Biomedical subjects
Publications and source records attributed to M Fishman.
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Forty-eight patients with Usher's syndrome were assess for the degree of visual loss, extent of lens opacities, and presence of foveal lesions. Twenty-one patients (44%) showed either atrophic or cystic-appearing bilateral foveal changes. Despite having foveal lesions and variable degrees of lens opacities most patients maintained central visual acuity of 20/60 or better until their middle 30s.
Severe ocular malformations, including microphthalmos, intraocular cartilage, cataract, persistent hyperplastic primary vitreous, and retinal dysplasia, occurred in a premature baby girl. The mother had ingested LSD during the first trimester of pregnancy. To our knowledge, this is the third case reported of ocular teratogenesis associated with maternal LSD ingestion. Further cases must be documented to establish an actual cause and effect relationship between the drug and the induced malformations.
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Two patients with bilateral vitelliform macular lesions had normal electro-oculogram findings. The fluorescein angiograms showed retinal pigment epithelial detachment. Detachment of the retinal pigment epithelium associated with lipid and/or protein accumulation within the subpigment epithelial space represents another mechanism by which a lesion ophthalmoscopically similar to that seen in classical Best's disease can be produced.
Three patients with vitelliform-like macular lesions had normal electroooculogram (EOG) light-peak/dark-trough ratios, unlike typical cases of vitelliform dystrophy (Best macular dystrophy). Leakage of fluorescein dye from perifoveal cappillaries implicated an increased permeability of these vessels as the probable cause for the vitelliform-appearing lesions. All patients with vitelliform lesions demonstrating normal EOG ratios should have an evaluation by fluorescein angiography to rule out a diagnosis of what we prefer to call pseudovitelliform macular degeneration.
Of 31 patients with retinitis pigmentosa, 18 (58%) had lesions of the retinal pigmentary epithelium within the maculae of both eyes. Six of the 31 patients (19%) showed macular cysts or holes (five bilateral, one unilateral) without angiographic evidence of leakage from perifoveal capillaries, while seven patients (23%) had macular cysts in both eyes associated with cystoid macular edema evident by fluorescein angiography. We believe that the macular cysts or holes were caused by changes at the vitreoretinal interface, eg, vitreous traction and preretinal membranes. Other pathologic sequences may also be responsible, such as an intrinsic increase in the permeability of retinal capillaries.
A total of 110 patients with retinitis pigmentosa were prospectively and consecutively evaluated for the presence of foveal lesions. Of these 69 (63 percent) patients showed one of two types of separate and distinct bilateral foveal lesions. Forty-seven (43 percent) patients had atrophic-appearing lesions of the retinal pigment epithelium within the fovea of both eyes, and an additional 22 (20 percent) patients showed bitalteral foveal cysts or partial-thickness holes. Of the 22 patients in this last group, 16 showed cystoid macular edema evident on fluorescein angiography.
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Twelve patients with diffuse drusen of Bruch membrane had their condition evaluated by electro-oculography (EOG). All had normal EOG light-peak/dark-trough ratios, which suggests that the disease does not involve a diffuse functional abnormality of the retinal pigment epithelium. This finding is in contrast to the abnormal EOG ratios reported in patients with fundus flavimaculatus. Categorizing these two diseases along with fundus albipunctatus as flecked retina syndrome should be continued on the basis of the somewhat similar morphologic appearance of the lesions, rather than because of similar results on functional testing.
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The induction of specific immunologic tolerance and its transfer has been studied in the in vitro response of unprimed rabbit spleen cells to solubilized phage antigens. Evidence presented shows that only viable cells transfer tolerance and that the responsible cells appear devoid of membrane-bound antigen but are sensitive to anti-thymocyte serum. It appears, therefore, that although the in vitro response to solubilized S-T2 has no demonstrable requirement for T "helper" cells, it is subject to the action of T "supp "suppressor" cells.
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The regulatory effects of rabbit antibodies specific for light chain determinants (b locus) on the formation of rabbit serum immunoglobulins have been studied in an in vitro system which measures of the response of unprimed rabbit spleen cells to solubilized T2 phage antigen. Treatment of spleen cells from b4b4 rabbits with anti-b4 serum, which was either incorporated into the culture medium or employed in appropriate pulse treatment of the cells before culture, prevented the formation of T2 neutralizing antibodies by such cells. Spleen cells of heterozygous (b4b5) rabbits formed anti-T2 antibodies which could be shown to be divided between the b4 and b5 specificities. Incorporation of anti-b4 or anti-b5 serum into the culture medium suppressed the specific anti-T2 response and, except in the instances noted in the text, did not significantly change the level of T2 neutralizing antibodies marked with the alternate allelic determinant. These findings are discussed in the light of the compensatory formation of an alternate immunoglobulin type which occurs during allotype suppression in vivo.
Tolerance was induced in rabbit spleen cells by incubation with solubilized T2 phage (S-T2)2 at 37degrees C. Spleen cells thus treated maintained normal responsiveness to an unrelated antigen, S-SP82. Transfer of tolerance was demonstrated in in vitro in that the addition of washed tolerant cells caused suppression of the response of untreated cells to an immunogenic dose of S-T2. Evidence is presented that this suppression is not due to the transfer of tolerogenic quantities of antigen. Spleen cell populations depleted of adherent cells were still capable of being made tolerant and of transferring tolerance.