Prognostic value of HLA-A 3, BW 35, B 7, and B 12 in ocular hypertension

The prevalences of HLA-A 3, BW 35, B 7 and B 12 in 80 Caucasian patients with ocular hypertension were intermediate between values found in ocular normotensives and in patients with primary open-angle glaucoma. The presence of HLA-B 7 or B 12 had significant predictive value for the development of glaucomatous damage to the optic nerve in patients with ocular hypertension. The HLA-A 3 antigen by itself, or in combination with B 7 and B 12 did not improve the prognostic value of the B 7 and B 12 antigens. Only one of the 20 white ocular hypertensives in this series with HLA BW 35 antigen developed glaucomatous visual field loss.

HLA antigens and corticosteroid response

Compared with normal individuals, patients with primary open-angle glaucoma have increased prevalences of HLA-B12 and B7 antigens and are more responsive to glucocorticoids. Lymphocytes from both ocular normotensive and glaucomatous individuals with the HLA-B12 antigen require significantly (P less than .02) lower concentrations of prednisolone to inhibit phytohemagglutinin-induced transformation.

Pilocarpine ocular inserts

Pilocarpine was administered to a selected group of ocular hypertensive subjects in the form of a synthetic biosoluble matrix inserted into the conjunctival cul-de-sac. Satisfactory lowering of the intraocular pressure resulted, with a minimum of subject intolerance. The decreased pressure response was significant in some cases for greater than 24 hours. Drug delivery by soluble inserts offers promise as a convenient and effective mode of therapy.

The prognostic value of HLA-B12 and HLA-B7 antigens in patients with increased intraocular pressure

The presence of the histocompatibility antigens HLA-B12 or HLA-B7 in 76 patients with increased intraocular pressure and a GG response to topical corticosteroids (intraocular pressure over 31 mm Hg after six weeks of topical 0.1% dexamethasone eyedrops, four times daily) correlated with the development of glaucomatous visual field loss. In close agreement with prevalences in patients with primary open-angle glaucoma, 14 (88%) of the 16 patients with increased intraocular pressure and a GG response who developed glaucomatous visual field loss had either HLA-B12 or B7 antigens. Fourteen (41%) of 34 patients with increased intraocular pressure and a GG response who had B12 or B7 antigens developed glaucomatous visual field loss but only two (5%) of 42 similar patients without either antigen had visual field loss. Other factors such as the initial intraocular pressure, the horizontal cup/disk ratio, and family history of glaucoma proved less valuable as prognostic indicators in this series.

Long-term epinephrine therapy of ocular hypertension

Nineteen patients with symmetrical ocular hypertension and symmetrical cupping of the optic nerves were made asymmetric with respect to intraocular pressure for one to five years by unilateral topical treatment with epinephrine hydrochloride. Development of glaucomatous visual field defects was observed in 32% of the untreated eyes and in none of the treated eyes (P less than .05). Progressive cupping of the optic nerve was noted in 53% of the untreated eyes and in 11% of the treated eyes (P less than .025). Evidence of glaucomatous damage was observed more frequently in subjects maintained on this regimen for longer periods and in subjects with initial horizontal cup/disc ratios greater than 0.4 (P less than .05). None of the eyes, either treated or untreated, with mean intraocular pressures less than 24 mm Hg developed glaucomatous damage during the period of this study.

Response to topical epinephrine. A practical prognostic test in patients with ocular hypertension

Eighty patients with ocular hypertension (intraocular pressure greater than 20 mm Hg) and GG-response to topical corticosteroids (over 31 mm Hg after six weeks of topical dexamethasome 0.1% four times a day) were tested for ocular hypotensive response to topical epinephrine. Of 80 patients observed for five to ten years, 20 (25%) developed gluacomatous visual field defects, and 34 (43%) were "responders" to topical epinephrine (IOP reduction of greater than 5 mm Hg). Of 20 patients who developed glaucomatous visual field defects, 17 (85%) had responded to topical epinephrine, but only 28% of those who did not have visual field defects showed this type of epinephrine response. Of 34 epinephrine responders, 17 (50%) developed glaucomatous visual field defects as compared to three of 46 (6.5%) nonresponders. The initial applanation IOP level proved less valuable as a prognostic indicator.

Pseudomembranous colitis associated with antibiotics

Colitis associated with antibiotics, particularly with lincomycin and clindamycin, is a well established entity. The colitis may be clinically and radiologically very difficult to distinguish from inflammatory bowel disease, including Crohn's disease and ulcerative colitis. A wide spectrum of pathological features is described with various antibiotics. However, the pathological picture in the pseudomembranous form is quite distinctive. The most important histological findings include a "mushroom-like" or "explosive" appearance of the pseudomembrane with a sudden transition to normal mucosa adjacent to the lesion. Rectal biopsy is both an accurate and a rapid method of establishing the diagnosis.

Positive FTA-ABS tests in subjects with corticosteroid-induced uveitis

Of 17 subjects who developed severe anterior nongranulomatous uveitis during or immediatelyy after testing with topical corticosteroid preparations, 14 (82%) had a positive fluorescent-treponemal-antibody absorption (FTA-ABS) test. No association was found between corticosteroid-induced uveitis and any specific HL-A locus.