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The Ocular Microbiology and Immunology Group 1978 Meeting
426
AMERICAN JOURNAL OF OPHTHALMOLOGY
ber 1981. The principal subjects of that Congress will be paracytosis and ocular injuries. Free papers of interest to African ophthalmologists and Public Health oph thalmology will also be welcome. W I L L I A M J. H O L M E S
T H E OCULAR MICROBIOLOGY AND IMMUNOLOGY GROUP 1978 M E E T I N G The 1978 meeting of the Ocular Micro biology and Immunology Group was held in Kansas City, Missouri, Oct. 21. G. Richard O'Connor moderated the morn ing session and Perry Binder the after noon session. T. J. Liesegang and R. K. Forster re ported on the spectrum of microbial keratitis in southern Florida. In the microbi ology laboratory of the Bascom Palmer Eye Institute, 663 corneal scrapings were evaluated between 1969 and 1977. About 80% of the bacteria were gram-positive cocci. They were sensitive most often to cephaloridirie, bacitracin, oxacillin, and gentamicin. Although Pseudomonas spe cies increased in number, its percentage of the total number of organisms recov ered did not increase. Pseudomonas was most often sensitive to gentamicin and carbenicillin. During the eight years of the study, the authors found io trend suggestive of a change in the prevalence of the various types of microbes recov ered or in their antibiotic sensitivities. Fusarium was the fungus most often re covered. Both fungal and bacterial keratitis increased in incidence during the fall and winter months of each year. Cultures on several different media may be neces sary to ensure recovery of the microbe and its identification. D. M. O'Day, P. Akrabawi, and S. Head used a rat model of F. solani endophthalmitis to test the recovery rate of the microorganism on various culture media. Brainheart infusion broth showed the
MARCH, 1979
greatest recovery of organisms, with thioglycollate broth and blood agar next in order. Sabouraud's dextrose agar had the lowest recovery rate. Sometimes it took several weeks for a culture to become positive. Direct examination of smears was not as reliable as culturing. R. Ramphal, M. T. McNiece, and F. M. Polack showed that trauma was necessary for bacteria (P. aeruginosa) to adhere to the corneal epithelium or stroma, and that adherence to the traumatized area required several minutes. They suggested that adherence might be the initial step in the pathogenesis of Pseudomonas infec tions. G. Smolin, G. A. Stern, M. Okumoto, and M. Friedlaender established P. aeru ginosa infections in rabbit corneas. The organism was gentamicin-resistant. Two groups of rabbits were treated with either a gentamicin-corticosteroid combination or gentamicin alone. After three days of treatment, there was no clinical differ ence between the two groups, but there were significantly more" organisms in the corneas of the animals treated with the combined therapy. The investigators be lieved that the use of corticosterpids early in an infection, before antibiotic sensitiv ities were known, would be hazardous. S. S. Fowler, J. V. Greiner, and M. R. Allansmith used a scanning electron mi croscope to examine 25 soft contact lenses from 17 asymptomatic contact-lens wear ers. All of the lenses examined were coat ed with materials of one sort or another. Bacteria were found on the lenses and some were believed to be proliferating. Fungi can adhere to lenses, produce an enzyme that can break up the lens, and then penetrate the lens. One of the discus sants believed the lenses should be washed before examination to determine whether or not the bacteria were truly adherent. M. Okumoto and G. Smolin cultured material collected from the eyelids, con-
VOL. 87, NO. 3
MEETINGS, CONFERENCES, SYMPOSIA
junctivae, and contact lenses of their first 51 extended-wear soft contact-lens pa tients (857 cultures). Pathogenic organ isms were recovered from 3.5% of the phakic eyes and from 8% of the aphakic eyes. Approximately 25% were Staphylococcus aureus, 30% were alpha strepto coccus, and 24% were gram-negative rods. In only three cases were repeated cultures positive for the same organisms. In five cases with positive cultures the patients were symptomatic. When posi tive cultures in the aphakic contact-lens wearers and in routine preoperative pa tients were compared, fewer pathogenic organisms were found in the aphakic contact-lens wearers. J. Lass, R. Thoft, A. R. Bellows, and H. Slansky presented the first reported case of a posttraumatic, exogenously acquired Nocardia asteroides endophthalmitis. The infection was complicated by malig nant glaucoma. After his injury, this de bilitated patient was immunosuppressed by corticosteroids. These factors (the de bilitation and corticosteroid therapy) could have predisposed the patient to the development of endophthalmitis. L. Forstot discussed the ocular signs of lepromatous leprosy. It was noted that the lepromatous form of the disease develops if the cell-mediated immune response is depressed. In patients with a normal cell-mediated immune response, the tu berculous form of leprosy is more likely to develop. Forstot used the auramine O stain to look for acid-fast organisms. The best treatment seemed to be a combina tion of dapsone and rifampin. J. H. Brinser and L. D. Perry recovered 1,188 isolates of staphylococci and micrococci from 452 patients. Methods of differentiating staphylococci from micrococci and the organisms' antibiotic sen sitivities were discussed. Surprisingly, S. epidermidis was resistant to erythromycin, penicillin, and tetracycline. E. Grave, H. Molinari, F. M. Polack, A.
427
Hubbard, and L. Van Nostran recalled that M-K medium now contains gentamicin for the sake of its antibacterial effect. When they added cefazolin to the M-K medium, the cefazolin increased the anti bacterial effect of the gentamicin against gram-positive bacteria that had been added experimentally. However, cefaz olin does not work well at 4°C, whereas gentamicin does. P. Young, M. Barza, A. Kane, and J. Baum examined the correlation between radioactive assay and corrected trephinedisc bioassay of penicillin G, cefamandole, and gentamicin in ocular tissues. The mean results of the two assay meth ods correlated well except for the level of gentamicin in the iris and choroid-retina in pigmented rabbits. This discrepancy did not exist when the experiment was performed in albino rabbits, suggesting that gentamicin binds tightly to melanincontaining tissue. R. A. Eiferman described a patient with peripheral corneal infiltrates in IgG monoclonal gammopathy. A biopsy of the affected area showed deposits of IgG and kappa light chains. Several members of the audience had seen similar corneal changes in their monoclonal gammopathy patients. At the business meeting that followed the morning session, the attending mem bers decided to hold the 1979 meeting of the Group on the Sunday immediately preceding the Academy meeting in San Francisco. The meeting will be held at the convention center or at the Francis I. Proctor Foundation. A vigorous effort will be made to hold the Group meeting near the Eye Bank meeting. D. Jones agreed to explore the logistics involved. The first paper of the afternoon session was presented by R. H. Poirer. Dr. Poirer discussed herpes simplex infections in children and emphasized the problems of management and amblyopia. A moderate number of the children he studied had
428
AMERICAN JOURNAL OF OPHTHALMOLOGY
stromal disease, and a moderate number of these were iododeoxyuridine-resistant. Dr. Laibson added that compliance with the application of medication is poor. If medication is to be used, he would rec ommend the ointment form. He felt that debridement might be the best method of therapy, however, and that it was best to give the child some Innovar for sedation before doing the debridement. Dr. Thygeson believed that, like a fever blister, it was advisable to leave the corneal herpetic lesion alone and let it heal by itself. H. E. Kaufman, E. D. Varnell, K. Mor gan, Y. Centifanto, and S. Rheinstrom reported on acycloguanosine. This drug is selectively phosphorylated by viral thymidine kinase but not by normal cellular thymidine kinase. It is as effective as IDU and is nontoxic. It has also been effective when given intravenously for the treat ment of herpetic iritis, but human studies are still too few to form a basis for any conclusions. W. M. Rotkis and J. W. Chandler com pared the in vitro activity of various anti viral agents against herpes simplex virus (HSV). The type 1 strain of herpes sim plex virus was susceptible to the drugs tested (IDU, acycloguanosine, and trifluorothymidine); type 2 was resistant to all three of these drugs; and the intermediate strains were somewhat resistant to IDU and susceptible to acycloguanosine and trifluorothyrnidine. Additionally, acy cloguanosine seemed to be much more attracted to herpes simplex virus-infected cells than to normal cells. R. W. Weinberg, B. B. Berger, H. H. Tessler, C. M. Vygantas, and G. Wyhinny described the case of an individual who had transfusions and large doses of sys temic corticosteroids after head trauma, and then developed bilateral nonrhegmatogenous retinal detachments. Cytomegalovirus was isolated in cultures of urine, sputum, throat and cervical material, and eventually of the subretinal fluid. The
MARCH, 1979
patient may have acquired the virus at the time of the blood transfusion. R. M. Stanifer and D. B. Jones reported a case of a young woman who had a clinical illness compatible with infec tious mononucleosis. The diagnosis of Epstein-Barr viral disease was made. The patient also developed a unilateral follicular conjunctivitis and multifocal anterior stromal opacities that lasted for 12 months. It was mentioned by one discus sant that disciform keratitis could occur in infectious mononucleosis and that a similar corneal picture had been seen in Dimmer's and paddi keratitis. The stro mal lesions were consistent with those occasionally seen in herpes simplex and herpes zoster. G. J. Stanton, M. P. Langford, and S. Baron reported the growth characteristics of hemorrhagic viruses, enterovirus type 70, and Coxsackievirus type A24. They found that enterovirus 70 grew well in many cells and that an animal model of the infection could be established. A lower animal may possibly act as a reser voir for this virus. One discussant stated that it had been shown that Coxsackie virus A24 did not cause acute hemorrhag ic conjunctivitis. S. Stenson, R. Jaffe, and R. Newman reported an outbreak of adenovirus type 10 disease that was characterized by pseudomembranes and subconjunctival and eyelid hemorrhages. The corneal changes were consistent with epidemic keratoconjunctivitis. Systemic symptoms were rare, and the ocular disease resolved in one to three weeks. The authors de scribed this erttity as acute hemorrhagic conjunctivitis, but several members of the audience, believed that in several respects it resembled epidemic keratoconjuncti vitis, not acute hemorrhagic conjunctivitis. G. Smolin, M. Okumoto, and M. Friedlaender used a 0.1% vitamin-A-acid oint ment twice a day in an attempt to improve corneal wound healing in a traumatized
VOL. 87, NO. 3
MEETINGS, CONFERENCES, SYMPOSIA
rabbit eye. There was significantly better epithelial healing in the eyes of the vitamin-A-acid-treated group than in the eyes of a group treated with the ointment base alone. R. Meyers-Elliott, D. Jacobs, and R. Gammon produced an experimental aller gic uveitis in guinea pigs after sensitizing the animals with bovine rhodopsin in complete Freund's adjuvant. Cellmediated immunity to the antigen devel oped before the onset of either disease or antibodies. Immunofluorescent staining showed the presence of autoantibodies in the photoreceptor layer of the retina. This supports the suggestion that rhodopsin is a significant antigen in the induction of autoimmune uveitis. It was suggested that the pineal gland be examined also.
429
D. H. Char, P. Stein, R. Masi, and M. Christensen found increased levels of im mune complexes in ten of 16 patients with chronic iridocyclitis and in ten of 12 patients with chronic diffuse uveitis. T. E. Gillette and M. R. Allansmith found secretory component (or secretory piece) in the epithelium of the ductules of the lacrimal gland and lacrimal acini. They believe that the secretory piece is produced at these sites. M. B. Abelson and M. R. Allansmith have used histamine in a concentration of 100 mg/ml to produce ocular allergy and are now using this model to investigate the behavior of various topical vasocon strictors and antihistamines. GILBERT SMOLIN
AMERICAN JOURNAL OF OPHTHALMOLOGY
ber 1981. The principal subjects of that Congress will be paracytosis and ocular injuries. Free papers of interest to African ophthalmologists and Public Health oph thalmology will also be welcome. W I L L I A M J. H O L M E S
T H E OCULAR MICROBIOLOGY AND IMMUNOLOGY GROUP 1978 M E E T I N G The 1978 meeting of the Ocular Micro biology and Immunology Group was held in Kansas City, Missouri, Oct. 21. G. Richard O'Connor moderated the morn ing session and Perry Binder the after noon session. T. J. Liesegang and R. K. Forster re ported on the spectrum of microbial keratitis in southern Florida. In the microbi ology laboratory of the Bascom Palmer Eye Institute, 663 corneal scrapings were evaluated between 1969 and 1977. About 80% of the bacteria were gram-positive cocci. They were sensitive most often to cephaloridirie, bacitracin, oxacillin, and gentamicin. Although Pseudomonas spe cies increased in number, its percentage of the total number of organisms recov ered did not increase. Pseudomonas was most often sensitive to gentamicin and carbenicillin. During the eight years of the study, the authors found io trend suggestive of a change in the prevalence of the various types of microbes recov ered or in their antibiotic sensitivities. Fusarium was the fungus most often re covered. Both fungal and bacterial keratitis increased in incidence during the fall and winter months of each year. Cultures on several different media may be neces sary to ensure recovery of the microbe and its identification. D. M. O'Day, P. Akrabawi, and S. Head used a rat model of F. solani endophthalmitis to test the recovery rate of the microorganism on various culture media. Brainheart infusion broth showed the
MARCH, 1979
greatest recovery of organisms, with thioglycollate broth and blood agar next in order. Sabouraud's dextrose agar had the lowest recovery rate. Sometimes it took several weeks for a culture to become positive. Direct examination of smears was not as reliable as culturing. R. Ramphal, M. T. McNiece, and F. M. Polack showed that trauma was necessary for bacteria (P. aeruginosa) to adhere to the corneal epithelium or stroma, and that adherence to the traumatized area required several minutes. They suggested that adherence might be the initial step in the pathogenesis of Pseudomonas infec tions. G. Smolin, G. A. Stern, M. Okumoto, and M. Friedlaender established P. aeru ginosa infections in rabbit corneas. The organism was gentamicin-resistant. Two groups of rabbits were treated with either a gentamicin-corticosteroid combination or gentamicin alone. After three days of treatment, there was no clinical differ ence between the two groups, but there were significantly more" organisms in the corneas of the animals treated with the combined therapy. The investigators be lieved that the use of corticosterpids early in an infection, before antibiotic sensitiv ities were known, would be hazardous. S. S. Fowler, J. V. Greiner, and M. R. Allansmith used a scanning electron mi croscope to examine 25 soft contact lenses from 17 asymptomatic contact-lens wear ers. All of the lenses examined were coat ed with materials of one sort or another. Bacteria were found on the lenses and some were believed to be proliferating. Fungi can adhere to lenses, produce an enzyme that can break up the lens, and then penetrate the lens. One of the discus sants believed the lenses should be washed before examination to determine whether or not the bacteria were truly adherent. M. Okumoto and G. Smolin cultured material collected from the eyelids, con-
VOL. 87, NO. 3
MEETINGS, CONFERENCES, SYMPOSIA
junctivae, and contact lenses of their first 51 extended-wear soft contact-lens pa tients (857 cultures). Pathogenic organ isms were recovered from 3.5% of the phakic eyes and from 8% of the aphakic eyes. Approximately 25% were Staphylococcus aureus, 30% were alpha strepto coccus, and 24% were gram-negative rods. In only three cases were repeated cultures positive for the same organisms. In five cases with positive cultures the patients were symptomatic. When posi tive cultures in the aphakic contact-lens wearers and in routine preoperative pa tients were compared, fewer pathogenic organisms were found in the aphakic contact-lens wearers. J. Lass, R. Thoft, A. R. Bellows, and H. Slansky presented the first reported case of a posttraumatic, exogenously acquired Nocardia asteroides endophthalmitis. The infection was complicated by malig nant glaucoma. After his injury, this de bilitated patient was immunosuppressed by corticosteroids. These factors (the de bilitation and corticosteroid therapy) could have predisposed the patient to the development of endophthalmitis. L. Forstot discussed the ocular signs of lepromatous leprosy. It was noted that the lepromatous form of the disease develops if the cell-mediated immune response is depressed. In patients with a normal cell-mediated immune response, the tu berculous form of leprosy is more likely to develop. Forstot used the auramine O stain to look for acid-fast organisms. The best treatment seemed to be a combina tion of dapsone and rifampin. J. H. Brinser and L. D. Perry recovered 1,188 isolates of staphylococci and micrococci from 452 patients. Methods of differentiating staphylococci from micrococci and the organisms' antibiotic sen sitivities were discussed. Surprisingly, S. epidermidis was resistant to erythromycin, penicillin, and tetracycline. E. Grave, H. Molinari, F. M. Polack, A.
427
Hubbard, and L. Van Nostran recalled that M-K medium now contains gentamicin for the sake of its antibacterial effect. When they added cefazolin to the M-K medium, the cefazolin increased the anti bacterial effect of the gentamicin against gram-positive bacteria that had been added experimentally. However, cefaz olin does not work well at 4°C, whereas gentamicin does. P. Young, M. Barza, A. Kane, and J. Baum examined the correlation between radioactive assay and corrected trephinedisc bioassay of penicillin G, cefamandole, and gentamicin in ocular tissues. The mean results of the two assay meth ods correlated well except for the level of gentamicin in the iris and choroid-retina in pigmented rabbits. This discrepancy did not exist when the experiment was performed in albino rabbits, suggesting that gentamicin binds tightly to melanincontaining tissue. R. A. Eiferman described a patient with peripheral corneal infiltrates in IgG monoclonal gammopathy. A biopsy of the affected area showed deposits of IgG and kappa light chains. Several members of the audience had seen similar corneal changes in their monoclonal gammopathy patients. At the business meeting that followed the morning session, the attending mem bers decided to hold the 1979 meeting of the Group on the Sunday immediately preceding the Academy meeting in San Francisco. The meeting will be held at the convention center or at the Francis I. Proctor Foundation. A vigorous effort will be made to hold the Group meeting near the Eye Bank meeting. D. Jones agreed to explore the logistics involved. The first paper of the afternoon session was presented by R. H. Poirer. Dr. Poirer discussed herpes simplex infections in children and emphasized the problems of management and amblyopia. A moderate number of the children he studied had
428
AMERICAN JOURNAL OF OPHTHALMOLOGY
stromal disease, and a moderate number of these were iododeoxyuridine-resistant. Dr. Laibson added that compliance with the application of medication is poor. If medication is to be used, he would rec ommend the ointment form. He felt that debridement might be the best method of therapy, however, and that it was best to give the child some Innovar for sedation before doing the debridement. Dr. Thygeson believed that, like a fever blister, it was advisable to leave the corneal herpetic lesion alone and let it heal by itself. H. E. Kaufman, E. D. Varnell, K. Mor gan, Y. Centifanto, and S. Rheinstrom reported on acycloguanosine. This drug is selectively phosphorylated by viral thymidine kinase but not by normal cellular thymidine kinase. It is as effective as IDU and is nontoxic. It has also been effective when given intravenously for the treat ment of herpetic iritis, but human studies are still too few to form a basis for any conclusions. W. M. Rotkis and J. W. Chandler com pared the in vitro activity of various anti viral agents against herpes simplex virus (HSV). The type 1 strain of herpes sim plex virus was susceptible to the drugs tested (IDU, acycloguanosine, and trifluorothymidine); type 2 was resistant to all three of these drugs; and the intermediate strains were somewhat resistant to IDU and susceptible to acycloguanosine and trifluorothyrnidine. Additionally, acy cloguanosine seemed to be much more attracted to herpes simplex virus-infected cells than to normal cells. R. W. Weinberg, B. B. Berger, H. H. Tessler, C. M. Vygantas, and G. Wyhinny described the case of an individual who had transfusions and large doses of sys temic corticosteroids after head trauma, and then developed bilateral nonrhegmatogenous retinal detachments. Cytomegalovirus was isolated in cultures of urine, sputum, throat and cervical material, and eventually of the subretinal fluid. The
MARCH, 1979
patient may have acquired the virus at the time of the blood transfusion. R. M. Stanifer and D. B. Jones reported a case of a young woman who had a clinical illness compatible with infec tious mononucleosis. The diagnosis of Epstein-Barr viral disease was made. The patient also developed a unilateral follicular conjunctivitis and multifocal anterior stromal opacities that lasted for 12 months. It was mentioned by one discus sant that disciform keratitis could occur in infectious mononucleosis and that a similar corneal picture had been seen in Dimmer's and paddi keratitis. The stro mal lesions were consistent with those occasionally seen in herpes simplex and herpes zoster. G. J. Stanton, M. P. Langford, and S. Baron reported the growth characteristics of hemorrhagic viruses, enterovirus type 70, and Coxsackievirus type A24. They found that enterovirus 70 grew well in many cells and that an animal model of the infection could be established. A lower animal may possibly act as a reser voir for this virus. One discussant stated that it had been shown that Coxsackie virus A24 did not cause acute hemorrhag ic conjunctivitis. S. Stenson, R. Jaffe, and R. Newman reported an outbreak of adenovirus type 10 disease that was characterized by pseudomembranes and subconjunctival and eyelid hemorrhages. The corneal changes were consistent with epidemic keratoconjunctivitis. Systemic symptoms were rare, and the ocular disease resolved in one to three weeks. The authors de scribed this erttity as acute hemorrhagic conjunctivitis, but several members of the audience, believed that in several respects it resembled epidemic keratoconjuncti vitis, not acute hemorrhagic conjunctivitis. G. Smolin, M. Okumoto, and M. Friedlaender used a 0.1% vitamin-A-acid oint ment twice a day in an attempt to improve corneal wound healing in a traumatized
VOL. 87, NO. 3
MEETINGS, CONFERENCES, SYMPOSIA
rabbit eye. There was significantly better epithelial healing in the eyes of the vitamin-A-acid-treated group than in the eyes of a group treated with the ointment base alone. R. Meyers-Elliott, D. Jacobs, and R. Gammon produced an experimental aller gic uveitis in guinea pigs after sensitizing the animals with bovine rhodopsin in complete Freund's adjuvant. Cellmediated immunity to the antigen devel oped before the onset of either disease or antibodies. Immunofluorescent staining showed the presence of autoantibodies in the photoreceptor layer of the retina. This supports the suggestion that rhodopsin is a significant antigen in the induction of autoimmune uveitis. It was suggested that the pineal gland be examined also.
429
D. H. Char, P. Stein, R. Masi, and M. Christensen found increased levels of im mune complexes in ten of 16 patients with chronic iridocyclitis and in ten of 12 patients with chronic diffuse uveitis. T. E. Gillette and M. R. Allansmith found secretory component (or secretory piece) in the epithelium of the ductules of the lacrimal gland and lacrimal acini. They believe that the secretory piece is produced at these sites. M. B. Abelson and M. R. Allansmith have used histamine in a concentration of 100 mg/ml to produce ocular allergy and are now using this model to investigate the behavior of various topical vasocon strictors and antihistamines. GILBERT SMOLIN