A retrospective analysis of Heparin-surface-modified intraocular lenses versus regular polymethylmethacrylate intraocular lenses in patients with uveitis

Background: Several studies described the benefits of the heparin-surface-modified intraocular lens (HSM IOL) with regard to the reduced inflammation in routine extracapsular cataract extractions. However, limited information is available about the advantages of the HSM IOL in patients with an intraocular inflammation. Aim: To assess the eventual benefits of the HSM IOL compared to the regular polymethylmethacrylate intraocular lens (PMMA IOL) in patients with uveitis. Methods: A retrospective study of 43 patients with uveitis of various origins who underwent an extracapsular cataract extraction (24 with HSM, 19 with PMMA IOL). The activity of intraocular inflammation, visual acuity, eventual complications, and medications were examined. Standardized follow-up dates were used (before surgery, one and fourteen days, five and eleven months after surgery.) Results: No difference in the inflammatory activity was noted between HSM and PMMA groups; neither at short term clinical evaluation, nor at five months after surgery. Despite a slightly better visual acuity in the HSM group before surgery, no long term differences were observed. After surgery the increase in visual acuity was similar for both groups, as well as the frequency of cystoid macular oedema (CMO) and synechiae. Fewer patients in HSM group required Nd:YAG posterior capsulotomy, but the difference was not significant. Conclusion: No clinical advantage was found when the HSM IOL was compared with the regular PMMA IOL in 43 patients with uveitis.     

Long term ocular and neurological involvement in severe congenital toxoplasmosis.

AIMS--This study was set up to determine the long term ocular and systemic sequelae in patients with severe congenital toxoplasmosis. METHODS--Cross sectional and retrospective study of 17 patients with severe congenital toxoplasmosis. RESULTS--In addition to chorioretinitis (100%), the most common abnormal ocular features were optic nerve atrophy (83%), visual acuity of less than 0.1 (85%), strabismus, and microphthalmos. In 50% of cases we observed iridic abnormalities and about 40% developed a cataract. Overt endocrinological disease, diagnosed in five of 15 patients, included panhypopituitarism (n = 2), gonadal failure with dwarfism (n = 1), precocious puberty with dwarfism and thyroid deficiency (n = 1), and diabetes mellitus and thyroid deficiency (n = 1). The observed endocrinological involvement was associated in all cases with obstructive hydrocephalus with a dilated third ventricle and optic nerve atrophy. CONCLUSION--The recognition of long term ocular, neurological, and endocrinological sequelae of congenital toxoplasmosis is important for medical management of these severely handicapped patients.     

Aqueous chamber taps in toxoplasmic chorioretinitis

The clinical value of the determination of toxoplasma antibodies in anterior chamber taps was evaluated in 12 posterior uveitis patients suspected of a toxoplasmic retinochoroiditis, in four patients with Fuchs's heterochromia and in 31 cataract patients.The posterior uveitis patients all had marked inflammation of the vitreous obstructing the examination of the fundus of the time of aqueous humour aspiration. The clinical diagnosis toxoplasmic uveitis (n = 9) was made after the inflammation of the vitreous had subsided and fundus examination became possible again. Paired serum and aqueous samples were tested for total immunoglobulin levels and toxoplasma antibodies.Eight of the nine clinical toxoplasmic uveitis patients had detectable toxoplasma antibodies in their aqueous, whereas none of the other seven uveitis patients were positive. All of these eight toxoplasmic uveitis patients had a coefficient above 1.5. Of the 31 control patients only one had a positive antibody titer at a dilution of 1/2 with a corresponding coefficient of 1.1. This study shows that aqueous humour examination for toxoplasma antibodies is a valuable diagnostic tool in a selected group of posterior uveitis patients.     

The use of HLA-B27 as a diagnostic and prognostic aid in acute anterior uveitis (AAU) in the Netherlands

Acute anterior uveitis (AAU) may be considered to be one manifestation of the seronegative spondylarthropathies of which ankylosing spondylitis (AS) is the prototype, especially when the patient is HLA-B27 positive. However, it is not yet clear under which circumstances a patient with AAU should be reffered to the rheumatologist. In a retrospective study we evaluated the management of 68 consecutive HLA-B27⁺ AAU patients from a rheumatologic point of view. Although the majority (73%) showed rheumatic problems, only half (52%) of the patients was referred to a rheumatologist, due to problems in evaluation of clinical history and of x-ray reading of the sacroiliac (SI) joints. Because HLA-B27 typing will determine whether the AAU patients at risk have AS or a related arthropathy, we suggest using HLA-B27 typing in AAU patients as a diagnostic and prognostic aid. When the AAU patient is found to be HLA-B27 positive, the rheumatologist will be able to split these patients into those with AS and those without. Early diagnosis of AS in AAU patients is important as an early start of drug therapy and physiotherapy may prevent deformities and improve final rheumatologic outcome.     

Distinct cytokine and chemokine profiles in the aqueous of patients with uveitis and cystoid macular edema

PURPOSE: To investigate the global cytokine and chemokine expression pattern in the aqueous humor of uveitis patients and relate them to clinical features. DESIGN: Cross-sectional study. METHODS: In 31 aqueous humor samples from uveitis patients, the concentration of mediators was measured by a multiplex immunoassay. Eleven control samples were included. RESULTS: Uveitis samples had higher levels of interleukin-6, interleukin-8, soluble intercellular adhesion molecule, soluble vascular cell adhesion molecule (sVCAM), and interferon-inducible protein-10 (IP-10) than nonuveitis controls. Active uveitis samples had higher levels of interleukin-6, interleukin-10, interferon-gamma, sVCAM, regulated on activation, normal T cell expressed and secreted (RANTES), and IP-10 than quiescent uveitis samples. Infectious uveitis was associated with higher levels of interleukin-10 than noninfectious uveitis (P < .03 for all subgroups). No significant differences were found between cystoid macular edema (CME) and non-CME samples. CONCLUSIONS: Elevated levels of specific mediators were found in active and in infectious uveitis, but not in CME. Mediator profiles might lead to a better understanding of the pathogenesis of uveitis.     

Lineage tracing of the endoderm during oral development

Background: The contribution of the endoderm to the oral tissues of the head has been debated for many years. With the arrival of Cre/LoxP technology endoderm progenitor cells can now be genetically labeled and tissues derived from the endoderm traced. Using Sox17-2A-iCre/Rosa26 reporter mice we have followed the fate of the endoderm in the teeth, glands, and taste papillae of the oral cavity. Results: No contribution of the endoderm was observed at any stage of tooth development, or in development of the major salivary glands, in the reporter mouse during development. In contrast, the minor mucous glands of the tongue were found to be of endodermal origin, along with the circumvallate papilla and foliate papillae. The mucous minor salivary glands of the palate, however, were of mixed ectodermal and endodermal origin. Conclusions: In contrast to urodele studies, the epithelium of murine teeth is derived solely from the ectoderm. The border between the ectoderm- and endoderm-derived epithelium may play a role in determining the position of the lingual glands and taste buds, and may explain differences observed between taste buds in the anterior and posterior part of the tongue.     

Polymerase chain reaction detection of Neisseria meningitidis in the intraocular fluid of a patient with endogenous endophthalmitis but without associated meningitis

PURPOSE: To report a patient with Neisseria meningitidis endophthalmitis without associated meningitis with full visual recovery, with early detection of the microorganism using polymerase chain reaction (PCR) analysis. DESIGN: Retrospective, observational case report. PARTICIPANTS: One patient with endogenous endophthalmitis. METHODS: Polymerase chain reaction analysis and culture of the intraocular fluid sample. Polymerase chain reaction analysis was performed with a universal (16S rRNA) primer set to detect bacterial DNA, and subsequently a specific probe was used to detect Neisseria species DNA. RESULTS: The 16S rRNA primers detected bacterial DNA, the specific probe detected Neisseria species DNA, and culture was positive for Neisseria meningitidis serotype C. CONCLUSIONS: A universal bacterial PCR can be very helpful for the diagnosis of endogenous bacterial endophthalmitis at an early stage of the disease.