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Biomedical subjects

A A Bialasiewicz

Publications and source records attributed to A A Bialasiewicz.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Combined pars-plana-vitrectomy and tectonic keratoplasty; indications for and results from 15 patients].

BACKGROUND: Acute endophthalmitis requires a vitrectomy. Vitrectomy and autokeratoplasty has been reported, if the infection originates from a stromal keratitis in an aphakic eye. This retrospective non-randomized cohort study points out the requirements, indications and results of combined keratoplasty and vitrectomy in keratitis and endophthalmitis compared with noninfectious corneal and vitreoretinal problems. PATIENTS AND SURGERY: In 1995-1999, a vitrectomy and keratoplasty was performed on 15 patients (16 eyes), 10 of these with an endophthalmitis (median 71 years) and a follow-up of 2-60 months (median 19.3 months). 14 of 15 patients had had multiple prior surgery. Stromal keratitis as a sequela of keratoplasty was seen in 5 eyes (3x ruptured suture), 5x diffuse infiltration in compromised corneas (1x with a perforation, 2x with Fuchs' corneal dystrophy, 3x postoperative). In the patients without endophthalmitis 6 eyes were aphakic with corneal scars and no fundus visualization. Five eyes had a retinal detachment, one had an intraocular foreign body. An allogeneic keratoplasty was done in 14, and an allogeneic sclerokeratoplasty and an autologous sclerokeratoplasty in one eye each. RESULTS: Keratoplasty without keratoprosthesis allowed for fundus visualization, and a pars plana vitrectomy was done with a wide angle contact lens, 8x with C2F6-, 1x with silicone oil 5000 cs instillation, and gentamicin and 15 micrograms r-tPA added. In 5 vitrectomy specimens (50%) pathogenic bacteria were found. No recurrences of infection were seen. Conservation of the eyes and postoperative fundus visualization was possible in each case. The postoperative increase in visual acuity of 0.1 or better was significant in both patient groups. 2 eyes remained at preoperative levels, 14 ameliorated by > 1 lines. Complications were 1x directly postoperative graft decompensation, 1x rejection after 40 months, 6x persisting secondary glaucomas, 2x hypotony syndromes, 1x with phthisis and enucleation, 1x epiretinal gliosis. CONCLUSIONS: Curative surgery of acute keratitis and endophthalmitis by vitrectomy and keratoplasty may result in similarly successful outcomes as in noninfectious corneal scars and vitreoretinal pathology, if some requirements (e.g. adequate antibiotic treatment, graft material, skilled anterior and posterior segment surgeon) are fulfilled.

Adult↗
PubMed1999

[Therapy refractory unilateral chronic blepharokeratoconjunctivitis as the chief manifestation of auto-aggression syndrome. Clinico-histopathologic findings].

UNLABELLED: Autoaggressive syndromes as causes of diseases underlying chronic blepharitis and keratoconjunctivitis that are refractory to treatment are often difficult to recognize. PATIENTS: Three female patients (age 21, 25, 41 years) and one male patient (age 42 years) had suffered from a right-(4x) or left-(1x) handed treatment-refractory blepharokeratoconjunctivitis for 1, 2, 11 and 30 months prior to admission. In each case more than 5 ophthalmologists and 2-6 eye hospitals had been consulted, and extraocular surgery had been performed 1-4 times. RESULTS: Patients presented with a visual acuity of 0.3 p (1x), 0.1 (1x), FC (1x), HM (1x). In three patients contact eczema of the facial skin and lids and a corneal pannus were observed; in two patients we saw purulent pseudomembranous and in two patients chronic cicatrizing keratoconjunctivitis. Conjunctival smears grew P. aeruginosa, and S. aureus; impression cytology showed infiltration with neutrophils and epithelial keratinization; histopathology indicated chronic inflammatory, partly purulent subepithelial and stromal conjunctival infiltrate with hyper- and parakeratosis fibrous strands and epithelial cell loss; the lower lids showed parakeratosis, focal necrosis, intercellular edema and a lymphohistiocytic round-cell infiltrate. Furthermore, multiple allergies to antibiotics and preservatives (4x), lacerations of the arms and legs (2x) and an irritative-toxic dermatitis (1x) were substantiated. In the patients who agreed to a psychiatric consultation, somatized-agitated longing for care combined with a dependent and infantile personality (1x) and reactive depression (2x) were verified. CONCLUSIONS: In patients suffering from treatment-refractory unilateral chronic blepharokeratoconjunctivitis correlated with the hand, one must take into consideration the fact that other factors may be involved: possible exacerbation prior to examinations; multiple inpatient diagnostic and surgical procedures in different locations; histopathological mixed inflammatory patterns; and psychiatric syndromes.

Adult↗
PubMed1999

[r-tPA in keratoplasty à chaud. Report of 50 patients].

BACKGROUND: Fibrinolytic treatment using recombinant plasminogen activator (r-tPA) has been reported in cataract surgery; however, reports are lacking with respect to complex surgical interventions including keratoplasty because of anterior segment infections. PATIENTS AND METHODS: This report deals with a prospective study comprising 50 patients (50 eyes) suffering from a serpent ulcer treated by keratoplasty à chaud. r-tPA (25 micrograms) was instilled intracamerally at the end of surgery in 25 eyes. RESULTS: The 25 eyes treated with r-tPA were subsequently less inflamed than the control population (decrease in inflammatory cells 1.5 days vs 7 days, fibrin reaction 1x vs 12x), had highly significantly better visual acuity and there was significantly reduced inpatient hospitalization (median 9.9 vs 19.3 days). No hemorrhages were observed in either population; medically treated infection recurrences (S. aureus, C. tropicalis, acanthameba) were observed in 3 and primary graft failure or rejection in both populations 3x. CONCLUSIONS: This study showed that perioperative application of r-tPA had a beneficial effect. This therapeutic avenue should be further evaluated in a randomized, double-masked multicenter study.

Adolescent↗
PubMed1999

Tapioca melanomas of the iris: immunohistology and report on two cases.

BACKGROUND: Tapioca-like tumors are rare, and their benign or malignant nature is obscure without histological work-up. We report on the clinical and histological features of different types of tumors in two patients. CASE REPORT: Two patients aged 17 and 45 years presented with brownish iris masses increasing in size. Full-thickness en bloc excision of melanocytic tumors (5.5 mm and 7.0 mm in diameter) was carried out. Histological work-up revealed a nevus cell nevus in the young patient and an epithelioid malignant melanoma in the middle-aged patient evolving from the ciliary body. Staining for HMB-45 was marked in both tumors, for S-100 low in the nevus and marked in the melanoma, and for p53 negative in the nevus and positive in the melanoma. Ki67 stains were negative. CONCLUSION: We propose that excision of anteriorly located pigmented tumors that increase in size is indicated in order to determine whether they are benign or malignant. In these case reports, tapioca-like tumors include a benign and a malignant entity. To our knowledge, a nevus cell nevus presenting as a tapioca-like tumor has not previously been described. Curative surgery and histological and immunohistological evaluation are required to characterize the malignant potential of these tumors and the prognosis.

Adolescent↗
PubMed1999

[Detection of human papillomavirus types in tumors and inflammations of the eye].

BACKGROUND: Infections by the human papillomavirus occur in the skin and in the mucosa. They may play a significant role in the neoplastic transformation of cells. At least half of all the epithelial tumours of the ocular surface and the lacrimal drainage system have been shown to be HPV associated. However, in ca. 50% of these tumors only a limited number of mucosal HPV types could be detected by commercially available test systems. This study reports of HPV specific sequences in putatively HPV associated tumorous and inflamed tissues of the eye. MATERIALS AND METHODS: 32 biopsies of 26 patients suffering from chronic hyperplastic lesions of the lid, conjunctiva and lacrimal drainage system were examined using DNA extraction, amplification of HPV specific sequences by nested polymerase chain reaction (PCR), cloning and sequencing of the PCR products. RESULTS: Ten HPV types could be detected in 11 biopsies of 8 patients with papillo-mas, seborrheic and actinic keratosis, dacryocystitis and syringoma. In 5 of 9 histologically verified papillomas HPV 6, 20, 23, DL 332 (HPV 5b-related), DL 284 (HPV 20-related) and NN-AA44 were detected, HPV 5b, 38 and DL 284 in seborrheic keratoses, HPV 36 in actinic keratosis, NN-AA44 und NN-AA45 in dacryocystitis and HPV 20, 23 and DL 332 in syringoma. CONCLUSIONS: The DNA techniques used in this study represent important methods for the detection of HPV types and allow an association of HPV types with defined tumours and inflammations of the eye. In two of the biopsies putatively new HPV types could be identified.

Adolescent↗
PubMed1999

[Severe ocular injuries caused by fishing equipment].

BACKGROUND: Severe ocular injuries due to fishing equipment are rare, almost exclusively involve the anterior segments of men, and bear a bad prognosis. We report on two men and one woman with different etiologies of accidents. PATIENTS: In two men (53 and 39 yrs. OD and OS) and one woman (27 yrs., OD) a choroidal rupture due to a lead weight and subsequent choroidal neovascularisation (1x), temporal and nasal scleral and retinal lacerations (2x) due to a fish pick and a fish hook were noted. A laceration of the m. rectus int. (1x), uveal and retinal prolapse (1x), traumatic aniridia and aphakia (1x), a 12 and a 15 mm corneoscleral perforation temporal and nasal resp. including a retinal incarceration, a giant retinal tear 270 degrees, and vitreous and subretinal hemorrhage were seen. SURGERY: Interventions included 2x tight wound closure, 3x ppv, retinotomies (1x) endolasercoagulation (3x), silicone oil instillation (3x), muscel refixation (1x), and posterior lens implantation (1x). Subsequent surgery were silicone oil removal (2x) and membrane peeling (1x). RESULTS: An anatomical reconstruction was achieved in all of the patients, and the best postoperative visual acuity was gained after 4-6 months (+6.0 sph (2x) = 0.5, and +4.0 sph (1x) = 0.3). Silicone oil was removed after 4 and 13 months resp. followed by hypotony and redetachments, in one patient with silicone oil in place vision remained stable for > 2 years up to now at 0.5. CONCLUSIONS: Accidents due to fishing equipment may result in lacerations and contusions and involve women as well as. Surgery for extensive lacerations and complications of choroidal ruptures may not be hopeless, however, the prognosis for subsequent interventions is not good. Indications to remove silicone oil in eyes bearing a relative ciliary body insufficiency due to a long-standing insufficient wound closure should be done very cautiously.

Adult↗
PubMed1999

[Immunohistochemical characterisation of surgically excised choroidal neovascularisation in age-related macular degeneration].

AIM: The objective of the study was to gather further information about the pathogenesis of choroidal neovascularisations (CNV), which is still not clearly understood, and to establish criteria for making decisions on a appropriate therapy. Immunohistochemical characteristation should allow a more comprehensive evaluation of cellular components of the membranes and their functional role. PATIENTS AND METHODS: In 29 patients (16 women, 13 men) with age-related macular degeneration ranging in age from 46 to 91 years (mean age, 76.4 years), CNV were excised by pars-plana vitrectomy. Sections were stained with hematoxylin-eosin (HE) and periodic acid-Schiff (PAS) and examined by light microscopy. For the immunohistochemical characterisation of the surgical specimens the following anti-genetic determinants were used: glial fibrillary acid protein (GFAP) for glial cells, synaptophysin for neuronal cells, neuron-specific enolase (NSE) for neuronal and neuroectodermal cells, CD 31 for endothelial cells and pancytokeratin (KL1) for cells of the retinal pigment epithelium (RPE). Cells undergoing apoptosis were labeled with the TUNEL technique. RESULTS: 22 (76%) surgical specimens showed TUNEL positive cells in the connective tissue, vascular endothelium and retinal pigment epithelium. Positive immunostaining of neuronal antigenetic determinants was found for glial fibrillary acid protein in 22 patients (76%), for synaptophysin in 28 patients (97%) and for neuron-specific enolase in 21 patients (72%) CNV. The epithelial marker KL1 was positive in 28 patients (97%) and the endothelial marker CD 31 in 20 patients (69%). CONCLUSION: The immunohistochemical analyses of CNV showed that in the majority of cases during the excision of choroidal neovascularizations in addition to scar tissue and connective tissue also parts of the native retinal pigment epithelium and of the neurosensory retina are removed which is only partly visible with standard staining techniques. These findings suggest that the mostly not satisfying postoperative results are partly due to the damage of neuronal cells and a partial loss of the retinal pigment epithelium. Apoptosis as a regulating mechanism in choroidal neovascularization. The variable appearence of apoptosis suggests that it is possibly related to the degree of activity of CNV.

Aged↗
PubMed1999

Alpha/beta- and gamma/delta TCR(+) lymphocyte infiltration in necrotising choroidal melanomas.

AIM: To detect specific tumour infiltrating T cells (TIL) carrying antigen specific MHC-I restricted receptor genes on necrotising and non-necrotising malignant melanomas and to correlate the findings with clinical data. METHODS: alpha/beta- and gamma/delta- TIL were determined by immunohistochemical staining in melanomas of patients with known follow up of more than 10 years. An antigen retrieval method was used to determine variable genes delta1 and gamma1 on TCR(+) cells by an anti-TCR Vdelta1 and anti-CrgammaM1, and of Valpha and Vbeta TCR(+) by an anti-pan-TCR(+) alpha/beta antibody. RESULTS: Intratumoral TIL were present in 86 of 113 (76.1%) necrotising melanomas (NMM) v 21 of 100 (21%) in non-necrotising melanomas (MM); of these, Valpha/beta- TCR(+) cells were present in 52 of 74 (70.3%) TIL harbouring NMM v four of 21 (19%) MM; Vgamma1 in 29 of 74 (39.2%) NMM v two of 21 (10%) MM; and Vdelta1 in 39 of 74 (52.7%) NMM v three of 21 (14%) MM. Extratumoral lymphocytic infiltration was seen in 86 (76.1%) NMM including Valpha/beta TCR(+) cells in 10 (11.6%) cases, v five (5%) MM cases with no Valpha/beta TCR(+) cells detected. Vgamma1 and Vdelta1 TCR(+) cells were not found in extratumoral infiltrates. CONCLUSIONS: In NMM, the median survival was 69.3 (range 6-237) months, 19 of 74 patients (25.7%) survived 5 years, and mortality was associated with advanced stage (p<0.001), patient age (p<0.023), and extent of necrosis (p<0.048). Survival was increased with evidence of Vgamma1 and Vdelta1 TCR(+) cells (p<0.026).

Adult↗
PubMed1998

[Intraocular pseudotumor in an AIDS patient. Block excision, differential diagnosis, histology].

BACKGROUND: Intraocular pseudotumors are a rare event in Aids patients and often pose diagnostic problems. CASE REPORT: A 37-year-old patient who had had HIV seroconversion for 7 years was seen to developed progressively growing, multiple, disseminated, subretinal lesions OD > OS, accompanied by exudative retinal detachment and iritis. Since all etiological laboratory diagnostic efforts to detect an infectious, noninfectious and neoplastic systemic lesion failed, a diagnostic and curative therapeutic chorioretinal excisional biopsy specimen of the largest of the tumors (3 x 3 x 2 mm) was taken. The histological work-up demonstrated granulation tissue similar to an intraocular pseudotumor without signs of infection, malignancy or reactive lymphoid hyperplasia. This finding resulted in systemic corticosteroid treatment with complete resolution of the lesions in both eyes and no recurrences. CONCLUSIONS: An invasive diagnostic procedure in patients suffering from lesions of unknown cause resulting in the institution of an appropriate medical treatment may be beneficial for the integrity and vision of the respective eye.

Adult↗
PubMed1998

[Necrotizing keratitis in chronic polyarthritis. Combined immunosuppressive and surgical therapy].

INTRODUCTION: Areactive forms of keratitis in patients with seropositive rheumatoid arthritis are inflammations threatening the visual acuity and integrity of the eye. They commonly occur in a rheumatologically inactive interval and have a poor prognosis. A retrospective evaluation of medicamentous and surgical strategies for a curative therapy with optical rehabilitation is necessary to optimise the treatment of patients with necrotic sclerokeratitis. PATIENTS AND METHODS: A total of 27 eyes of 22 patients (14 women and 8 men, ranging in age at the time of operation from 40 to 88 years; mean 68.7 years) with seropositive rheumatoid arthritis and secondary Sjögren's syndrome were reviewed retrospectively. There were 17 eyes with necrotic keratitis and 9 eyes with necrotic sclerokeratitis. In one eye, necrotic sclerokeratitis with bacterial transmigrating keratitis and hypopyon occurred. OPERATIONS: In 8 cases we performed a perforating mini-keratoplasty, in 16 cases a tectonic and optical perforating keratoplasty, in 3 cases a tectonic sclerokeratoplasty, in 9 patients a combined keratoplasty and cataract extraction with posterior chamber lens implantation and in 1 case a partial conjunctival plasty. Follow-up ranged from 7 months to 4 years (average 2.8 years). RESULTS: In all eyes, a sufficient tectonic and primary curative effect was achieved only under cyclophosphamide immunosuppression. In 3 cases, a rekeratoplasty had to be performed because of recurrent keratitis after changing the systemic cyclophosphamide therapy to methotrexate, glucocorticosteroids or non-steroid antiphlogistic agents. Visual acuity outcome was depending on the eccentricity of the keratoplasty and earlier affections of the eye. Postoperatively, the visual acuity improved in 23 eyes. In 3 cases, no change of visual acuity was achieved. Visual acuity deteriorated in one case from counting fingers to hand motions. Peri- and postoperative complications during the follow-up period were corneal infiltration around sutures in 4 eyes, graft rejecting reactions in 3 cases, and sicca syndrome in 6 cases. CONCLUSIONS: The intensive cooperation of ophthalmologists and rheumatologists enables the successful treatment of apparently hopeless situations in necrotic sclerokeratitis in patients with seropositive rheumatoid arthritis. The rate of complications under an immunosuppressive therapy with cyclophosphamide was found at average 2.8 years follow-up to be low. The indication for the combined therapy depends on the ophthalmological findings; rheumatologists and ophthalmologists should decide on the appropriate dosage for the systemic cyclophosphamide therapy. Topical glucocorticosteroid therapy alone is contra-indicated.

Adult↗
PubMed1998

[Recurrent pterygium over 15 years: epibulbar cartilaginous findings].

BACKGROUND: Epibulbar and extraocular cartilage bearing tumors in adults are extremely rare. PATIENT: A nasally located pterygium in a 24-year-old patient was excised and recurred over the ensuing 15 years six times requiring local excisions, and each time a histological diagnosis of pterygium was made. Only a curative excision including a biopsy of the insertion of the m. rectus medialis and a sclerokeratoplasty revealed the tumor to bear cartilage histologically in an unusual place. A Ruthenium-106 brachytherapy was followed by a triple procedure for visual rehabilitation, and no further recurrences were observed. CONCLUSION: The differential diagnosis of a cartilaginous tumor most likely a choristoma growing in an unusual localisation should be considered in adults suffering from recurrent pterygia without known physical risk factors, and a curative excision be performed. Further treatment options depend on the appearance of the tumor.

Adult↗
PubMed1998

[Immunohistochemical markers for cytoplasmic antigens in acquired melanosis, malignant melanomas, and nevi of the conjunctiva].

BACKGROUND: Benign and malignant melanocytic lesions of the conjunctiva are difficult to differentiate histologically. At present in the ophthalmologic literature there is not known a high specific and simply applicable histological feature (tumor marker) of differentiation to identify melanocytic lesions of the conjunctiva. METHODS: In this study 55 nevi, 15 primary acquired melanoses (stage Ia) and 54 melanomas of the conjunctiva were examined retrospectively immunhistochemically by antibodies vs. S-100 protein, and the melanoma-associated antigens HMB-45 and NKI/C3 using the labelled avidin-biotin method. 45 patients (25 female, 20 male) with malignant melanomas of the conjunctiva have been followed up clinically. RESULTS: S-100, HMB-45 and NKI/C3 are highly significant markers to identify malignant melanomas of the conjunctiva (sensitivity: S-100: 96.4%, HMB-45: 96.3%, NKI/C3: 98.1%), whereas markers in acquired melanoses (sensitivity: 93.3%, 78.6% and 92.9%), and nevi (sensitivity: 92.9% 40.7%, 98.2%) are not. Positive tumor markers do not correlate with local recurrences or metastasis. The localization of malignant melanomas and the lymphocytic infiltration are not prognostically significant. The only significant risk factor (p = 0.0485) predicting the development of recurrence or metastasis is tumor thickness > 1.5 mm. CONCLUSIONS: The tumor markers S-100, HMB-45 and NKI/C3 cannot differentiate reliably between benign and malignant melanocytic lesions of the conjunctiva, and positive tumor markers do not correlate with local recurrences or metastasis. The only significant risk factor (p = 0.0485) predicting the development of metastasis is tumor thickness (> 1.5 mm).

Adult↗
PubMed1998

[Clinical and histopathological aspects of 113 necrotizing malignant melanomas of the choroid. 1. Clinical and histological features of necrotizing choroidal melanomas].

BACKGROUND: Tumor necrosis may reflect a destructive immune reaction. Systematic and statistically significant comparative clinico-histopathologic studies have not yet been reported. PATIENTS AND METHODS: 113 necrotizing choroidal melanomas (NCM) recruited from 701 enucleated globes 1967-1988 were resectioned, stained and compared to 100 choroidal melanomas without necrosis (CM), and data of 74 patients with a follow-up of more than 10 years were evaluated. RESULTS: Statistically significant characteristics of NCM were: patient age < 60 yrs. for NCM 27.4%, CM 46%; patient age in men for NCM was 64 yrs on average (CM: 58 yrs.), in women for NCM 67 yrs. (CM: 59 yrs.). Time elapsed between first symptoms and enucleation was < 12 months in 15.9% of NCM (89% for CM), and > 12 months in 23.9% of NCM (11% in CM). Mixed or epitheloid cell tumors was seen in 54.9% of NCM and 49% of CM, spindle cell tumors in 36.3% of NCM and 51% in CM. Advanced tumor stages T3 and T4 were present in 45.1% resp. 36.3% of NCM compared to 37% resp. 16% in CM. Scleral invasion was documented in 67.3% of NCM and 37% of CM, extrascleral dissemination in 43% of NCM and 16% of CM. Secondary glaucomas were seen in 62.2% of NCM and 6% CM, a penetration through Bruch's membrane in 61.0% of NCM and 46% of CM. Intratumoral hemorrhage was noted in 68.14% of NCM and 24% of CM, extratumoral bleeding in 23.9% of NCM and 0% CM. Inflammatory reactions in tumors were observed in 96.7% of NCM harboring > 30% necrosis compared to 5% in CM, and extratumoral in 94.5% of NCM and 0% of CM. Intraocular extratumoral necrosis was seen in 23.9% of NCM and 0% of CM. There were no significant differences in the degree of pigmentation of the 90.3% pigmented NCM or of the 94% pigmented CM, neither in the tumor localization, being constantly behind the equator in 87% of cases. Survival of patients with NCM patients was 5 years and 9 months on average (5-year mortality rate 41.9%), and 74.3% were deceased from metastatic spread. CONCLUSIONS: Significant clinical and histopathological differences between necrotizing and non-necrotizing malignant melanomas of the choroid can be identified. The inflammatory reaction of NCM must be further elucidated, particularly with respect to the nature of tumor-infiltrating lymphocytes.

Adult↗
PubMed1998

[Clinical and histopathological aspects of 113 necrotizing malignant melanomas of the choroid. 2. Immunogenetic characterization of T-cell receptor-positive tumor-infiltrating lymphocytes and survival of patients with necrotizing melanomas of the choroid].

BACKGROUND: T-cell receptor (TCR) gene analysis of tumor infiltrating lymphocytes (TIL) has been recognized to play a pivotal role in the immunosurveillance of solid neoplasms. PATIENTS AND METHODS: Therefore, 113 necrotizing choroidal melanomas (NMM) were compared to 100 non-necrotizing melanomas (MM) histologically and immunohistochemically. RESULTS: NMM showed TIL more frequently (76.11% vs. 21%, p < 0.001). V alpha/V beta- (70.3% of NMM) and V gamma 1- (39.2% of NMM) and V delta 1- (52.7% of NMM) TCR+ cells were distributed focal or diffuse, and correlated with tumor volume, diameter, and scleral invasion. 74.33% of NMM patients had died after 240 months (5 year survival: 58.1%). Mortality was not significantly associated with TIL (p < 0.33) or V alpha/V beta-TCR+ cells (p < 0.2), however, survival was significantly increased with evidence of V gamma 1- and V delta 1-TCR+ cells (p < 0.026). CONCLUSIONS: V alpha/V beta-, V gamma 1- and V delta 1-TCR+ tumor infiltrating lymphocytes can be demonstrated in choroidal melanomas. This is a basis for functional studies providing a rationale for the evaluation of immunotherapeutic modalities.

Adult↗
PubMed1997

[Alpha/beta and gamma/delta T-cell receptors--analysis of conjunctival tissue of patients with ocular pemphigoid].

BACKGROUND: In the conjunctiva of asymptomatic persons and patients with ocular cicatricial pemphigoid the existence and distribution of alpha/beta- and gamma/delta-T cell receptor (TCR)-positive cells has not previously been investigated. PATIENTS AND METHODS: Biopsy specimens from 20 patients with clinically diagnosed ocular cicatricial pemphigoid (OCP) were compared with 20 specimens from asymptomatic persons. Additionally, 3 specimens from patients with OCP treated with cytotoxic drugs and 8 specimens from patients who had undergone mucosal transplantation were studied. Antigen retrieval was done in deparaffinized specimens for immunohistochemical identification of alpha/beta- and gamma/delta-TCR-positive cells by monoclonal antibodies and an appropriate detection system. All steps were performed in triplicate, and negative control sera were applied. RESULTS: alpha/beta-TCR-positive cells were observed in the conjunctival epithelium and stroma of all the asymptomatic persons and in all patients with OCP. gamma/delta-TCR-positive cells were found in 4 out of 20 patients with OCP in epithelial sites, but not in asymptomatic persons. Patients with OCP who had received cytotoxic treatment exhibited neither alpha/beta- nor gamma/delta-TCR-positive cells. Staining sites of alpha/beta-TCR-positive cells changed from membrane-bound to nuclear in patients who had undergone mucosal transplantation, and were cytoplasmic rather than membrane-bound in gamma/delta-TCR positive cells. CONCLUSIONS: This study presents preliminary evidence for the existence of distinct T-cell subsets in the conjunctiva of healthy persons and of patients with OCP. Further functional studies in fresh tissue material may provide better insights into the role of defined T-cell subsets in the immunopathogenesis of autoimmune diseases of the outer eye such as OCP.

Biopsy↗
PubMed1996

Alpha/beta- and gamma/delta-T-cell-receptor-positive lymphocytes in healthy and inflamed human conjunctiva.

BACKGROUND: The possible existence and distribution patterns of alpha/beta- and gamma/delta-TCR+ cells, which are important constituents of immune surveillance and act via the CD3+ cell complex have not yet been elucidated in the healthy and inflamed conjunctiva. MATERIALS AND METHODS: Paraffin-embedded conjunctival specimens included 18 from 18 patients with ocular cicatricial pemphigoid (OCP), 20 from 20 healthy controls, 6 from 6 patients with lye burns, and 6 from 2 patients with Stevens-Johnson syndrome; all were worked up by histology and immunohistochemistry. RESULTS: alpha/beta-TCR+ cells were visualized in the conjunctival epithelium and stroma of healthy persons, OCP, lye burns and Stevens-Johnson syndrome. alpha/ beta-TCR+ cells and a small number of gamma/delta-TCR+ cells were observed in the corneal epithelium and stroma of patients who have failing corneal grafts. After ileal mucosa transplantation to the epibulbar conjunctiva, membrane staining changes to nuclear and cytoplasmic staining. Treatment with systemic cytotoxic drugs abolishes all alpha/beta-TCR+ and gamma/delta-TCR+ cells. CONCLUSIONS: alpha/beta-TCR+ cells can be found in the non-infected epithelium and stroma of the healthy and inflamed (OCP, lye burns, and Stevens-Johnson syndrome) conjunctiva, as well as in the corneal epithelium and stroma of failing corneal grafts, whereas gamma/delta-TCR+ cells are absent. A small number of gamma/delta-TCR+ cells are present in the corneal stroma and adjacent conjunctival epithelium of patients with chronic corneal graft rejection or after transplantation of gut tissue. Further investigations may establish the role, if any, of these T-cell subsets in immune surveillance of the non-infected outer eye and in corneal graft rejection.

Burns, Chemical↗
PubMed1996

[Descemetocele after Excimer laser phototherapeutic keratectomy in herpes simplex virus-induced keratitis: a clinico-pathologic correlation].

BACKGROUND: The indications for phototherapeutic keratectomy in superficial and deep corneal scars in Herpes simplex virus infections are controversial. Serious incidents after PTK have as yet not been reported. PATIENTS AND METHODS: A 62-year-old patient had suffered from recurrent central herpetic keratitis since 1948 and was treated for corneal scarring for the first time in 1992 by PTK. In 1995, epithelial defects were noted and, since medical treatment was unsuccessful, repeat PTK was performed. Two weeks after the second PTK, stromal infiltration with a subsequent corneal ulcer was followed by a descemetocele and perforation. RESULTS: The recurrence of Herpes simplex keratitis was treated with systemic acyclovir, and the corneal perforation, the posterior synechiae and the complicated cataract were managed by a triple procedure à chaud (7.0 x 7.5 mm). The inflammation calmed down, and a significant improvement of vision was noted at dismissal. Histopathology of the corneal button showed no epithelial cells, endothelial cell rarefication, loss of Bowman's layer resulting from PTK, stromal edema, a descemetocele with perforation of 1.5 mm in diameter, and immunohistochemically Herpes simplex virus in the deep stroma and pre-Descemet. CONCLUSIONS: Considering the clinical data and the histopathology we conclude that repeat excimer laser phototherapeutic keratectomy of herpetic keratitis without antiviral coverage may result in complications.

Cicatrix↗