THE DIAGNOSIS AND TREATMENT OF HUMAN UVEITIS

该项目的目标是开发改进的诊断方法 以及治疗人类葡萄膜炎。关于诊断的三项研究如下： (1)我们检查葡萄膜炎患者的活检和病理标本 和艾滋病开发改进的诊断测试并更好地了解 炎症性眼病的病理生理学。正在进行的研究 眼内淋巴瘤表现为多次玻璃体切除或腰椎穿刺术 被要求诊断约三分之一的患者，适当地， 由经验丰富的细胞病理学家迅速处理病理标本 仍然是做出正确诊断的关键。(二)改进方法 为了诊断眼结节病，我们检测了泪腺和 结膜活组织检查干扰素-γ的存在； 抗原；白介素2、3、4、6和8；以及被认为是 是这种疾病的特效药。今年，我们回顾了46 经活检证实为结节病的患者和21例葡萄膜炎患者。在病人中 对于眼部受累，最敏感的诊断测试是 肺弥散能力(DLCO)，78%的患者肺弥散能力降低 测试过。对患者进行促肾上腺皮质激素释放激素测试 以确定是否有缺陷的下丘脑-垂体- 肾上腺轴与自身免疫性眼病风险增加相关 炎症性疾病。(3)我们对内毒素诱导的动物的研究 葡萄膜炎(EIU)显示，肿瘤坏死因子α可引起 自相矛盾的眼病恶化。 在治疗方面，我们有三个项目：(1)我们正在继续 一项比较乙酰唑胺和安慰剂的掩蔽、随机交叉研究 用于治疗葡萄膜炎黄斑囊样水肿；迄今有31例患者 已经被招募了。(2)外用FK50治疗EIU 在老鼠身上。动物的眼部炎症显著减轻 外用FK506(0.3%和0.5%)与对照组比较 动物，这一发现可能对急性眼病的治疗有用 人类的炎症。(3)眼内淋巴瘤的最佳治疗方法 仍然不清楚；然而，以前的研究表明，如果不治疗 患者在确诊后1年内死亡。11项回顾回顾 眼内淋巴瘤患者接受放疗、化疗、 或者两者都显示出与治疗相关的大量死亡。在一个关节里 协议和国家癌症研究所，我们现在正在调查 中枢神经系统淋巴瘤的替代治疗方案。

The goal of this project is to develop improved methods for diagnosing and treating human uveitis. Three studies of diagnosis are as follows: (1) We examine biopsy and pathology specimens from patients with uveitis and AIDS to develop improved diagnostic tests and to understand better the pathophysiology of inflammatory eye disease. Ongoing studies of intraocular lymphoma show that multiple vitrectomies or lumbar punctures are required to diagnose about one-third of the patients, Appropriate, prompt handling of pathology specimens by an experienced cytopathologist remains critical to making the correct diagnosis. (2) To improve methods for diagnosing ocular sarcoidosis, we test lacrimal gland and conjunctival biopsies for the presence of interferon-gamma; Kveim antigen; interleukins 2,3,4,6 and 8; and T-cell receptors believed to be specific for this disease. This year we retrospectively reviewed 46 patients with biopsy-proven sarcoidosis and 21 with uveitis. In patients with ocular involvement, the most sensitive diagnostic test was the pulmonary diffusing capacity (DLCO), which diminished in 78% of patients tested. Corticotropin-releasing hormone tests are performed on patients with uveitis to determine whether a defective hypothalamic-pituitary- adrenal axis is associated with increased risk for autoimmune ocular inflammatory disease. (3) Our study of animals with endotoxin-induced uveitis (EIU) showed that tumor necrosis factor alpha causes a paradoxical exacerbation of ocular disease. In the area of treatment, we have three projects: (1) We are continuing a masked, randomized crossover study to compare acetazolamide to placebo for the treatment of uveitic cystoid macular edema; to date 31 patients have been recruited. (2) Topically applied FK 50 was used to treat EIU in the rat. Ocular inflammation was reduced significantly in animals treated with topical FK 506 (0.3% and 0.5%) when compared with control animals, a finding that may be useful in the treatment of acute ocular inflammation in humans. (3) The optimal therapy for intraocular lymphoma remains unclear; however, previous studies suggest that untreated patients die within 1 year of diagnosis. Retrospective review of 11 patients with intraocular lymphoma treated with radiation, chemotherapy, or both showed substantial treatment-related mortality. In a joint protocol and the National Cancer Institute, we now are investigating alternative treatment regimens for central nervous system lymphoma.