Norio Usui

Progressive outer retinal necrosis caused by herpes simplex virus type 1 in a patient with acquired immunodeficiency syndrome.

OBJECTIVE/BACKGROUND To identify the etiologic agent of rapidly progressive outer retinal necrosis (PORN) in a 32-year-old man with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from cytomegalovirus (CMV). Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis, diagnosed clinically as PORN. Death occurred after failure of multiple organs. DESIGN Case report. METHODS Both globes were taken at autopsy, fixed in formalin, and examined histopathologically and immunohistochemically to identify causative agents in the retinal lesions. MAIN OUTCOME MEASURE Immunohistochemistry. RESULTS All layers of the retina were severely damaged and contained focal calcification. Cytomegalic inclusion bodies were found in cells in the damaged retina of the right eye. Immunohistochemical studies for herpesviruses revealed the presence of CMV antigens in the right retina at the posterior pole and herpes simplex virus type 1 (HSV-1)-specific antigen in the periphery of both retinas. No varicella-zoster virus (VZV) antigen was detected in either retina. CONCLUSIONS PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, HSV-1 can be an etiologic agent.

Ocular Complications in Myelodysplastic Syndromes as Preleukemic Disorders

PurposeTo identify ocular complications in patients with myelodysplastic syndromes (MDS), who have a propensity to progress to acute myeloid leukemia (AML).MethodsForty-one patients with MDS were the subjects in this retrospective study, and 21 patients with AML were selected as controls. Reviewing their clinical records, we verified that corneal ulcer, iridocyclitis, vitreous hemorrhage, retinal hemorrhage, and optic neuritis had been evaluated using slit-lamp assessment and opthalmoscopy in all the patients. In this study, the MDS patients were classified into those with refractory anemia (RA) and those with refractory anemia with excess blasts (RAEB).ResultsOcular complications were found in 19 (46.3%) of the 41 patients with MDS, comprising corneal ulcer (two cases), iridocyclitis (five), vitreous hemorrhage (one), retinal hemorrhage (ten), cotton wool spots (one), and optic neuritis (two). (Some patients had more than one ocular complication.) Ocular complications were identified in 12 of the 21 (57.1%) patients with AML. There was no significant difference in frequency of ocular complications between MDS and AML (P = 0.4892). In MDS, retinal hemorrhage was associated with significantly reduced platelet counts (P = 0.0063). The frequency of ocular complications was significantly higher in MDS-RAEB than in MDS-RA (P = 0.0478). Retinal hemorrhage was significantly more frequent in patients with MDS-RAEB than in patients with MDS-RA (P = 0.0433).ConclusionOcular complications in MDS patients should be carefully examined as prognostic factors for progression to acute leukemia. Jpn J Ophthalmol 2005;49:377–383

Human herpesvirus-8 in Kaposi's sarcoma of the conjunctiva in a patient with AIDS

PurposeTo demonstrate human herpesvirus-8 (HHV-8) in Kaposis sarcoma (KS) of the conjunctiva in a patient with acquired immunodeficiency syndrome (AIDS).MethodsClinical observation, pathologic findings of conjunctival specimens, immunohistochemical staining for HHV-8-specific antigen, polymerase chain reaction (PCR) analysis of HHV-8 DNA, and detection of specific antibody in patients serum at appropriate times.ResultsIn the conjunctival specimen, swollen endothelial-like cells were found with slit-like vessels. CD 31-positive cells were noted on the inner surface of the slit-like vessels, and HHV-8 latency-associated nuclear antigen was detected. The presence of HHV-8 DNA was demonstrated by PCR. Anti-HHV-8 antibody was found in the patients serum.ConclusionsThis is the first case report in the ophthalmology literature that provides histological, DNA, and serological evidence that HHV-8 is involved in the pathogenesis of conjunctival KS. Jpn J Ophthalmol 2006;50:7–11

Bacterial infection in the conjunctiva of patients with adenoviral conjunctivitis

Purpose: We evaluate the microbiological features of mixed infection in adenovirus-infected conjunctiva.Subjects: Isolation of bacteria was performed in 82 samples of adenoviral conjunctivitis at six eye clinics in Japan.Methods: For microbiological diagnosis, we performed immunochromatography (IC) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis for detection and serotyping of adenovirus, and PCR for detection of herpes simplex virus (HSV) and Chlamydia trachomatis antigens out of 82 samples with adenoviral conjunctivitis.Results: Pathogenic bacteria were isolated in 6 samples out of 82. Out of these 6 cases, 5 samples were gram-negative rods and most of them were Flavobacterium meningosepticum (4 samples). Adenovirus type 8 was isolated from all these mixed infection cases. However, HSV-1 and Chlamydia trachomatis were not found.Conclusions: From these results, it is suggested that gram-negative rods, especially F. meningosepticum, are the most common bacteria causing mixed bacterial infection in adenoviral conjunctivitis.

Typing of Herpes Simplex Virus in Patients with Uveitis

AIM To examine the type of herpes simplex virus (HSV) in cases with uveitis. MATERIALS AND METHODS Intraocular fluid specimens obtained from 3 cases with herpetic iridocyclitis and 6 cases with acute retinal necrosis (ARN) were examined by polymerase chain reaction (PCR). HSV typing was performed by the restriction patterns of the PCR products. Serum samples obtained from these cases and 33 cases with uveitis were examined by neutralization test (NT) for the availability of the typing of HSV. RESULTS The restriction patterns of the PCR products amplified from 3 specimens of iridocyclitis revealed HSV type 1 DNA. HSV type 2 DNA was identified in 5 of 6 cases of ARN and HSV type 1 DNA was found in only one case. The results of serum NT titers correlated with the typing of the amplicons. CONCLUSIONS In the cases studied, HSV type 1 was the dominant etiological agent in herpetic iridocyclitis, while HSV type 2 played a similar role in HSV-associated ARN. The examination of the serum NT may be helpful for the identification of the etiological types of HSV in patients with uveitis.

Aqueous and serum β2-microglobulin levels in patients with senile cataracts, and cataracts associated with uveitis or atopy

β(2)-Microglobulin (β(2) M) has been reported to be elevated in patients with a variety of neoplasms and inflammatory disorders, and is believed to be a sensitive although nonspecific marker for lymphocyte activation and/or proliferation. In order to investigate the role of inflammation in the pathogenesis of various types of cataract, the authors measured β(2)M concentrations in the aqueous humor and serum of patients with senile cataracts (82 eyes), cataracts secondary to uveitis (16 eyes) and cataracts associated with atopic dermatitis (eight eyes). In addition, measurements were made in six patients with rhegmatogenous retinal detachment (RRD) and three patients with central retinal artery occlusion (CRAO) for comparison. The average aqueous β(2)M was increased in eyes with uveitic cataracts (678 μg/1) and RRD (533 μg/1), when compared to eyes with senile cataracts (265 μg/1), atopic cataracts (309 μg/1) and CRAO (122 μg/1). However, comparison of β(2)M to albumin aqueous-to-serum ratios (protein coefficient analysis) revealed that the aqueous β(2)M elevation was specific in only uveitic cataracts, with the elevation in RRD being most likely due to breakdown of the bloodocular barrier. Higher aqueous β(2)M concentrations were also found in cataracts with a posterior subcapsular cataract component, although this was related to a higher percentage of uveitic cataracts in this group. There was no statistically significant difference found in association with a past medical history of diabetes mellitus, hypertension or heart disease. These results are discussed in the context of the pathogenesis of cataract and the role of β(2)M in inflammatory processes of the eye.