Search

: ObjectiveTo report a case of bilateral progressive subretinal fibrosis and blindness with multifocal granulomatous chorioretinitis occurring after intraocular surgery. We propose that this is a variant of sympathetic ophthalmia.: DesignClinicopathologic case report.: MethodsThe left enucleated globe was examined by histopathologic methods. The patient’s sera were subjected to immunohistochemical studies against retinal antigens, and collagen 2types in areas of fibrosis were identified. Polymerase chain reaction was used to test for herpes virus DNA in microdissected, formalin-fixed, paraffin-embedded tissue.: ResultsThe enucleated globe demonstrated histopathologic features similar to an entity previously described as progressive subretinal fibrosis with multifocal granulomatous chorioretinitis. The patient’s sera demonstrated antibodies directed against retinal photoreceptors and pigment epithelium. Polymerase chain reaction for herpes virus was negative. Immunohistochemical studies demonstrated types III, IV, V, and VI collagen in areas of fibrosis.: ConclusionsThe clinical history along with the histopathologic and immunohistochemical findings suggest that progressive subretinal fibrosis with multifocal granulomatous chorioretinitis may represent a variant of sympathetic ophthalmia and that retinal autoimmunity may play a role in its pathogenesis. [Copyright &y& Elsevier]

The role of the monoterpenes, especially limonene and perillyl alcohol, in the treatment of certain cancers is currently being evaluated in clinical trials. In this study, the effects of perillyl alcohol (POH) and its analog, perillaldehyde (PALD), on human carcinoma cell lines (BroTo and A549) cultured in vitro were investigated using proliferation assays (MTT and colony formation) and DNA content analysis by flow cytometry. POH and PALD elicited dose- and time-dependent inhibition of proliferation in both cell lines. Concentrations of POH and PALD that inhibited cell proliferation by 50% (IC50) in 24 hr were 1 and 3 mM, respectively. DNA content analysis revealed that 1 mM of either POH or PALD caused cell cycle arrest in the G1 phase in both cell lines while POH alone caused increased hypodiploid and annexin V-positive populations in both BroTo and A549 cells. POH induced apoptosis and was more effective than PALD at inhibiting the proliferation of BroTo and A549 cells cultured in vitro. [Copyright &y& Elsevier]

Injection of pharmacotherapy into the suprachoroidal space, between the sclera and choroid, is an alternative delivery technique developed with the rationale of providing higher drug concentrations to posterior ocular structures compared with other intraocular and periocular injection procedures. This study was conducted to evaluate the safety and efficacy of suprachoroidally injected triamcinolone acetonide formulation (CLS-TA), a suspension of triamcinolone acetonide, in improving vision among patients with noninfectious uveitis complicated by macular edema (ME). Phase 3 masked, randomized trial. One hundred sixty patients with ME secondary to noninfectious uveitis. Patients were required to have a best-corrected visual acuity (BCVA) of 5 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letters (Snellen equivalent, 20/800) and 70 or fewer ETDRS letters read (Snellen equivalent, 20/40) in the study eye. Patients were randomized 3:2 to suprachoroidally injected CLS-TA or sham treatment, with administrations at day 0 and week 12. The primary end point was improvement from baseline of 15 or more ETDRS letters in BCVA at week 24. The secondary end point was reduction from baseline in central subfield thickness (CST) at week 24. In the CLS-TA arm, 47% of patients gained 15 or more ETDRS letters in BCVA versus 16% in the control arm (P < 0.001), meeting the primary end point. Mean reductions in CST from baseline were 153 μm versus 18 μm (P < 0.001). No serious adverse events (AEs) related to treatment were reported. Corticosteroid-associated AEs of elevated intraocular pressure occurred in 11.5% and 15.6% of the CLS-TA and control groups, respectively. Cataract AE rates were comparable (7.3% and 6.3%, respectively). Patients in the CLS-TA study arm experienced clinically significant improvement in vision relative to the sham procedure, demonstrating the efficacy of suprachoroidal injection of CLS-TA for the treatment of ME in a vision-threatening disorder. [ABSTRACT FROM AUTHOR]

Up to 14% of the U.S. population is estimated to have obstructive sleep apnea (OSA), while the outcomes of the treatments have variable results. In the current study, a three-dimensional fluid-structure interaction modeling was applied to simulate the upper airway to identify the precise location, severity, and characteristic of airway collapse. This was accomplished using Simpleware ® and ANSYS ® software applied to a 3-D rendering of the airway in a real patient with severe OSA. During this simulation, areas which are prone to collapse and precipitate apneic episodes were identified at the tip of the soft palate and the base of the tongue, with intrathoracic pressure as low as −1370 Pa. These results are consistent with anatomical structures currently indicated and targeted in the treatment of OSA. This improved FSI modeling simulation, which is the first to completely model the whole upper airway without consideration of the nasal cavity in OSA, and can allow virtual modification of the airway prior to actual treatment by doctors. [ABSTRACT FROM AUTHOR]

Purpose To evaluate longitudinal vision-related quality of life (VRQoL) in patients with noninfectious uveitis. Design Cohort study using randomized controlled trial data. Participants Patients with active or recently active intermediate uveitis, posterior uveitis, or panuveitis enrolled in the Multicenter Steroid Treatment Trial and Follow-up Study. Methods Data from the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) for the first 3 years after randomization were evaluated semiannually. Analyses were stratified by assigned treatment (129 implants vs. 126 systemic therapies) because of substantial differences in the trajectories of VRQoL. The impact of baseline measurements of visual function (visual acuity and visual field), demographics, and disease characteristics was assessed using generalized estimating equations. Main Outcome Measures Primary outcome was the NEI-VFQ-25 composite score over 3 years after randomization. Results Individuals in both treatment groups showed similar improvement in NEI-VFQ-25 scores after 3 years of follow-up (implant: 11.9 points; 95% confidence interval [CI], 8.6–15.2; P < 0.001; systemic: 9.0 points; 95% CI, 5.6–12.3; P < 0.001; P = 0.21 for interaction). Individuals in the implant group showed a substantial improvement during the first 6 months followed by stable scores, whereas individuals in the systemic group showed a steady improvement over the course of follow-up. Worse initial visual acuity and visual fields were associated with lower initial NEI-VFQ-25 scores for both treatment groups. In the systemic group, these differences were maintained throughout follow-up. In the implant group, individuals with initial visual acuity worse than 20/40 showed additional improvement in NEI-VFQ-25 score to come within −7 points (95% CI, −15.0 to 0.9) of those with visual acuity 20/40 or better initially, a clinically meaningful but not statistically significant difference ( P = 0.081). Results based on sensitivity analyses showed similar patterns. Conclusions Both treatment groups demonstrated significant improvements in NEI-VFQ-25 scores; however, the improvement was immediate for the implant group as opposed to gradual for the systemic group. Poorer visual function was associated significantly with initial differences in NEI-VFQ-25 scores. However, only individuals in the implant group with poor visual acuity were able to overcome their initial deficits by the end of 3 years. [ABSTRACT FROM AUTHOR]

Abstract: Plant products such as perillyl alcohol have been reported to possess anti-tumor activities against a number of human cancers though the mechanism of action has not yet been elucidated. The effects of perillyl alcohol (POH) and its metabolite perillic acid (PA) on the proliferation of non small cell lung cancer (NSCLC, A549, and H520) cells were investigated. Both POH and PA elicited dose-dependent cytotoxicity, induced cell cycle arrest and apoptosis with increasing expression of bax, p21 and caspase-3 activity in both the cell lines. Combination studies revealed that exposing the cells to an IC50 concentration of POH or PA sensitized the cells to cisplatin and radiation in a dose-dependent manner. These results indicate that POH and PA in combination therapy may have chemotherapeutic value against NSCLC. [Copyright &y& Elsevier]

: PurposeTo describe the occurrence of conjunctival ulcers as a manifestation of Behc¸et’s disease.: DesignRetrospective, noncomparative, interventional case series with histopathologic correlation.: MethodsSix patients who fulfilled the diagnostic criteria for Behc¸et’s disease and presented with painful conjunctival ulcers were included in the study. Three of these ulcers were biopsied and studied histologically and immunohistochemically. The lesions were treated with topical or subconjunctival injection of corticosteroids and, in one case, with oral indomethacin.: ResultsAlthough all six patients fulfilled the diagnostic criteria for Behc¸et’s disease, two developed uveitis and other signs of Behc¸et’s disease only months to years after the appearance of the conjunctival ulcers. The 3- to 5-mm, round to oval ulcers were located in the limbal and/or bulbar conjunctiva. Histopathology revealed disrupted epithelium, infiltration of both acute and chronic inflammatory cells, and high endothelial venules. Immunohistochemical analysis of the infiltrating lymphocytes revealed primarily T-cell populations admixed with several B cells and CD68-positive histiocytes. After treatment, the conjunctival lesions invariably healed without scarring.: ConclusionsIn addition to the oral and genital ulceration, ulcers can also be found in the conjunctiva of patients with Behc¸et’s disease. Although this is a rare clinical sign, when accompanied by uveitis or orogenital ulcers, it may suggest a diagnosis of Behc¸et’s disease. [Copyright &y& Elsevier]

: PurposeTo describe the ocular presentation of disseminated mycobacterial disease occurring during immune-recovery in a patient with acquired immune deficiency syndrome (AIDS).: Study designCase report and literature review.: ParticipantsA 41-year-old AIDS patient with a prior diagnosis of cytomegalovirus retinitis.: MethodsThe patient developed progressive, bilateral multifocal choroiditis with panuveitis 2 months after beginning and responding to highly active antiretroviral therapy. His left eye became blind and painful and was enucleated. Pathologic examination revealed massive choroiditis with well-formed, discrete granulomas and multiple intracellular and extracellular acid-fast organisms within the choroidal granulomas. Culture and polymerase chain reaction of vitreous specimens revealed Mycobacterium avium complex (MAC).: ResultsEmpiric, and later sensitivity-guided, local and systemic antibiotic therapy was used to treat the remaining right eye, but it continued to deteriorate. Despite medical therapy, three vitrectomies and repeated intravitreal injections of amikacin, a total retinal detachment ensued. One week after the third vitrectomy, the patient died from mesenteric artery thrombosis in the setting of disseminated mycobacterial disease.: ConclusionsThis is the first report of ocular inflammation as the presenting finding in the recently recognized syndrome of immune-recovery MAC disease. Pathogenesis of this entity is related to an enhanced immune response to a prior, subclinical, disseminated infection. The formation of discrete granulomas, normally absent in MAC infections in AIDS, reflects this mechanism. [Copyright &y& Elsevier]

: PurposeProspective evaluation of the efficacy and safety of subconjunctival triamcinolone injections for resistant, nonnecrotizing, anterior scleritis.: DesignProspective, noncomparative, interventional case series.: ParticipantsTwelve eyes of 10 consecutive patients seen in the Doheny Eye Institute between August 1999 and December 2000 with diffuse, nonnecrotizing anterior scleritis that was resistant to systemic antiinflammatory therapy. Eyes with a history of steroid response were excluded.: InterventionSubconjunctival injection of triamcinolone acetonide to the areas of maximal inflammation.: Main outcome measuresScleritis activity, adverse treatment effects, and number of systemic medications required at the end of the follow-up period.: ResultsWithin 1 to 14 days after injection, complete resolution of signs and symptoms was achieved in 11 eyes and partial resolution in 1 eye. Two patients had one recurrence each, 2.5 and 11 months after injection. Six of 10 patients were able to discontinue all systemic therapy (prednisone ± immunosuppressive drugs); the remaining 4 needed continued oral therapy for systemic indications. Transient ocular hypertension and subconjunctival hemorrhage occurred in one eye each. Median follow-up period was 15 months. No eye developed necrotizing scleritis.: ConclusionsSubconjunctival injection of triamcinolone acetonide is a safe and effective treatment for resistant, nonnecrotizing anterior scleritis. It provides rapid effect, is well tolerated, and may spare patients the significant complications and side effects of systemic corticosteroid and immunosuppressive therapy. [Copyright &y& Elsevier]