Intraocular and episcleral venous pressure increase during inverted posture

We measured intraocular and episcleral venous pressure in 11 subjects in both the supine and the head-down vertical position. Gonioscopy was performed in eight subjects. The intraocular pressure changes were correlated with the alterations in episcleral venous pressure using linear regression analysis. We found that for each 0.83 +/- 0.21 mm Hg increase in episcleral venous pressure there was a rise of 1 mm Hg in intraocular pressure (r = .80, P = .003). Upon inversion, blood appeared in Schlemm's canal in half of the eyes studied with gonioscopy, suggesting that it refluxed into the canal from increased episcleral venous pressure. The mechanism of a sustained intraocular pressure rise during gravity inversion appears to be closely related to increased venous pressure in the orbit.

Multivesicular liposomes. Sustained release of the antimetabolite cytarabine in the eye

We entrapped the antimetabolite cytarabine hydrochloride in a multivesicular liposome for sustained drug delivery to the eye. The in vitro half-life of cytarabine release from these liposomes was 359 hours. Following subconjunctival administration of 6 mg of cytarabine to 12 rabbits, the tissue half-life of drug at the injection site was 52.5 hours in the six rabbits treated with liposomes compared with 0.2 hours in the six nonliposome controls treated with the same amount of drug in normal saline solution. The aqueous humor drug concentration peaked after 1.5 hours in both the experimental (0.4 mg/L) and control (19 mg/L) groups. In control eyes, the cytarabine level of both the tissue and aqueous humor had decreased to less than 1% of peak value by eight hours. In the liposome-treated eyes, almost 30% of the cytarabine remained in the conjunctiva and episcleral tissue after 72 hours. The difference in cytarabine levels in tissue between the liposome-treated group and controls was highly significant. By controlling the rate of drug release, it may be possible to reduce the ocular toxicity and increase the efficacy of this drug for treating ocular proliferative disorders.

Pseudophakic pupillary block with angle-closure glaucoma in diabetic patients

Six diabetic patients (five women and one man, 63 to 79 years old) developed pseudophakic pupillary block with angle-closure glaucoma two days to one year after undergoing extracapsular cataract extraction. None of the six had had a peripheral iridectomy during the procedure. Symptoms included pain and visual loss. Corneal edema and intraocular pressures as high as 80 mm Hg were also present. Laser iridotomies decreased the intraocular pressure in three cases but failed in a fourth. In one case corneal edema prevented laser treatment but a surgical peripheral iridectomy was successful. One eye with central retinal vein occlusion was treated with panretinal photocoagulation and trabeculectomy.

The cytoskeleton of the cynomolgus monkey trabecular cell. I. General considerations

Many cellular functions involve the complex network of actin filaments, microtubules, and intermediate filaments collectively known as the cytoskeleton. Stereo transmission electron microscopic observations of whole cynomolgus monkey trabecular cells, which were extracted, S-1 labeled, and critical-point dried, were employed to simultaneously identify these three major cytoskeletal systems and visualize their three-dimensional nature. A double fluorescence technique for actin and microtubules was used to provide a broad view of cytoskeletal relationships within the cell. Actin microfilaments were the most prominent elements of the cytoskeleton. They appeared as bundles in stress fibers. Between stress fiber bundles, a continuous meshwork of microfilaments and intermediate filaments could be seen. Numerous microtubules radiated from the centriole region to the cell periphery. This comprehensive overview of the cytoskeleton of the cynomolgus monkey trabecular cell can be used to understand structure-function relationships of the trabecular cell cytoskeleton and its influence on outflow facility.

The cytoskeleton of the cynomolgus monkey trabecular cell. II. Influence of cytoskeleton-active drugs

The effects of cytochalasin B (10(-6) M and 10(-5) M), taxol (10(-5) M), and colchicine (10(-5) M) on the cytoskeleton of cynomolgus monkey trabecular cells were examined with Nomarski observations, fluorescent labeling as well as extraction, S-1 labeling, and critical-point drying. Changes in actin, microtubules, and intermediate filaments, the three major cytoskeletal systems, were correlated with changes in the overall shape and organization of the monkey trabecular cell. Incubation with cytochalasin B caused a marked alteration on actin filament structure, as well as cell shape and cytoskeletal organization. Effects on microtubule structure were noted with taxol, nocodozole, or colchicine; however, no marked changes in overall cell shape or other cytoskeletal structures were observed. These studies demonstrate the importance of actin filaments in regulating the shape and cytoskeletal organization of cynomolgus monkey trabecular cells.

Acquired dyschromatopsia in glaucoma

Recent studies have suggested that the recognition of blue-yellow color vision deficits may have some predictive value in determining which ocular hypertensives are at risk of developing glaucoma and in monitoring the progress of the disease in glaucoma patients. This article reviews current theories of normal color vision and the differences that may occur in glaucoma, outlining methods of color vision testing and interpretation, and summarizing the results of recent studies.

The effect of refractive correction on automated perimetric thresholds

We determined the effect of introducing errors in refractive correction on the threshold retinal sensitivity in the central 6 degrees of the visual field in 11 normal subjects using automated static perimetry (Octopus program 62). A summated value of threshold retinal sensitivity was computed for each visual field by taking the sum of all 21 measured points in units of decibels. In 21 of 22 tested eyes, the emmetropic condition was associated with the highest summated retinal sensitivity. Summated retinal sensitivity decreased with increasing plus spherical (+1.00 and +2.00 diopters) power in 21 of 22 eyes. Threshold retinal sensitivity decreased -0.377 dB/degree for each degree away from fixation (P less than .0001). These slopes did not appear to depend on the refractive error (P = .77). Thus, even small refractive errors can artifactitiously decrease threshold retinal sensitivity within the central 6 degrees of the visual field.

Betaxolol in patients with glaucoma and asthma

We evaluated the use of topically administered betaxolol, a cardioselective beta-adrenergic blocking agent, in 11 patients (eight women and three men, 40 to 81 years old) who had asthma and severe glaucoma with increased intraocular pressure despite maximally tolerated medical therapy. In each of these patients, timolol was either contraindicated or had previously led to development of pulmonary symptoms or complications. Before betaxolol, mean forced expiratory volumes in one second were 66% in the men and 80% in the women of reported normal values in age- and height-matched groups. Betaxolol was then topically administered twice daily. All patients continued to administer betaxolol without exacerbation of pulmonary symptoms and without deterioration in measured pulmonary function tests. Betaxolol further reduced intraocular pressure by a mean of 18% (4 mm Hg) when added to the patients' otherwise maximal regimen.

Neovascular glaucoma following neodymium-YAG laser posterior capsulotomy

Iris neovascularization and neovascular glaucoma were diagnosed in three diabetic patients following neodymium-YAG laser posterior capsulotomy. Each of the patients had previously undergone an uncomplicated extracapsular cataract extraction with insertion of a posterior chamber lens implant. These occurrences are consistent with the hypothesis that the posterior lens capsule may serve as a protective barrier to a diffusible vasoproliferative factor from the vitreous or retina. Both the beneficial optical effects and the potential adverse effects should be carefully considered prior to performing neodymium-YAG laser posterior capsulotomy in diabetic patients or other patients with ischemia in the fundus. Following neodymium-YAG laser posterior capsulotomy, these eyes should be closely followed up for signs of neovascularization and possible panretinal photocoagulation.

Subconjunctival injections. Preservative-related changes in the corneal endothelium

The morphologic effects on rabbit corneal endothelium of several common ophthalmic vehicle constituents were examined following subconjunctival administration. Profound dose-dependent changes consisting of intercellular vacuolization and thickening of the endothelial layer were noted within 1 day following administration of solutions that contained sodium bisulfite or methylparaben and propylparaben. These changes persisted for at least 5 days except in those eyes treated with the lowest concentration of sodium bisulfite. In contrast, administration of sodium citrate and creatinine or unpreserved normal saline resulted in only minimal effects. These changes are of concern because these agents are present in many preparations used to treat a wide variety of eye diseases.

The effect of ultraviolet, visible and infrared radiation on the rabbit blood-aqueous barrier

We studied the effects of visible (400-750 nm), infrared (750-1100 nm), and ultraviolet (300-400 nm) radiation on the breakdown of the blood-aqueous barrier (BAB) in albino rabbit eyes using fluorophotometry and fluorescein-bound albumin. There was no evidence of BAB breakdown following exposure to visible (158 J cm-2) or infrared (106 J cm-2) radiation. Fluorescence was detected in the anterior chamber 15 min following ultraviolet (UV) (300-400 nm; 37 J cm-2 and 73 J cm-2) and ultraviolet-A (UV-A) (320-400 nm; 45 J cm-2 and 90 J cm-2) irradiation. This fluorescence peaked at 2 hr after irradiation. Reestablishment of the BAB, indicated by no detectable fluorescence, occurred in all animals after 24 hr. There was a significant increase in fluorescence with increasing UV-irradiation dosage in all groups (P less than 0.05). Comparison of BAB breakdown following exposure to ultraviolet 320-400 nm and 300-400 nm in the same dosage (45 J cm-2) indicated that the inclusion of shorter wavelength UV exposure produced a significantly higher degree of BAB breakdown (P less than 0.001).

Effect of adding betaxolol to dipivefrin therapy

We evaluated the safety and effectiveness of adding topically administered betaxolol 0.5% twice daily in 39 patients with ocular hypertension or primary open-angle glaucoma already being treated with dipivefrin 0.1% twice daily. The addition of the betaxolol significantly decreased (P less than .01) the mean intraocular pressure after two weeks (2.82 mm Hg) and four weeks (3.63 mm Hg). There were no significant changes in pulse rate, mean arterial pressure, or pupil diameter. The administration of betaxolol to patients already receiving dipivefrin appears to be clinically useful.

Prostanoids in rabbit aqueous humor: effect of laser photocoagulation of the iris

The authors measured concentrations of prostanoids (prostaglandin-like substances) in aqueous humor from normal pigmented rabbit eyes and from those subjected to argon laser photocoagulation of the iris. The predominant prostanoids quantitatively were prostaglandin E2 (PGE2), PGF2 alpha, and PGD2 with minor amounts of 6-keto-PGF1 alpha and thromboxane B2. In all cases, concentrations of prostanoids in laser-treated eyes were substantially greater than those in normal eyes. This finding was particularly striking in the case of PGE2 which increased 60-fold from 87 pg/ml to 5.5 ng/ml after irradiation. Concentrations of prostanoids following photocoagulation were related to the number of administered laser lesions and prostanoid release was associated with an initial hypertensive response and disruption of the blood-aqueous barrier.

Experimental investigations of intraocular eicosanoids: cultured human trabecular cells and laser photocoagulation of the rabbit iris

The significance of prostaglandins and other eicosanoids in normal ocular physiology and in ocular disease is not well understood. We have utilized cultured human trabecular cells and an in vivo model of laser-induced inflammation in the rabbit eye to gain information concerning eicosanoid biosynthesis and its regulation in the anterior segment. Further investigations using these experimental paradigms should help to elucidate the physiologic and pathophysiologic roles of eicosanoids in the eye.

Acute effects of dexamethasone on intraocular pressure in glaucoma

The effects of 3 mg orally administered dexamethasone on the intraocular pressure (IOP) were examined in four patients with primary open-angle glaucoma hospitalized for this study. Plasma-free glucocorticoid activity was measured by a radioreceptor assay. Diurnal rhythms of IOP and plasma-free glucocorticoid activity were detected prior to administration of dexamethasone. The plasma-free glucocorticoid activity rose two- to threefold in the 30-min period following steroid administration and then declined throughout the rest of the day. IOP was approximately 2 mmHg higher in the 0-4-hr period and approximately 5.5 mmHg higher in the 4-8-hr period following the pharmacologic doses of dexamethasone compared with similar periods on control days. The increase in the IOP was highly significant (P less than 0.006) in the latter time period. These findings suggest that the glucocorticoids may have a greater role in regulating IOP than generally has been appreciated.

Angiotensin-converting enzyme activity in human aqueous humor

We measured aqueous angiotensin-converting enzyme (ACE) activity in 37 patients. Patients with granulomatous uveitis and probable sarcoidosis (based on increased serum ACE activity or characteristic radiologic findings) had a significant increase in aqueous ACE activity compared with normal subjects. Aqueous ACE activity was also significantly elevated in patients with sarcoid who had normal serum ACE activity. We believe that measurement of aqueous ACE activity should be considered in patients with uveitis who have normal serum ACE activity and are suspected of having sarcoidosis.

Effect of inverted body position on intraocular pressure

We evaluated changes in intraocular pressure in eyes with primary open-angle glaucoma after inversion into a totally dependent position with the head down and compared them with the changes intraocular pressure in healthy nonglaucomatous eyes. Five minutes after inversion, intraocular pressure increased from 16.8 mm Hg +/- 2.8 (sitting) to 32.9 mm Hg +/- 7.9 in normal eyes and from 21.3 mm Hg +/- 2.3 (sitting) to 37.6 mm Hg +/- 5.0 in glaucomatous eyes. Although visual fields were unchanged after inversion, glaucomatous eyes may be particularly susceptible to such changes and unable to withstand the transient but significant increase in intraocular pressure that occurs after assuming an inverted position. We recommend that patients with ocular hypertension or glaucoma refrain from this activity.

Flurbiprofen pretreatment in argon laser trabeculoplasty for primary open-angle glaucoma

We examined the influence of topically administered flurbiprofen sodium 0.03%, a potent prostaglandin inhibitor, on the inflammatory response and intraocular pressure following argon laser trabeculoplasty. Our investigation included one eye of each of 118 patients with primary open-angle glaucoma in whom laser trabeculoplasty was indicated. Sixty-three patients received flurbiprofen and 55 received a vehicle during the two-hour period immediately preceding laser therapy and for one week postoperatively. No significant differences in postoperative IOPs were noted between groups. However, when we considered conjunctival erythema at 24 hours or control of inflammation at the termination of the investigation, the eyes receiving flurbiprofen had less inflammation than did the vehicle-treated eyes.

Diagnosing sarcoidosis by transconjunctival biopsy of the lacrimal gland

A transconjunctival approach produced adequate biopsy specimens of the lacrimal gland in 24 of 27 patients with possible sarcoidosis. In five of the 24 noncaseating granuloma confirmed the diagnosis of sarcoidosis. Three of the five patients with enlarged lacrimal glands and four of the seven patients with increased lacrimal gland uptake of gallium had sarcoidosis confirmed by the biopsy. In carefully selected cases transconjunctival biopsy of the lacrimal gland should be considered an important part of the diagnostic evaluation of possible sarcoidosis.

Laboratory diagnosis of ophthalmic sarcoidosis

Because the eye is involved in about 25% of patients with active sarcoid, the ophthalmologist is often the first physician to see these patients. Although clinical findings may suggest sarcoid, laboratory tests (e.g., x-ray, skin tests, blood chemistries, etc.) may be normal or inconclusive. Thus, it is important that the ophthalmologist be aware of the availability and limitations of the various biochemical, immunological, radiological, and histopathological tests that contribute to the early diagnosis of sarcoidosis. The authors review diagnostic procedures and present a flowchart detailing indications for each.

The organization of actin filaments in human polymorphonuclear leukocytes

Actin constitutes a major component of the cytoskeleton of human polymorphonuclear leukocytes (PMNs). In this study, we present a comprehensive view of the organization of actin in various PMN regions and functional states. Transmission electron microscopic observations were made on whole mount, migrating, and phagocytizing PMNs. Positive identification of actin filaments was made through S-1 myosin subfragment labeling. In all PMNs studied, actin filaments were primarily organized as a three-dimensional meshwork. The density of this meshwork was greatest within the cell cortex. At peripheral regions of nonpolarized (viz., no distinct head or tail region) and polarized PMNs, actin filaments organized into parallel bundles or overlapping arcs. These bundles or arcs were oriented either perpendicular or parallel to the cell periphery. At the base of the PMN, actin filaments converged upon dense, plaquelike condensations. This latter pattern of actin organization was also observed in some pseudopods at the cell front and in phagocytic processes engulfing bacteria. In areas of internalized bacteria, the surrounding actin appeared as a loose meshwork. Treatment of PMNs with the antiactin drug, cytochalasin B, revealed shearing of the peripheral actin meshwork, condensation of the meshwork around the nuclear region, and dissolution of the basal plaquelike condensations.

Breakdown and reestablishment of blood-aqueous barrier with laser trabeculoplasty

Seventeen patients with primary open-angle glaucoma underwent laser trabeculoplasty. Measurement of fluorescein leakage into the anterior chamber showed significant differences between surgically treated eyes and control eyes (not surgically treated) one day postoperatively and one week postoperatively. The increase in fluorescein leakage probably represents a disruption of the blood-aqueous barrier. In contrast, there were no differences between the eyes preoperatively or one month postoperatively. Hence, the long-term pressure-lowering effects of laser trabeculoplasty do not seem to be related to any permanent change in the blood-aqueous barrier.

Indications for surgical management of hyphema in patients with sickle cell trait

We analyzed 22 sickle cell trait hyphemas. Fourteen of the 22 eyes were adequately controlled with medical therapy alone, ie, the intraocular pressure averaged less than 25 mm Hg during consecutive 24-hour periods and there were no repeated transient rises of IOP above 30 mm Hg. Surgery was performed in eight eyes, because of inadequate medical control. Thirteen of the 14 medically treated eyes had acceptable levels of IOP within the first 24 hours; only one of the eight surgically treated eyes had adequate control during the first 24 hours. This suggests that control during the first 24 hours portends a good prognosis, while lack of control during that period predicts continued difficulty managing the IOP. This seems to be important in view of previous experience that suggests that these eyes do not tolerate minimal to moderate elevations in IOP as well as those of patients without sickle cell anemia.

Prostaglandin production by human trabecular cells: in vitro inhibition by dexamethasone

In addition to the well-known ability of prostaglandins (PGs) to raise intraocular pressure (IOP), it recently has been reported that moderate and low doses of PGE2 and PGF2 alpha significantly reduce IOP in a variety of experimental animals. These studies suggested to us that PGs might serve as endogenous regulators of outflow facility in the meshwork if these autacoids were produced and secreted by human trabecular cells. To examine this possibility, media from well-defined trabecular cell material were assayed using specific radioimmunoassays. Morphologically differentiated human trabecular cells produced high levels of PGE2, and somewhat lower levels of PGF2 alpha and 6KF1 alpha in the presence and absence of serum. In a typical experiment, the following PG levels were detected in the cell culture media after 24 hours: PGE2; 225; PGF2 alpha, 33.5; 6KF1 alpha, 12.7 ng/ml with the presence of 10% fetal calf serum; and PGE2, 30.0; PGF2 alpha, 4.8; 6KF1 alpha, 3.6 ng/ml in serum-free media. Since glucocorticoids are known to inhibit PG pathways in other tissues, this effect was examined in the cultured trabecular cells. Moderate concentrations of dexamethasone (DEX) produced a marked inhibition in the levels of all three PGs. For PGE2 production, 10(-8) M DEX inhibited approximately 75%, and 10(-7) M DEX inhibited approximately 90%. More detailed dose-response studies revealed that the I50 for inhibition of PG production by dexamethasone was less than 10 nM, thus indicating that the steroid effect probably involved high affinity glucocorticoid receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of corticosteroid pretreatment on argon laser trabeculoplasty

We treated 18 patients with open-angle glaucoma with topical 1.0% prednisolone acetate before performing argon laser trabeculoplasty in an attempt to prevent the increase in intraocular pressure frequently observed during the immediate postoperative period. Intraocular pressure was measured hourly for eight hours postoperatively and was increased in 14 patients. The mean maximum increase, 7.72 +/- 8.62 mm Hg, occurred an average of 3.06 +/- 1.86 hours after laser treatment. Substantial increases in intraocular pressure (more than 15 mm Hg) were observed in five patients within eight hours postoperatively. There were no significant differences in the intraocular pressures of these patients and of 20 similar patients with open-angle glaucoma who did not receive corticosteroid therapy immediately, one week, and two months postoperatively. Corticosteroid pretreatment of patients undergoing laser trabeculoplasty apparently does not influence either the increase in intraocular pressure during the immediate postoperative period or the intraocular pressure two months after treatment.

Early and late failures of argon laser trabeculoplasty

Sixty-five eyes in 52 patients with open-angle glaucoma were treated with argon laser trabeculoplasty (ALT). Although a majority of the eyes showed a decrease in intraocular pressure (IOP) of 5 mm Hg or more, eight eyes required filtering surgery within one year of treatment, and extensive peripheral anterior synechiae and persistent elevation of IOP developed in an additional two eyes that did not undergo surgery. In four of six eyes with juvenile glaucoma that were treated with ALT, complications developed and/or filtering surgery was required. A rise in IOP more than a year after treatment was noted in two eyes that had shown an initial satisfactory response to ALT. Although ALT seems to be a valuable addition to glaucoma therapy, the potential exists for both early and late complications and failures.

Low-dose trabeculoplasty

We treated 21 eyes (18 patients) with open-angle glaucoma by low-dose laser trabeculoplasty consisting of 25 laser burns spaced over one quadrant (90 degrees) of the trabecular meshwork. After one month these eyes showed an average decreased in intraocular pressure of 6.86 +/- 2.95 mm Hg. Sixteen eyes underwent a second treatment consisting of an additional 25 laser burns spaced over a second quadrant of the trabecular meshwork. Intraocular pressure decreased an additional 3.56 +/- 2.94 mm Hg in these eyes. Although low-dose trabeculoplasty decreases intraocular pressure by an amount similar to that achieved with standard laser trabeculoplasty treatment protocols, additional study is needed to determine whether complications are reduced and whether the beneficial effect is sustained over a long period of follow-up.

Immediate intraocular pressure response to argon laser trabeculoplasty

We conducted a randomized, double-masked study of 40 patients with open-angle glaucoma to ascertain the immediate intraocular pressure response after treatment of either one half (180 degrees) or the entire (360 degrees) trabecular meshwork by argon laser trabeculoplasty. We found a statistically significant difference in the magnitude of intraocular pressure changes between the two groups (P less than .02), with those patients receiving fewer burns having a smaller increase. Substantial increases in intraocular pressure were observed in five of the 20 patients in whom the entire trabecular meshwork was treated. One of these patients had marked loss of visual field within 24 hours.

Influence of the number of laser burns administered on the early results of argon laser trabeculoplasty

We conducted a prospective, randomized, double-masked study to examine the influence of the number of burns administered on intraocular pressure after argon laser trabeculoplasty. Each of 40 patients with open-angle glaucoma had 50 burns placed over one half the trabecular meshwork (Group 1, 20 patients) or 100 burns placed over the entire trabecular meshwork (Group 2, 20 patients). There was no significant difference between the mean intraocular pressure decreases in Group 1 (-9.20 +/- 6.43 mm Hg) and Group 2 (-6.95 +/- 5.74 mm Hg) after two months (P less than .25). In each group, the intraocular pressure was lowest after two months in those patients in whom it was not increased during the immediate postoperative period (Group 1, P less than .006; Group 2, P less than .07). Because the changes in intraocular pressure were statistically similar in the two groups and because patients receiving only 50 burns may have fewer complications, administering 50 laser burns to one half the trabecular meshwork appears to be the better choice for an initial procedure.

Detection of glucocorticoid receptors in cultured human trabecular cells

To evaluate potential direct effects of glucocorticoids on the aqueous outflow pathway, the cellular binding of steroids to cultured human trabecular cells was examined. After incubation of cells with 5 to 40 nM [3H]dexamethasone, specific binding (i.e., binding that could be blocked by an excess of nonlabeled steroid) was detected by measuring the total cell-associated labeled hormone. A binding affinity of 5 nM and 60,000 receptor sites/cell were demonstrated with labeled dexamethasone. Incubation of human trabecular cells with 40 nM [3H]dexamethasone for 60 min revealed that 62% +/- 7 of the specific binding was found in the nuclear fraction and 38% +/- 3 was in the cytoplasmic fraction. In competition studies, dexamethasone had a higher affinity for these sites than cortisol, which in turn had a higher affinity than progesterone. These studies suggest that functional glucocorticoid receptors are present in human trabecular cell cultures. Therefore it is possible that a direct action of glucocorticoids on trabecular cells could contribute to the decreased outflow facility observed in steroid glaucoma.

Limited gallium scans and angiotensin converting enzyme in granulomatous uveitis

The use of serum angiotensin converting enzyme (ACE) and limited gallium scans of the head, neck, and chest for patients with granulomatous uveitis is described. Mean serum ACE activity was elevated in patients with granulomatous uveitis regardless of the presence of systemic sarcoidosis. Furthermore, pathologic gallium uptake was noted in lacrimal glands, parotid glands, and lungs in some cases. These results indicate that sarcoidosis may be more common than previously believed in these patients.

Uveitis associated with sarcoidosis and angiotensin converting enzyme

We evaluated serum angiotensin converting enzyme activity in three groups of patients as follows: 20 patients with systemic sarcoidosis and ophthalmic manifestations of the disease (Group 1); 27 patients with granulomatous uveitis and no evidence of systemic sarcoidosis (Group 2); and 17 patients with well-defined uveitis syndromes, both granulomatous and nongranulomatous (Group 3). Serum angiotensin converting enzyme activity in control subjects was 22.0 +/- 0.7 nanomol/min/ml (mean +/- S.E.). Compared to control subjects, serum angiotensin converting enzyme activity was significantly increased in Groups 1 and 2 for patients not using corticosteroids (57.9 +/- 7.4 and 41.5 +/- 4.4 nanomal/min/ml, respectively) as well as those using corticosteroids (40.3 +/- 5.1 and 35.6 +/- 4.8 nanomal/min/ml). Enzyme activity was not significantly different from controls for Group 3. Our study shows that the increase of serum angiotensin converting enzyme activity in some patients with granulomatous uveitis is strong evidence of sarcoid uveitis even in the absence of clinicoradiographic or histologic findings of systemic sarcoidosis.

Angiotensin-converting enzyme in sarcoid uveitis

The diagnosis of ocular sarcoid is presumptive in the absence of systemic disease. The association of elevated serum angiotensin-converting enzyme (ACE) levels with active systemic sarcoid has been well described. With a sensitive fluorimetric assay for ACE, we found that five of ten chronic granulomatous uveitis patients without systemic sarcoid had elevated serum ACE levels. None of ten patients with uveitis of known etiology had elevated serum ACE levels. We believe that the association of an elevated serum ACE level with chronic granulomatous uveitis suggests the diagnosis of ocular sarcoid.

Human trabecular cells. I. Establishment in tissue culture and growth characteristics

After a careful dissection of trabecular tissue from recent postmortem specimens, human trabecular cells were established in tissue culture with 250 ng/ml fibroblast growth factor (FGF), Dulbecco's modified Eagle's medium (DME), and 10% human serum. These conditions have allowed propagation of human trabecular cells for a number of passages at high density without apparent cellular degeneration. FGF increased the rate of cell division and the plating efficiency for trabecular cells but was not needed after cells had achieved confluency. Human trabecular cells had a pattern of growth which differed from human corneal keratocytes and human corneal endothelial cells compared at a similar passage. Propagation of human trabecular cells in vitro may provide a valuable source of experimental material to study the functional aspects of these cells which line the trabecular meshwork.

Uveitis associated with sarcoidosis and angiotensin converting enzyme

Sarcoid uveitis is usually a presumptive diagnosis based on the simultaneous presence of uveitis and clinicoradiographic or histologic findings of sarcoidosis. The elevation of serum ACE in some patients with granulomatous uveitis is strongly presumptive of sarcoid uveitis even in the absence of these findings. Serum ACE may prove to be a useful indicator of ocular sarcoid in the absence of otherwise undetectable systemic disease.