Masao Okumoto

Idoxuridine-Liposome Therapy for Herpes Simplex Keratitis

In the treatment of acute and chronic herpetic keratitis, an idoxuridine-liposome preparation was more effective than a comparable therapeutic regimen of idoxuridine alone. Both antiviral agents were more effective than a control combination of liposome and saline.

Trends in the etiology of infectious corneal ulcers at the F. I. Proctor Foundation.

Objective: We analyzed laboratory results from corneal ulcers seen from 1976 to 1999 at the Francis I. Proctor Foundation, a referral center in San Francisco, to determine the relative frequencies of pathogens and to analyze for trends in frequencies of the most common pathogens. The results were compared with a previous study of corneal ulcers seen from 1948 to 1976 at the same institution. Methods: Ulcers presenting to the Proctor Foundation were Gram stained and cultured using standard techniques. Herpetic corneal ulcers were excluded from the study. Results: Organisms were isolated from 427 ulcers, 38% of all cases. Two hundred seventy-eight (59%) isolates were gram-positive bacteria, 145 (31%) gram-negative bacteria, 16 (3%) Acanthamoeba spp., and 36 (8%) fungi. Staphylococcus aureus was the most common organism, composing 20% of all isolates, followed by viridans group streptococci (12%), Streptococcus pneumoniae (11%), Pseudomonas aeruginosa (6%), Moraxella spp. (5%), and Serratia marcescens (4%). Over the 24-year study period the proportion of positive cultures decreased and the incidence of S. marcescens increased significantly. Comparing the period of 1948–1976 to 1976–1999, the frequency of S. pneumoniae and P. aeruginosa decreased, and that of S. marcescens increased significantly. Conclusion: The common pathogens associated with corneal ulcers have changed over the past 50 years in Northern California, with S. pneumoniae and P. aeruginosa being isolated relatively less often and S. marcescens being isolated with increasing frequency. The decrease in isolation of organisms over the 1976–1999 period may have resulted from increasing empiric antibiotic treatment by referring ophthalmologists.

Ocular Ferning Test: A Qualitative Test for Mucus Deficiency

A new qualitative test for the study of conjunctival mucus has been developed. Conjunctival scrapings were obtained from 196 patients. Microscopic mucus ferning (arborization) was observed in 148 (91%) patients with various forms of acute conjunctivitis. Six patients (18%) with cicatrizing conjunctivitis (diffuse conjunctival cicatrization, ocular pemphigoid, Stevens-Johnson syndrome) had mucus ferning in their conjunctival scrapings specimens. Mucus ferning was significantly absent (P less than 0.005) in patients with diffuse conjunctival cicatrization when compared to mucus ferning in other forms of conjunctivitis. Ocular mucus ferning test is a simple inexpensive office test for the evaluation of patients with mucus deficiency.

Mycobacterium Chelonei Keratitis

A 35-year-old man developed an indolent corneal ulcer after removal of a metallic foreign body. Acid-fast bacteria were found on corneal scrapings and Mycobacterium chelonei was isolated on culture. Although initially responding to treatment with subconjunctival and topical amikacin, the patient had a relapse that necessitated a penetrating keratoplasty. Pathologic studies disclosed acid-fast organisms in the midcorneal stroma with an intact overlying epithelium.

The Microbial Flora in Extended-Wear Soft Contact-Lens Wearers

Of 857 cultures of material collected from the eyelids, conjunctivae, and contact lenses of 51 extended-wear soft-contact-lens wearers, 44 (5%) grew potential pathogens. The aphakic patients wearing contact lenses had fewer recoverable pathogens (24 of 295 or 8%) than a group of preoperative cataract patients (63 of 295 or 21%). On five occasions, positive cultures accompanied clinical symptoms, and on three occasions, repeated cultures grew the same potential pathogen.

Listeria Monocytogenes Endophthalmitis

A 62-year-old white man developed an acute anterior chamber inflammation in his left eye. Listeria monocytogenes was cultured from the vitreous aspirate. There was no evidence for ocular trauma or distant site of infection from which hematogenous spread of the organism occurred. No underlying state of immunocompromise was demonstrated. The endophthalmitis responded well to therapy.

TRIC Agents Isolated in the United States. X. Immunofluorescence in the Diagnosis of TRIC Agent Infection in Man.

Summary Conjunctival scrapings from volunteers experimentally infected with TRIC agents and from patients with spontaneous eye disease were examined by immunofluorescence. Brightly fluorescing inclusions were demonstrated with hyperimmune TRIC anti-sera. The findings were compared with those obtained by Giemsa stain, iodine stain or isolation of the infectious agent in embryonated eggs. Immunofluorescence appears to offer an improved method for laboratory diagnosis of TRIC infections.

Antiviral effects of highly purified bacteria-derived human leukocyte interferons (subtypes A and D) and a human fibroblast interferon against herpes virus infection of the rabbit eye

Highly purified preparations of two recombinant-DNA derived human leukocyte interferon subtypes (LeIF-A and LeIF-D) and a similarly derived fibroblast interferon were compared for efficacy against herpes simplex virus, type 1, infection of the rabbit cornea. LeIF-D appeared to be more effective than LeIF-A especially when compared on the basis of interferon units. The fibroblast interferon showed no significant effects. The greater activity of LeIF-D compared with LeIF-A could be due to greater direct antiviral effects, as observed in rabbit cell cultures.

Anaerobic Streptococcal Corneal Ulcer

An anaerobic streptococcus caused a central corneal ulcer in a 10-year-old girl. There were no identifying clinical findings. The lesion healed promptly and satisfactorily with antibiotic therapy.

Indomethacin and the corneal immune response.

To study the effect of treating rabbits with a locally administered noncorticosteroid anti-inflammatory drug, we gave 26 rabbits unilateral subconjunctival injections of 15 mg of indomethacin suspension daily for 16 days, starting one day before the intracorneal injection of the same eye with bovine gamma globulin. We graded the eyes clinically and killed groups of rabbits on postimmunization days 6, 9, 12, and 15. We determined the number of antibody-forming cells in the homolateral cervical lymph nodes, corneas, and uveal tracts and tested the sera, aqueous humor, and vitreous humor for antibodies. Indomethacin-treated eyes showed significantly less inflammatory response, and an insignificantly greater number of antibody-forming cells, than the controls.