Immunology Service Research Articles

Viscocanalostomy in patients with glaucoma secondary to uveitis: Preliminary report

Purpose: To assess the efficacy of viscocanalostomy in eyes with uncontrolled glaucoma secondary to uveitis. Setting: Immunology and Uveitis Service, Department of Ophthalmology and Visual Sciences, University Hospital San Raffaele, Milan, Italy. Methods: All consecutive patients with glaucoma secondary to uveitis and inadequate intraocular pressure (IOP) control (IOP >21 mm Hg) under maximum-tolerated medical therapy had viscocanalostomy. Patients with active uveitis at the time of surgery, peripheral anterior synechias in the upper quadrant, previous ocular surgery, or sight in only 1 eye were excluded. Eleven eyes of 11 patients with a mean age of 52.2 years ± 19.9 (SD) were operated on. The etiology of the uveitis was recorded. The ocular variables were IOP, best corrected visual acuity, number of antiglaucoma medications, and complications. Success was defined as an IOP between 6 mm Hg and 21 mm Hg (inclusive) without medication (complete success), or with 1 or more antiglaucoma medications and/or goniopuncture (qualified success). The mean follow-up was 45.9 ± 11.6 months (range 23 to 56 months). Results: Viscocanalostomy significantly reduced IOP from a mean baseline value of 35.1 ± 7.0 mm Hg (range 23 to 48 mm Hg) to a mean final value of 18.1 ± 4.9 mm Hg (range 12 to 30 mm Hg) ( P<.0001). Complete success was achieved in 6 eyes (54.5%) and qualified success, in 10 eyes (90.9%). The mean number of preoperative and final antiglaucoma medications was 3.4 ± 0.8 (range 2 to 4) and 0.7 ± 1.2 (range 0 to 3), respectively ( P = .0004). Complications were minor and included transient hyphema and postoperative IOP spike. Conclusion: This preliminary study suggests that viscocanalostomy is a safe, effective surgical alternative for treating glaucoma in patients with uveitis.

Long-term progression, prognosis, and treatment of patients with recurrent ocular manifestations of Reiter's syndrome

Purpose To investigate the spectrum of ocular involvement, to examine the clinical outcome, and to analyze the influence of treatment in patients with chronic ocular manifestations of Reiter's syndrome (RS) referred to a tertiary care ocular immunology service. Design Retrospective, noncomparative, interventional case series. Participants Twenty-five patients with RS evaluated at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary from 1981 through 2001. Methods Charts of patients were reviewed and data on age, gender, follow-up time, ocular symptoms, extraocular involvement, ocular complications, therapy, and visual acuities were recorded. Main outcome measures Visual acuity, ocular complications, disease progression, clinical outcome, and systemic treatment. Results Twenty-five patients (20 male and 5 female) diagnosed with RS, with a mean age at presentation to our service of 37 years, were studied. The mean follow-up was 48.5 months. Eighty-five percent of patients tested were positive for human leukocyte antigen B27. Sixty-four percent of patients had a positive family history. All patients had oligoarthritis and enthesitis, most commonly affecting the back (56%), Achilles tendon (52%), and sacroiliac joint (24%). Eighty percent had a history of infection, most frequently urethritis (68%). Forty-four percent had a history of mucocutaneous lesions. All patients demonstrated ocular involvement at the time of diagnosis (68% with unilateral and 32% with bilateral disease), 84% had evidence of uveitis, 3% had scleritis, 2% had conjunctivitis, and 1% had pars planitis and iridocyclitis. During follow-up, the ocular complications included conjunctivitis (96%), anterior uveitis (92%), posterior uveitis (64%), keratitis (64%), cataract (56%), intermediate uveitis (40%), scleritis (28%), cystoid macular edema (28%), papillitis (16%), and glaucoma (16%). Systemic treatment for ocular inflammation was initiated in all patients. Ninety-six percent were treated with nonsteroidal anti-inflammatory agents. Eighty-eight percent were treated with corticosteroids, 64% requiring systemic prednisone. Immunosuppressive therapy was initiated in 52% of patients, with all receiving methotrexate. Seven patients required more than one immunosuppressive agent. The mean initial visual acuity was 20/25 in the right eye and 20/30 in the left eye. The mean final visual acuity was 20/25 in the right eye and 20/25 in the left eye. Conclusions Reiter's syndrome may be associated with chronic recurrent ocular inflammation. Systemic therapy (including immunosuppressive treatment) typically is required to control the ocular inflammation and to prevent progressive visual loss.

Mycophenolate mofetil as an immunomodulatory agent in the treatment of chronic ocular inflammatory disorders

Purpose To evaluate the outcomes of patients with chronic ocular inflammatory disease treated with mycophenolate mofetil as an immunosuppressive and steroid-sparing agent. Design Retrospective noncomparative interventional case series. Participants All patients with ocular inflammatory disease treated with mycophenolate mofetil at a single institution between 1998 and 2001. Methods Charts of patients seen on the Ocular Immunology and Uveitis Service at the Massachusetts Eye and Ear Infirmary were reviewed. Patients with chronic ocular inflammatory disease were included in the study. Main outcome measures Control of inflammation, steroid-sparing effect, visual acuity, and adverse reactions were measured. Results A total of 54 patients were evaluated. Control of ocular inflammation with mycophenolate mofetil as monotherapy was achieved in 35 patients (65%) and in 67 eyes (62%), and a steroid-sparing effect was achieved in 29 (54%) patients. Visual acuity was maintained or improved in 51 patients (94%) and in 97 eyes (90%). Side effects requiring discontinuation of medication occurred in 10 patients (18%). There was neither long-term morbidity nor mortality due to mycophenolate mofetil. Conclusions Mycophenolate mofetil is effective in the treatment of patients with steroid-dependent or -resistant chronic ocular inflammatory disorders that fail to respond to conventional steroid treatment. It is a safe and effective steroid-sparing immunomodulatory agent and can be considered an important addition to our armamentarium in the care of patients with ocular inflammatory disease.

Multifocal choroiditis and panuveitis: Immunomodulatory therapy

Purpose To report our analysis of the efficacy of immunomodulatory therapy on the course of 19 patients with multifocal choroiditis and panuveitis (MCP). Design Retrospective, noncomparative, interventional case series. Participants Nineteen patients with multifocal choroiditis with panuveitis evaluated on the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary from 1978 to 2000. Methods Fifteen patients were treated with systemic immunomodulatory therapy; 4 patients (who refused therapy) were treated with systemic steroids. All patients were analyzed for control of inflammation, visual acuity outcome, and tolerance of immunomodulatory therapy. Main outcome measures Control of inflammation and visual acuity. Results Nineteen patients with bilateral MCP with a mean follow-up of 72.7 months were studied. Fifteen were treated with immunomodulatory agents, whereas 4 patients received only systemic steroids; these 4 developed serious systemic steroid-related complications, and 12 others had cataract and/or glaucoma related to chronic topical, regional, or systemic steroid use before immunomodulatory therapy. Two patients who refused immunomodulatory therapy lost considerable vision in three of their four eyes. Of the 15 patients treated with immunomodulatory drugs, 7 patients lost considerable vision in one eye on steroid therapy but maintained good vision in the other eye once immunomodulatory therapy was instituted. No patient lost vision in any eye once he or she was treated with immunomodulatory treatment. Conclusions Immunomodulatory therapy controls inflammation and preserves vision in patients with multifocal choroiditis and panuveitis.

Intraocular lens tolerance in surgery for cataracta complicata: Assessment of four implant materials

Purpose. To evaluate various available intraocular lenses (IOL) (PMMA, acrylic, heparin coated PMMA, and silicone) in patients with cataracta complicata and evaluate IOL tolerance, post-operative inflammation, cystoid macular edema, and posterior capsular opacification(PCO) requiring Nd:YAG capsulotomy. Design. randomized, double masked clinical trial. Participants. Patients evaluated in the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary and deemed to need cataract surgery by standard criteria were asked to participate in the clinical trial. Patients had to have a diagnosis of chronic uveitis, which was inactive for 3 months prior to cataract surgery. Results. Acrylic lenses appeared to provide the best overall results when evaluated for post-operative inflammation, PCO rates, visual acuity, and cystoid macular edema (CME) (compared to PMMA, silicone, and heparin coated PMMA).

Intraocular lens tolerance in surgery for cataracta complicata: Assessment of four implant materials

Purpose. To evaluate various available intraocular lenses (IOL) (PMMA, acrylic, heparin coated PMMA, and silicone) in patients with cataracta complicata and evaluate IOL tolerance, post-operative inflammation, cystoid macular edema, and posterior capsular opacification(PCO) requiring Nd:YAG capsulotomy. Design. randomized, double masked clinical trial. Participants. Patients evaluated in the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary and deemed to need cataract surgery by standard criteria were asked to participate in the clinical trial. Patients had to have a diagnosis of chronic uveitis, which was inactive for 3 months prior to cataract surgery. Results. Acrylic lenses appeared to provide the best overall results when evaluated for post-operative inflammation, PCO rates, visual acuity, and cystoid macular edema (CME) (compared to PMMA, silicone, and heparin coated PMMA).

Anaphylaxis to muscle relaxants in Northern Ireland

*Department of Clinical Anaesthesia, and The Regional Immunology Service, The Royal Group of Hospitals, Belfast, Northern Ireland

Wegener’s granulomatosis: the relationship between ocular and systemic disease. Harper SL, Letko E, Samson CM, Zafirakis P, Sangwan V, Nguyen Q, Uy H, Baltatzis S, Foster CS. J Rheumatol 2001;28:1025–1032.

Wegener’s granulomatosis (WG) is an etiologically obscure entity with multiple systemic manifestations. Ocular involvement is present in up to 58% of patients with WG. These authors describe a series of patients with ocular manifestations of WG to evaluate the presence of ocular lesions in the setting of systemic WG and to determine the value of ocular inflammation in the diagnosis of WG. A computerized database was used to generate a list of patients cared for in the Ocular Immunology Service of the Massachusetts Eye and Ear Infirmary during the 10-year period 1988–1998 with a diagnosis of WG. A detailed chart review was undertaken to determine demographic characteristics, history, initial manifestation of WG, initial ocular presentation, biopsy results, laboratory testing results, treatment, total follow-up period, and final outcome. Forty-seven patients found to have WG were identified. Twenty-eight were women (59.6%), and 19 were men (40.4%). The average age was 53 years (range, 18–90). Patients were divided into four groups. Group I included 27 patients (57.4%) who had systemic disease first and subsequently developed an ocular lesion. Group II included three patients (6.3%) who had ocular inflammation first and then subsequently developed systemic manifestations of WG. Group III included three patients (6.3%) who presented because of ocular symptoms but on initial evaluation were found to have occult systemic manifestations consistent with WG or biopsy evidence of WG. Group IV included 14 patients (30%) with ocular lesions and no history or presence of systemic disease at their last follow-up visit. The authors conclude that ocular inflammation can occur with or without obvious systemic manifestations of WG. It may represent the first sign of WG and may enable the knowledgeable physician to diagnose this potentially lethal disease.—Thomas J. Liesegang

DiGeorge anomaly: A comparative study of the clinical and immunologic characteristics of patients positive and negative by fluorescence in situ hybridization

Background: DiGeorge anomaly (DGA) is defined as a field defect characterized by dysmorphic facies, hypoparathyroidism, congenital heart defects, and a deficiency in cell-mediated immunity, usually associated with a microdeletion in chromosome 22q11.2. Data correlating clinical and genetic information, especially in terms of the extent of the immunodeficiency and infectious complications, are scant. Objective: The goal of this study was to define the severity of the immunodeficiency and infectious illnesses in DGA patients with characteristic clinical and genetic findings and compare them with a similar group of patients without a microdeletion in chromosome 22q11.2. Methods: A retrospective chart review of patients referred for evaluation of DGA to our immunology service from 1989 to 1995 was conducted. Clinical and immunologic data were collected from their initial evaluation. Patients meeting at least 3 of 4 of these criteria were considered to meet strict clinical diagnostic criteria for DGA, and the results of analysis for a microdeletion in chromosome 22q11.2 for each patient was noted. Results: Sixteen of the 22 patients meeting strict clinical criteria for DGA were available for analysis for the microdeletion at chromosome 22q.11.2. Of these, 13 (81%) were positive by fluorescence in situ hybridization (FISH); 9 of 13 (69%) had low CD3 numbers, 6 of 10 assayed (60%) had low thymulin levels; 10 of 13 (77%) had low CD4 numbers, and 10 of 12 (83%) had absent or small thymus glands. B cells were increased in 9 of 13 (69%) patients. Mitogen and antigen responses were normal in 6 of 7 (86%) patients tested. Eight of 13 (62%) had a history of increased frequency of infectious illnesses. All had recurrent respiratory infections, including sinusitis, otitis media, and pneumonia. Three of the 16 patients tested (19%) were FISH negative. Two of 3 (67%) had low CD3 and CD4 numbers. B cells were elevated in all patients. All had recurrent respiratory infections, low thymulin levels, and absent thymus glands. Conclusions: Contrary to traditional descriptions, this group of clinically and genetically defined patients with DGA had a predominantly mild cell-mediated immunodeficiency syndrome usually associated with infections characteristic of humoral immunodeficiencies. The patients who were FISH positive did not differ significantly from those that were FISH negative in terms of clinical and immunologic findings or infectious complications. (J Allergy Clin Immunol 2000;105:983-7.)

Evaluation of assays of serum IgG subclasses and IgG antigen-specific antibodies in the investigation of recurrent infection.

Patients who have recurrent infections require laboratory investigation for possible underlying immunodeficiency. We retrospectively evaluated the usefulness of two relevant assays (serum IgG subclass concentration and levels of IgG antigen-specific antibodies to a panel of relevant carbohydrate and protein antigens) in the management of patients referred to a regional clinical immunology service over a 3-year period. Of 97 patients for whom both assays were performed, five (5.2%) had a low result for IgG subclasses but this did not influence the management of any patient; 51 patients (53%) had a low result for antigen-specific antibodies and this influenced management in 43 cases. We conclude that knowledge of the serum IgG subclass concentrations is of dubious relevance and this calls into question whether the assay should continue to be offered. This regional service has ceased to perform the assay routinely in such patients. Our findings require confirmation by a larger multicentre study that should assess the clinical outcome of any changes in practice.

Secondary Glaucoma in Patients with Uveitis

Purpose: To evaluate the prevalence of secondary glaucoma (SG), clinical forms of uveitis more frequently associated with glaucoma, and describe the treatment and complications encountered in a cohort of patients with glaucoma and uveitis during a 10-year period. Methods: The hospital records of patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary for a decade were reviewed for cases of SG. Results: One hundred and twenty of the 1,254 patients (9.6%) with uveitis developed SG. SG was more frequent in anterior uveitis (67%) but was also associated with posterior uveitis (13%) and pars planitis (4%). Herpetic keratouveitis (22%), Fuchs’ iridocyclitis (19%), juvenile rheumatoid arthritis-associated iridocyclitis (16%), syphilis (14%), and sarcoidosis (12%) were the leading types of uveitis associated with SG. Despite aggressive medical and surgical therapy, SG was associated with progressive visual field loss and optic nerve damage in 39 patients (33%). Conclusion: SG is an underappreciated, vision-threatening complication in patients with uveitis. Increased vigilance for emergence of this complicating problem during the care of patients with uveitis is warranted, and medical and surgical treatment for reducing IOP should be especially aggressive in these patients. We hypothesize that earlier, more aggressive treatment of uveitis will reduce the presence of glaucoma as an additional vision-robbing complication of uveitis.

NEWBORN SCREENING FOR HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN THE BRONX, NY, AND EVOLVING PUBLIC HEALTH POLICY

New advances in the diagnosis and treatment of HIV infection continue to propel changes in public understanding of HIV infection and the administration of public health law. Over the past decade, New York State has moved from a policy of blind newborn screening for seroprevalence data to mandatory HIV testing as part of the statewide Newborn Screening (NBS) Program. A new statewide program of expedited HIV testing (48-hr turnaround results) of pregnant women and newborns (whose HIV status is unknown at the time of delivery) began in the summer of 1999. To better understand the impact this program might have on the patients who receive health care at Lincoln Medical and Mental Health Center (Lincoln Hospital), we evaluated our experience with the current NBS program prior to inauguration of the new expedited testing program. We evaluated the NBS program from February 1, 1997, to January 31, 1999, including total number of HIV-exposed/infected infants born, mother's HIV status (if known) at the time of delivery, amount of time between blood sampling and return of the test results to the Hospital, and medical follow-up of infants with positive newborn screening test results. This was a retrospective study of the NBS registry and the medical records of patients who receive primary health care from the Pediatric Immunology Service of the Department of Pediatrics at Lincoln Hospital. One hundred and four newborns were identified with positive-HIV antibody (HIV-Ab-positive), and 13 (12.5%) were confirmed to be HIV-infected by positive polymerase chain reaction (PCR) test of viral DNA. Sixty-five (62.5%) of the newborns with positive NBS screening test results were born to mothers who were known to be HIV-infected prior to delivery; 39 (37.5%) were unanticipated. Four (30%) of the 13 HIV-infected babies were born to mothers who were known to be HIV-infected prior to delivery, and 9 (70%) were born to mothers whose HIV status was unknown at the time of delivery. Eighty percent (80%) of HIV-Ab-positive infants continued to receive follow-up care at Lincoln Hospital. Relocation to other health-care facilities occurred as a result of parental choice or due to foster care placement. No babies were "lost" from the NBS program. The average time between sampling and receipt of results for all blood tests was 16 days (range 10 to 141). Nearly 40% of newborns who acquired HIV infection from their mothers were unanticipated because the mother's HIV status was unknown at the time of delivery. These unanticipated HIV-infected infants represent missed opportunities for prevention of maternal-to-child transmission of HIV infection and early therapeutic intervention for HIV-infected infants. The new expedited HIV-testing program for New York State will facilitate early diagnosis, prevention and treatment of the HIV-exposed/infected infant for whom maternal HIV status is unknown at the time of delivery.

Neurocognitive Status of HIV-infected Children at Age Three Years 264

This retrospective study delineates outcome status at age three by AIDS defining diagnosis for children with perinatally acquired HIV infection, and determines whether prenatal drug exposure and preterm birth are related to outcome status. The study sample consists of HIV-infected children who were attended by the Special Immunology Service and who had at least one developmental evaluation (Bayley or McCarthy Scales)during the study period(February 1991-May 1995). We selected a limited age range to determine neurocognitive outcome,(3 years +/- 6 months), distinguished outcome by AIDS defining illness (LIP and non-LIP, and incorporated mortality into a definition of extremely poor outcome status. We hypothesized that prenatal drug exposure and low birthweight would negatively impact outcome. Seventy-four children met the CDC criteria for diagnosis of HIV infection; 48 had AIDS (1987 AIDS surveillance case definition); 16 had LIP AIDS. All had receeived antiretroviral treatment. Twelve children were not available for testing within the age limit selected for study and were excluded. Twelve additional children died before they could be tested at age 3. The remaining 50 children all received neurocognitive testing at age 3 (+ 6 months). The majority were functioning within broadly normal limits on neurocognitive testing at age three (DQ >70). However, 53% of the children with a diagnosis of AIDS had neurocognitive test scores <70. Children who had LIP AIDS were less likely to score in that range than those with non-LIP AIDS, although more likely than HIV+ children who did not have AIDS (p=.009). Extremely poor outcome, as defined by the lower limit of the Bayley or McCarthy test (<50) or death by age three, occurred exclusively among those with a diagnosis of non-LIP AIDS. Lower birthweight was associated with extremely poor outcome status, although prenatal drug exposure was not. Outcome studies of HIV-infected children are a reflection of the survival of those less affected with the disease.

Panic response to sodium lactate infusion in patients with multiple chemical sensitivity syndrome

Background: Many patients who are first seen with what has been called multiple chemical sensitivity syndrome (MCS) experience symptoms suggestive of panic disorder including chest tightness, shortness of breath, palpitations, paresthesias, lightheadedness, and mental confusion. Although such patients are often convinced that these symptoms reflect toxic effects of environmental “chemicals,” direct evidence of this is lacking. To the contrary, a previous study has shown that some of these individuals exhibit hyperventilation responses on exposure to nonnoxious stimuli, and it has been suggested that the resulting hypocarbia accounts for their symptoms. We postulated that some patients with self-identified MCS had an underlying condition similar to panic disorder and would therefore demonstrate similar responses to provocative challenges, such as sodium lactate infusion. Methods: Patients referred to an allergy and clinical immunology service for evaluation of “chemical sensitivity” were investigated to rule out underlying medical conditions, including asthma, as a cause of their symptoms and were enrolled for study after giving informed consent. After a standardized psychiatric assessment was performed, patients underwent single-blind intravenous infusions of normal saline solution (placebo) and sodium lactate (which reproduces symptoms in individuals with underlying panic disorder). All patients were referred for independent psychiatric assessment. Results: The standardized psychiatric assessment identified four of five patients as meeting DSM III-R diagnostic criteria for panic disorder along with other depressive and/or anxiety-related disorders. All five patients with self-identified chemical sensitivity exhibited a positive symptomatic response to sodium lactate compared with placebo infusion. Independent psychiatric assessment confirmed the diagnosis of panic disorder on the basis of DSM III-R criteria in each of the five patients. Conclusions: These results suggest that MCS may have a neurobiologic basis similar, if not identical, to that of panic disorder. We speculate that treatments with demonstrated efficacy in panic disorder may also be of benefit in MCS, and conversely, treatments that reinforce anticipatory anxiety and avoidance behavior in patients with MCS may be detrimental. (J Allergy Clin Immunol 1997;99:570-4.)

Prevalence of allergic conjunctivitis in Italian young man

AllergyVolume 51, Issue 7 p. 517-518 Prevalence of allergic conjunctivitis in Italian young man G. Ciprandi, G. Ciprandi *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this authorA. Vizzaccaro, A. Vizzaccaro *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this authorI. Cirillo, I. Cirillo *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this authorP. Cerqueti, P. Cerqueti *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this authorG. W. Canonica, G. W. Canonica *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this author G. Ciprandi, G. Ciprandi *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this authorA. Vizzaccaro, A. Vizzaccaro *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this authorI. Cirillo, I. Cirillo *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this authorP. Cerqueti, P. Cerqueti *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this authorG. W. Canonica, G. W. Canonica *Allergy and Clinical Immunology Service DI.M.I. Viale Benedetto XV 6 16132 Genoa ItalySearch for more papers by this author First published: July 1996 https://doi.org/10.1111/j.1398-9995.1996.tb04662.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume51, Issue7July 1996Pages 517-518 RelatedInformation

Referral Patterns of Uveitis in a Tertiary Eye Care Center

To analyze the referral patterns and diagnosis of uveitis during the past decade in a large tertiary eye center. The records of 1237 patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary from 1982 to 1992 were classified and analyzed. Data regarding sex, race, nationality, referral site, ages at presentation and onset of uveitis, ocular involvement, clinical characteristics, ocular condition, and systemic disease associations were obtained. The mean age at onset of uveitis was 37.2 years; the male-to-female ratio was 1:1.4. Most patients were white (85.8%), born in the United States (83.1%), and referred from within New England (84.7%). Anterior uveitis was most common (51.6%), followed by posterior uveitis (19.4%), panuveitis (16.0%), and intermediate uveitis (13.0%). Chronic (58.3%), nongranulomatous (77.7%), and noninfectious (83.1%) were the most frequent types of uveitis. The most common entities included idiopathic (34.9%), seronegative spondyloarthropathies (10.4%), sarcoidosis (9.6%), juvenile rheumatoid arthritis (5.6%), systemic lupus erythematosus (4.8%), Behçet's disease (2.5%), and the acquired immunodeficiency syndrome (2.4%). The appearance of new uveitic entities, such as the acute retinal necrosis syndrome, multifocal choroiditis and panuveitis, birdshot retinochoroidopathy, and acquired immunodeficiency syndrome-related uveitis, and the reemergence of the classic infectious causes of uveitis, tuberculosis and syphilis, have changed the way we approach the diagnosis and management of posterior and panuveitis at the Massachusetts Eye and Ear Infirmary.

Hepatic encephalopathy in patients submitted to liver transplantation may be precipitated by benzodiazepines present in transfused blood: [formula omitted] Depts. of Internal Medicine and of Pharmaceutical Sciences a, Modena University and Transplantation Unit b and Immunology Service c, S. Martino Hosp. Genoa, Italy

Hepatic encephalopathy in patients submitted to liver transplantation may be precipitated by benzodiazepines present in transfused blood: [formula omitted] Depts. of Internal Medicine and of Pharmaceutical Sciences a, Modena University and Transplantation Unit b and Immunology Service c, S. Martino Hosp. Genoa, Italy

Prevalence of autoantibodies in patients with chronic hepatitis C (CHC): Comparison with blood donors: [formula omitted] Medicine 1 and Immunology Service§, Spedali Civili, Brescia, Italy

Prevalence of autoantibodies in patients with chronic hepatitis C (CHC): Comparison with blood donors: [formula omitted] Medicine 1 and Immunology Service§, Spedali Civili, Brescia, Italy

Cataract Surgery in Patients with Sarcoidosis-associated Uveitis

The authors analyzed the incidence of cataract development and the visual outcome of cataract surgery performed on patients with sarcoidosis-associated uveitis who were treated at the Immunology Service at the Massachusetts Eye and Ear Infirmary during a 17-year period. The records of 102 patients with sarcoidosis-associated uveitis who were treated with topical and regional corticosteroids, systemic nonsteroidal anti-inflammatory drugs, systemic steroids, or with systemic immunosuppressive chemotherapy were reviewed. Cataract surgery was performed on those eyes in which cataract developed, resulting in decreased visual acuity of 20/100 or less. The incidence of cataract development and visual results of cataract extraction and intraocular lens implantation were analyzed. In this cohort of 102 patients, visually significant cataracts that warranted surgery developed in 10 (16 eyes). In addition, four patients (5 eyes) had a visually significant cataract at the time of first evaluation. A total of 14 patients (21 eyes) underwent cataract surgery. Posterior chamber lens implantation accompanied cataract surgery in 19 (90.5%) of 21 eyes. The average final visual acuity of the 21 eyes after cataract surgery was 20/51, and 61% of the eyes achieved a stable visual acuity of 20/40 or better. The major causes of the decreased visual acuity in patients who had less than 20/40 visual acuity were sequelae of chronic posterior uveitis, cystoid macular edema, epiretinal membrane, and glaucomatous optic nerve damage. Posterior chamber lens implantation and cataract surgery in patients with sarcoidosis-associated uveitis can be well tolerated when absolute control of the inflammation is achieved. Pre-existing retinal pathology and glaucoma as a result of uncontrolled inflammation resulting in permanent ocular structural damage were found to be the most important factors for determining the postoperative final visual acuity.

Immunogenetics of drug-related or pseudo-ocular cicatricial pemphigoid: [formula omitted] (1,2,3), A Mohimen (1), R Neuman (4,5), CS Foster (4,5), CA Alper (1,6), EJ Yunis (1,2,3), and AR Ahmed (1,7). 1) The Center for Blood Research, Boston MA., 2) Div. of Immunogenetics, Dana-Farber Cancer Institute, Boston, MA., 3) Dept. of Pathology, Harvard Medical School, Boston, MA., 4) Immunology and Uveitis service,

Immunogenetics of drug-related or pseudo-ocular cicatricial pemphigoid: [formula omitted] (1,2,3), A Mohimen (1), R Neuman (4,5), CS Foster (4,5), CA Alper (1,6), EJ Yunis (1,2,3), and AR Ahmed (1,7). 1) The Center for Blood Research, Boston MA., 2) Div. of Immunogenetics, Dana-Farber Cancer Institute, Boston, MA., 3) Dept. of Pathology, Harvard Medical School, Boston, MA., 4) Immunology and Uveitis service,