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

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The goal of this project is to develop improved methods for diagnosing and treating human uveitis and the ocular complications of AIDS. This project encompasses clinical trials evaluating new diagnostic and therapeutic approaches for patients with intraocular inflammatory disease, immunologic and histologic studies of blood and tissue specimens obtained from patients with ocular inflammation, and natural history studies of patients with various forms of uveitis. A number of studies have focused on improving diagnostic tests for uveitis. Conjunctival and lacrimal gland biopsy specimens from patients with sarcoidosis have been analyzed using reverse transcriptase-polymerase chain reaction (RT-PCR) and showed increased detection of certain gammadelta T-cell receptor clonotypes. This information will provide valuable information on the nature of the ocular inflammatory response in these patients and may help to differentiate this disease from other forms of uveitis. The Clinical Branch remains involved in a number of studies designed to improve the treatment of uveitis and ocular malignancy. A prospective, double-masked, randomized study demonstrated that acetazolamide therapy caused a statistically significant but small decrease in cystoid macular edema compared with placebo, although visual acuity did not substantially change. A multicenter, randomized clinical trial evaluating a heparin surface-modified intraocular lens in patients with uveitis has recruited 12 patients, 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 complications related to acquired immunodeficiency syndrome (AIDS). We are retrospectively reviewing the ophthalmologic examinations of 600 AIDS patients to improve diagnosis. We recently showed that about 50 percent of patients have no ocular complaints at the time of diagnosis of cytomegalovirus (CMV) retinitis, suggesting that regular screening eye examinations are needed to detect this retinal infection at an early state. In addition, we are involved in the study of new medical and surgical treatment for CMV retinitis, including a sustained-release ganciclovir implant.