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Previous investigations have found elevated levels of s-IgA in the parotid saliva and normal levels in submandibular saliva of patients with Sjögren's syndrome (SS). Fox et al. also found elevated levels of cytokines (i.e., IL-2 and IL-6) in serum, salivary epithelial cells and parotid saliva of patients with SS. The oral administration of pilocarpine hydrochloride stimulates whole and parotid salivary flow. The purpose of this study was to determine the levels of s-IgA and IL-2 and IL-6 in whole saliva before and after administration of pilocarpine hydrochloride in SS subjects. Ten definitively diagnosed SS subjects were enrolled in the study, as were ten controls (C). The mean age was 57.2 years and all subjects were female. Whole unstimulated saliva (WUS) was collected by standard techniques for 5 min, after which the volume and flow rate were determined (mean WUS: SS = 0.047 vs C = 0.480 ml/min). Samples were centrifuged and the immunoglobulin analysis performed on the supernatants by immunoreactivity in a double-sandwich technique as previously described by Rudney et al. Cytokine analysis was performed similarly utilizing commercially available kits from R&D Systems. The results as analyzed by pairwise t-tests revealed comparable levels of s-IgA in the saliva of the SS patients, as compared to controls at baseline (means +/- SEM: SS-IgA = 348.1 +/- 82.0 vs C-IgA = 284.0 +/- 65.1 micrograms/ml; NS). Whole salivary flow was significantly increased (328%) in the SS subject group 60 min after the administration of 5 mg pilocarpine hydrochloride (means +/- SEM: 0.0472 +/- 0.017 vs 0.1546 +/- 0.054 ml/min; P < 0.01). There was no significant change in the concentration of s-IgA in the SS subject group following the pilocarpine dose (means +/- SEM: SS-IgA = 439.9 +/- 121.2 microliters/ml; P = NS). There were elevated levels of IL-2 in the saliva of four out of the ten and IL-6 in two out of the ten SS patients, as compared to controls (means +/- SEM: SS-IL-2 = 127.8 +/- 11.4 vs C-IL-2 = 30.8 +/- 1.6 pg/ml and SS-IL-6 = 41.4 +/- 7.1 vs C-11.6 +/- 2.8 pg/ml). There was also a significant decrease in the concentration of IL-2 in the same four out of ten SS subjects following the pilocarpine dose (means +/- SEM: SS-IL-2 = 32.4 +/- 10.3; P < 0.01). These preliminary results indicate that s-IgA levels do not change with increased salivary flow following the administration of pilocarpine hydrochloride in patients with Sjögren's syndrome. While cytokines are elevated in the whole saliva of some SS patients, a decrease in IL-2 concentration may occur with increased salivary flow.

A prospective study was conducted on 65 patients who had a cataract operation. One eye had intracapsular cataract extraction (ICCE) with a Choyce-IX anterior chamber lens (ACL) and the fellow eye extracapsular cataract extraction (ECCE) with a posterior chamber lens (PCL). To evaluate the cystoid macular edema (CME), a fluorescence angiogram was recorded on the day of discharge and after 6 months. The severity of the CME was classified in three stages (degrees I-III). At discharge, no eye had CME grade III. CME grade I or grade II was seen in the ICCE group in 23% and in the ECCE group in 7.6%. After 6 months one eye of each group showed CME grade III (1.5%). CME grades I and II were seen after ICCE in 13.8% and 7.8% while the eyes with ECCE presented CME in 6.1% of grade I and of grade II, respectively. Visual acuity (VA) in the eyes with grades I and II CME was the same as in eyes without CME. The VA (median) of the ICCE group was 0.8 and of the ECCE 0.7. Because of infection of the capsular bag (toxic lens syndrome), in one case the PCL together with the capsular bag had to be explanted after 7 months. As for visual acuity and clinically significant CME (grade III), there was no statistical difference between ICCE plus Choyce-IX ACL eyes versus ECCE plus PCL eyes in the same patient.