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19th Annual Meeting of the Ocular Microbiology and Immunology Group
Vol. 99, No.2
223
Meetings
the more sophisticated surgeon will find it enjoyable reading and very informative because Jaffe has done an excellent job of keeping up with the explosion of new technology since the last edition three years ago. The author points out that topics such as anatomy, embryology, and the optical correction of aphakia have been omitted, and yet there is enough historical background to refresh our memory. The text, especially that dealing with complications, is very well written and specific. Jaffe was fortunate in having superb help with drawings, pictures, and photographs so that the reader looking up a subject to get help with a cataract problem in his own practice does not feel shortchanged. Cataract surgery has always been a fascinating topic for ocular surgeons as proven by the many courses, seminars, and lectures given every year on the subject. This volume augments the enormous amount of information we are exposed to, and the reader will be pleasantly surprised when perusing this volume to find it covers well the points that might have been missed or which seemed vague during other presentations. The second part of the book, on the complications of cataract surgery, is especially valuable. Any cataract problem that interferes with a smooth end result brings concern, anxiety, and exasperation. This volume should help to keep the reader out of trouble before, during, and after cataract surgery, offering alternative rational solutions to most dilemmas. It is a satisfying book because the material is valid and reliable, and covers each complication in some depth. The other three editions have won the respect of ophthalmic surgeons, and this one is the best of all. It will be a valuable, worthwhile friend in your ophthalmic library.
Books Received
Oftal mologla e Cllnlca Medica. By Rubens Belfort, Jr., and Pedro Paulo Bonomo. Sao Paulo, Livrarla Roca Ltda., 1983. 240 pages, index, Illustrated.
A brief text on the eye in systemic disease written in Portuguese for medical students and internists.
Practical Ophthalmic Problems. By Wayne F. March. 51. Louis, Warren H. Green, lnc., 1984. Softcover, 91 pages, index, illustrated. $18.50
A short softcover book addressed to the nonophthalmologist in daily practice.
Meetings
19TH ANNUAL MEETING OF THE OCULAR MICROBIOLOGY AND IMMUNOLOGY GROUP The 19th annual meeting of the Ocular Microbiology and Immunology Group was held in Atlanta in conjunction with the American Academy of Ophthalmology. A. A. Bialasiewicz and G. J. [ahn discussed rapid microbiologic diagnosis in newborn blennorrhea. For Chlamydia they used Giemsa stains, McCoy cell cultures, monoclonal antibody direct immunofluorescent techniques, and serum sampling for immunoglobulin G indirect immunofluorescent technique. For other bacterial infections they used Gram stains, cultures, the API technique, and direct immunofluorescent techniques. P. Rapoza, L. Kiessling, H. R. Taylor, and T. C. Quinn examined 48 consecutive neonates with conjunctivitis. Twenty-six patients had chlamydial conjunctivitis. Cultures and monoclonal antibodystained conjunctival smears for Chlamydia were in accord in 25 of 26 cases. The remaining patients had the following organisms in descending frequency: Streptococcus uiridans, Staphylococcus epidermidis, S. aureus, Hemophilus parainfluenzae, and H. influenzae. The chlamydial infections were treated with systemic erythromycin. I. Avni, R. C. Arffa, and J. B. Robin discussed lectin identification of bacterial and mycotic organisms. They used commercially available fluoresceinconjugated lectins. By means of a panel of four lectins they were able to differentiate rapidly and consistently Fusarium solani, Aspergillus fumigatus, and Candida albicans taken from stock cultures and previously infected animals (corneal scrapings and vitreous aspirates). Using a panel of six fluoresceinconjugated lectins they were also able to differentiate
224
AMERICAN JOURNAL OF OPHrHALMOLOGY
several gram-negative rods and gram-positive cocci taken from stock bacterial cultures. M. B. Moore, C. Newton, M. B. McDonald, H. E. Kaufman, J. P. McCulley, H. Gelender, M. W. Luckenbach, R. G. Yaeger, and G. S. Visvesvara described three young healthy patients who used soft daily-wear contact lenses and developed a stromal ring infiltrate. Penetrating keratoplasty (two cases) or superficial keratectomy (one case) showed amoebae in the tissue. Propamadine isethionate. miconazole, and polymyxin B-bacitracin-neomycin were used successfully to treat these cases. Propamidine isethionate is amoebicidal and may be cysticidal. It is not FDA-approved for ocular use. M. S. Osata, D. N. Ugland, N. M. Robinson, K. R. Wilhelmus, R. L. Font, and D. B. Jones observed that Acanthamoeba keratitis occurs in patients with compromised epithelium. The stromal ring of infiltrate is characteristic. The disease progresses slowly and is refractory to antibiotics. These investigators believe that the most useful and rapid staining technique is with cellufluor, a chemofluorescent dye that has a preferential affinity for the chitin-rich cyst wall. Culturing on plates with minimal nutrient media overlaid with dead Escherichia coli may be helpful. They believe that none of the available drugs are cysticidal and that corticosteroids may play an important role in controlling this disease. T. J. Roussel, P. R. Badenoch, and D. J. Coster discussed the effectiveness of gentamicin in their rat model of bacterial keratitis and an in vitro assay. They noted that the concentration of gentamicin in vivo necessary to produce an antimicrobial effect against S. aureus comparable to the in vitro concentration was 30 to 100 times greater. They postulate that this difference relates to the dynamic interaction between host, micro-organism, and antibiotic rather than antibiotic binding and inactivation. W. B. Jackson, W. M. Orr, and K. Colden discussed the intraocular penetration of netilmicin, a newly released aminoglycoside. Compared to gentamicin, it has increased activity against Enterobacteriaceae in vitro and has decreased ototoxicity and nephrotoxicity. The subconjunctival administration of the drug results in aqueous humor levels that are probably effective whereas intramuscular injections result in lower aqueous humor levels. J. Colin, J. F. Bonissent, and C. Riche discussed the intravitreal penetration of cefotaxime, a thirdgeneration cephalosporin, which has activity against Pseudomonas and staphylococcal species. A single intravenous dose was not as effective as a continuous infusion in causing increased levels in the vitreous. Higher levels were obtained in inflamed eyes. The drug level may not be high enough in the vitreous to
February, 1985
retard the growth of Pseudomonas and staphylococcal species. M. Barza, J. Baum, F. Szoka, and D. D'Amico reported upon the reduced toxicity of liposomeassociated amphotericin B injected intravitreally in monkeys. J. D. Bullock discussed an experimental model for the study of endogenous ocular nocardiosis. An intracarotid injection of 103 colony-forming units resulted in eyelid, iris, and chorioretinal lesions. Lesions were also found throughout the internal organs at autopsy. G. Smolin, M. Matli, M. Okumoto, M. Mayers, and M. Samy used recombinant interferon to prevent recurrent herpesvirus from shedding into the tear film of rabbits after iontophoresis, 6-hydroxydopamine, and epinephrine stimulation. Increased levels of interferon were noted in the tear film 42 hours after topical administration of one drop four times a day for two consecutive days. J. B. Robin and Y. M. Centifanto-Fitzgerald utilized fluorescein-conjugated lections to identify herpes simplex type 1. The technique is rapid but less specific than conventional fluorescein-labeled antiherpes simplex monoclonal antibody techniques. V. Huber-Spitzy, F. J. Steinkogler, and G. Grabner discussed a case of bilateral severe necrotic blepharitis and dacryocystitis in a newborn caused by Pseudomonas aeruginosa. The child was unresponsive to antibiotics to which the organism was sensitive. Immunocompromised patients may develop this icthyma gangrenosum in which treatment must be directed against the defective granulocytes and defective immune status. G. W. Lavery, C. L. Bullen and R. L. Lindstrom discussed a patient with Nocardia asteroides who developed a corneal ulceration and iris nodules. Treatment consisted of topical sulfacetamide and systemic monocycline. It was noted that systemically administered sulfonamides and ampicillin may act synergistically against this organism. B. H. Koffler presented the case of a patient who developed an Eikenella corrodens corneal ulcer that responded to fortified penicillin eyedrops over a two-week period. M. B. Starr reported a case of Paecilomyces lilacinus keratitis that required a penetrating keratoplasty and concomitant antimicrobial therapy with miconazole. The organism was resistant to amphotericin Band primaricin. R. A. Eifferman and M. J. Oakley described three cases of herpes zoster ophthalmicus in children. Each of the children had mild perinatal cases of chicken pox. The typical skin lesions, keratoconjunctivitis, and mild iritis occurred in all of these cases.
Vol. 99, No.2
Meetings
S. Stenson discussed coarse epithelial keratitis in contact lens wearers. A dense epithelial and subepithelial pattern formed in the upper one third of the cornea with peculiar radial epithelial spokes and pannus. Several members of the audience had seen a similar pattern and believed it was the result of thimerosal or other preservatives. Changing the lens care regimen to solutions without preservatives allowed the patients to improve and to continue contact lens wear. T. J. Liesegang described 15 cases of extensive bulbar conjunctival follicular reaction associated with dipivefrin therapy. Some patients developed an atopic dermatologic response on the eyelids. The reaction was caused by the L-epinephrine because other medications with the same preservatives were tolerated. J. P. Wilmeth described keratoconjunctivitis associated with the use of curl activator. Ocular findings include edema, papillary conjunctivitis, and punctate staining of the cornea. Treatment consisted of prompt shampooing of the hair and discontinuing the activator. E. L. Stock, A. D. Mendelsohn, G. G. Lo, S. Ghosh, and R. B. O'Grady reported on a model of lipid keratopathy in rabbits. Rabbits rendered hypercholesterolemic on a high-cholesterol diet while subjected to corneal suture placement to induce neovascularization developed corneal lipid deposits in the area of the blood vessels. 1. R. Schwab reported on a subgroup of patients with Fuchs' heterochromic iridocyclitis who had necrotizing chorioretinal lesions characteristic of toxoplasmosis. Three of these patients had positive toxoplasmosis titers. C. F. Bahn, J. B. Sharefkin, A. Valcarcel, H. V. Hufnagel, S. Grove, and N. M. Rich cultured human vascular endothelial cells on cat corneas denuded of native endothelium. The cells formed a confluent monolayer. These corneas were transplanted into other cats. Between nine and 14 days after keratoplasty retrocorneal keratic precipitates formed. In vitro co-cultivation of the human vascular endothelial and peripheral blood lymphocytes from animals with the rejecting corneal grafts produced blast responses in the lymphocytes. A. W. Tuberville and T. O. Wood reported on aqueous humor protein and complement in pseudophakic bullous keratopathy. The studies indicated that there was no significant difference in these substances in the aqueous humor of patients with aphakic or pseudophakic bullous keratopathy. The degree of corneal decompensation, however, was directly related to the presence of complement components and protein.
225
D. J. Coster and K. A. Williams, in a model of penetrating keratoplasty in inbred rats, noted a combination of corticosteroids (prednisolone acetate 1%) and cyclosporine 1% in chremaphor-alcohol was more effective in protecting the corneal grafts than either drug alone. The use of corticosteroid alone was more effective than cyclosporine which in turn was more effective than the control drops. G. Grabner, J. Schreiner, T. A. Luger, and V. Huber-Spitzy reported on a thymocyte activity factor produced in vitro by human activity fibroblasts and conjunctival cells. This cytokine resembling interleukin-1 can affect lymphocytes, polymorphonuclear leukocytes, hepatocytes, and fibroblasts. P. Donshik, P. Mitchell, and D. Albert treated a child with ligneous conjunctivitis. Surgery, disodium cromoglycate, hyaluronidase, alpha-chymotrypsin, and dexamethasone were ineffective in clearing the condition. 1. J. Udell, S. J. Katz, and P. Mir reported a case of unilateral progressive, peripheral ulcerative keratitis with stromal neovascularization in which scrapings stained positively with herpes simplex type 1 monoclonal antibody by an indirect immunofluorescence technique. G. W. Zaidman and R. Weinberg discussed a case of neurosyphilis and retrobulbar neuritis in a patient with the acquired immune deficiency syndrome. This case reemphasizes that syphilis and its ocular manifestations are common and easily treatable causes of ocular morbidity, especially in patients with the acquired immune deficiency syndrome. In 198374,000 cases of syphilis were recorded and 40% to 45% occurred in homosexuals. P. E. Newman, P. Kozarsky, and G. O. Waring reported a case of the first larval stage of the rodent botfly Cuterebra in the anterior chamber of a patient. The minimal anterior chamber inflammation was easily controlled by topical corticosteroids. During the succeeding eight months the larva atrophied. The larva probably entered by direct entrance. S. 1. Butrus, B. C. Henderson, and J. P. Ganley saw a diabetic patient with bilateral endophthalmitis who developed the syndrome of inappropriate antidiuretic hormone. It was suggested that the intensive antibiotic therapy may have also played a role in the development of this syndrome. M. Carney, R. S. Weinberg, and R. K. Guerry reported two cases of Bacillus cereus endophthalmitis which developed after a foreign body entered the eye. In each case the infection resulted in eventual enucleation of the eye. These cases may be ocular emergencies that may require immediate vitrectomy and institution of systemic and ocular c1indamycin and gentamicin therapy.
226
AMERICAN JOURNAL OF OPHTHALMOLOGY
M. R. Allansmith, A. Cornell-Bell, and D. A. Sullivan concluded that a gender-related morphologic difference in lacrimal glands probably exists in all species and that this difference varies from 21 % in humans to 76% in rats. The acini are also larger in males. C. M. Kaslow, J. M. Baisch, and D. D. Brudette studied intraocular anti-S reactivity in S antigeninduced experimental autoimmune uveitis in rats. The serum titers of anti-S reactivity did not show a correlation to the time of onset or severity of uveitis. There was general correlation between activity in the vitreous or retina and aqueous. Those rats that had not yet demonstrated clinical uveitis had lower titers (using the enzyme linked immunosorbent assays [ELISA] technique) than those that did exhibit uveitis. G. Pararajasegaram, J. Harrison, A. Wells, M. Hammer, P. LiII, and A. Fox induced uveitis by intravitreal injection of streptococcal cell wall fragments in rabbits or intraperitoneal injection of
February, 1985
these fragments in rats. They have developed an enzyme-linked immunoassay for the detection of streptococcal cell wall antigens using wheat germ agglutinin. S. D. Trocme, R. S. Baird, K. ]. Block, and M. R. Allansmith infected rats with the worm Nipposirongylus brasiliensis. Topical application of worm extract alone in these rats did not induce clinical or histologic ocular anaphylaxis. However, topical application of worm extract, following disruption of the conjunctival epithelium by local administration of 10 J.LI of 1 M dithiothreitol, did result in significant mast cell degranulation in the external ocular tissues. J. Harrison, P. LiII, M. Hammer, and A. Fox injected muramyl dipeptide into the vitreous of rats and caused an acute inflammatory response within 18 hours. Increasing doses of the dipeptide caused increased iritis and vitreous and anterior chamber reaction. Histologically the uveitis was characterized by a mild polymorphonuclear cell infiltration. GILBERT SMOLIN
223
Meetings
the more sophisticated surgeon will find it enjoyable reading and very informative because Jaffe has done an excellent job of keeping up with the explosion of new technology since the last edition three years ago. The author points out that topics such as anatomy, embryology, and the optical correction of aphakia have been omitted, and yet there is enough historical background to refresh our memory. The text, especially that dealing with complications, is very well written and specific. Jaffe was fortunate in having superb help with drawings, pictures, and photographs so that the reader looking up a subject to get help with a cataract problem in his own practice does not feel shortchanged. Cataract surgery has always been a fascinating topic for ocular surgeons as proven by the many courses, seminars, and lectures given every year on the subject. This volume augments the enormous amount of information we are exposed to, and the reader will be pleasantly surprised when perusing this volume to find it covers well the points that might have been missed or which seemed vague during other presentations. The second part of the book, on the complications of cataract surgery, is especially valuable. Any cataract problem that interferes with a smooth end result brings concern, anxiety, and exasperation. This volume should help to keep the reader out of trouble before, during, and after cataract surgery, offering alternative rational solutions to most dilemmas. It is a satisfying book because the material is valid and reliable, and covers each complication in some depth. The other three editions have won the respect of ophthalmic surgeons, and this one is the best of all. It will be a valuable, worthwhile friend in your ophthalmic library.
Books Received
Oftal mologla e Cllnlca Medica. By Rubens Belfort, Jr., and Pedro Paulo Bonomo. Sao Paulo, Livrarla Roca Ltda., 1983. 240 pages, index, Illustrated.
A brief text on the eye in systemic disease written in Portuguese for medical students and internists.
Practical Ophthalmic Problems. By Wayne F. March. 51. Louis, Warren H. Green, lnc., 1984. Softcover, 91 pages, index, illustrated. $18.50
A short softcover book addressed to the nonophthalmologist in daily practice.
Meetings
19TH ANNUAL MEETING OF THE OCULAR MICROBIOLOGY AND IMMUNOLOGY GROUP The 19th annual meeting of the Ocular Microbiology and Immunology Group was held in Atlanta in conjunction with the American Academy of Ophthalmology. A. A. Bialasiewicz and G. J. [ahn discussed rapid microbiologic diagnosis in newborn blennorrhea. For Chlamydia they used Giemsa stains, McCoy cell cultures, monoclonal antibody direct immunofluorescent techniques, and serum sampling for immunoglobulin G indirect immunofluorescent technique. For other bacterial infections they used Gram stains, cultures, the API technique, and direct immunofluorescent techniques. P. Rapoza, L. Kiessling, H. R. Taylor, and T. C. Quinn examined 48 consecutive neonates with conjunctivitis. Twenty-six patients had chlamydial conjunctivitis. Cultures and monoclonal antibodystained conjunctival smears for Chlamydia were in accord in 25 of 26 cases. The remaining patients had the following organisms in descending frequency: Streptococcus uiridans, Staphylococcus epidermidis, S. aureus, Hemophilus parainfluenzae, and H. influenzae. The chlamydial infections were treated with systemic erythromycin. I. Avni, R. C. Arffa, and J. B. Robin discussed lectin identification of bacterial and mycotic organisms. They used commercially available fluoresceinconjugated lectins. By means of a panel of four lectins they were able to differentiate rapidly and consistently Fusarium solani, Aspergillus fumigatus, and Candida albicans taken from stock cultures and previously infected animals (corneal scrapings and vitreous aspirates). Using a panel of six fluoresceinconjugated lectins they were also able to differentiate
224
AMERICAN JOURNAL OF OPHrHALMOLOGY
several gram-negative rods and gram-positive cocci taken from stock bacterial cultures. M. B. Moore, C. Newton, M. B. McDonald, H. E. Kaufman, J. P. McCulley, H. Gelender, M. W. Luckenbach, R. G. Yaeger, and G. S. Visvesvara described three young healthy patients who used soft daily-wear contact lenses and developed a stromal ring infiltrate. Penetrating keratoplasty (two cases) or superficial keratectomy (one case) showed amoebae in the tissue. Propamadine isethionate. miconazole, and polymyxin B-bacitracin-neomycin were used successfully to treat these cases. Propamidine isethionate is amoebicidal and may be cysticidal. It is not FDA-approved for ocular use. M. S. Osata, D. N. Ugland, N. M. Robinson, K. R. Wilhelmus, R. L. Font, and D. B. Jones observed that Acanthamoeba keratitis occurs in patients with compromised epithelium. The stromal ring of infiltrate is characteristic. The disease progresses slowly and is refractory to antibiotics. These investigators believe that the most useful and rapid staining technique is with cellufluor, a chemofluorescent dye that has a preferential affinity for the chitin-rich cyst wall. Culturing on plates with minimal nutrient media overlaid with dead Escherichia coli may be helpful. They believe that none of the available drugs are cysticidal and that corticosteroids may play an important role in controlling this disease. T. J. Roussel, P. R. Badenoch, and D. J. Coster discussed the effectiveness of gentamicin in their rat model of bacterial keratitis and an in vitro assay. They noted that the concentration of gentamicin in vivo necessary to produce an antimicrobial effect against S. aureus comparable to the in vitro concentration was 30 to 100 times greater. They postulate that this difference relates to the dynamic interaction between host, micro-organism, and antibiotic rather than antibiotic binding and inactivation. W. B. Jackson, W. M. Orr, and K. Colden discussed the intraocular penetration of netilmicin, a newly released aminoglycoside. Compared to gentamicin, it has increased activity against Enterobacteriaceae in vitro and has decreased ototoxicity and nephrotoxicity. The subconjunctival administration of the drug results in aqueous humor levels that are probably effective whereas intramuscular injections result in lower aqueous humor levels. J. Colin, J. F. Bonissent, and C. Riche discussed the intravitreal penetration of cefotaxime, a thirdgeneration cephalosporin, which has activity against Pseudomonas and staphylococcal species. A single intravenous dose was not as effective as a continuous infusion in causing increased levels in the vitreous. Higher levels were obtained in inflamed eyes. The drug level may not be high enough in the vitreous to
February, 1985
retard the growth of Pseudomonas and staphylococcal species. M. Barza, J. Baum, F. Szoka, and D. D'Amico reported upon the reduced toxicity of liposomeassociated amphotericin B injected intravitreally in monkeys. J. D. Bullock discussed an experimental model for the study of endogenous ocular nocardiosis. An intracarotid injection of 103 colony-forming units resulted in eyelid, iris, and chorioretinal lesions. Lesions were also found throughout the internal organs at autopsy. G. Smolin, M. Matli, M. Okumoto, M. Mayers, and M. Samy used recombinant interferon to prevent recurrent herpesvirus from shedding into the tear film of rabbits after iontophoresis, 6-hydroxydopamine, and epinephrine stimulation. Increased levels of interferon were noted in the tear film 42 hours after topical administration of one drop four times a day for two consecutive days. J. B. Robin and Y. M. Centifanto-Fitzgerald utilized fluorescein-conjugated lections to identify herpes simplex type 1. The technique is rapid but less specific than conventional fluorescein-labeled antiherpes simplex monoclonal antibody techniques. V. Huber-Spitzy, F. J. Steinkogler, and G. Grabner discussed a case of bilateral severe necrotic blepharitis and dacryocystitis in a newborn caused by Pseudomonas aeruginosa. The child was unresponsive to antibiotics to which the organism was sensitive. Immunocompromised patients may develop this icthyma gangrenosum in which treatment must be directed against the defective granulocytes and defective immune status. G. W. Lavery, C. L. Bullen and R. L. Lindstrom discussed a patient with Nocardia asteroides who developed a corneal ulceration and iris nodules. Treatment consisted of topical sulfacetamide and systemic monocycline. It was noted that systemically administered sulfonamides and ampicillin may act synergistically against this organism. B. H. Koffler presented the case of a patient who developed an Eikenella corrodens corneal ulcer that responded to fortified penicillin eyedrops over a two-week period. M. B. Starr reported a case of Paecilomyces lilacinus keratitis that required a penetrating keratoplasty and concomitant antimicrobial therapy with miconazole. The organism was resistant to amphotericin Band primaricin. R. A. Eifferman and M. J. Oakley described three cases of herpes zoster ophthalmicus in children. Each of the children had mild perinatal cases of chicken pox. The typical skin lesions, keratoconjunctivitis, and mild iritis occurred in all of these cases.
Vol. 99, No.2
Meetings
S. Stenson discussed coarse epithelial keratitis in contact lens wearers. A dense epithelial and subepithelial pattern formed in the upper one third of the cornea with peculiar radial epithelial spokes and pannus. Several members of the audience had seen a similar pattern and believed it was the result of thimerosal or other preservatives. Changing the lens care regimen to solutions without preservatives allowed the patients to improve and to continue contact lens wear. T. J. Liesegang described 15 cases of extensive bulbar conjunctival follicular reaction associated with dipivefrin therapy. Some patients developed an atopic dermatologic response on the eyelids. The reaction was caused by the L-epinephrine because other medications with the same preservatives were tolerated. J. P. Wilmeth described keratoconjunctivitis associated with the use of curl activator. Ocular findings include edema, papillary conjunctivitis, and punctate staining of the cornea. Treatment consisted of prompt shampooing of the hair and discontinuing the activator. E. L. Stock, A. D. Mendelsohn, G. G. Lo, S. Ghosh, and R. B. O'Grady reported on a model of lipid keratopathy in rabbits. Rabbits rendered hypercholesterolemic on a high-cholesterol diet while subjected to corneal suture placement to induce neovascularization developed corneal lipid deposits in the area of the blood vessels. 1. R. Schwab reported on a subgroup of patients with Fuchs' heterochromic iridocyclitis who had necrotizing chorioretinal lesions characteristic of toxoplasmosis. Three of these patients had positive toxoplasmosis titers. C. F. Bahn, J. B. Sharefkin, A. Valcarcel, H. V. Hufnagel, S. Grove, and N. M. Rich cultured human vascular endothelial cells on cat corneas denuded of native endothelium. The cells formed a confluent monolayer. These corneas were transplanted into other cats. Between nine and 14 days after keratoplasty retrocorneal keratic precipitates formed. In vitro co-cultivation of the human vascular endothelial and peripheral blood lymphocytes from animals with the rejecting corneal grafts produced blast responses in the lymphocytes. A. W. Tuberville and T. O. Wood reported on aqueous humor protein and complement in pseudophakic bullous keratopathy. The studies indicated that there was no significant difference in these substances in the aqueous humor of patients with aphakic or pseudophakic bullous keratopathy. The degree of corneal decompensation, however, was directly related to the presence of complement components and protein.
225
D. J. Coster and K. A. Williams, in a model of penetrating keratoplasty in inbred rats, noted a combination of corticosteroids (prednisolone acetate 1%) and cyclosporine 1% in chremaphor-alcohol was more effective in protecting the corneal grafts than either drug alone. The use of corticosteroid alone was more effective than cyclosporine which in turn was more effective than the control drops. G. Grabner, J. Schreiner, T. A. Luger, and V. Huber-Spitzy reported on a thymocyte activity factor produced in vitro by human activity fibroblasts and conjunctival cells. This cytokine resembling interleukin-1 can affect lymphocytes, polymorphonuclear leukocytes, hepatocytes, and fibroblasts. P. Donshik, P. Mitchell, and D. Albert treated a child with ligneous conjunctivitis. Surgery, disodium cromoglycate, hyaluronidase, alpha-chymotrypsin, and dexamethasone were ineffective in clearing the condition. 1. J. Udell, S. J. Katz, and P. Mir reported a case of unilateral progressive, peripheral ulcerative keratitis with stromal neovascularization in which scrapings stained positively with herpes simplex type 1 monoclonal antibody by an indirect immunofluorescence technique. G. W. Zaidman and R. Weinberg discussed a case of neurosyphilis and retrobulbar neuritis in a patient with the acquired immune deficiency syndrome. This case reemphasizes that syphilis and its ocular manifestations are common and easily treatable causes of ocular morbidity, especially in patients with the acquired immune deficiency syndrome. In 198374,000 cases of syphilis were recorded and 40% to 45% occurred in homosexuals. P. E. Newman, P. Kozarsky, and G. O. Waring reported a case of the first larval stage of the rodent botfly Cuterebra in the anterior chamber of a patient. The minimal anterior chamber inflammation was easily controlled by topical corticosteroids. During the succeeding eight months the larva atrophied. The larva probably entered by direct entrance. S. 1. Butrus, B. C. Henderson, and J. P. Ganley saw a diabetic patient with bilateral endophthalmitis who developed the syndrome of inappropriate antidiuretic hormone. It was suggested that the intensive antibiotic therapy may have also played a role in the development of this syndrome. M. Carney, R. S. Weinberg, and R. K. Guerry reported two cases of Bacillus cereus endophthalmitis which developed after a foreign body entered the eye. In each case the infection resulted in eventual enucleation of the eye. These cases may be ocular emergencies that may require immediate vitrectomy and institution of systemic and ocular c1indamycin and gentamicin therapy.
226
AMERICAN JOURNAL OF OPHTHALMOLOGY
M. R. Allansmith, A. Cornell-Bell, and D. A. Sullivan concluded that a gender-related morphologic difference in lacrimal glands probably exists in all species and that this difference varies from 21 % in humans to 76% in rats. The acini are also larger in males. C. M. Kaslow, J. M. Baisch, and D. D. Brudette studied intraocular anti-S reactivity in S antigeninduced experimental autoimmune uveitis in rats. The serum titers of anti-S reactivity did not show a correlation to the time of onset or severity of uveitis. There was general correlation between activity in the vitreous or retina and aqueous. Those rats that had not yet demonstrated clinical uveitis had lower titers (using the enzyme linked immunosorbent assays [ELISA] technique) than those that did exhibit uveitis. G. Pararajasegaram, J. Harrison, A. Wells, M. Hammer, P. LiII, and A. Fox induced uveitis by intravitreal injection of streptococcal cell wall fragments in rabbits or intraperitoneal injection of
February, 1985
these fragments in rats. They have developed an enzyme-linked immunoassay for the detection of streptococcal cell wall antigens using wheat germ agglutinin. S. D. Trocme, R. S. Baird, K. ]. Block, and M. R. Allansmith infected rats with the worm Nipposirongylus brasiliensis. Topical application of worm extract alone in these rats did not induce clinical or histologic ocular anaphylaxis. However, topical application of worm extract, following disruption of the conjunctival epithelium by local administration of 10 J.LI of 1 M dithiothreitol, did result in significant mast cell degranulation in the external ocular tissues. J. Harrison, P. LiII, M. Hammer, and A. Fox injected muramyl dipeptide into the vitreous of rats and caused an acute inflammatory response within 18 hours. Increasing doses of the dipeptide caused increased iritis and vitreous and anterior chamber reaction. Histologically the uveitis was characterized by a mild polymorphonuclear cell infiltration. GILBERT SMOLIN