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Purpose: To describe the distribution, clinical findings, visual outcomes, treatment, and complications of children with uveitis at a tertiary referral ophthalmic center. Methods: Retrospective cohort study. We reviewed the medical records of all patients

To describe recent evidence from the literature regarding cataract surgery and lens implantation in patients with uveitis.Most uveitic patients enjoy good vision despite potentially sight-threatening complications, including cataract development. In those patients who develop cataracts, successful surgery stems from educated patient selection, careful surgical technique, and aggressive preoperative and postoperative control of inflammation. Although commonly accepted in the adult patient population, recent investigations reflect the increased tolerance for primary intraocular lens placement in the pediatric cohort. The role of absolute control of inflammation continues with greater focus on immunomodulatory therapies. However, these agents bear their own side effect and complication profiles, including recent evidence of increased mortality. As a result, localized treatment with not only these agents but also with corticosteroids offers a potential balance.Cataract extraction with intraocular lens implantation in the setting of meticulous control of inflammation can optimize visual outcome in adults and children with uveitis.

Purpose: To describe the course of ocular toxoplasmosis during pregnancy. Methods: This study was a retrospective, non-comparative case series of four pregnant women who were treated for ocular toxoplasmosis during pregnancy. Results: All of the participants had severe and treatment-resistant toxoplasmic retinochoroiditis during pregnancy, leaving three of them with decreased visual acuity in spite of aggressive therapy. Delivery of the infant appeared to help the recovery in two patients. Conclusions: Pregnant state may provoke the recurrence of ocular toxoplasmosis.

Purpose of review This review surveys publications from peer-reviewed literature published since 2001on the matter of uveitis associated with juvenile idiopathic arthritis. Recent findings Uveitis associated with juvenile idiopathic arthritis (JIA) continues to blind substantial numbers of children every year, even in the most developed of societies. This is so because of delayed diagnosis (as a consequence of the silent, asymptomatic nature of ocular inflammation in some patients), and because of delayed referral by general ophthalmologists of children with JIA-associated uveitis to ocular immunologists prepared to move on to systemic immunomodulatory therapy in those instances where the child's uveitis is chronic or continues to recur with each attempt at tapering corticosteroid. The evidence for this is vast. Summary Progress in the matter of reducing the prevalence of blindness secondary to this disease will require the increasing willingness of the world's ophthalmologists to refer patients with JIA-associated uveitis much earlier in the course of his or her disease for consideration of immunomodulatory therapy, and will require legislation mandating visual acuity testing in children attending day care centers.

Background: Men with germline breast cancer 1, early onset (BRCA1) or breast cancer 2, early onset (BRCA2) gene mutations have a higher risk of developing prostate cancer (PCa) than noncarriers. IMPACT (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in BRCA1/2 mutation carriers and controls) is an international consortium of 62 centres in 20 countries evaluating the use of targeted PCa screening in men with BRCA1/2 mutations. Objective: To report the first year's screening results for all men at enrolment in the study. Design, setting and participants: We recruited men aged 40-69 yr with germline BRCA1/2 mutations and a control group of men who have tested negative for a pathogenic BRCA1 or BRCA2 mutation known to be present in their families. All men underwent prostate-specific antigen (PSA) testing at enrolment, and those men with PSA > 3 ng/ml were offered prostate biopsy. Outcome measurements and statistical analysis: PSA levels, PCa incidence, and tumour characteristics were evaluated. The Fisher exact test was used to compare the number of PCa cases among groups and the differences among disease types. Results and limitations: We recruited 2481 men (791 BRCA1 carriers, 531 BRCA1 controls; 731 BRCA2 carriers, 428 BRCA2 controls). A total of 199 men (8%) presented with PSA > 3.0 ng/ml, 162 biopsies were performed, and 59 PCas were diagnosed (18 BRCA1 carriers, 10 BRCA1 controls; 24 BRCA2 carriers, 7 BRCA2 controls); 66% of the tumours were classified as intermediate-or high-risk disease. The positive predictive value (PPV) for biopsy using a PSA threshold of 3.0 ng/ml in BRCA2 mutation carriers was 48%-double the PPV reported in population screening studies. A significant difference in detecting intermediate-or high-risk disease was observed in BRCA2 carriers. Ninety-five percent of the men were white, thus the results cannot be generalised to all ethnic groups. Conclusions: The IMPACT screening network will be useful for targeted PCa screening studies in men with germline genetic risk variants as they are discovered. These preliminary results support the use of targeted PSA screening based on BRCA genotype and show that this screening yields a high proportion of aggressive disease. Patient summary: In this report, we demonstrate that germline genetic markers can be used to identify men at higher risk of prostate cancer. Targeting screening at these men resulted in the identification of tumours that were more likely to require treatment. (C) 2014 European Association of Urology. Published by Elsevier B. V. All rights reserved.

Purpose:To evaluate the efficacy of entanercept (Enbrel®) versus placebo in preventing relapses of chronic or recurrent non-infectious uveitis in patients controlled on and being tapered from methotrexate. Methods:20 patients with chronic or recurrent non-infectious uveitis, and with control of inflammation on low-dose (

Purpose: To compare clinical characteristics and outcomes in patients with uveitis caused by herpes simplex virus (HSV) and varicella zoster virus (VZV). Design: Retrospective comparative study. Participants: Forty patients with HSV uveitis and 24 patients with VZV uveitis. Methods: A retrospective study of 40 patients with HSV and 24 patients with VZV uveitis was performed. The patients were followed between May 1987 and September 1999 (median follow-up time, 46 months). The diagnosis of HSV uveitis was made clinically and serologically, and the diagnosis of VZV uveitis was made clinically. Main Outcome Measures: Clinical presentation of the disease, ocular complications, visual acuity, surgical and medical treatments needed. Results: Both populations were comparable for gender and age at disease onset. The course of the disease tended to be remitting and recurrent in HSV patients and chronic in VZV patients (P = 0.046). The most frequent ocular complication in both groups was secondary glaucoma (54% HSV, 38% VZV). Twenty-five percent of VZV patients developed posterior pole complications (cystoid macular edema, epiretinal membrane, papillitis, retinal fibrosis, and detachment) compared with 8% of HSV patients (P = 0.069). Treatment modalities selected were generally similar in the two groups, although periocular and systemic steroids were required more frequently in HSV patients (60% versus 25%; P = 0.01). Surgical procedures were required with similar frequency in both populations. The percentage of eyes that were legally blind at end of follow-up was also comparable (HSV, 20%; VZV, 21%). The visual outcome was similar in the studied populations. Conclusions: This study represents the only direct comparison of HSV and VZV uveitis patients reported in the literature. HSV patients were more likely to be treated with periocular and systemic steroids, and VZV patients were more likely to develop posterior pole complications (a finding of borderline significance). Other parameters evaluated in this study were not statistically different in the two patient groups. (C) 2002 by the American Academy of Ophthalmology.

Purpose: To report our experience with the use of chlorambucil for otherwise treatment-resistant uveitis and to assess its safety and efficacy. Design: Noncomparative interventional case series. Participants; Twenty-eight patients with intractable noninfectious uveitis. Methods: We reviewed the records of 28 patients (56 eyes) with chronic noninfectious uveitis who were treated with chlorambucil from 1987 to 2000. Diagnoses included Adamantiades-Behcet's disease (ABD) (7 patients), juvenile rheumatoid arthritis (JRA)-associated uveitis (10 patients), pars planitis (2 patients), sympathetic ophthalmia (1 patient), idiopathic uveitis (6 patients), Crohn's disease (1 patient), and HLA-B27-associated uveitis (1 patient). All patients were refractory to other immunomodulatory therapy and systemic steroids. The median duration of treatment with chlorambucil was 12 months (range, 4-50 months), whereas the median daily dosage was 8 mg (range, 4-22 mg). Patients were followed for a median follow-up period of 46 months (range, 4-166 months) after chlorambucil treatment was begun and continued to be followed for relapse after cessation of therapy. Main Outcome Measures: Visual outcome, response to treatment, treatment-related side effects, drug dosage, previous and final treatment, discontinuation of systemic corticosteroids. Results. Chlorambucil was discontinued in seven patients because of side effects: two females had temporary amenorrhea develop, two patients had unacceptable gastrointestinal intolerance, one patient had infection, and 2 patients had progressive leukopenia. Nineteen patients (68%) showed positive clinical response to the treatment, four (14%) initially responded then relapsed after discontinuation of the drug, three patients with ABD had improvement of ocular disease but worsening of systemic symptoms, and two had persistent inflammation. Visual acuity was improved in 24 eyes (43%), stable in 22 (39%), and worsened in 10 eyes (18%). Systemic prednisone was successfully discontinued in 19 of the 28 patients (68%), and 14 patients were free of inflammation at the end of follow-up without any systemic medication. Conclusions: Chlorambucil can be a safe and effective alternative for preserving vision in patients with otherwise treatment resistant uveitis. (C) 2002 by the American Academy of Ophthalmology.

Seasonal allergic conjunctivitis is the only ocular disease to involve solely Type-1 hypersensitivity, the other main forms of ocular allergy--perennial allergic conjunctivitis, vernal and atopic keratoconjunctivitis and giant papillary conjunctivitis--each having a more complex immunological basis and a chronic inflammatory component. Involvement of secondary inflammatory cells, particularly eosinophils, in addition to the mast cells resident in the conjunctival substantia propria, can lead to more serious corneal damage with vision-threatening potential. Thoughtful management of allergic conjunctivitis is needed in order to control the ocular inflammation without incurring steroid-induced side-effects, and patient education is also an important factor in maintaining optimal allergen avoidance, especially in the more severe and chronic cases. Laboratory models can be helpful in assessing the potential of new drugs, and SWR mice (topically sensitised and challenged with short ragweed) show clinical signs of allergic conjunctivitis, together with mast cell and eosinophil involvement, remarkably similar to the human pathophysiology. The antiinflammatory activity of both steroids and nedocromil sodium observed in this animal model supports therapeutic evidence of the usefulness of second-generation mast cell stabilising drugs in the treatment of ocular allergy.

PURPOSE: To evaluate ocular features in patients presenting with inflammation in the presence of anti-cardiolipin antibodies. METHODS: A descriptive study of 13 patients presenting with idiopathic ocular inflammation involving anterior and posterior segment was performed. Patients were followed for a mean follow-up of 22 months (range, 1 to 125). A comprehensive report of ocular involvement, including visual symptoms, visual acuity, clinical characteristics, funduscopic and fluorangiographic features, was reported. Systemic associated symptoms were analyzed. Laboratory investigations included anticardiolipin antibody titers and isotypes, presence of other autoantibodies, and markers of immune system activation. RESULTS: The most common ocular symptom at presentation was blurred vision (eight patients) followed by redness and pain(three patients) and visual loss(two patients). Anterior segment abnormalities, including iritis (eight patients) scleritis (two patients) and filamentary keratitis (one patient), were present in 76% of patients, whereas the most represented feature of posterior involvement was retinal vasculitis (60%) followed by vitritis (38%), retinal detachment (15%), posterior scleritis (7%), and central retinal artery occlusion (7%). All patients had abnormal titers of anticardiolipin antibodies, predominantly IgG isotype; six had markers of immune system activation. CONCLUSIONS: Although posterior pole disease is more commonly associated with anticardiolipin antibodies, the anterior segment can also be involved with a wide spectrum of features. Scleritis has never been previously described as associated with anticardiolipin antibodies. Systemic symptoms are frequently present in association with ocular disease. (Am J Ophthalmol 2001;131: 451-456, (C) 2001 by Elsevier Science Inc. All rights reserved).

Background: Polyarteritis nodosa is a necrotizing vasculitis affecting medium and small-sized arteries throughout the body, including ocular tissues. Untreated polyarteritis nodosa carries a very poor prognosis. Treatment with steroids increases the 5-year survival to 48%, whereas addition of cytotoxic immunosuppressive treatment improves the outcome dramatically. Methods: The authors reviewed five cases of polyarteritis nodosa with a spectrum of ocular findings which preceded and contributed to its diagnosis. Results: The ophthalmic manifestations of polyarteritis nodosa in these patients included scleritis, peripheral ulcerative keratitis, nongranulomatous uveitis, retinal vasculitis, pseudotumor of the orbit, and central retinal artery occlusion associated with temporal arteritis. In four patients, cytotoxic immunosuppressive therapy was begun promptly, and elimination of inflammation was achieved. Conclusions: The authors' presentation of these cases is intended to emphasize the fact that ocular inflammation can be the earliest presenting manifestation of polyarteritis nodosa and that its recognition may lead to the early institution of therapy, which can decrease morbidity and mortality in this disease.

Atopy arises from a complex interplay between immunogenetic controls and complex environmental allergens. Family studies of atopic patients indicate a polygenic control of IgE production overlayed with exposure to certain ubiquitous environmental antigens. Ultrapurified antigen studies in families indicate that HLA-D immune response genes, notably HLA-DR/Dw2, are implicated in some atopic responses. IgE-binding factors and gene regulation of proteins controlling glycosylation of them also influence the serum levels of IgE, as do the levels of at least two cytokines, IL-4 and gamma interferon.

Contains fulltext : 154257.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To evaluate the additive value of the prostate cancer gene 3 (PCA3) urine test to serum prostate-specific antigen (PSA) in prostate cancer (PC) screening among breast cancer, early-onset gene (BRCA) mutation carriers. This study was performed among the Dutch participants of IMPACT, a large international study on the effectiveness of PSA screening among BRCA mutation carriers. MATERIALS AND METHODS: Urinary PCA3 was measured in 191 BRCA1 mutation carriers, 75 BRCA2 mutation carriers, and 308 noncarriers. The physicians and participants were blinded for the results. Serum PSA level>/=3.0ng/ml was used to indicate prostate biopsies. PCA3 was evaluated (1) as an independent indicator for prostate biopsies and (2) as an indicator for prostate biopsies among men with an elevated PSA level. PC detected up to the 2-year screening was used as gold standard as end-of-study biopsies were not performed. RESULTS: Overall, 23 PCs were diagnosed, 20 of which were in men who had an elevated PSA level in the initial screening round. (1) PCA3, successfully determined in 552 participants, was elevated in 188 (cutoff>/=25; 34%) or 134 (cutoff>/=35; 24%) participants, including 2 of the 3 PCs missed by PSA. PCA3 would have added 157 (>/=25; 28%) or 109 (>/=35; 20%) biopsy sessions to screening with PSA only. (2) Elevated PCA3 as a requirement for biopsies in addition to PSA would have saved 37 (cutoff>/=25) or 43 (cutoff>/=35) of the 68 biopsy sessions, and 7 or 11 PCs would have been missed, respectively, including multiple high-risk PCs. So far, PCA3 performed best among BRCA2 mutation carriers, but the numbers are still small. Because PCA3 was not used to indicate prostate biopsies, its true diagnostic value cannot be calculated. CONCLUSIONS: The results do not provide evidence for PCA3 as a useful additional indicator of prostate biopsies in BRCA mutation carriers, as many participants had an elevated PCA3 in the absence of PC. This must be interpreted with caution because PCA3 was not used to indicate biopsies. Many participants diagnosed with PC had low PCA3, making it invalid as a restrictive marker for prostate biopsies in men with elevated PSA levels.

PURPOSE. To report a case of acute retinal necrosis caused by herpes simplex virus 2 in an otherwise healthy patient. CASE REPORT. A 45-year-old man presented with one month's history of decreased vision in the right eye. He had previously received a course of intravenous gancyclovir because of a clinical suspicion of cytomegalovirus retinitis. The patient's ocular history was remarkable for a similar episode in the left eye thirty years earlier, resulting in important visual impairment. System and laboratory investigations were unremarkable. Ocular examination showed severe anterior granulomatous uveitis, vitreous haze, areas of necrosis and retinal exudates. The anterior chamber tap disclosed the presence of HSV type 2, and oral steroids and acyclovir were instituted. Two weeks after the patient had been discharged, a retinal detachment occurred in the right eye, necessitating surgical repair. The presence of HSV type 2 was confirmed in the vitreous. Visual acuity recovered completely after surgery and the patient was placed on a maintenance dose of oral acyclovir CONCLUSIONS. HSV type 2 is a rare cause of acute retinal necrosis in healthy patients. Bilateral involvement can occur in the fellow eye, even with a long delay. Acute retinal necrosis is a severe ocular inflammatory syndrome associated with a very poor visual outcome. It is caused by VZV, HSV type 1 and, less commonly, by HSV type 2. The disease can affect healthy patients and cause bilateral involvement in the fellow eye, even with a long delay.

Atopic ocular diseases involve a spectrum of immuno-inflammatory responses. There are minimal pathologic changes with SAC. With PAC, there is increased mast cell activation and late-phase inflammatory cell infiltrate as a consequence of continued allergic stimulation. Associated with the more chronic and severe forms of atopic ocular disorders, GPC, VKC and AKC, there is persistent mast cell, eosinophil, and lymphocyte activation resulting in pathologic changes. Therapeutic intervention for atopic ocular diseases has focused on symptomatic improvement. However, with an increasing understanding of the molecular mechanisms associated with the allergic inflammatory response, experimental studies may facilitate the development of preventative strategies.

Although uncommon, SO is a fearful postoperative complication because of its potential to blind both eyes. It can result not only from penetrating ocular surgery but also from nonpenetrating ocular procedures. Thus, it is important to consider in any patient who has undergone ocular surgery and develops bilateral uveitis, particularly because prompt, sufficient treatment is required to maximize visual outcome. It is also important to note that the disease may present with a spectrum of clinical findings, none of which is pathognomonic. Thus, suspicion is important for making the diagnosis. Treatment should address the T-cell-mediated nature of the disease. With appropriate treatment, visual acuity of no less than 20/60 is likely. However, before the start of treatment, which consists of immunosuppressants, infection must be ruled out and potential side effects of treatments must be considered. Furthermore, any patient with a history of SO needs ample immunosuppressant coverage for ocular procedures. Better understanding of the pathogenesis of the disease may lead to safer treatments that result in improved visual outcome and a cure. Meanwhile, because of its relapsing nature, SO requires continual, close surveillance, even after many years of quiescence.

Cornea epithelium is subject to constant trauma and shedding of the surface epithelium, and replenishment is from epithelial cells beneath and peripheral to the central desquamating epithelium. The origin of the corneal epithelium appears to reside in the crypts of Vogt, where a population of "immortal" stem cells resides, possessing enormous potential for clonogenic cell division. These cells, like all stem cells, have inherent properties which enable them to accomplish error-free replication which avoids development of abnormal differentiation and cellular dysfunction; a low mitotic rate and asymmetrical DNA segregation are essential in this error-free proliferation of these relatively primitive, poorly differentiated cells. The limbal stem cells lack the keratin 3 differentiation marker typical of all the rest of corneal epithelium, but does possess keratin 19. Cell kinetic studies show that limbal stem cells, and the cells into which they evolve, transiently amplifying cells (TAC) remain in the so called "proliferative" compartment, undergoing cell division and not evolving to commitment to further specialized differentiation. These cells (stem cells and TAC) are located exclusively in the limbal region, with the stem cells in the basal epithelium and TAC occurring in the basal and suprabasal levels, extending up to the superficial layers. The corneal epithelium is then maintained by cellular proliferation of these cells which then migrate further onto the central cornea and become terminally differentiated. The lack of a vascular supply and the presence of special elements within the corneal basement membrane, and differences in vitamin A concentrations may be some of the primary factors responsible for the terminal differentiation events.

When properly used, diagnostic vitrectomy can be an extremely helpful procedure for establishing the etiology of ocular inflammation. New instruments have enabled more expedient and safer surgery. Analytical assays continue to improve in quality and quantity as our understanding of ocular diseases grows. Though no single assay is completely sensitive, a combination of assays may improve the yield and accuracy of diagnostic vitreous biopsy (Table 5). Keeping abreast of these advances may aid ophthalmologists in obtaining earlier diagnosis and better outcomes for their patients.

This study investigated the effectiveness of tetrandrine (TDR) on experimental allergic conjunctivitis secondary to ragweed pollen. SWR/J mice were divided as follows: group 1, normal controls; group 2, sensitized but untreated; group 3, sensitized, buffered saline (BS)-treated; and group 4, sensitized, TDR-treated. The last three groups were exposed to ragweed through topical contact on the nasal and conjunctival mucosae followed by challenge with the allergen on the conjunctiva. Groups 3 and 4 received doses of BS and TDR, respectively. The allergic conjunctivitis was evaluated by scoring of the clinical signs and histopathology. mRNA gene expression of interleukin 1 beta (IL-1 beta) and IL-5 in the conjunctiva was analyzed by polymerase chain reaction techniques. All mice exposed to ragweed developed allergic conjunctivitis clinically and histologically. The conjunctivitis was significantly modulated by intraperitoneal injection of a new anti-inflammatory agent, TDR. Histopathologic analysis demonstrated that TDR strikingly reduced the conjunctival eosinophil infiltration and the number of intact and degranulating mast cells. IL-1 beta and Il-5 mRNA gene expression in the conjunctiva of TDR-treated mice was dramatically down-regulated compared with untreated and BS-treated controls. The results indicate that TDR may have potential clinical use in the treatment of conjunctivitis.

The onset of necrotizing scleritis (NS) and peripheral ulcerative keratitis (PUK) in the clinical course of rheumatoid arthritis (RA) may reflect the presence of systemic, potentially lethal vasculitis. In an effort to better characterize this subset of patients with severe RA-associated corneal and/or scleral inflammation and to analyze the efficacy of therapy, we reviewed our experience in the medical and surgical management of 16 tertiary referral cases (25 eyes) unresponsive to aggressive conventional therapy with topical and systemic steroids as well as with systemic nonsteroidal drugs. Cytotoxic immunosuppressive therapy was instituted in all patients with NS and/or PUK. Cyclophosphamide and methotrexate were the most successful agents used. Cytotoxic immunosuppressive drugs in conjunction with early aggressive surgical treatment halted the relentlessly progressive inflammation and preserved the integrity of the globe in 92% of eyes. Visual acuity could be stabilized or improved in 83% of patients with NS and in 68% of patients with PUK.

Although systemic and local autoimmune diseases are the primary possibilities in the differential diagnosis of noninfectious peripheral ulcerative keratitis (PUK), other unusual etiologies such as systemic or local malignancies also must be considered. We report on two patients with PUK whose study led to the discovery and subsequent treatment of a chronic myelogenous leukemia and a sebaceous cell carcinoma of the eyelid, respectively. The results emphasize the need for meticulous diagnostic pursuit, including the possibility of malignancy in patients with peripheral ulcerative keratitis.

Purpose To report the case of a patient with Stevens-Johnson Syndrome (SJS) with Boston Keratoprosthesis (KPro) who may have benefited from infliximab infusions. Materials and Methods Patient A 34-year-old woman with a history of acute SJS at age 12 had three Boston KPro Type II implanted since 2003 into her right eye. The first two were followed by tissue necrosis and aqueous leak, necessitating reoperation. After the third device was implanted, monthly infliximab infusions were started. Methods Infliximab 5 mg/kg infusions were started in January 2008, repeated after 2 weeks, and then given monthly for a year. The treatment is continuing combined with regular eye examinations. Results While receiving infliximab, the skin around the keratoprosthesis has not shown a trace of retraction or necrosis. This is in sharp contrast to events following the two previous attempts at visual rehabilitation. The patient's vision has been generally stable for a year and is currently 20/30. Conclusion A KPro in a patient with SJS normally has a poor long-term prognosis. However, retention of the prosthesis and visual outcome may benefit from monthly infliximab infusions.

The purpose of this study was to analyze the distribution and types of collagen in the substantia propria of the conjunctiva of patients with ocular cicatricial pemphigoid (OCP). Biopsy specimens were collected from 10 patients with active OCP, five patients with active Behcet's disease, nine patients with atopic keratoconjunctivitis, five patients with chronic rosacea blepharoconjunctivitis, and six normal patients undergoing cataract surgery. Cryostat tissue sections were cut and stained using an indirect immunofluorescence technique, employing a panel of primary antibodies directed against seven collagen types. Differences between OCP, Behcet's, and normal conjunctiva were seen in the staining for collagen types III, IV, and VII. The intensity of staining for type III collagen was increased in the substantia propria of OCP conjunctiva as compared to the other groups. The basement membrane zone (BMZ) of OCP patients was typically disrupted and fragmented in appearance when stained for type IV collagen, a finding not seen in the non-OCP specimens. The BMZ staining pattern for type VII collagen in OCP conjunctiva was even more disrupted than that seen for type IV collagen, particularly on the posterior side, which was thickened and reduplicated with short fibers extending into the superficial stroma. The production of type III collagen by fibroblasts of the substantia propria is a common feature of diseases associated with subepithelial fibrosis. The damage to the epithelial BMZ and the subsequent attempt at repair with aberrant type IV and VII collagen production are unique to conjunctiva affected by OCP.

A three-year retrospective study of 36 cases of infectious endophthalmitis seen at a large referral eye center between 1977 and 1980 was conducted. The criterion for infectious endophthalmitis was the culture of microorganisms from aqueous or vitreous on at least two media. The most frequent pathogen was Staphylococcus epidermis; it was isolated from 18 (50%) of the cases. In cases of infectious endophthalmitis following recent cataract extraction, S. epidermidis was isolated from 10 to 17 eyes (58.8%). Complete loss of visual function occurred in 16 of the 36 eyes (44.4%); a visual acuity of 20/400 or better as recorded in 15 eyes (41.6%) and 20/100 or better in eight (22.2%). Fifty percent of the cases were treated with vitrectomy and intraocular antibiotics. Poor visual outcome was associated with gram-negative organisms or delay of vitrectomy more than 24 hours after the initial diagnosis. In cases of postoperative S. epidermidis endophthalmitis, the most favorable visual outcomes were associated with use of intraocular antibiotics and vitrectomy; 80% of cases so treated had a final visual acuity of 20/400 or better and 60% had a visual acuity of 20/100 or better.

The authors used an antineoplastic-antibiotic agent, mitomycin, in the form of eye drops as adjunctive treatment for primary and recurrent pterygia after surgical excision. Sixteen primary and four recurrent pterygia were treated with 1.0 mg/ml mitomycin eye drops, 14 primary and 10 recurrent pterygia were treated with 0.4 mg/ml mitomycin eye drops, and 18 primary pterygia were treated with placebo eye drops. Postoperative follow-up for the eyes treated with mitomycin eye drops ranged from 3 to 34 weeks (mean, 23 weeks). One of 44 pterygia treated with mitomycin recurred after 5 months (recurrence rate, 2.3%), whereas 16 of 18 primary pterygia treated with placebo eye drops developed postoperative granulomas and recurrent pterygia with a mean postoperative period of 6 weeks (recurrence rate, 88.9%). Topical mitomycin (1.0 mg/ml) caused conjunctival irritation, excessive lacrimation, and mild superficial punctate keratitis. These topical side effects were minimized with the 0.4 mg/ml mitomycin dosage. No systemic toxicity was noted with either dosage. The authors believe that mitomycin eye drops is a safe and effective adjunct to surgical excision in the treatment of primary or recurrent pterygia, or both.

• Masked, controlled rabbit studies were done to determine the toxic effects on corneal wound healing of 0.1% idoxuridine drops, 3% adenine arabinoside monophosphate drops, and 1% trifluorothymidine drops, the clinically used concentrations. Neither idoxuridine nor trifluorothymidine significantly retarded closure of epithelial wounds. All three drugs caused toxic changes in the regenerating epithelium clinically and by histopathologic examination. Treatment with arabinoside monophosphate, the monophosphate ester of vidarabine, significantly retarded closure of epithelial wounds and caused impressive toxic changes in the regenerating epithelium. Vascularization of the corneal stroma was present in all eyes treated with this drug. The trifluorothymidine and idoxuridine had much milder toxic effects on regenerating epithelium and appeared equal in regard to production of such effects. The strength of stromal wounds was somewhat reduced by idoxuridine and trifluorothymidine and significantly Increased by arabinoside monophosphate when compared to controls. These findings were confirmed by hydroxyproline assay of the stromal scars. ( Arch Ophthalmol 95:2062-2067, 1977)