1/12. Surgical excision of iris nodules in the management of sarcoid uveitis.PURPOSE: To illustrate the role of surgical removal of iris nodules (granulomas) in the management of sarcoid uveitis. STUDY DESIGN: Two interventional case reports. methods: The authors describe the clinical course of two 10-year-old males with long-standing granulomatous uveitis refractory to medical antiinflammatory and immunomodulatory therapy. Both patients were seen with iris masses, which were excised and biopsied, with findings of sarcoidosis. MAIN OUTCOME MEASURES: Control of ocular inflammation as evidenced by decrease in inflammatory cells in both anterior and posterior chambers. RESULTS: On excision of the iris masses, the ocular inflammation was controlled in both patients. CONCLUSIONS: The authors hypothesize that iris granulomas may not only be products of persistent antigenic stimulation characteristic of sarcoidosis but subsequently become foci of continued cytokine production and ocular inflammation. Total surgical removal of the iris masses may help in the diagnosis and control of sarcoid uveitis refractory to medical management.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/12. A case of adult-onset tubulointerstitial nephritis and uveitis ("TINU syndrome") associated with sacroileitis and Epstein-Barr virus infection with good spontaneous outcome.The authors report a case of tubulointerstitial nephritis and uveitis (TINU syndrome) in a 48-year-old woman. The patient's ocular symptoms (relapsing bilateral uveitis) began 4 months before the renal disease was diagnosed and were treated successfully with local steroid therapy. The main baseline laboratory findings were anemia, a rapid sedimentation rate, and a decreased renal function. urinalysis results showed mild proteinuria and some hyaline and hyaline-granular casts. Immunoglobulin (Ig) G and IgM antibodies to Epstein-Barr virus (EBV) were present. The renal biopsy showed interstitial lymphocytes and infiltration by rare plasma cells, tubular atrophy without granulomas, and slight expansion of the mesangium; electronic microscopy showed rare electron-dense deposits in the mesangium; no vascular alterations were seen, and immunofluorescent staining was uniformly negative. X-ray of the pelvis showed bilateral sacroileitis, which has been previously described in only 1 case of TINU syndrome; human leukocyte antigen B27 was negative. After 6 months without any therapy, all laboratory findings were normal; after 30 months, renal function was still normal, uveitis had not relapsed, but sacroiliac involvement was still present; EBV-viral capsid antigen (VCA) IgM were still high (28 UA/mL), and the EBV IgG titers were increased (VCA>170, EBV-nuclear antigen 108 UA/mL). This case confirms that this rare entity, originally observed in children, may occur and have a favorable spontaneous renal outcome also in the adult; EBV may play a role, as previously suggested. This is, to the authors' knowledge, the first reported case of TINU syndrome with the association of a well-documented bilateral sacroileitis.- - - - - - - - - - ranking = 3keywords = antigen (Clic here for more details about this article) |
3/12. Macular hole closure after peribulbar steroid injection.PURPOSE: To report the closure of a macular hole after a peribulbar corticosteroid injection in a patient with anterior uveitis associated with human leukocyte antigen B*27. DESIGN: Interventional case report.The patient was evaluated by comprehensive ophthalmic check-up and optical coherence tomography. RESULTS: A healthy 50-year-old woman presented to our service with active human leukocyte antigen B*27-associated anterior uveitis, macular hole in the right eye and macular edema in the left eye. visual acuity was 20/200 in both eyes. Peribulbar injections of triamcinolone acetonide were administered in both eyes. Three months later, visual acuity improved to 20/50 in both eyes, and the uveitis was in complete remission. Optical coherence tomography verified that the macular hole in the right eye was closed. CONCLUSIONS: inflammation and macular edema might be contributing factors in macular hole formation in patients with uveitis. This case indicates that treatment of inflammation and macular edema might lead to macular hole closure in similar cases.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
4/12. choroiditis, pigment epithelial detachment, and cystoid macular edema as complications of poststreptococcal syndrome.PURPOSE: Two cases of poststreptococcal uveitis are presented. One patient developed nongranulomatous anterior uveitis (case 1). A second patient developed nongranulomatous anterior uveitis followed by granulomatous uveitis with concurrent choroiditis, retinal pigment epithelial detachment, and cystoid macular edema (case 2). Current concepts regarding the pathogenesis of poststreptococcal syndrome and its ocular sequelae are also discussed. case reports: Case 1: A 31-year-old female patient presented with bilateral nongranulomatous uveitis after a recent onset of sore throat. A past diagnosis of rheumatic fever was revealed during acquisition of the patient's history. blood chemistry analysis indicated elevated anti-streptolysin O antibody titers as the only significant elevated result. Case 2: A 33-year-old female presented initially with bilateral nongranulomatous uveitis. A history of recurrent sore throat was reported. blood chemistry analysis revealed elevated anti-streptolysin O antibody titers only. "Mutton fat" keratic precipitates eventually developed; however, the bilateral uveitis resolved after topical cycloplegic and corticosteroid treatment. An anterior granulomatous uveitis with concurrent choroiditis, retinal pigment epithelial detachment, and cystoid macular edema ensued during a recurrent episode. blood chemistry analysis was unremarkable at that time. CONCLUSIONS.: Anterior nongranulomatous/granulomatous and posterior uveitis should be considered clinical manifestations of poststreptococcal syndrome in patients with a clinical history and/or serological evidence indicating possible past streptococcal infection. A variation of host-genetic-predisposed immune response, the patient's human leukocyte antigen haplotype, pathogen virulence, and/or deposition location of immune circulating complexes may give rise to the diverse spectrum of clinical ocular sequelae in poststreptococcal syndrome. Poststreptococcal uveitis may comprise a similar immunologic pathogenesis to that of acute rheumatic fever, acute glomerulonephritis, and other autoimmune diseases.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
5/12. Anterior uveitis in children. An analysis of 75 cases with special reference to retinal anti-S antibodies.In this prospective study of childhood uveitis, 75 children with anterior uveitis were analyzed to determine whether a relationship could be found between the occurrence of uveitis, its clinical features, and humoral immunity to retinal S-antigen. For the purposes of analysis, children were divided into acute (18 cases) and chronic (57 cases) categories, depending on the duration of ocular inflammation. Clinical features of both of these groups were compared and significant differences were found in the occurrence of unilateral vs bilateral involvement, the incidence of complications, and visual outcome. serum samples from children with acute (7 cases) and chronic uveitis (28 cases) and from healthy children (132 cases) were tested for antibodies to S-antigen by enzyme-linked immunosorbent assay (ELISA). A statistically significant difference in the level of specific antibodies between patients with chronic uveitis and controls was found. However, there was no difference between children with acute uveitis and healthy patients, nor was there any correlation between the severity of uveitis and antibody titer. For further elucidation of the significance of circulating anti-S antibodies, 14 children with chronic anterior uveitis were followed for as long as 18 months after the initial visit. Multiple serum antibody titers to bovine retinal S-antigen were determined and compared with the clinical activity at the time of each sampling. In only 6 of 14 patients did the titers to S-antigen tend to decrease with clinical improvement and stabilize at titers somewhat higher than normal values.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 4keywords = antigen (Clic here for more details about this article) |
6/12. Clinical and immunopathological studies of pars planitis in a family.We examined a family in which two brothers with identical HLA typing have pars planitis with snowbanking. Immunopathological studies of one of their eyes showed that in the area of snowbanking over the pars plana there was mild to moderate inflammatory cell infiltration, consisting of mostly Pan T (Leu 4 ) lymphocytes. The ratio of T helper/inducer to T suppressor/cytotoxic cells was approximately 10:1. Few macrophages (OKM1 ) were identified. Very few B cells and no NK cells were observed. Some retinal vessels had a perivascular infiltration consisting of mostly T lymphocytes. Most of the inflammatory cells bore class II antigens (HLA-DR ), while T cells bore few IL-2 receptors (anti-TAC ). The snowbank consisted mainly of glial elements (GFAP ) and basement membrane components (type IV collagen and laminin) with the predominant cell the Muller cell (Mu ). A site of inflammation at the iris-ciliary body junction also stained for B cells (Leu 14 ). These findings suggest that the snowbank could be formed by the glial elements of the peripheral retina. The chronic inflammation in pars planitis appears to consist of helper T cells, both in the pars plana, and the retinal vasculature.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/12. Presumed chronic ocular histoplasmosis syndrome: a clinical-pathologic case report.An eye of a patient with clinically typical presumed ocular histoplasmosis was studied by light microscopy, electron microscopy and immuno-fluorescence techniques. There was clinical and pathological evidence of anterior segment involvement. The posterior segment showed granulomatous and nongranulomatous chorioretinal lesions with and without subretinal neovascularization. Immunohistopathological staining for histoplasma antigens revealed positive staining at sites of lymphoid inflammation. Organisms were not identified.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/12. psoriasis associated with anterior uveitis.A patient with psoriasis and anterior uveitis is described. In her family the two entities of iridocyclitis and psoriasis occurred separately in two generations and appeared associated in the third generation. Tissue typing of the family revealed HL-A 27 antigen in two members and HL-A 17 in the other two members. The possible relevance of HL-A antigens to the two clinical entities is discussed.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
9/12. Metastatic adenocarcinoma to the anterior uvea and increased carcinoembryonic antigen levels.A 47-year old man developed chronic unilateral iridocyclitis with secondary glaucoma, and increased plasma carcinoembryonic antigen levels. The eye was enucleated seven months later, and histopathologic examination revealed a metastatic mucin-producing carcinoembryonic antigen-positive adenocarcinoma. The patient died one year after the initial onset of symptoms. The primary site of the tumor was not proven, but most likely was the gastrointestinal tract.- - - - - - - - - - ranking = 6keywords = antigen (Clic here for more details about this article) |
10/12. mycobacterium fortuitum infection: evidence of bactericidal defect due to hyperactive antigen-specific suppressor cells. Correction in vitro and in vivo by cholinergic agonist and indomethacin.Immunologic studies in a patient with long-standing mycobacterium fortuitum infection revealed normal numbers of T cells, T inducers, T suppressors, B cells, and monocytes, significant in vitro proliferative response to M. fortuitum antigen, and poor bactericidal activity against M. fortuitum but not against Escherhicia coli. M. fortuitum antigen-activated suppressor cells contributed to the bactericidal defect. The activity of these suppressor cells could be eliminated by the in vitro treatment of blood mononuclear cells with a combination of a cholinergic agonist and indomethacin, but not with either alone. Administration of the two drugs to the patient resulted in reversal of the bactericidal defect and dramatic clinical improvement. Systemic atypical (nontuberculous) mycobacterial infection may activate specific suppressor cells that could compromise the host's phagocytic cell function. Modulation of those suppressor cells by a combination of a cholinergic agonist and prostaglandin synthetase inhibitor could reverse this abnormality and may be beneficial to the patient.- - - - - - - - - - ranking = 6keywords = antigen (Clic here for more details about this article) |
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