DIAGNOSIS AND TREATMENT OF HUMAN UVEITIS AND AIDS-RELATED OCULAR DISEASE

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The title of this project has been changed from "The Diagnosis and Treatment of Human Uveitis" to "The Diagnosis and Treatment of Human Uveitis and AIDS-Related Ocular Disease," to reflect the expanded scope of the project to include the study of ocular disease in patients with AIDS. In addition, this project was previously listed in the Laboratory of Immunology but is now listed in the Clinical Branch. The goal of this project is to develop improved methods for diagnosing and treating human uveitis and AIDS-related ocular disease. This project encompasses clinical trials evaluating new diagnostic and therapeutic approaches and immunologic and histologic studies on blood and tissue specimens obtained from patients A number of studies have focused on improving diagnostic tests for uveitis. Examination of lacrimal gland and conjunctival biopsies from patients with sarcoidosis has demonstrated lymphocytic infiltration and specific T-cell receptor repertoires despite a lack of granuloma formation, and these resul should help improve the diagnostic yield of biopsies for the diagnosis of sarcoidosis. We have also shown that lumbar puncture can miss malignant involvement of the leptomeninges in patients with intraocular lymphoma and that ventricular taps are needed. The Clinical Branch is involved in a number of studies designed to improve the treatment of uveitis and ocular malignancy. A prospective, double- masked, randomized study of acetazolamide for uveitis-associated cystoid macular edema has just completed enrollment, and data will be analyzed this year. In addition, we completed a pilot study examining the efficacy and toxicity of a chemotherapy regimen for therapy of patients with central nervous system lymphoma involving the brain or eye. A complete response was obtained in seven of eight patients; the other patient had a partial response. A clinical trial evaluating a heparin surface-modified intraocul lens in patients with uveitis is under way, and a natural history study of patients with uveitis and good vision is in progress. Finally, the Clinical Branch is involved in studies with ocular complicatio related to AIDS. We are retrospectively reviewing the ophthalmologic examinations of 550 AIDS patients to improve diagnosis of ocular complications such as infection. In addition, we are participating in an open-label study of didofovir for the treatment of resistant cytomegaloviru (CMV) retinitis in patients with AIDS.