High incidence of asymptomatic urogenital infection in patients with uveitis anterior

Acute anterior uveitis (AAU) may be associated with systemic infectious or inflammatory disease. We examined 92 patients with the first attack of acute anterior uveitis; all patients were free of any extraocular symptoms. A thorough clinical examination did not reveal any systemic underlying disease. In the course of microbiological examination, however, a high incidence of asymptomatic infection of the urethra and/or cervix with ureaplasma urealyticum, chlamydia trachomatis and mycoplasma hominis was found. Infections with ureaplasma were significantly more frequent in patients with AAU when compared with a sex- and age-matched control group. There was no statistically valid association of these infections with the HLA-B27 phenotype in the patients. The higher rate of urogenital infections in patients with AAU may reflect a higher rate of sexual promiscuity. Transmission of infectious agents seems to be one possible factor in the pathogenesis of AAU.Abbreviation AAU acute anterior uveitis     

葡萄膜炎患者血清中SIL—2R的测定及意义

目的:探讨葡萄膜炎与可溶性白细胞介素2受体(SIL-2R)的关系。方法:用双抗体夹心ELISA法检测64例活动期葡萄膜炎患者血清中SIL-2R水平,并以61例健康人作为对照组。结果:活动期葡萄膜炎患者血清中SIL-2R水平明显高于健康人。活动期的前葡萄膜炎、中间葡萄膜炎、Behcet病及Vogt-Koyanagi-Harada综合征患者血清中SIL-2R水平无显著性差异。缓解期葡萄膜炎患者血清中SIL-2R水平明显低于活动期。结论:血清中SIL-2R水平与葡萄膜炎病情密切相关。眼科学报1998;14:64—65。     

Acute tubulointerstitial nephritis with uveitis syndrome presenting as multiple tubular dysfunction including Fanconi's syndrome

We describe an 11-year-old male patient with acute tubulointerstitial nephritis with uveitis (TINU) syndrome. He presented with easy fatigability, pallor, nocturia and weight loss. laboratory examination disclosed anaemia, polyclonal hypergammaglobulinaemia, low molecular weight proteinuria, glycosuria, aminoaciduria, proximal and distal renal tubular acidosis, a urine concentration defect and decreased creatinine clearance. The multiple renal tubular dysfunction and slight glomerular dysfunction subsided spontaneously. Bilateral anterior uveitis was manifested 7 months after the onset of the disease. This is the first reported case of TINU syndrome with multiple proximal and distal tubular dysfunction including a complete type of Fanconi's syndrome.     

Retinal pigment epithelial correlates of avian retinal degeneration: electron microscopic analysis

The delayed amelanotic (DAM) strain of domestic chicken is characterized by an early, developmental onset of choroidal inflammation and destruction of both feather and choroidal melanocytes. Secondarily, retinal pigment epithelial (RPE) cells in the peripapillary region develop abnormalities, and a series of progressive histopathological changes ensues which includes reduction and ultimate loss of RPE-melanin granules and RPE-cell atrophy. The earliest sign of RPE-cell abnormality is a dramatic alteration in the distribution of intracellular melanin granules. Apical processes also show a lessening of contact with photoreceptor outer segments, leading in more advanced stages to their retraction and development of retinal detachments. Other progressive alterations in RPE cells include disorganization and loss of basal infoldings; size reductions and density increases in both mitochondria and myeloid bodies from early to advanced stages; appearance of large macrophages in the subretinal space; Loss of intercellular junctional complexes; and progressive reduction in the density of melanin granules. These abnormalities appear to spread in a cell-by-cell, radial pattern, until widespread areas of the retina become severely pathologic and atrophic. The DAM chorioretinal disorder appears to show many of the histopathologic features which characterize experimentally induced uveitis and other ocular diseases which may result from hypersensitivity to, or autoimmune reaction against, pigments of the uveal tract.     

Aqueous humor analysis as a diagnostic tool in toxoplasma uveitis

Analysis of local toxoplasma antibody production to confirm a suspected clinical diagnosis of toxoplasma chorioretinitis is a valuable diagnostic tool. Determination of toxoplasma antibodies in the blood of the patient is of limited use. When blood toxoplasma tests are negative this indicates that toxoplasma as a causative organism in the pathogenesis of uveitis is unlikely.A positive blood test is a sensitive test (100% patients positive) but not a specific test since so many healthy individuals already have undergone subclinical infection and have acquired humoral immunity against the parasite.We analysed 93 paired aqueous and serum samples for toxoplasma antibodies and total IgG and determined the Goldmann-Wittmer coefficient. In patients retrospectively diagnosed as having toxoplasma chorioretinitis 16 out of 22 had a positive coefficient, indicating local parasite antibody production. In one patient with AIDS we also found a positive toxoplasma coefficient. Three out of 15 patients with posterior uveitis of unknown origin also had a positive coefficient. None of the cataract patients tested (n=32) had a positive coefficient. Major drawbacks of aqueous humor analysis are that a false negative antibody coefficient can occur when a massive blood aqueous barrier breakdown has occurred.     

Electroretinography and electro-oculography to localize abnormalities in early-stage inflammatory eye disease

Electrophysiological investigations were performed in patients with inflammatory eye disease characterized by the presence of vitreous cells. The eyes were classified into four categories on the basis of fluorescein angiography: 1) no fluorescein leakage from retinal vessels, 2) fluorescein leakage from peripheral retinal vessels, 3) fluorescein leakage from the disc or macular vessels, and 4) fluorescein leakage from retinal vessels associated with pigment epithelial and choroidal changes. The electro-oculogram light rise was abnormally increased in the eyes in category 1, but it progressively declined for those in the other categories. The ratio of the b-wave (postreceptoral component) and a-wave (receptoral component) of the flash electroretinogram was unchanged in all categories, but the electroretinographic amplitudes progressively declined from a somewhat supernormal level in category 1 to subnormal in the other categories. Thus, in inflammatory eye disease, changes in the electrical potentials arising in the pigment epithelium and photoreceptors are the earliest detectable signs. Some biochemical changes in the choroid, pigment epithelium, and the photoreceptors appear to take place before any pathological changes in these structures or in the retinal vessels are detectable by ophthalmoscopy or fluorescein angiography.     

Management of Acanthamoeba keratitis. A case report and review of the literature

A recalcitrant corneal ulcer resulted in an extensive corneal opacity requiring penetrating keratoplasty. Histopathologic studies and subsequent cultures established the diagnosis of Acanthamoeba keratitis. A second transplant was performed due to a culture-proven recurrence of the keratitis in both the recipient and the graft, with progressive thinning. This has remained clear for six months on systemic ketoconazole and topical miconazole drops. This case demonstrates the difficulty in initial diagnosis of Acanthamoeba keratitis and the apparent successful medical control of the infection despite transplantation into an infected recipient bed.     

Serum Antibody Responses to Bovine Retinal S-Antigen and Rod Outer Segments in Proliferative Diabetic Retinopathy before and after Argon Laser Photocoagulation

Using the enzyme-linked immunosorbent assay, the serum antibody titers to bovine retinal S-antigen and rod outer segments in preand post-argon laser treated diabetic retinopathy patients were compared to each other and to the titers of age- and sex-matched normal controls. The increase in anti-S titer following the initial laser treatment gave a P < 0.01 using the two-tailed paired Student’s t-analysis as compared to the prelaser anti-S titer. Both pre- and post-laser anti-S titers were elevated over normal controls with P values of <0.02 and <0.001, respectively. Eight weeks after the initial laser treatment, anti-S titers began to decline approaching control levels 12 weeks later. No significant change was found between pre- and post-laser titers when rod outer segments were used as antigen although the pre- and postlaser titers were increased over normal controls with P values of <0.05 and <0.001, respectively. The release and possible alteration of retinal components following photocoagulation may account for the rise in anti-S titers, while the prephotocoagulation titers may be due to retinopathy-related photoreceptor cell alteration.     

Acute anterior uveitis and conjunctivitis following yersinia infection in children

We studied characteristics of ocular inflammation associated with yersinia infection in six children, three boys and three girls, ranging in age between 4 and 14 years. Four patients developed acute anterior uveitis with aqueous flare and cells, small keratic precipitates, cells in the vitreous, and occasionally with fibrinous exudates, posterior synechiae and macular edema. The uveitis was unilateral in two patients and bilateral in two. In three 10- to 14-year-old patients the uveitis resolved during corticosteroid treatment in 3 to 8 (mean 6) weeks. In a 4-year-old girl with positive antinuclear antibody titers bilateral uveitis lasted for 17 weeks. Two uveitis patients had recurrent episodes. Two patients had mucopurulent bilateral mild conjunctivitis which resolved in 3 to 5 days. All patients had symptoms of reactive arthritis and one had sacroiliitis. All tested patients were HLA-B27 positive. Our results indicate that in HLA-B27 positive children, especially after the age of 10 years, yersinia infection may occasionally trigger reactive iritis or conjunctivitis which often occur together with other HLA-B27 associated rheumatic diseases.Department of Ophthalmology, University of Tampere, PO Box 607, SF-33101 Tampere, Finland     

Immunology of chorioretinal disorders

Because of its uniqueness, the eye has long been a favored site for immunological study. It is a highly active tissue immunologically, with virtually all types of immune reactions present. This article reviews the ocular immune response, chorioretinal diseases with immunologic features, and immunology of ocular tumors. Immunologic data is discussed as it relates to the pathogenesis, clinical features, and therapy of chorioretinal disease.