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[Rheumatic iridocyclitis in childhood--differentiation on the basis of clinical and immunological parameters (author's transl)].

In approximately 10% of the children suffering from juvenile chronic arthritis (JCA), rheumatic iridocyclitis was also diagnosed. In 90 JCA and iridocyclitis patients we studied relative risk, clinical course and prognosis by means of several clinical and immunological parameters. Antinuclear antibodies (ANA), selective IgA-deficiency, oligoarthritis type of onset of the disease and manifestation of JCA during infancy--predominantly in girls--were quite often accompanied by a pronounced susceptibility to rheumatic iridocyclitis, while seropositivity (RF-positivity) and systemic onset of juvenile chronic arthritis normally rule out rheumatic iridocyclitis. Among HLA-B27-positive boys of school age, the acute course of rheumatic iridocyclitis, which rarely results in serious and lasting complications, is more frequent; in some cases juvenile sacroiliitis or ankylosing spondylitis are evident. The evaluation of the risk factors makes it possible to systematically define subgroups likely to develop chronic iridocyclitis and less susceptible groups of patients, thus facilitating early diagnosis and treatment as well as clinical observation of the development of chronic iridocyclitis.

Adolescent↗

Antibodies to iris and retina detected in sera from patients with juvenile rheumatoid arthritis with iridocyclitis by indirect immunofluorescence studies on human eye tissue.

Sera from 12 patients with juvenile rheumatoid arthritis (JRA) with active iridocyclitis were incubated with frozen, sectioned, whole human eye tissue. Antibodies were detected using fluorescein conjugated goat F(ab')2 antibody to human IgG by immunofluorescent microscopy. Immunofluorescence was determined on tissue from the iris, retina, and 3 portions of the ciliary body. Sera of patients with JRA with iridocyclitis were compared to sera from patients with JRA with and without antinuclear antibodies (ANA) and healthy children. An increased frequency of antibody to the human iris was seen with sera of patients with JRA with iridocyclitis compared to healthy children's sera. A higher frequency of antibody was also noted to human retina in sera of patients with JRA with iridocyclitis compared to patients without ANA and healthy children. No increased frequency of antibody was detected to ciliary body. Sera of 7 patients with JRA with iridocyclitis were also compared during a time of inactive eye disease to a time of active disease. No difference in binding to eye tissue was detected at times of inactive disease compared to controls. Our results demonstrate the presence of antibody to iris and retina by immunofluorescence in the sera of patients with JRA with iridocyclitis.

Antibodies, Antinuclear↗

Human leukocyte antigen-DRB1*1104 in the chronic iridocyclitis of pauciarticular juvenile rheumatoid arthritis.

To determine whether genetic markers for chronic iridocyclitis could be identified, we used both serologic and oligonucleotide dot blot techniques to characterize immunogenetically 164 children with early-onset pauciarticular juvenile rheumatoid arthritis. Seventy-eight children (47.6%) had chronic iridocyclitis and 86 (52.4%) had not had evidence of eye disease during a mean follow-up period after the onset of arthritis of 15.8 years (minimum of 5.5 years). Control subjects were 218 healthy, unrelated individuals. The analysis was limited to alleles known to be associated with an increased or decreased risk of early-onset pauciarticular juvenile rheumatoid arthritis or of chronic iridocyclitis in this form of juvenile rheumatoid arthritis. Only one split of human leukocyte antigen (HLA)-DR5, HLA-DRB1* 1104, showed a statistically significant association with a risk of chronic iridocyclitis (chi-square value = 7.52; p = 0.036 adjusted; odds ratio 3.45); HLA-DQA1* 0501 and HLA-DQB1* 0301, both in linkage disequilibrium with HLA-DRB1* 1104, also were significantly associated with eye disease. Patients with both the DRB1* 1104 and DPB1* 0201 genes had a 7.7-fold increased risk for chronic iridocyclitis compared with that for other patients. The presence of HLA-DRB1* 1104 was about four times as specific, but only about one third as sensitive, as antinuclear antibodies in identifying patients at risk for eye disease. Although all children with early-onset pauciarticular juvenile rheumatoid arthritis should undergo periodic slit-lamp examinations, those with the HLA class II gene DRB1* 1104 are at particularly high risk for eye disease, and we recommend that they be monitored carefully for its evolution.

Adult↗

Herpes zoster sine herpete. A potential cause of iridoplegic granulomatous iridocyclitis.

OBJECTIVE: Herpes zoster ophthalmicus (HZO) is a recurrence of varicella zoster virus involving cranial nerve V-1, but does not always have skin manifestations. The objective of this work is to study iridoplegic granulomatous iridocyclitis as an acute, fulminant iridocyclitis that probably is caused by the recurrence of varicella zoster virus without skin eruptions. PARTICIPANTS: The author reports 15 cases of iridoplegia granulomatous iridocyclitis with involvement of the anterior uveal tract without known skin eruptions. RESULTS: All patients have had a clinical course of iridocyclitis closely resembling those cases of herpes zoster with skin eruptions. Nine of the 15 are documented to have had a recurrence of varicella zoster virus with an appropriate rise and fall of systemic titers. The remaining six patients had clinical findings, including loss of accommodation, iridoplegia, and sectoral iris atrophy that were more typical for HZO than other infectious agents. CONCLUSIONS: Iridoplegic granulomatous iridocyclitis is a newly described, acute, fulminant uveitis probably caused by a herpes virus and most probably by varicella zoster virus. Herpes zoster sine herpete (erupticum) should be suspected as a potential diagnosis in patients with appropriate anterior segment manifestations. Further study is necessary to discern if any of such cases could be caused by herpes simplex.

Acute Disease↗

HLA antigens and antinuclear antibody titres in juvenile chronic iridocyclitis.

HLA antigen frequencies and antinuclear antibody titres were studied in 43 patients with juvenile chronic iridocyclitis. We did not detect an increased incidence of HLA-B27 in patients having chronic iridocyclitis associated with juvenile rheumatoid arthritis or in patients with "chronic iridocyclitis in young girls". Both groups of patients had a statistically significant increased incidence of antinuclear antibodies. However, these antibodies were detected more frequently in patients with chronic iridocyclitis associated with JRA than in patients with "chronic iridocyclitis in young girls".

Adolescent↗

Clinical manifestations of iridocyclitis in leprosy.

Iridocyclitis--an inflammation of the iris and ciliary body occurs in lepromatous spectrum of leprosy of long duration. It is usually bilateral, has a very chronic course with acute exacerbations which are suppressed with the help of corticosteroids and other antiinflammatory drugs--Mydriatic to keep the Pupil dilated and also an antibiotic to take care of secondary infection which may be present. It is a major cause of blindness, due to its secondary damaging effects on the various ocular tissues. Medical and Paramedical Workers attending these patients must be made aware of the chronicity of the iridocyclitis so that regular referrals for examination of the eyes including slit lamp examination could be done and the activity of the disease and its complications detected early and treated. This chronic variety of iridocyclitis often gets less medical attention because of its insidious onset and minimal clinical signs in early stages, except by slit lamp examination. 57 patients suffering from iridocyclitis attending the ophthalmic department of S.L.R. & T.C. Karigiri were followed up carefully over a period of 2 1/2 years to study the clinical manifestations of iridocyclitis, it's complications and management.

Adult↗

Doyne lecture. Heterochromic iridocyclitis.

Fuchs' heterochromic iridocyclitis is a rare but significant cause of visual impairment. This form of uveitis is misdiagnosed more than any other in the entire field of uveitis. This is particularly true among brown-eyed individuals in whom gross heterochromia may not be diagnosed for many years. The clinical presentation of Fuchs' heterochromic iridocyclitis may include a number of generally unrecognised variants among which are Koeppe nodules, transient synechia formations, and blood-filled cysts. Recently the relationship of heterochromic iridocyclitis to posterior inflammatory lesions, such as those of toxoplasmosis, has been explored. Although the disease was once thought to be a degenerative or trophic disorder, current investigations reveal that it is a true inflammation of immunologic origin. The disorder may be related to a depression of suppressor T-cell activity. The aetiology of the disease is still obscure, but in some cases an association with simple heterochromia has been found among families in whom multiple members are affected by either simple heterochromia or Fuchs' heterochromic iridocyclitis. Corticosteroid treatment of Fuchs' heterochromic iridocyclitis is not effective and should be reserved for those patients in whom inflammatory products obstruct the visual axis. Most patients should be treated by observation alone. Cataract and glaucoma are the most important complications. Treatment of the glaucoma is particularly difficult and often unsuccessful.

Adrenal Cortex Hormones↗

Herpes simplex virus DNA identification from aqueous fluid in Fuchs heterochromic iridocyclitis.

PURPOSE: To report the presence of herpes simplex virus DNA in the aqueous humor of an eye with Fuchs heterochromic iridocyclitis. METHODS: In an eye with a clinical diagnosis of Fuchs heterochromic iridocyclitis, samples of aqueous humor and anterior capsule of the lens were obtained during cataract surgery. Polymerase chain reaction was performed on the samples to detect the presence of viral DNA including herpes simplex virus, varicella-zoster virus, and cytomegalovirus. Serologic analysis was also performed for antiviral immunoglobulins. RESULTS: Herpes simplex virus DNA was identified in the aqueous humor but not in the anterior capsule. Serum immunoglobulin G was positive for herpes simplex virus, varicella-zoster virus, and cytomegalovirus. CONCLUSIONS: The presence of herpes simplex virus DNA in the aqueous humor of an eye with Fuchs heterochromic iridocyclitis suggests that herpes simplex virus infection may play a role in the pathogenesis of Fuchs heterochromic iridocyclitis.

Adult↗

Immune deposits in iris biopsy specimens from patients with Fuchs' heterochromic iridocyclitis.

To investigate whether Fuchs' heterochromic iridocyclitis may be an immune complex vasculitis, we used an immunofluorescence technique to detect immunoglobulins and complement in iris biopsy specimens from nine patients with Fuchs' heterochromic iridocyclitis, 12 patients with other types of uveitis, and nine patients with glaucoma but without uveitis. No specific immune deposits were observed in the irises of the patients with Fuchs' heterochromic iridocyclitis. Immunoglobulin G, IgA, IgM, and complement were detected in patients with Fuchs' heterochromic iridocyclitis and patients with uveitis, and these results differed significantly (P less than .05) from the group without uveitis. The immune deposits were found only in the iris vessel walls. No light-microscopic evidence of an inflammatory vascular process could be detected. Further studies are necessary to investigate whether the immune reactants originate from the circulation or result from local formation.

Adult↗

Varicella-zoster viral antigen identified in iridocyclitis patient.

BACKGROUND: The varicella-zoster virus (VZV) antigen has not been identified immunohistologically in iridocyclitis due to VZV. CASE: A 65-year-old woman diagnosed with iridocyclitis and secondary glaucoma underwent trabeculectomy. Samples of aqueous humor and juxtacanalicular and iris tissue were obtained for immunohistological and polymerase chain reaction (PCR) study. OBSERVATIONS: Slit-lamp microscopy revealed ciliary injection, corneal epithelial edema, mutton fat precipitates, flare, cells, and progressive iris atrophy in the right eye. Subsequently, scant eruptions on her right upper eyelid appeared and disappeared within a week. Although a diagnostic increase in the complement fixation antibody titer to VZV was not observed, we started medical treatment for VZV, on suspicion of iridocyclitis due to VZV. Despite medical treatment, the ratio of peripheral anterior synechia was greater than 60% and iris atrophy progressed in parallel. The intraocular pressure in the right eye remained above 30 mm Hg at 6 months after the first visit, so trabeculectomy was performed. VZV-specific DNA was detected in the aqueous humor by the PCR study. Immunohistological examination demonstrated numerous VZV antigen-positive cells in the iris stroma, in particular, vascular endothelial cells. CONCLUSION: To our knowledge, this is the first report of the detection of VZV antigen in the iris of an iridocyclitis patient.

Aged↗

Fuchs' heterochromic iridocyclitis following bilateral ocular toxoplasmosis.

PURPOSE: To describe the development of Fuchs' heterochromic iridocyclitis (FHI) following bilateral ocular toxoplasmosis in an Asian Indian female. METHODS: Case report of a patient with bilateral ocular toxoplasmosis who developed bilateral Fuchs' heterochromic iridocyclitis. RESULTS: Features characteristic of bilateral Fuchs' heterochromic iridocyclitis developed following several attacks of bilateral toxoplasmic retinochoroiditis in a 26-year-old Indian female patient. CONCLUSION: Fuchs' heterochromic iridocyclitis can develop over a period of time in patients with ocular toxoplasmosis.

Adult↗

Increase of macrophage migration inhibitory factor in sera of patients with iridocyclitis.

AIMS: To determine whether macrophage migration inhibitory factor (MIF) levels were increased in sera of the patients with iridocyclitis. METHODS: Sera were obtained from 41 patients with acute iridocyclitis, 13 patients with chronic iridocyclitis, and 44 healthy control subjects. MIF levels were determined by a human MIF ELISA. RESULTS: The average levels of MIF in the sera of patients with both acute and chronic iridocyclitis were significantly higher than that of healthy subjects. CONCLUSION: Uveitis induces the elevation of serum MIF, which may affect various inflammatory symptoms in uveitis.

Acute Disease↗

Acute iridocyclitis in a patient with AIDS diagnosed as toxoplasmosis by PCR.

PURPOSE: To study the etiology of an acute iridocyclitis in a patient with AIDS using polymerase chain reaction (PCR) analysis of aqueous humor. METHODS: Case report describing a patient diagnosed with toxoplasmic retinochoroiditis in his left eye. He stopped his treatment after three weeks and subsequently developed an acute iridocyclitis without chorioretinitis in the fellow eye. Anterior chamber paracentesis was performed and aqueous humor was assayed by PCR. RESULTS: PCR of the aqueous humor showed positivity for Toxoplasma gondii. The iridocyclitis responded to topical dexamethasone and oral treatment with pyrimethamine and sulfadiazine. CONCLUSION: PCR is an effective method to diagnose toxoplasmic iridocyclitis in a patient with AIDS.

AIDS-Related Opportunistic Infections↗