Advances in ocular therapy: noncorticosteroid anti-inflammatory agents. Fifth annual Jules Stein Lecture

Nonsteroidal anti-inflammatory drugs in ophthalmology

Nonsteroidal anti-inflammatory drugs (NSAIDs) are increasingly employed in ophthalmology to reduce miosis and inflammation, manage scleritis, and prevent and treat cystoid macular edema associated with cataract surgery. In addition, they may decrease postoperative pain and photophobia associated with refractive surgery and may reduce the itching associated with allergic conjunctivitis. In recent years, the U.S. Food and Drug Administration has approved new topical NSAIDs, and previously approved NSAIDs have been reformulated. These additions and changes result in different pharmacokinetics and dosing intervals, which may offer therapeutic advantages. For example, therapeutic effects on diabetic retinopathy and age-related macular degeneration may now be achievable. We provide an updated review on NSAIDs and a summary of their current uses in ophthalmology with attention to potential future applications.

Conjunctivitis of allergic origin: immunologic mechanisms and current approaches to therapy

The pathogenesis of ocular allergy involves multiple mechanisms, which lead to mast cell degranulation and the release of chemical mediators. Mast cell mediators that have been implicated in allergic ocular disease include histamine, eosinophil chemotactic factors, eosinophil granule major basic protein, platelet-activating factor, prostaglandin D2, and several other less well-defined preformed or newly synthesized mediators. The release of these chemical mediators ultimately results in conjunctival vasodilation, increased vascular permeability, leukocyte chemotaxis, and, rarely, ocular surface destruction. Current therapy of ocular allergy involves elimination of the offending allergen, modulation of the immune system, and pharmacologic inhibition of the chemical mediators. The purpose of this article is to provide a better understanding of the pathogenesis and current therapy of ocular allergic disorders and to review the central role of the mast cell and chemical mediators involved in ocular allergy.

The effect of indomethacin, prostaglandin E2 and interferon on the multiplication of herpes simplex virus type 1 in human lymphoid cells

The control of latency and reactivation of herpesvirus (HSV) infection is poorly understood. The activation of latent HSV is usually associated with a local or systemic rise in prostaglandins (PGs). It is possible that PGs may act indirectly by suppressing the inhibitory effect of interferon (IFN) on HSV replication. IFN has also been shown to decrease the number of herpetic recurrences and to speed up the healing of lesions. We investigated the effect of indomethacin (IND: a non-steroid anti-inflammatory drug which inhibits PGE2), PGE2, IFN-alpha and various combinations thereof on HSV-1 replication in established human lymphoid cells: Raji and Raji-HSV (a persistently infected subpopulation of Raji cells which continuously produces HSV-1 particles). We found that, in contrast to exogenous PGE2, IND suppressed HSV-1 replication in both cell lines. Attempts to overcome the inhibitory effect of IND by addition of PGE2 were unsuccessful. IFN also inhibited HSV-1 replication when a low multiplicity of infection was used. Moreover, the inhibition of HSV-1 multiplication was more marked in cultures treated with IFN in the presence of IND. PGE2 did not decrease or reverse the protective effect of IFN. Our results also suggest that the effects of PGE2, IND and IFN on HSV-1 replication depend on the multiplicity of infection. Further, the present observations together with previously published data would indicate that the inhibitory effect of IND on HSV-1 replication is independent of cell type or origin, while the enhancing effect of PGE2 on virus growth may depend on these factors.

Noncorticosteroidal anti-inflammatory agents in Ophthalmology

Efforts have been made to develop noncorticosteroidal anti-inflammatory therapy. The goals of such therapy have been to eradicate the primary cause, prevent the initial tissue injury, moderate inflammatory response, and enhance tissue repair while minimizing and eliminating the undesirable aspects of the therapy.

Release of prostaglandins in experimental immunecomplex endophthalmitis and phacoallergic uveitis

Prostaglandins-E were demonstrated in the aqueous humour, the anterior uvea, and the choroid of rabbits in which type III allergic reactions were produced by two different methods. In general the levels of prostaglandins were found to be higher in those animals in which the immune complexes were formed from autologous rather than heterologous tissue antigens.

Indomethacin and the corneal immune response

To study the effect of treating rabbits with a locally administered noncorticosteroid anti-inflammatory drug, we gave 26 rabbits unilateral subconjunctival injections of 15 mg of indomethacin suspension daily for 16 days, starting one day before the intracorneal injection of the same eye with bovine gamma globulin. We graded the eyes clinically and killed groups of rabbits on postimmunization days 6, 9, 12, and 15. We determined the number of antibody-forming cells in the homolateral cervical lymph nodes, corneas, and uveal tracts and tested the sera, aqueous humor, and vitreous humor for antibodies. Indomethacin-treated eyes showed significantly less inflammatory response, and an insignificantly greater number of antibody-forming cells, than the controls.