Mild Uveitis Research Articles

Intraocular Lens Implantation following Cataract Extraction in Fuchs’ Heterochromic Uveitis

Nine patients with cataract secondary to heterochromic uveitis underwent intraocular lens implantation after extracapsular cataract extraction from the posterior chamber, and were followed up for a period ranging from 12 to 36 months (mean 23.3). Visual acuity was restored to 6/9 unaided or better in 5 cases and 6/12 unaided in 3 cases whose reduction of vision was due to massive pigmentation like keratic precipitates (KP) on the implant. A 6/18 unaided visual acuity in the ninth case was due to opacification of the posterior capsule. Postoperative complications included: mild uveitis (2 cases) and massive pigmentation like KP on the lens implant (3 cases). The rest of these patients had mild pigmentation. There were no cases that developed either intraocular pressure or inflammatory pupillary membranes. Additionally, disappearance of KP from the cornea was observed in 2 cases.

Massive Pseudophakie Pigment Dispersion Associated With an Iris Nevus

A 67-year-old woman examined 12 months following extracapsular cataract extraction had a massive pseudophakic pigment dispersion associated with diffuse corneal epithelial edema, mild uveitis, and secondary glaucoma. She underwent penetrating keratoplasty following removal of a posterior chamber intraocular lens (IOL), anterior vitrectomy, capsulectomy, and iris biopsy. Histopathologic examination revealed a pigmented iris nevus and signs of iris erosion by the IOL loop. Because 3 months later the eye developed streptococcal endophthalmitis and had to be eviscerated, we had the opportunity to examine the eye contents; we found no evidence of phakoanaphylactic uveitis.

JUVENILE RHEUMATOID ARTHRITIS IN AUCKLAND

Although features of juvenile rheumatoid arthritis (JRA) have been well described in British, American, and to a lesser extent Australian communities we can find no previous study of the clinical characteristics of this disease in a New Zealand population or indeed in any population containing Polynesians. In a follow-up study of 55 Auckland residents with juvenile rheumatoid arthritis, current information was obtained for 78% of the study group with a mean interval from disease onset to follow up of 9.3 years. The outcome for the group as a whole was excellent although patients with a polyarticular course, regardless of onset subtype, had a poorer outcome with respect to both ongoing disease activity and functional disability. Polynesian patients were represented in all onset subtypes in proportion to their frequency in the general community and there was no recognisable influence of race on the course of the disease. Despite careful ophthalmological examination only one case of mild uveitis was detected, a much lower incidence than in British and American reports.

Juvenile rheumatoid arthritis in Auckland: a long term follow-up study with particular reference to uveitis.

Although features of juvenile rheumatoid arthritis (JRA) have been well described in British, American, and to a lesser extent Australian communities we can find no previous study of the clinical characteristics of this disease in a New Zealand population or indeed in any population containing Polynesians. In a follow-up study of 55 Auckland residents with juvenile rheumatoid arthritis, current information was obtained for 78% of the study group with a mean interval from disease onset to follow up of 9.3 years. The outcome for the group as a whole was excellent although patients with a polyarticular course, regardless of onset subtype, had a poorer outcome with respect to both ongoing disease activity and functional disability. Polynesian patients were represented in all onset subtypes in proportion to their frequency in the general community and there was no recognisable influence of race on the course of the disease. Despite careful ophthalmological examination only one case of mild uveitis was detected, a much lower incidence than in British and American reports.

Decreased ecto-5'-nucleotidase activity in rabbit lymphocytes during experimental lens-induced uveitis.

An experimental uveitis was produced by immunizing albino and pigmented rabbits with heterologous (rat) lens protein six times at two-week intervals. After sensitization the anterior lens capsules were disrupted in an operation. After operation the rabbits were examined repeatedly with a slit-lamp. On the seventh day after operation the animals were sacrificed and both eyes were enucleated. The inflammatory reaction in the uveal tract was verified histopathologically. Thymus and spleen lymphocytes were purified using BSA-gradients. Ecto-5'-nucleotidase (AMP-ase) activity on the intact lymphocytes was measured biochemically and B-cells were counted using the fluorescent anti-IgG technique. Purified spleen and thymus lymphocytes were also analyzed using transmission electron microscopy. The AMP-ase activity of purified spleen lymphocytes was significantly decreased in albino rabbits suffering from experimental lens-induced uveitis when compared to that observed in control animals. The AMP-ase activity was also decreased in pigmented rabbits suffering from a very mild uveitis. Moreover, a decreased AMP-ase activity was observed in albino rabbits which were only immunized but not operated on and did not show any signs of uveitis. Differences in neither the B-cell proportions nor the ultrastructure of the purified lymphocytes could be observed in any of these experimental groups. It is proposed that the biochemical change in spleen lymphocytes observed in the present work is a reflection of the general immunological state which in certain conditions may lead to uveitis.

Granulomatous Reaction to Choyce Style Intraocular Lens

Despite the large number of intraocular lens implants performed since Ridley first devised the procedure, there have been few reports of postmortem examination in clinically successful cases. We report a patient who tolerated his Choyce Mark VIII style implant well, despite a three-month episode of mild nongranulomatous uveitis occurring two months postoperatively, until his death 17 months later. This is the sixth postmortem study of an anterior chamber IOL and the only one in which there was a conspicuous granulomatous reaction on the anterior iris surface, with large foreign body giant cells. Despite the presence of a foreign body, the previous eyes that have clinically tolerated implants well and have come to postmortem examination have shown remarkably little inflammation; none have shown this degree of granulomatous reaction previously.

The Progression of the Ocular Abnormalities of Herpes Zoster: Histopathologic Observations of Nine Cases

The ocular pathologic findings from nine patients who suffered from herpes zoster ophthalmicus are described. Autopsy material from four patients who died within weeks of the illness and ocular specimens from five patients who required surgery for complications of the disease months to years later demonstrated how the ocular abnormalities caused by zoster may progress in severity with time. The changes ranged from superficial keratitis and mild uveitis to severe granulomatous inflammation of the ciliary body, choroid, and optic nerve within the first several weeks of the disease. In some instances damage secondary to vasculitis predominated, and in others inflammation directly involved ocular tissue. In some chronically affected eyes, granulomatous reaction to Descemet's membrane persisted for years, whereas in others the inflammatory reaction apparently resolved, allowing successful penetrating keratoplasty to be performed in one case.

Amines in the Subretinal Fluid and Aqueous

We examined 49 samples of subretinal fluid and nine samples of aqueous from patients with retinal detachments. Seven amines (histamine, dopamine, methylamine, ethanolamine, dimethylamine, pyridoxamine, and piperidine) were positively identified and quantitated. The amines in the subretinal fluid were similar to those present in the aqueous. The presence of histamine in the subretinal fluid, observed only in fresh retinal detachment, suggested an inflammatory process, at least in the early stages of some cases of retinal detachment. This is consistent with the clinical observations that mild uveitis frequently accompanies a rhegmatogenous retinal detachment.

Immunopathology of the lens. III. Humoral and cellular immune responses to autologous lens antigens and their roles in ocular inflammation.

In experimental rabbits it has been shown for the first time that autologous lens protein is antigenic when injected with Freund's complete adjuvant. Although lens haemagglutinins were detected in 6 out of 7 rabbits, in only 3 of the 6 animals did the titre reach a maximum of 1:640. A weak agar precipitation reaction was obtained with only 1 of the 3 sera. It would appear, therefore, that the passive haemagglutination test is superior for the detection of autologous lens antibodies. The response to autologous lens antigen both in magnitude as well as in duration varied in different rabbits, which suggested to us the possible role played by a central control mechanism involving the immune-response (Ir) and immune-associated (Ia) genes which are part of the major histocompatibility complex. Alternatively, this variation may be the result of an antigenic competition between various autologous crystallins. Antibodies to autologous lens protein as detected by immunofluorescence and immunoperoxidase techniques were shown to be of the IgG class. Systemic autologous immunisation produces only a mild uveitis and does not lead to a granulomatous intraocular inflammation. Intravitreal injections of autologous lens protein in pre-immunised animals, however, produced an Arthus type of acute endophthalmitis. Autologous lens antisera showed limited cross-reactivity with ocular and extraocular tissues, which could be detected only by such sensitive techniques as immunofluorescence and immunoperoxidase methods.

AMŒBIC INFECTION OF THE EYE

A healthy Huntingdonshire schoolteacher of 32 had mild unilateral keratoconjunctivitis and uveitis which did not respond to treatment. 6 months later progressive indolent corneal ulceration, pain, and loss of vision led to a corneal graft, which was rejected. A free-living soil amœba, Acanthamœba polyphaga, was repeatedly isolated from the affected eye. A Lincolnshire farmer of 59 developed an identical clinical condition which required enucleation of the eye after a year. A similar Acanthamœba was grown from his eye tissue. These are the first eye infections caused by free-living amœbæ to be reported in the U.K.

Experimental Allergic Uveitis

Summary Guinea pigs and rabbits given injections of homologous retina emulsified in Freund's adjuvant developed ocular lesions typically affecting the uveal tract. Injections of both species with heterologous retina also resulted in uveitis in some instances, depending on the species of retina used. These results were obtained by both single and repeated injections of retinal tissue. In contrast, single injections of many other homologous or heterologous intraocular tissues, including uvea itself, were ineffective in production of ocular disease. A series of repeated injections of the guinea pig with homologous uvea resulted in mild uveitis demonstrated histologically, but not clinically. Similar injections of the guinea pig with heterologous uvea were ineffective in production of uveitis, as were injections of both homologous or heterologous uvea in the rabbit. Immunization of the rabbit with homologous optic nerve elicited uveitis and encephalomyelitis which occurred simultaneously in the same animal. Similar immunization of the guinea pig resulted in encephalomyelitis only. These results were correlated with demonstration of encephalitogenic antigen in rabbit retina, but not in guinea pig retina. The interrelation and differentiation of these models of EAU are discussed.