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Aqueous Flare and Cell Meter in Iridocyclitis
LETTERS TO THE JOURNAL the flare to a bovine serum albumin concentra tion using the following equation:
Aqueous Flare and Cell Meter in Iridocyclitis Kunitoshi Ohara, M . D . , Akira O k u b o , M . D . , Atsuko Miyazawa, M . D . , and Hiroshi Sasaki, M . D . Department of Ophthalmology, School.
Jichi
Y = χι·Μ χ 4 # 6 5 /
where Y and X represented albumin concentra tion (mg/dl) and photon count, respectively (Y. Tsurimaki and M. Sawa, unpublished data). The data were expressed as an average of five readings for each measurement. The laser flare-cell meter demonstrated an albumin concentration of 9,019 mg/dl and 63 cells/0.075 mm 3 in the left hypopyon iridocycli tis and an albumin concentration of 3,268 mg/dl and 52.6 cells/0.075 mm 3 in the right hypopyon iridocyclitis (Figure). Both hypopyons disap peared after one week, but albumin concentra tions remained at R.E.: 643 mg/dl and L.E.: 499 mg/dl, and the cell counts were R.E.: 1.0 ± 1.4/0.075 mm 3 and L.E.: 0.6 ± 0.9/0.075 mm 3 on May 25, 1988. The laser flare-cell meter has been used to compute the aqueous flare and cells in patients after extracapsular cataract extraction and in traocular lens implantation (Y. Tsurimaki, M. Sawa, H. Shimizu, unpublished data). The flare-cell meter clearly quantified the hypopyon iridocyclitis in Behçet's disease, which is char acterized by ocular attacks associated with se vere cellular reaction in the anterior chamber. 2 The range of the aqueous protein expressed by albumin concentration exceeded those seen in postoperative iridocyclitis, but the cell counts were in the same range (Y. Tsurimaki, M. Sawa, H. Shimizu, unpublished data). The data suggested the applicability of the flare-cell meter for quantifying aqueous flare and float ers. Its use can minimize individual and interhospital variations in the quantification of iri-
Medical
Inquiries to Kunitoshi Ohara, Μ.Ό., Department of Oph thalmology, Jichi Medical School, 3311-1 Yakushiji, Minamikawachimachi, Kawachi-gun, Tochigi-ken 329-04, Japan.
A laser flare-cell meter has been developed that was reported to quantify the flare and cells in postoperative inflammation following intra ocular lens implantation. 1 We used this instru ment in a patient with Behçet's disease to test its application in endogenous uveitis. On examination May 6, 1988, a 27-year-old woman with Behçet's disease was noted to have hypopyon iridocyclitis in the left eye. Her right eye had been aphakic for two years after extracapsular cataract extraction and the left eye had a mature cataract. Best-corrected visual acuity was R.E.: 20/60 and L.E.: hand motions. The hypopyon diminished within one week after topical treatment. On May 18, 1988, we noted severe iridocyclitis in the right eye, but no hypopyon was seen. However, the next day the hypopyon developed in the right eye. This was treated with subconjunctival corticosteroid injection and oral corticosteroids. We used a laser flare-cell meter that consisted of a helium-neon laser beam scanner and a photomultiplier, which was interfaced with a personal computer with a monitor display and a printer. 1 We converted the photon count for
THE JOURNAL welcomes letters that describe unusual clinical or pathologic findings, experimental results, and new instruments or techniques. The title and the names of all authors appear in the Table of Contents and are retrievable through the Index Medicus and other standard indexing services. Letters must not duplicate data previously published or submitted for publication. Each letter must be accompanied by a signed disclosure statement and copyright transfer agreement published in each issue of THE JOURNAL. Letters must be typewritten, double-spaced, on 8 1/2 x 11-inch bond paper with 1 1/2-inch margins on all four sides. (See Instructions to Authors.) They should not exceed 500 words of text. A maximum of two black-and-white figures may be used; they should be cropped to a width of 3 inches (one column). Color figures cannot be used. References should be limited to five. Letters may be referred to outside editorial referees for evaluation or may be reviewed by members of the Editorial Board. All letters are published promptly after acceptance. Authors do not receive galley proofs but if the editorial changes are extensive, the corrected typescript is submitted to them for approval. These instructions markedly limit the opportunity for an extended discussion or review. Therefore, THE JOURNAL does not publish correspondence concerning previously published letters.
487
488
AMERICAN JOURNAL OF OPHTHALMOLOGY
October, 1988
3. Krause, U., and Raunio, V.: The protein of the pathologic human aqueous humor. Ophthalmologica 19:280, 1970.
100
The Effect of Bromocriptine on Anterior Uveitis Alan G. Palestine, M . D . , and Robert B. Nussenblatt, M . D . Laboratory of Immunology, National Eye Institute, National Institutes of Health.
Figure (Ohara and associates). Aqueous protein and cell count of the hypopyon iridocyclitis. Circles and squares indicate values in the right and left eyes, respectively. Asterisks indicate values obtained in the most apparent hypopyon. docyclitis and make quantitative evaluation of surgical trauma and various therapeutic effects more accurate and reliable. The validity of the instrument in various types of endogenous uveitis remains to be de termined, since we do not know if albumin represents the major component of aqueous proteins in these eyes. 3 The scattering from the cells may interfere with the flare measurement, and endogenous uveitis may show mild inflam mation with scarce aqueous cells that could not be detected through the small scanning win dow of the present model (K. Ohara, unpub lished data).
References 1. Sawa, M., Tsurimaki, Y., Tsuru, T., and Shimizu, H.: New quantitative method to determine protein concentration and cell number in aqueous in vivo. Jpn. J. Ophthalmol. 32:132, 1988. 2. Behçet's Disease Research Committee of Japan: Behçet's disease. Guide to diagnosis of Behçet's dis ease. Jpn. J. Ophthalmol. 18:291, 1974.
Inquiries to Alan G. Palestine, M.D., Laboratory of Immunology, National Eye Institute, 9000 Rockville Pike, Bldg. 10, Rm. 10N222, Bethesda, MD 20892. The role of neuroendocrine modulation of the immune system has received increasing attention over the past several years. Prolactin, a lactogenic hormone produced by the anterior pituitary, has been shown to be a potent modu lator of the immune response in experimental animals. It is now clear that prolactin can stim ulate immune responsiveness and that decreas es in the circulating prolactin level can result in immunosuppression of both cellular and hu moral immune processes in a variety of animal model systems. 1,2 In addition to its effect as a sole agent, prolactin can enhance the effect of cyclosporine as an immunosuppressive agent in animal models. 2 There is, however, less evidence that circu lating prolactin can affect the immune response in humans. Bromocriptine is a dopamine ago nist that is a potent suppressor of prolactin release from the pituitary. We have demon strated an enhancement of the effect of cyclosporine by bromocriptine in intermediate and posterior uveitis. 3 Additionally, five pa tients with anterior uveitis who were treated with bromocriptine for either hyperprolactinemia or Parkinson's disease were described by others to have concurrent marked improve ment in the activity of their uveitis. 4 Although the immunologie mechanism of idiopathic anterior uveitis is not clear, it is presumed to be a disorder mediated by the immune system. Suppression of the immune response is therapeutically useful in this disease. Based upon our experience with regulation of the immune response by prolactin in ocular inflammatory models and the observations above, we designed a small, masked random ized study to test whether a dramatic treatment
Aqueous Flare and Cell Meter in Iridocyclitis Kunitoshi Ohara, M . D . , Akira O k u b o , M . D . , Atsuko Miyazawa, M . D . , and Hiroshi Sasaki, M . D . Department of Ophthalmology, School.
Jichi
Y = χι·Μ χ 4 # 6 5 /
where Y and X represented albumin concentra tion (mg/dl) and photon count, respectively (Y. Tsurimaki and M. Sawa, unpublished data). The data were expressed as an average of five readings for each measurement. The laser flare-cell meter demonstrated an albumin concentration of 9,019 mg/dl and 63 cells/0.075 mm 3 in the left hypopyon iridocycli tis and an albumin concentration of 3,268 mg/dl and 52.6 cells/0.075 mm 3 in the right hypopyon iridocyclitis (Figure). Both hypopyons disap peared after one week, but albumin concentra tions remained at R.E.: 643 mg/dl and L.E.: 499 mg/dl, and the cell counts were R.E.: 1.0 ± 1.4/0.075 mm 3 and L.E.: 0.6 ± 0.9/0.075 mm 3 on May 25, 1988. The laser flare-cell meter has been used to compute the aqueous flare and cells in patients after extracapsular cataract extraction and in traocular lens implantation (Y. Tsurimaki, M. Sawa, H. Shimizu, unpublished data). The flare-cell meter clearly quantified the hypopyon iridocyclitis in Behçet's disease, which is char acterized by ocular attacks associated with se vere cellular reaction in the anterior chamber. 2 The range of the aqueous protein expressed by albumin concentration exceeded those seen in postoperative iridocyclitis, but the cell counts were in the same range (Y. Tsurimaki, M. Sawa, H. Shimizu, unpublished data). The data suggested the applicability of the flare-cell meter for quantifying aqueous flare and float ers. Its use can minimize individual and interhospital variations in the quantification of iri-
Medical
Inquiries to Kunitoshi Ohara, Μ.Ό., Department of Oph thalmology, Jichi Medical School, 3311-1 Yakushiji, Minamikawachimachi, Kawachi-gun, Tochigi-ken 329-04, Japan.
A laser flare-cell meter has been developed that was reported to quantify the flare and cells in postoperative inflammation following intra ocular lens implantation. 1 We used this instru ment in a patient with Behçet's disease to test its application in endogenous uveitis. On examination May 6, 1988, a 27-year-old woman with Behçet's disease was noted to have hypopyon iridocyclitis in the left eye. Her right eye had been aphakic for two years after extracapsular cataract extraction and the left eye had a mature cataract. Best-corrected visual acuity was R.E.: 20/60 and L.E.: hand motions. The hypopyon diminished within one week after topical treatment. On May 18, 1988, we noted severe iridocyclitis in the right eye, but no hypopyon was seen. However, the next day the hypopyon developed in the right eye. This was treated with subconjunctival corticosteroid injection and oral corticosteroids. We used a laser flare-cell meter that consisted of a helium-neon laser beam scanner and a photomultiplier, which was interfaced with a personal computer with a monitor display and a printer. 1 We converted the photon count for
THE JOURNAL welcomes letters that describe unusual clinical or pathologic findings, experimental results, and new instruments or techniques. The title and the names of all authors appear in the Table of Contents and are retrievable through the Index Medicus and other standard indexing services. Letters must not duplicate data previously published or submitted for publication. Each letter must be accompanied by a signed disclosure statement and copyright transfer agreement published in each issue of THE JOURNAL. Letters must be typewritten, double-spaced, on 8 1/2 x 11-inch bond paper with 1 1/2-inch margins on all four sides. (See Instructions to Authors.) They should not exceed 500 words of text. A maximum of two black-and-white figures may be used; they should be cropped to a width of 3 inches (one column). Color figures cannot be used. References should be limited to five. Letters may be referred to outside editorial referees for evaluation or may be reviewed by members of the Editorial Board. All letters are published promptly after acceptance. Authors do not receive galley proofs but if the editorial changes are extensive, the corrected typescript is submitted to them for approval. These instructions markedly limit the opportunity for an extended discussion or review. Therefore, THE JOURNAL does not publish correspondence concerning previously published letters.
487
488
AMERICAN JOURNAL OF OPHTHALMOLOGY
October, 1988
3. Krause, U., and Raunio, V.: The protein of the pathologic human aqueous humor. Ophthalmologica 19:280, 1970.
100
The Effect of Bromocriptine on Anterior Uveitis Alan G. Palestine, M . D . , and Robert B. Nussenblatt, M . D . Laboratory of Immunology, National Eye Institute, National Institutes of Health.
Figure (Ohara and associates). Aqueous protein and cell count of the hypopyon iridocyclitis. Circles and squares indicate values in the right and left eyes, respectively. Asterisks indicate values obtained in the most apparent hypopyon. docyclitis and make quantitative evaluation of surgical trauma and various therapeutic effects more accurate and reliable. The validity of the instrument in various types of endogenous uveitis remains to be de termined, since we do not know if albumin represents the major component of aqueous proteins in these eyes. 3 The scattering from the cells may interfere with the flare measurement, and endogenous uveitis may show mild inflam mation with scarce aqueous cells that could not be detected through the small scanning win dow of the present model (K. Ohara, unpub lished data).
References 1. Sawa, M., Tsurimaki, Y., Tsuru, T., and Shimizu, H.: New quantitative method to determine protein concentration and cell number in aqueous in vivo. Jpn. J. Ophthalmol. 32:132, 1988. 2. Behçet's Disease Research Committee of Japan: Behçet's disease. Guide to diagnosis of Behçet's dis ease. Jpn. J. Ophthalmol. 18:291, 1974.
Inquiries to Alan G. Palestine, M.D., Laboratory of Immunology, National Eye Institute, 9000 Rockville Pike, Bldg. 10, Rm. 10N222, Bethesda, MD 20892. The role of neuroendocrine modulation of the immune system has received increasing attention over the past several years. Prolactin, a lactogenic hormone produced by the anterior pituitary, has been shown to be a potent modu lator of the immune response in experimental animals. It is now clear that prolactin can stim ulate immune responsiveness and that decreas es in the circulating prolactin level can result in immunosuppression of both cellular and hu moral immune processes in a variety of animal model systems. 1,2 In addition to its effect as a sole agent, prolactin can enhance the effect of cyclosporine as an immunosuppressive agent in animal models. 2 There is, however, less evidence that circu lating prolactin can affect the immune response in humans. Bromocriptine is a dopamine ago nist that is a potent suppressor of prolactin release from the pituitary. We have demon strated an enhancement of the effect of cyclosporine by bromocriptine in intermediate and posterior uveitis. 3 Additionally, five pa tients with anterior uveitis who were treated with bromocriptine for either hyperprolactinemia or Parkinson's disease were described by others to have concurrent marked improve ment in the activity of their uveitis. 4 Although the immunologie mechanism of idiopathic anterior uveitis is not clear, it is presumed to be a disorder mediated by the immune system. Suppression of the immune response is therapeutically useful in this disease. Based upon our experience with regulation of the immune response by prolactin in ocular inflammatory models and the observations above, we designed a small, masked random ized study to test whether a dramatic treatment