|Year : 1964 | Volume
| Issue : 2 | Page : 65-67
Effect of topical hydrocortisone and dionine on healed trachoma
HV Nema, BR Shukla, A Bal
Trachoma Research Centre, A.M.U. Institute of Ophthalmology, Aligarh, India
|Date of Web Publication||14-Feb-2008|
H V Nema
Trachoma Research Centre, A.M.U. Institute of Ophthalmology, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nema H V, Shukla B R, Bal A. Effect of topical hydrocortisone and dionine on healed trachoma. Indian J Ophthalmol 1964;12:65-7
At present there is no exact method of knowing when the agent of trachoma is definitely destroyed or rendered inactive. Many attempts have been made in the past to distinguish healed trachoma from trachoma of low activity by the local application of copper sulphate, silver nitrate, staphylococcal toxoid, toxin of Koch Weeks bacillus, placental extract and corticosteroid. Interest in cortisone as provocative test was stimulated by the investigations of Ormsby and coworkers (1952), who reported that the topical use of the hormone caused reactivation of inclusion conjunctivitis. Several other workers including Freyche and Nataf (1953), Thygeson (1953), Nataf and associates (1955) and Mohsenine and Darougar (1957) found recrudescence of cured trachoma after local cortisone treatment. On the other hand, Mitsui described both positive and negative results in his large series of cases. The present study was, therefore, undertaken to elucidate the validity of cortisone as a provocative test in trachoma and further to explore the effect of dionine solution on lealed trachoma.
Material and Method :
In this study, 395 primary school children of Aligarh between 5 - 12 years of age were examined with the help of binocular loupe (magnification 2.5 times). Out of these, 91 were found to be suffering from healed trachoma (trachoma IV). The diagnostic criterion was based on W.H.O. classification (1955). All these children were examined again on slitlamp and the findings in detail were recorded on W.H.O./UNICEF individual record cards. Conjunctival scraping was taken from every child and inclusion positive or cases showing specific cytology of trachoma (Thygeson, 1946) consisting of polymorphonuclear cells, plasma cells, lymphoblasts and distinctive macrophages (Leber cells) were excluded. These children were then randomly allocated into three groups (A, B & C). Group A was put on hydrocortisone 1% (EfcorlinGlaxo), group B on dionine aqueous solution 2% and group C (control) on liquid paraffin drops. The treatment schedule followed in all three groups, was thrice daily applications of medicaments. First, second and final clinical and cytological examinations (blind) were done after 9 (3 days), 15 (5 days) and 27 (11 days) applications respectively in each group. Slides collected at each examination were stained by Giemsa technique and examined for the presence of H.P. inclusions and specific cytology of trachoma.
Results obtained during the study are tabulated in [Table - 1],[Table - 2].
| Discussion|| |
The problem of distinguishing healed trachoma from trachoma of low activity with any degree of certainty has yet to be resolved, though for all practical purposes, a combination of all the negative clinical and cytological signs has made it possible to assess a probable cure of this disease. Our work deferred from that reported by other workers investigating provocative effect of cortisone on healed trachoma in two ways. Firstly it had the advantage of a control study to rule out any possibility of reinfection amongst children, secondly the application of dionin solution which is frequently used in ophthalmic practice, but has not received due attention in its role of reactivation of a smouldering infection.
it is evident from [Table - 1] that hydrocortisone and dionine solution could produce recrudescence in six and nine cases in groups A and B respectively, while group C (control) showed no reactivation. The maximum recrudescence was observed after 11 days (27 applications), which may be the minimum period for such a test [Table - 2]. On the basis of these findings we feel that cortisone has some role in the reactivation of healed trachoma as reported by Freyche & Nataf (1953), Thygeson (1953) and Mohsenine & Darougar (1957). Moreover, Nataf and coworkers (1955) using a 2% cortisone acetate solution and administering only one subconjunctival injection of 0.4 cc every three or four days, demonstrated reactivation in three out of eleven trachoma IV cases, eighteen out of thirty active trachoma cases and three out of five late trachoma III cases. Bietti (1955) believed that among other mechanical and clinical means employed for reactivation of trachoma, locally applied steroids also could produce more or less the appearance of inclusions if the cure has not been completed.
In the light of these reports it seems that cortisone has a provocative effect on latent trachoma, but the question whether nonreactivation after use of cortisone should be accepted as a certain criterion of cure remains yet to be answered. The recent studies of Wang and Graystone (1962) on the effect of cortisone on monkey trachoma has shown evidence of relapse and recurrent infections in only 50% of animals. Poleff (1962) in his personal communication expressed that cortisone was capable of producing reappearance of inclusions but not always. Further Mitsui in a large series has reported equivocal results after cortisone treatment.
From our own observations, it is apparent that hydrocortisone caused reactivation in a small number of cases (16.2%). Therefore, in our opinion the acceptance of cortisone as a definite provocative test for the cure of trachoma may not be taken without reservation.
The trial with dionine solution 2% appeared to be more satisfactory and encouraging. We have had a larger number of reactivations as compared to the cortisone group. Though, statistical analysis of the results showed that the percentage reactivation was not significant (t=1.40) for 64 degrees of freedom between the dionine and hydrocortisone groups. However, there is found to be increasing trend in the percentage reactivation rates from group A to group B.
The exact mode of reactivation of trachoma by dionine solution is not known. It may be due to its lymphagogue and hyperoemic actions that the dormant virus is stimulated into activity by some unknown cytochemical reactions. In the absence of a reliable criterion of cure, dionine may require further trial and confirmation by other workers.
| Summary|| |
Effect of topical hydrocortisone 1% and dionine solution 2% was studied on 91 healed trachomatous primary school children. 16.2% and 31.0 reactivation was observed in hydrocortisone and dionine groups respectively. With small number of reactivation in hydrocortisone group, cortisone cannot be accepted as a certain criterion of cure of trachoma, while dionine with greater number of reactivation rate requires further consideration.
| Acknowledgments|| |
We are grateful to Indian Council of Medical Research for the facilities provided during this study and to Mr. N. R. Parthasarthy, Statistician, Trachoma Control Pilot Project for statistical analysis of the results.
| References|| |
Bietti G. B. (1955) Present Status of the Treatment of Trachoma by Chemotherapy and Antibiotics. W.H.O./Trachoma/39.
Freyche M. J., Nataf R., Maurin J. and Delon P. (1953), Cortisone as a Means of Establishing Criteria of Cure in Trachoma. W.H.O./Trachoma/35.
Mitsui Y. cited in 8.
Mohsenine H. and Darougar S. (1957). Rev. Intern. Trach. 37, 336.
Nataf R., Maurin J. and Dupland P. (1955). The Use of Cortisone as a Test of Cure and a "Provocative Test" in Trachoma. W.H.O./Trachoma/36.
Ormsby H. L.. Thompson G. A., Cousineau G. G.. Lloyd L. A. and Hassard J. (1952) Amer. J. Ophthal. 12, 1811.
Poleff L. (1962), Personal Communication.
Thygeson P. (1946) Amer. J. Ophthal. 29, 1499.
Thygeson P. (1953) Rev. Intern. Trach. 10, 450.
Wang S. P. and Grayston J. T. (1962) Ann. N.Y. Acad. Science 98 (1), 177.
W.H.O. Expert Committee on Trach. (1955), W.H.O./Trach./67.
[Table - 1], [Table - 2]