Purpose Local allergic rhinitis (LAR) has been reported in the field of otolaryngology; however, the concept of local allergic conjunctivitis (LAC) has not been widely studied in the ophthalmologic community. We routinely examined total IgE levels in tear fluids (t-tIgE) and antigen-specific IgE levels in serum (s-sIgE) in patients with suspected allergic conjunctivitis, on the basis of Japanese guidelines for allergic conjunctival diseases. There are several cases in which the results of t-tIgE and s-sIgE testing are divergent. We suggest that these divergent cases correspond to LAR in otolaryngology. Methods The study included 148 patients (33 men and 115 women) with clinical symptoms and signs of allergic conjunctivitis. Allerwatch Tear IgE Ò was used for measurement of t-tIgE levels. ImmunoCAP Rapid Ò and View Allergy 39 Ò were used for measurement of s-sIgE levels. Conjunctival cytology using spatula was used to identify eosinophils on the conjunctiva. Results A total of 83 patients (56.1%) were positive and 65 patients were negative for t-tIgE in the AW. In the ICR, 97 patients (65.5%) were positive for at least one of the eight allergens, whereas 51 (34.5%) were negative for all allergens. Among 83 patients positive for t-tIgE, 14 (16.9%) had no detectable s-sIgE. Therefore, we considered the possibility of LAC in cases in which only local IgE could be detected. Among 28 cases (18.9%) who were negative for t-tIgE and s-sIgE, 21 underwent conjunctival scraping; eosinophils were found in four cases and eosinophilic granules in two. Accordingly, we considered the possibility of non-IgE-type AC in these six cases. Conclusions These results suggest the existence of LAC that is a candidate of a phenotype of AC.

SUMMARY As diabetic retinopathy progresses, the non-perfused area in the retina gradually enlarges as the capillaries are obstructed. To elucidate the process of capillary obstruction we examined macular capillaries in 104 diabetics, using fluorescein angiography. The follow-up period was three to eight years. We found that some capillaries in the macula were obstructed, then became unobstructed. Reflow of blood into the macula after the obstruction was observed in nine patients (8.7%). The time between obstruction and reflow varied from two months to four years. There were four cases of simple, three of preproliferative, and two of proliferative retinopathy. Reflow in the capillaries was confirmed as occurring at the same position and in vessels with the same diameter as seen before the obstruction. There was no leakage of the fluorescein dye from the capillary where reflow took place. We tentatively conclude that one of the causes of this phenomenon is a functional obstruction.It is generally accepted that diabetic retinopathy is a form of microangiopathy. As the retinopathy progresses, the non-perfused area in the retina gradually enlarges as a result of obstruction of the capillaries.Although several ophthalmologists reported this phenomenon, each report was of one case and the state of the capillaries before the obstruction was not described.'" Almost all reported that this phenomenon occurred after photocoagulation. We therefore examined the occurrence rate of the reflow of the obstructed capillaries, the type of capillary reflow, and the possible relation to photocoagulation. Subjects and methodsFluorescein angiography was carried out from 1977 to 1985 on 104 eyes of 104 diabetics aged 16 to 78 years. All were treated by diabetologists and the follow-up was for three to eight years. Thirty were cases of insulin-dependent diabetes mellitus (IDDM) and 74 of non-insulin-dependent diabetes mellitus (NIDDM). Diabetics without retinopathy, deterCorrcspondcncc to Yasuo Yamana. MD, Yamana Eye Clinic, 10-Nabeyama Nakama-shi Fukuoka, 809 Japan. mined by ophthalmoscopy, numbered 22. In 58 cases there was a simple retinopathy, 18 had a preproliferative retinopathy, and six a proliferative retinopathy.All patients were examined by ophthalmoscopy after the pupil had been dilated with 10% phenylephrine and 0-5% cyclopentolate. Fluorescein fundus angiography and colour photography were carried out periodically, the frequency depending on the severity of the diabetic retinopathy. 5 ml of 10% sodium fluorescein was given intravenously.We examined coagulation and platelet aggregation at the time of occlusion, and adenosine-5'-diphosphate (ADP) and coagulation were examined at the time of occlusion and after reflow in patient 1 and after reflow in eight patients.

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Background Recently, the number of patients with pollinosis, particularly Japanese cedar pollinosis, has markedly increased. We previously reported about local allergic conjunctivitis, which is a phenotype of allergic conjunctivitis (AC). AC cases are often sensitized by various antigens. This study aimed to investigate the relationship among total tear IgE (t-tIgE), specific serum IgE (s-sIgE), and total serum IgE (t-sIgE) levels in patients with pollen-induced AC. Methods In 2019, 1372 patients were clinically diagnosed with AC at the Yamana Eye Clinic using t-tIgE, t-sIgE, and s-sIgE tests against 39 allergens. Among the pollen-induced AC patients who underwent allergen testing, 99 tested positives for s-sIgE against pollen. The subjects comprised 33 (33.3%) male and 66 (66.7%) female individuals aged 9–86 years. Results The t-tIgE test was positive in 68 (68.7%) patients and negative in 31 (31.3%) patients. In the t-sIgE test, 45 (45.5%) patients had t-sIgE levels above the reference value of 170 IU/mL. The higher the total score of the positive class value of each pollen-specific IgE (pollen-sIgE) antibody, the higher the positive rate of t-tIgE (p < 0.001). Of 32 patients in whom food-specific IgE (food-sIgE) was detected, 81.3% of the pollen-sIgE-positive and food-sIgE-positive cases were also positive for t-sIgE and t-tIgE. However, significant difference was not found between the total score of food-sIgE of the t-tIgE positive group and negative group. Conclusions Pollen-induced AC is caused by pollen sensitization of the conjunctiva. Food-induced AC might be induced by the different pathological mechanism involved in pollen-induced AC.

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