Robert D. Wertz

Conjunctival inflammation and amyloidosis in allergic granulomatosis and angiitis (Churg-Strauss syndrome).

A 37-year-old woman developed nodular, waxy conjunctival lesions associated with the exacerbation of Churg-Strauss syndrome. Conjunctival and skin biopsy specimens demonstrated a diffuse inflammatory process composed of eosinophils, plasma cells, lymphocytes, and focal collections of histiocytes. There were amyloid deposits in the conjunctiva and skin. To our knowledge, this is the first report of conjunctival changes and amyloidosis associated with the Churg-Strauss syndrome.

Aqueous humor sCD44 concentration and visual field loss in primary open-angle glaucoma

PurposeTo correlate aqueous humor soluble CD44 (sCD44) concentration, visual field loss, and glaucoma risk factors in primary open-angle glaucoma (POAG) patients. MethodsAqueous samples were obtained by paracentesis from normal and glaucoma patients who were undergoing elective surgery and analyzed for sCD44 concentration by enzyme-linked immunosorbent assay. ResultsIn normal aqueous (n=124) the sCD44 concentration was 5.88±0.27 ng/mL, whereas in POAG aqueous (n=90) the sCD44 concentration was 12.76±0.66 ng/mL, a 2.2-fold increase (P<0.000001). In POAG patients with prior successful filtration surgery (n=13), the sCD44 concentration was decreased by 43% to 7.32±1.44 (P=0.001) in comparison with POAG patients without filtration surgery; however, the sCD44 concentration in the prior successful filtration subgroup with no medications and normal intraocular pressure was 12.62±3.81 (P=0.05) compared with normal. The sCD44 concentration of normal pressure glaucoma patients was 9.19±1.75 ng/mL, a 1.6-fold increase compared with normal (P=0.02). Race and intraocular pressure pulse amplitude were significant POAG risk factors in this cohort of patients. In both normal and POAG patients with mild and moderate visual field loss, sCD44 concentration was greater in African Americans than in whites (P=0.04) ConclusionssCD44 concentration in the aqueous of POAG patients correlated with the severity of visual field loss in all stages in white patients and in mild to moderate stages in African American patients. sCD44 concentration in aqueous is a possible protein biomarker of visual field loss in POAG.

Alternatives to standard cataract surgery.

Two alternatives to standard cataract surgery have been developed which have distinct benefits in selected patients. Phacoemulsification, which requires only a small incision and little recovery time, is particularly suited to young patients. Elderly patients, who often cannot wear aphakic spectacles or contact lenses, may benefit from intraocular lens implantation.