|Year : 1979 | Volume
| Issue : 2 | Page : 39-41
Betamethasone and trachoma
NK Jain, V Thakur, A Gupta, HV Nema
Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
H V Nema
Medical Enclave, Banaras Hindu University, Varanasi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain N K, Thakur V, Gupta A, Nema H V. Betamethasone and trachoma. Indian J Ophthalmol 1979;27:39-41
Presently, there is no reliable test for the assessment of the cure of trachoma. For all practical purposes disappearance of the characteristic conjunctival and corneal signs as well as of the inclusions in the scrapings has been used as an index of cure of the disease. Many methods such as, mechanical rubbing or scraping conjunctiva, chemical stimulation, instillation of placental extract and cortisone were tried in the past to distinguish between the healed trachoma and latent trachoma but none of them had given a dependable response. The differentiation between the healed trachoma and latent trachoma has assumed a greater importance particularly owing to increased international travel. Hence the need developing a reliable test for the cure of trachoma was felt. In the recent past, cortisone,,, and hydrocortisone. were tried for this purpose with encouraging results. However, the subsequent studies on large number of cases domonstrated their limitation due to equivocal response,, Nevertheless, in comparison to other provocating agents (with the exception of dionine), steroid provided some promise especially on the grounds of introduction of its higher analogue and strain variation of the trachoma agent. It was, therefore, thought worthwhile to evaluate the effect of betamethasone on healed trachoma.
| Materials and methods|| |
Eighty cases of healed trachoma without any sequelae were selected from the out-patient department of the Bhuwaika Eye Hospital, Banaras Hindu University. Each case was examined with the help of slit lamp bio-microscopy to exclude the presence of active signs of trachoma in conjunctiva and cornea. Then scrapings were taken from the upper palpebral conjunctiva and after staining with Giemsa stain were screened under microscope for the cytology of active trachoma. Only such cases demonstrating negative cytology of trachoma were included in this study. None of the cases had any kind of treatment for the past three monthc. The cases were divided into two more or less identical grcups (A & B) consistint of 40 each.
The patients in group A received betamethasone (0.1 percent) and neomycin eye drops (0.5 per cent) while patients in group B received only sterile normal saline drops thrice daily for ten days. The patients were called for clinico-cytological re-examinations on the 5th day after receiving 12th instillation and then on 11th or 12th day after completing 30 instillations. The reactivation of the disease in both the groups was assessed on clinico-cytological findings.
Clinical features of 38 cases of group A and 40 cases of group B on the 5th day did not differ materially from their initial findings. Similarly, their cytological picture also remained unaltered. Two cases of the group A did not report for follow up. Only 35 cases of the group A and 31 cases of the group B could receive the proposed 30 instillations of medicaments, hence they were evaluated for reactivation of the disease, either on 11th or on 12th day.
It was found that 5 cases of group A and one case of the group B showed clinical reactivity of the disease as evident by presence of papillary hypertrophy and biomicroscopically demonstrable prefollicles on the upper palpebral conjunctiva and initial pannus in the cornea. Cytological examination revealed inclusion bodies in. the scrapings of the four cases of the group A while none from group B. Significant trachomatous cytological changes such as abundance of olymorphonuclear cells, multinucleated epithelial cells, nuclear debris and plasma cells were seen in additional 4 cases of the group A and 1 case of the group B, though they were inclusion negative.
| Discussion|| |
With an increased international travel, tourist from the trachomatous countries often go to the countries practically free of trachoma and face surveillance from health authority usually not much conversant with the trachoma of low activity. It is true that as long as there is no dependable criterion of cure of the disease, it cannot be hoped that the migration laws will be made more humaneor that trachomatoligists from different countries may agree on the best method of preventing the spread of the. disease. Considering this lacuna in our knowledge,, various metals, toxins, and hormones were tested for their possible potentiality to reactivise the agent of trachoma but none had received universal acceptance. Nevertheless, cortisone has attracted the attention of many workers,,,,, and impressed them. Our own study reveals the efficacy of betamethasone in its role to produce recrudescence of healed trachoma in four cases. It is evident from the table that though betamethesone failed to reactivate trachoma after 12 applications it has caused reactivation of the disease clinically in 5 cases (11.43%) and cytologically in four cases (22.85%) after 30 instillations. If we consider cytological reactivation purely on the ground of demonstration inclusion bodies then cytological recrudescene of the disease was found in only four cases. Incidentally all these four cases also showed clinical reactivity of the disease. Hence there remains no doubt regarding their reactivation. In control group, clinical reactivation of trachoma was seen only in one case while other cases showed cytological reactivity without the presence of inclusion bodies. Therefore, none of the cases in the control group should be considered reactivated.
Our results are in full agreement with the reports of Freyeche et al, who demonstrated mild clinico-cytological reactivation in 5 out of 50 patients with almost complete citatrized trachoma after the application of cortisone and also to that of Thygeson who found abundant inclusion bodies in four out of seven patients receiving 2.5% cortisone acetate at short intervals of one to two hours. Similarly, Nema et al also obtained reactivation of trachoma in a limited number of cases (6 out of 37 cases) following the use of hydrocortisone. On the other hand, Collier was not impressed by the reactivating role of steroid on trachoma. Moreover, in a double blind study on the effect of ccrticosteroid on the the course of trachoma, Singh and Agarwal reported negative results. They opined that prednisolone did not enhance the activity of trachoma even where the disease is already active. The variation of reactivation of , trachoma by steroid may be related to different treatment schedules adopted in different studies The results obtained in the present study indicate that an average duration of ten days with instillation of the drug at least three times a day, seem to be necessary for the reactivation of trachoma.
The mode of reactivation of trachoma by steroid is yet unknown, however, there appears to be two possibilities: a direct multiplication of the trachoma agent or a lowering of local tissue resistance, which may directly facilitate the growth of the TRIC agent, possibly latter factor plays a dominant role . Such belief gets support from recent reports indicating that continuous and frequent local applications of steroid facilitate the appearance of herpes simplex keratitis: still more convincing experimental work may be needed to decide the proper mode of action of steroid on TRIC agent. In spite of a positive clinico-cytological reactivation of trachoma in 11.43% of our series, we have no hesitation to state that betamethasone drops may not be accepted as an ideal provocating agent for distinguishing healed trachoma from the trachoma of low activity.
| Summary|| |
Effects of betamethasone drops were evaluated on 40 controlled cases of healed trachoma. The drug could produce clinico-cytological reactivity of diseases in 11.43% of cases. The mode of reactivation of trachoma by steroid is not known, however, a few possibilities have been suggested. Probably, the drug does not fulfil the merits of an ideal provocating agent of healed trachoma.
| References|| |
Collier, L.H. (Personal communication)-Quoted by Satnam Singh and Agarwal, K.C., 1963, Bull. Wld. HIM. Org., 29, 548.
Freysche, M.J. and Natag, R., 1951, W.H.O. Trachoma, 18
Freysche, M.J. Nataf, R. Maurin, J. and Deloh, P. 1953, W.H.O. Trachoma, 35.
Mohsenine, H. and Daraugar, S. 1957, Rev. Int. Trachoma, 37, 336.
Nataf, R., Maurin, J. and Duplaud, P., 1955, W.H.O. Trachoma, 36.
Nema, H.V. Shukia, B.R. and Bal, A., 1964, J. All India Ophihal. Scc., 12, 65.
Satnam Singh and Agarwal, K.C., 1963, Wull. Wld. HIth. Org., 29, 548.
Thygeson, P., 1953, Rev. Int. Trachoma, 10, 450.
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