE: To report cytomegalovirus (CMV) DNA in aqueous humor from a patient with unilateral corneal endotheliitis. DESIGN: Case report. METHODS: A 51-year-old man presented with unilateral corneal endotheliitis with linear keratic precipitates and coin-shaped lesions. Tear and aqueous humor samples were subjected to polymerase chain reaction to look for DNA from herpes simplex virus (HSV), varicella zoster virus (VZV), and CMV. RESULTS: Aqueous humor from the diseased eye contained DNA from CMV but not HSV or VZV. Its specificity was confirmed by Southern blot tests. Intravenous ganciclovir treatment resulted in the localization of his corneal edema and the reduction in keratic precipitates. There was severe destruction of corneal endothelial cells. CMV DNA was not detected in tears or control samples. CONCLUSIONS: In this healthy man with corneal endotheliitis, we detected CMV DNA in aqueous humor from the affected eye, but not HSV or VZV. This suggests that CMV may cause corneal endotheliitis in patients without immunodeficiency.     

The Effect of Topical Ganciclovir and Corticosteroid on Cytomegalovirus Corneal Endotheliitis in Korean Patients

Purpose: To report long-term outcomes of topical ganciclovir (GCV) and corticosteroids in Korean patients with cytomegalovirus (CMV) corneal endotheliitis.

Methods: This retrospective study included 13 eyes from 13 patients with CMV corneal endotheliitis, with a follow-up period of 24.5 ± 8.2 months. The patients were consistently maintained with topical 2% GCV and 1% prednisolone acetate eyedrop.

Results: All patients demonstrated unilateral typical coin-shaped keratic precipitates (KPs) or linear KP, and positive CMV polymerase chain reaction of aqueous humor. After 2 weeks of treatment, all patients showed decrease of clinical signs. During the follow-up, four patients developed mild anterior chamber inflammation with increased intraocular pressure without typical coin-shaped KPs or edema, started to use the initial dose, and resolved the clinical signs. One patient showed recurrence of corneal edema twice, and was administered systemic valgancyclovir for 2 weeks upon second recurrence with resolution of clinical signs.

Conclusion: Long-term maintenance therapy with topical GCV and corticosteroids are effective and maintain corneal endothelial function in Korean patients with CMV endotheliitis.     

Increased Aqueous Humor CD4+/CD8+ Lymphocyte Ratio in Sarcoid Uveitis

Purpose: To determine aqueous humor CD4+/CD8+ T-lymphocyte ratio changes in sarcoid and non-sarcoid uveitis with anterior chamber involvement.

Methods: The case-control study includes 61 patients with either anterior uveitis, intermediate uveitis with anterior spill, or panuveitis. A total of 21 of them were categorized as sarcoid uveitis and 40 as non-sarcoid uveitis according to diagnostic criteria. CD4+/CD8+ ratio in the aqueous humor was determined using flow cytometry.

Results: Significantly higher CD4+/CD8+ ratio in the aqueous humor was observed in patients with sarcoid uveitis (6.3 ± 1.4; mean ± SEM) compared to non-sarcoid uveitis (1.6 ± 0.1; mean ± SEM). Whole blood CD4+/CD8+ ratio was not elevated in subjects with sarcoid and non-sarcoid uveitis. Aqueous humor CD4+/CD8+ ratio >3.5 was observed to be associated with sarcoid uveitis (OR 38, 95% CI 7.0–205.2).

Conclusion: Increased aqueous humor CD4+/CD8+ ratio in sarcoid uveitis. Immunophenotyping of localized lymphocytosis in aqueous humor could be utilized as an additional confirmatory marker for ocular sarcoidosis.     

白内障超声乳化术对房水流畅系数的影响

目的：应用眼压描记法观察白内障超声乳化术对房水流畅系数的影响。

方法：选取2018-01/10在我院接受白内障超声乳化联合人工晶状体植入术的年龄相关性白内障患者126例126眼，手术前后采用非接触眼压计测量眼压，采用Schiotz电子眼压计测量房水流畅系数。

结果：术后1d本组患者眼压(19.01±1.81mmHg)较术前(17.09±1.70mmHg)升高，但术后1wk，1、3mo眼压均较术前降低(P<0.05)； 术后1wk，1、3mo房水流畅系数(0.20±0.01、0.22±0.02、0.22±0.02)均较术前(0.19±0.02)明显改善(P<0.05)。

结论：白内障超声乳化术会增加房水流畅系数，这可能与术后眼压降低有关。     

Anti-Inflammatory Effect of Dehydroxymethylepoxyquinomicin,a Nuclear factor–κB Inhibitor,on Endotoxin-Induced Uveitis in Rats In vivo and In vitro

ABSTRACT

Purpose: To determine the anti-inflammatory effects of dehydroxymethylepoxyquinomicin (DHMEQ), a nuclear factor-κB (NF-κB) inhibitor, on endotoxin-induced uveitis (EIU) in rats.

Methods: EIU was induced by a subcutaneous injection of lipopolysaccharide (LPS) in Lewis rats. DHMEQ was injected intraperitoneally concurrently with the LPS. Aqueous humor was collected 24 h after the LPS injection. Isolated peritoneal exudate cells (PECs) were exposed to LPS with or without DHMEQ to determine the production of TNF-α, IL-6, and MCP-1.

Results: DHMEQ significantly reduced the number of infiltrating cells, and the concentrations of proteins, TNF-α, and IL-6 in the aqueous humor. DHMEQ suppressed the production of TNF-α, IL-6, and MCP-1 from PECs. Immunochemistry revealed a reduction in the translocation of the NF-κB p65 into the nuclei in DHMEQ-exposed PECs.

Conclusions: The results indicate that DHMEQ has anti-inflammatory effects on EIU and may be a promising agent to treat intraocular inflammation.     

DNA of cytomegalovirus detected by PCR in aqueous of patient with corneal endotheliitis after penetrating keratoplasty

PURPOSE: Corneal endotheliitis often leads to severe endothelial dysfunction and can be caused by herpes simplex virus (HSV), varicella zoster virus (VZV), and other viruses (eg, the mumps virus). We report a case of corneal endotheliitis caused by cytomegalovirus (CMV) that developed after a penetrating keratoplasty. METHODS: A complete ophthalmologic examination was performed on a patient with corneal endotheliitis that developed after a penetrating keratoplasty. To determine the cause of the endotheliitis, polymerase chain reaction (PCR) was used to amplify the DNA of HSV, VZV, and CMV in samples of the aqueous humor. RESULTS: Slit-lamp biomicroscopy showed a moderate stromal edema in the upper temporal part of the transplanted cornea along with keratic precipitates (KPs) arranged in a coin-shaped pattern. Repeated treatments with steroids and acyclovir were only temporarily successful. PCR detected the DNA of CMV in an aqueous sample, and the treatment was switched to topical and systemic application of ganciclovir. This resulted in the disappearance of the KPs and resolution of the stromal edema within 2 weeks. CONCLUSIONS: From the PCR results and the favorable response to ganciclovir, the corneal endotheliitis was most likely caused by cytomegalovirus in this case.     

Evaluating the presence of SARS-CoV-2 in the intraocular fluid of COVID-19 patients

Purpose:To detect the presence of SARS-CoV-2 in aqueous and vitreous humor of COVID-19 patients in a pilot study.Methods:Consecutive patients planned for emergency ophthalmic surgeries after ocular trauma were subjected to naso-oropharyngeal RT-PCR test for SARS-CoV-2. Laboratory-confirmed cases were enrolled for the study. During surgery, 0.1 mL aqueous and vitreous each was aspirated. The vitreous tap was collected on clinical suspicion of endophthalmitis. RT-PCR test was used to detect SARS-COV-2 nucleotide in the samples. Cycle threshold (Ct) for E gene of ≤35 along with confirmatory results on one of the two target genes (RdRp or ORF1b) was considered as positive.Results:One hundred and thirty two patients were found positive on naso-oropharyngeal RT-PCR test for SARS-CoV-2 preoperatively. Seven patients with ocular trauma were studied. The mean age was 31.8 years. There were six male and one female patient. Two patients had symptoms of mild COVID-19 disease and the rest were asymptomatic. The mean Ct value of the E gene on naso-oropharyngeal RT-PCR was 23.14 ± 4.7. Corneal and corneoscleral laceration repair was done in five patients, intracorneal wooden foreign body was removed in one patient, and injection of intravitreal antibiotics was done in one patient. Aqueous and vitreous tap was collected in 7 and 5 patients, respectively. None of the aqueous or vitreous samples was found positive for SARS-CoV-2.Conclusion:SARS-CoV-2 was not detected by RT-PCR in aqueous or vitreous humor in this pilot study. Future studies with a larger sample size are needed to further explore the presence of SARS-CoV-2 in intraocular fluids.     

原发性开角型青光眼患者房水中IL-37和IL-6的表达及意义

目的:检测原发性开角型青光眼(POAG)患者房水中IL-37和IL-6的含量,并分析IL-6和IL-37含量与眼压或视野平均缺损的相关性。方法:采用前瞻性病例对照研究,利用酶联免疫吸附试验(ELISA)对2019-06/2020-01在南京医科大学附属眼科医院连续就诊的25例POAG患者和25例年龄相关性白内障(ARC)患者房水中IL-37和IL-6含量进行检测。同时测定POAG组患者眼压、视野平均缺损。结果:房水中IL-37和IL-6含量POAG组患者为25.80±2.87、43.87±7.75pg/mL,ARC组患者为23.75±3.88、36.53±7.60pg/mL,两组间IL-37和IL-6含量比较均有差异(P<0.05)。IL-6与眼压正相关(r=0.5817,P<0.05),IL-37与视野缺损正相关(r=0.4520,P<0.05)。结论:POAG患者房水中IL-37、IL-6含量均显著高于ARC组。IL-37和IL-6介导的免疫炎症反应可能参与了POAG的发病机制。     

Correlation of aqueous humor electrolytes with serum electrolytes in cataract patients

Purpose:To correlate the aqueous humor electrolytes with serum electrolytes in patients with cataract.Methods:In this study, 348 eyes of patients undergoing cataract surgery, who had presented between 1^st January 2019 and 30^th June 2020, were included. Serum electrolytes were obtained and 0.15 ml of aqueous humor was obtained during surgery using an insulin syringe via the side port incision. Mean and standard deviation was used to analyze all the categorical and continuous data including all the electrolytes levels. Pearson’s correlation of coefficient was used to analyze the comparison between serum and aqueous humor electrolytes. Student T-test was used to compare electrolyte values between the serum and aqueous humor.Results:We observed a significant correlation of the aqueous humor electrolytes with their serum counterparts. The coefficient of correlation is 0.155, 0.44, and 0.405 for Na+, K+, and Cl−, respectively. There is also a significant increase in the aqueous humor electrolytes as compared to the serum levels.Conclusion:A significant increase in electrolytes levels in the aqueous humor of cataract patients possibly could have a role in the etiology of cataract.     

Comparison of the Acute Effects of anti-TNF-alpha Drugs on a Uveitis Experimental Model

Purpose: To compare histopathological and biochemical effects of the anti-TNF-alpha drugs adalimumab and infliximab in a uveitis experimental model.

Methods: Histopathological evaluation was performed 24?h after endotoxin (200 μg into the footpad) and drug administration, as well as biochemical analysis of oxidative stress-related markers in the aqueous humor.

Results: Severe inflammation was found in rat anterior chamber of the eye 24?h after endotoxin. Only infliximab administration partially prevented the endotoxin-induced disruption of the blood–aqueous barrier, as well as the increase in Rantes and MCP-1 concentration in aqueous humor. Both drugs ameliorated the histopathological score after endotoxin. Biochemical analysis revealed that both drugs protected against endotoxin-induced oxidative stress, restoring all markers to control levels, except infliximab, which failed to restore GSH concentration.

Conclusions: Both anti-TNF-alpha drugs were effective in reducing histopathological inflammation but their mechanism of action appears to be different.     

糖尿病性白内障患者糖代谢异常、胰岛素抵抗与房水及血清中炎症因子的相关性分析

目的：通过测定糖尿病性白内障患者血清中糖代谢指标、胰岛素抵抗与房水和血清中炎症因子的水平,探讨其相关性。

方法：随机选取我院2017-02/2018-01糖尿病性白内障患者69例(观察组)和白内障患者65例(对照组),检测两组患者血清中糖化血红蛋白(HbA1c)、空腹血糖(FPG)、空腹胰岛素(FINS)的水平,计算胰岛素抵抗指数(HOMA-IR); 同时检测房水和血清中的胰岛素样生长因子-1(IGF-1)、白细胞介素-6(IL-6)含量,对HbA1c、HOMA-IR与房水和血清中IGF-1、IL-6含量进行相关性分析。

结果：对照组血清中的FPG、HbA1c、HOMA-IR,以及房水和血清中IGF-1、IL-6含量显著低于观察组,差异有统计学意义(均P<0.05)。HbA1c与房水及血清中的IGF-1和IL-6均呈正相关(P<0.05)。HOMA-IR与房水及血清中的IGF-1和IL-6均呈正相关(P<0.05)。

结论：糖尿病性白内障患者HbA1c、HOMA-IR与房水及血清中的IGF-1、IL-6含量具有相关性,通过对上述指标的测定可以辅助判断病情。     

糖尿病性白内障患者血清与房水中细胞因子表达的变化

目的：分析糖尿病性白内障患者血清和房水中维生素C、氧化应激产物、炎症因子及血管内皮生长因子(VEGF)水平变化。

方法：选取2018-01/2019-12我院收治的糖尿病性白内障患者40例40眼作为观察组,单纯白内障患者40例40眼作为对照组。分析两组患者血液和房水样本中维生素C、氧化应激产物(丙二醛)、炎症因子(IL-6和IL-8)及VEGF水平的差异。

结果：两组患者血清维生素C水平无差异(P>0.05),但观察组房水维生素C水平明显低于对照组(20.6±13.6mg/L vs 27.2±9.9mg/L,P<0.05); 两组患者血清丙二醛水平无差异(P>0.05),但观察组房水丙二醛水平明显高于对照组(12.6±4.6nmol/mL vs 8.0±3.1nmol/mL,P<0.001); 观察组血清和房水IL-6、IL-8水平均明显高于对照组(P<0.001); 两组患者血清VEGF水平无差异(P>0.05),但观察组房水VEGF水平明显高于对照组(45.6±20.6pg/mL vs 16.5±4.5pg/mL,P<0.001)。

结论：糖尿病性白内障患者与单纯白内障患者相比,虽然血清维生素C、氧化应激产物及VEGF水平相似,但其房水中维生素C、氧化应激产物及VEGF水平存在较大的差异,同时糖尿病性白内障患者血清和房水炎症因子水平相比单纯白内障患者更高。     

Total oxidative stress, paraoxonase and arylesterase levels at patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma

AIM:To investigate the oxidative stress status of the aqueous humor and serum of patients with pseudoexfoliation (PEX) syndrome and pseudoexfoliative glaucoma (PEG) and to measure paraoxonase (PON) and arylesterase (ARE) levels.METHODS: A total of 78 patients were enrolled in the study, with 26 patients in each separate group. The patients were divided into three groups:the first group entailed PEX syndrome patients, while the second group consisted of patients with PEG and the third group involved patients with no additional systemic diseases, other than the diagnosis of cataract as control. Total oxidative stress (TOS), total antioxidant capacity (TAC), PON, and ARE levels in aqueous humor and serum were measured.RESULTS: TAC, PON and arylesterase levels in aqueous humor and serum of the PEX syndrome and PEG patients were significantly decreased compared with control group (P<0.05). TOS values were higher in patients with PEX syndrome and PEG than controls (P<0.05). TAC, PON and ARE levels of aqueous humor did not differ significantly between the PEX syndrome and PEG groupsCONCLUSION: These findings are potentially of significance and add to the growing body of evidence for oxidative stress in PEX syndrome and PEG. Decreased antioxidant defense and increased oxidative stress system may play an important role in the pathogenesis of PEX syndrome and PEG.     

Change in Corneal Permeability to Timolol After Laser In Situ Keratomileusis and Photorefractive Keratectomy in Rabbit

Purpose To evaluate the change in corneal permeability to timolol 1 month after laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) in rabbits.Methods LASIK or PRK was performed on one eye of each of 20 rabbits. One month later, 20µl of 0.5% timolol was instilled into the 10 LASIK eyes, 10 PRK eyes, and the 20 control contralateral eyes. One hour later, 150µl of aqueous humor was collected from all eyes, and the concentration of timolol in the aqueous humor was measured by high-performance liquid chromatography. The effect of LASIK and PRK on the corneal permeability to timolol was analyzed.Results The average timolol concentrations in the aqueous humor of the ten eyes 1 month after LASIK and in the ten contralateral eyes were 1.16 ± 0.58µg/ml and 1.07 ± 0.39µg/ml (average ± SD, P = 0.678), respectively. The average timolol concentrations in the aqueous humor of the ten eyes 1 month after PRK and in the ten contralateral eyes were 1.24 ± 0.43µg/ml and 1.12 ± 0.30µg/ml (P = 0.483), respectively. The average ratio of timolol concentration in the aqueous humor of the LASIK or PRK eyes 1 month after surgery to that of the contralateral normal eyes was 1.18 ± 0.58 or 1.19 ± 0.67 (P = 0.972), respectively.Conclusions LASIK and PRK do not affect corneal permeability to timolol 1 month after surgery. Jpn J Ophthalmol 2005;49:12–14 © Japanese Ophthalmological Society 2005