Charalampos Livir-Rallatos

High levels of interleukin-12 in the aqueous humor and vitreous of patients with uveitis

OBJECTIVE This study aimed to investigate the role of interleukin-12 (IL-12) and interleukin-10 (IL-10) in initiation and maintenance of intraocular inflammation. DESIGN Case series. PARTICIPANTS Aqueous humor and vitreous levels of IL-12 and IL-10 were measured in 22 patients with uveitis undergoing cataract surgery, paracentesis of the anterior chamber, and/or vitrectomy for diagnostic reasons, and in 4 patients with cataract only. INTERVENTION Aqueous humor and vitreous levels of IL-12 and IL-10 were measured with specific enzyme-linked immunosorbent assays. MAIN OUTCOME MEASURES Disease activity was correlated to IL-12 levels in the aqueous humor and the vitreous of patients with uveitis. RESULTS Cytokine levels found in the anterior chamber and the vitreous are presented in picogram/milliliter (medium; range). The highest IL-12 levels were found in patients with active uveitis (108.5 pg/ml; 72-293 pg/ml). Interleukin-12 in patients with moderate uveitis or with their disease in remission was lower (32 pg/ml; 15-94 pg/ml) than in patients with active disease (P > 0.001) but higher than in the control group (10.5 pg/ml; 9-14 pg/ml). Interleukin-10 was detectable in only 3 of 22 patients with uveitis (12 pg/ml; 9-23 pg/ml). CONCLUSION The authors found statistically significant differences of IL-12 levels in the various patient groups (active vs. inactive vs. control). These results support the idea that these uveitis cases represent type 1 (Th1)-T lymphocyte-mediated diseases in which IL-12 plays a pivotal role in the initiation and maintenance of the intraocular inflammation. The high levels of IL-12 in the vitreous and/or aqueous humor of the patients with uveitis suggest that susceptibility or resistance to ocular autoimmunity may be connected to a genetic predisposition to an elevated Th1 response.

Recurrent nodular scleritis associated with varicella zoster virus

PURPOSE To describe a case of recurrent nodular scleritis that was apparently caused by reactivation of a varicella zoster virus infection. METHODS Case report. Immunohistochemistry and polymerase chain reaction were used to detect viral antigen and DNA in the biopsy specimen of inflamed sclera of a patient with a history of recurrent nodular scleritis.

Ocular Photodynamic Therapy in Choroidal Neovascularization Complicating Idiopathic Central Serous Chorioretinopathy

Two consecutive patients with idiopathic central serous chorioretinopathy and decreased vision subsequent to subfoveal choroidal neovascular membranes were treated with photodynamic therapy applied using the protocol of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study Group. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and leakage on fluorescein and indocyanine green angiography. Photodynamic therapy offered anatomical, angiographic, and functional improvement. After an initial complete response, the patients required re-treatment at 3 and 4 months, respectively. Cessation of leakage with improvement in visual acuity occurred, but subretinal fibrosis posed a possible limitation for full functional recovery. Although choroidal neovascular membranes complicating idiopathic central serous chorioretinopathy portend a poor visual prognosis, the overall response to photodynamic therapy was favorable.

Human mast cell subtypes in conjunctiva of patients with atopic keratoconjunctivitis, ocular cicatricial pemphigoid and Stevens-Johnson syndrome

Purpose: Investigate mast cell (MC S ) subtypes in atopic keratoconjunctivitis (AKC), ocular cicatrical pemphigoid (OCP), and Stevens-Johnson Syndrome (SJS). Methods: MC S subtypes were determined by immunohistochemistry of conjunctiva (obtained from 34 patients – 9 AKC, 9 OCP, 9 SJS and 7 normal) using monoclonal antibodies directed against chymase (MC C ) and tryptase (MC T ). Double staining was used to distinguish MC S as positive for both chymase and tryptase (MC TC ). Results: The number of MC S was significantly increased in AKC, OCP and SJS patients, compared to normal subjects. MC C were especially high in AKC, and moderately high in OCP. MC T and MC TC were similar in each disease group. Conclusions: While the AKC findings were not surprising, the result in OCP and SJS suggests that MC S play an underappreciated role in the inflammatory process of these disorders. Disparate proportions of MC S subtypes in these diseases may imply differential functions of MC S in these disorders.

Small-size pediatric vitrectomy wide-angle contact lens

PURPOSE We describe a new wide-field vitrectomy contact lens specifically designed to facilitate pediatric vitreoretinal surgery. DESIGN Experimental study, instrument description. METHODS A wide-field contact two-piece glass vitrectomy lens was designed with the largest diameter of 13.6 mm and a contact diameter of 7.00 mm, sacrificing only the more tilt-sensitive parts of the optics in order to reduce its physical size. RESULTS Laboratory measurements in a model eye demonstrated a 61-degree binocular field of view, a 94-degree static field of view, and a maximum 129-degree field of view. Image magnification was 0.50 x. No complications were linked to the use of this instrument, and the need to exchange for another lens was never encountered in 10 cases. The two-piece glass construction enabled this lens to be sterilized in an autoclave or sterilized by any other instrument sterilization technique. CONCLUSION The instrument successfully fulfilled the purpose of its design, providing at the same time an excellent wide field of view and ample space for the surgeon, performing well in 10 pediatric vitreoretinal cases (8 cases of retinopathy of prematurity; 2 cases of traumatic eye injury). Its loose two-piece design rendered it suitable for all sterilization techniques.

The role of scleral buckle in experimental posterior penetrating eye injury.

Purpose Although episcleral buckles are frequently placed as an additional procedure to vitreoretinal surgery, little is known about their independent effect after ocular trauma. The authors created a posterior penetrating ocular injury model to evaluate the isolated role of primary episcleral buckle placement. Methods Twenty eyes underwent surgery. The penetrating injury consisted of two 5-mm circumferential incisions placed five clock hours apart and 8 mm behind the limbus. A segmental episcleral buckle was placed over a randomly chosen injury site after wound closure. The degrees of fibrous proliferation, traction, and the presence of retinal detachment were evaluated on follow-up examinations. After enucleation and initial fixation, tissue sectioning was performed, and the greatest dimension of the fibrous proliferation at both wound sites was measured with a caliper. Results Two eyes were excluded from the study. Three eyes developed a retinal detachment; the remaining 15 eyes showed varying degrees of proliferation and traction on the retina. The greatest dimension of the fibrous proliferation at the buckle site (1.22 ± 1 mm) was significantly different from that at the nonbuckle site (2 ± 1.45 mm, P = 0.01). Conclusions Primary episcleral buckle placement at the time of surgical repair reduces vitreous traction from the buckle site and decreases the degree of fibrovascular proliferation.

Spontaneous Regression of Choroidal Neovascularization in a Patient with Pattern Dystrophy

Purpose. To present a case of a patient with pattern dystrophy (PD) associated choroidal neovascularization (CNV) that resolved spontaneously without treatment. Methods. A 69-year-old male patient was referred to our unit, for evaluation of a recent visual loss (metamorphopsias) in his left eye. Fundus examination, fundus autofluorescence imaging, and fluorescein angiography showed a choroidal neovascular membrane in his left eye. Since visual acuity was satisfactory the patient elected observation. Clinical examination and OCT testing were repeated at 6 and 12 months after presentation. Results. Visual acuity remained stable at the level of 0.9 (baseline BCVA) during the follow-up period (12 months). Repeat OCT testing showed complete spontaneous regression of the choroidal neovascular membrane without evidence of intra- or subretinal fluid in both follow-up visits. Conclusions. Spontaneous regression of choroidal neovascularization can occur in patients with retinal dystrophies and associated choroidal neovascular membranes. The decision to treat or observe these patients relies strongly on the presenting visual acuity, since, in isolated instances, spontaneous resolution of choroidal neovascularization may occur.