Anat Galor

Effect of CXCL-1/KC production in high risk vascularized corneal allografts on T cell recruitment and graft rejection

Background. The survival rate of corneal allografts in high-risk vascularized corneal bed recipients is poor, similar to vascularized solid organ allografts. Although the early induction of selective chemokines in solid organs is required for the optimal recruitment of T cells into rejecting allografts, little is known about the role of these chemokines in high risk corneal allografts. Methods. Orthotopic corneal allotransplants were performed in low-risk (nonvascularized) and high-risk (vascularized) C57BL/6 (H-2b) recipients using Balb/c (H-2d) donors. Intragraft production of CXC chemokines was measured by Luminex and enzyme-linked immunosorbent assay on corneal transplant extracts at different times after surgery. Rabbit anti-KC serum was used to test its role in high risk corneal allograft survival. Results. Early upregulation of CXCL1/KC occurs 3 days after transplantation in high risk allograft only. Moreover, the T-cell chemoattractants, CXCL9/Mig and CXCL10/IP10, are produced late (day 10) after surgery and their production correlates with the recruitment of CD4 T cells into the graft. Furthermore, in vivo neutralization of CXCL1/KC with anti-KC sera results in increased graft survival and decreased recruitment of T cells into high-risk allografts. Conclusion. We propose that a high risk vascularized cornea behaves like a vascularized solid organ transplant. The early production of CXCL1/KC is crucial to the induction of T-cell chemoattractants necessary for the recruitment of allospecific CD4 T cells into the graft. In vivo neutralization of CXCL1/KC represents a potential novel therapy that could be used to increase the survival rate of high-risk vascularized corneal allografts.

Predictive factors for short-term visual outcome after intravitreal triamcinolone acetonide injection for diabetic macular oedema: An optical coherence tomography study

Aim: To evaluate the predictive factors for visual outcome after intravitreal triamcinolone acetonide injection to treat refractory diabetic macular oedema (DME). Methods: A retrospective chart review of patients with DME who met the following inclusion criteria was performed: clinically significant diabetic macular oedema, receipt of a 4 mg/0.1 ml intravitreal triamcinolone acetonide injection and an optical coherence tomography (OCT) of the macula performed up to 10 days before injection. All patients received a full ophthalmic examination including best-corrected Snellen visual acuity (VA). The main outcome measure was the mean change in vision 3 months after injection. Results: Data from 73 eyes of 59 patients were analysed. After a mean follow-up of 324 days, the mean change in vision was −0.075 logarithm of minimum angle of resolution (logMAR) units, with 27.3% improving ⩾3 lines, 6.8% declining ⩾3 lines and 60.2% remaining stable within 1 line of baseline vision. Statistical analysis was performed using multivariate generalised estimating equations on the basis of data from 52 eyes of 42 patients. Factors associated with an improvement in vision 3 months after injection were worse baseline VA (−0.27 logMAR units/unit increase in baseline VA, p = 0.002) and presence of subretinal fluid (−0.17 logMAR units, p = 0.06). The presence of cystoid macular oedema negatively affected the visual outcome (0.15 logMAR units, p = 0.03). In addition, the presence of an epiretinal membrane (ERM) was associated with less visual improvement. ERM modified the effect of baseline VA as demonstrated by a significant interaction between these two variables (0.34 logMAR units/unit increase in baseline VA, p = 0.04). Conclusions: OCT factors and baseline VA can be useful in predicting the outcomes of VA 3 months after intravitreal triamcinolone acetonide injection in patients with refractory DME.

Disappearance of classic birdshot spots after immunosuppression with tacrolimus and mycophenolate mofetil

Birdshot chorioretinopathy is commonly diagnosed by characteristic choroidal spots on funduscopic exan. These spots are particularly prominent on indocyanine angiography and can resolve with treatment. The clinical significance of this is not clear. We present a case of birdshot chorioretinopathy with classic spots which resolved after immunosupression with mycophenolate mofetil, tacrolimus and prednisone. A 35-year-old white woman with a 1-year history of birdshot chorioretinopathy (BSCR) complicated by choroidal neovascular …

Resolution of conjunctival Kaposi sarcoma after institution of highly active antiretroviral therapy alone.

We present a case of conjunctival Kaposi sarcoma that resolved after treatment with highly active antiretroviral therapy alone. A 53-year-old man from Ghana was diagnosed with human immunodeficiency virus in July 2005 and presented on March 2006 with a 2-week history of itching, redness and pain in the right eye. His examination showed a large, mobile, slightly tender lesion of the conjunctiva, not involving caruncle (fig 1). At that time his CD4+ T cell count was 38 cells/μl. He had simultaneous lesions on his feet consistent with Kaposi sarcoma. Biopsy of his foot …

Recurrence rates of herpes simplex virus keratitis in contact lens and non-contact lens wearers.

Objective: To evaluate the recurrence rates of herpes simplex virus (HSV) keratitis in contact lens wearers compared with non-contact lens wearers. Methods: Retrospective cohort study. Charts of patients diagnosed with HSV keratitis seen at the Cleveland Clinic between January 2001 and December 2004 were reviewed. Results: One hundred seventeen patients were included in this study: 21 contact lens wearers and 96 non-contact lens wearers. Contact lens wearers were found to have a higher median recurrence rate (0.4 episodes/year) compared with non-contact lens wearers (0.2 episodes/year) (P=0.02). A multivariate regression evaluating factors predictive of the number of recurrences found that contact lens use remained a significant predictive variable (P=0.02) when accounting for patient demographic and disease factors and variable follow-up time. Conclusions: Patients with a history of HSV keratitis should be counseled about the potential increased risk of recurrence that may be associated with contact lens wear.

Surgical drainage of chronic serous retinal detachment associated with uveitis.

Purpose: To evaluate the anatomic and visual outcomes after surgical management of chronic serous retinal detachments (SRD) associated with uveitis. Methods: Retrospective, interventional, case study of patients with uveitis with controlled ocular inflammation who underwent drainage of a chronic SRD at the Cole Eye Institute (1998–2006). Data collected included diagnosis, ophthalmic findings, medical management, surgical technique, complications, and anatomic and visual outcomes. Results: Five patients with uveitis were identified who underwent surgical drainage of a SRD. Preoperative medical treatment included prednisone 1 mg/kg with various tapering regimens. The median time on oral corticosteroids preoperatively was 4 months (range 3–6 months). Four patients received further adjuvant treatment. Median time from SRD diagnosis to surgical drainage was 6 months (range 3–15 months). No patient had active intraocular inflammation preoperatively. Retinal reattachment was achieved in all patients after a median follow-up of 55 months (range 1–61 months). Four of five patients experienced improvement in visual acuity after surgical intervention. Conclusion: Select patients with uveitis with a SRD whose subretinal fluid fails to resorb after medical therapy and resolution of inflammation can achieve long-term retinal reattachment by surgical management.

Papillary conjunctivitis associated with kikuchi disease

Purpose: To describe a case of papillary conjunctivitis associated with Kikuchi-Fujimoto disease (KFD). Methods: Case report. Results: A 35-year-old black man developed bilateral eye redness before developing high fevers and cervical lymphadenopathy. Mediastinoscopy confirmed the diagnosis of KFD. The eye redness resolved on a regimen of prednisone 60 mg daily and recurred after corticosteroids were discontinued. The patient was found to have bilateral papillary conjunctivitis that resolved with topical prednisolone acetate. Conclusions: Papillary conjunctivitis may be associated with KFD.

Transient band keratopathy associated with ocular inflammation and systemic hypercalcemia

Purpose To report a case of visually significant band keratopathy associated with ocular inflammation and systemic hypercalcemia which markedly decreased in severity after treatment of these underlying factors. Methods Retrospective case report. Results A 53-year-old Asian female with granulomatous panuveitis in the left eye presented with diffuse band keratopathy through the central cornea. The serum calcium was elevated. The patient was treated with topical prednisolone acetate 1% and oral prednisone with marked improvement in inflammation. The band keratopathy lessened in severity with clearing of the central cornea and improvement in visual acuity. Conclusions Early medical treatment of underlying factors may allow reversal of band keratopathy.

Evidence that dry eye is a comorbid pain condition in a U.S. veteran population

Introduction: Recent evidence suggests that dry eye (DE) may be comorbid with other chronic pain conditions. Objectives: To evaluate DE as a comorbid condition in the U.S. veteran population. Methods: Retrospective review of veterans seen in the Veterans Administration Healthcare System (Veteran Affairs) between January 1, 2010, and December 31, 2014. Dry eye and nonocular pain disorders were ascertained by International Classification of Diseases, Ninth Revision (ICD-9) codes. Dry eye was further separated into ICD-9 codes representing tear film dysfunction or ocular pain. &khgr;2 and logistic regression analyses were used to examine frequency and risk of DE, ocular pain, and tear film dysfunction by pain disorders. Results: Of 3,265,894 veterans, 959,881 had a DE diagnosis (29.4%). Dry eye frequency increased with the number of pain conditions reported (P < 0.0005). Ocular pain was most strongly associated with headache (odds ratio [OR] 2.98; 95% confidence interval [CI] 2.95–3.01), tension headache (OR 2.64; 95% CI 2.58–2.71), migraine (OR 2.58; 95% CI 2.54–2.61), temporomandibular joint dysfunction (OR 2.39; 95% CI 2.34–2.44), pelvic pain (OR 2.30; 95% CI 2.24–2.37), central pain syndrome (OR 2.24; 95% CI 1.94–2.60), and fibromyalgia/muscle pain (OR 2.23; 95% CI 2.20–2.26), all P < 0.0005. Tear film dysfunction was most closely associated with osteoarthritis (OR 1.97; 95% CI 1.96–1.98) and postherpetic neuralgia (OR 1.95; 95% CI 1.90–2.00), both P < 0.0005. Conclusions: Dry eye, including both ocular pain and tear film dysfunction, is comorbid with pain conditions in this nationwide population, implying common mechanisms.