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PubMed1992

[An HLA-B27 negative case of ankylosing spondylitis with acute iridocyclitis].

The author experienced a 34-year-old male case of acute iridocyclitis with fibrinous exudates accompanied by ankylosing spondylitis with negative HLA-B27. Who was diagnosed definite ankylosing spondylitis by the New York criteria. The cause of ankylosing spondylitis was postulated to be a cross reaction between HLA-B27 and a certain Gram-negative bacillus. However, our case with negative HLA-B27 suggested the causes could comprise multiple factors in addition to HLA-B27. Since the clinical picture of iridocyclitis observed in our case showed no difference with those of HLA-B27 positive cases, iridocyclitis associated with ankylosing spondylitis is considered to be the same entity regardless of HLA-B27 being present or not.

Acute Disease↗

PubMed1991

[Acute iridocyclitis with fever and liver involvement during quinidine therapy].

Acute iridocyclitis is a rare hypersensitive reaction to quinidine treatment. The third case in the literature is reported here. A woman aged 80 years developed pyrexia, anorexia, nausea, skin rash and hepatic dysfunction after treatment with quinidine for two weeks. Four weeks later, while still receiving quinidine, she developed acute iridocyclitis. Quinidine treatment was withdrawn, the eye symptoms were treated and the patient recovered rapidly without complications. This case report draws attention to quinidine as a possible cause of iridocyclitis of unknown origin.

Acute Disease↗

PubMed1997

Antibodies to the 45 kDa DEK nuclear antigen in pauciarticular onset juvenile rheumatoid arthritis and iridocyclitis: selective association with MHC gene.

OBJECTIVE: To study the frequency of autoantibodies to the 45 kDa DEK nuclear antigen, a putative oncoprotein, in a sample of patients with juvenile rheumatoid arthritis (JRA), and to make correlations with disease subtype and complications such as iridocyclitis. Class I and Class II HLA associations with reactivity to the antigen were also sought. METHODS: Sera from 146 HLA typed patients with JRA representing all subtypes were analyzed for reactivity with the 45 kDa DEK protein by immunoblotting. The antigen was purified to near homogeneity from nuclei of HeLa cells. RESULTS: Antibodies to DEK were found in 57% of all patients with JRA compared to 3% of controls (p < 0.0001). Antibodies were detected more frequently in pauciarticular onset (78%) than in polyarticular onset patients (29%; p < 0.01) and controls (3%; p < 0.0001). 97% of patients with JRA (regardless of onset subtype) and iridocyclitis had anti-DEK antibodies compared to 47% of patients without eye disease (p < 0.0001). Anti-DEK antibodies were found more frequently in females compared to males in the pauciarticular onset disease group (84 vs 42%; p < 0.01). The occurrence of anti-DEK antibodies was closely associated with positive antinuclear antibody serology, and a strong association with the Class I gene HLA-A2 was also observed. CONCLUSION: Antibodies to the 45 kDa DEK protein are characteristic of the pauciarticular onset subtype of JRA, particularly in patients with a history of iridocyclitis. The occurrence of anti-DEK antibodies is significantly but paradoxically associated with the presence of the HLA-A2 allele in such patients.

Adolescent↗

PubMed1984

Chorioretinal scars in Fuchs' heterochromic iridocyclitis.

To determine the incidence of chorioretinal lesions in patients with Fuchs' heterochromic iridocyclitis, we reviewed the records of all patients with this disease seen at the Indiana University Uveitis Service, Indianapolis, since 1963. For comparison the records of age- and sex-matched patients with HLA-B27-positive iritis were also reviewed. The incidence of chorioretinal lesions in one or both eyes of patients with Fuchs' heterochromic iridocyclitis was significantly higher than in the patients with HLA-B27-positive iritis or than expected in the general population. Among the types of lesions manifested, the most notable increase was in toxoplasmosislike lesions. However, two of the five patients with these lesions had negative indirect hemagglutination assays for toxoplasmosis, down to undiluted serum. The reason for the high incidence of chorioretinal lesions in patients with Fuchs' heterochromic iridocyclitis is unclear and may be related to immunologic changes in these patients.

Adolescent↗

PubMed1982

Iridocyclitis in two patients with hypocomplementemic cutaneous vasculitis.

Two patients, a 48-year-old woman and a 56-year-old man, had hypocomplementemic cutaneous vasculitis syndrome. The patients had ocular pain and photophobia and were found to have bilateral recurrent iridocyclitis. We treated the iridocyclitis with cycloplegia and topical corticosteroids, which relieved their symptoms and diminished the clinical signs. The bilateral iridocyclitis found in both patients may have been secondary to immune complex deposition in the eye.

Antigen-Antibody Complex↗

PubMed1984

Iridocyclitis and an iris mass associated with secondary syphilis.

A 34-year-old white man developed iridocyclitis and an iris mass. The iridocyclitis was preceded by a nodular rash which spared the palms and soles. An anterior segment fluorescein angiogram was performed which showed numerous permeable vessels. An ultrasound examination of the mass showed that it extended to the ciliary body. He had both a positive RPRCT and FTA-Abs. A skin biopsy was done which disclosed the nodules to be a rare form of secondary syphilis. The patient was treated with topical steroids and a cycloplegic agent, and later prednisone and intravenous penicillin, with eventual resolution of iris mass, iridocyclitis and skin nodules.

Adult↗

PubMed1984

Inherited predisposition to iridocyclitis with juvenile rheumatoid arthritis: selectivity among HLA-DR5 haplotypes.

HLA-DR5 is associated with a chronic iridocyclitis and juvenile rheumatoid arthritis with onset in early childhood. Previously published data provided indirect evidence for selective linkage between two HLA-B alleles and HLA-DR5. To test this observation further, 38 families, the probands of which have chronic iridocyclitis and juvenile rheumatoid arthritis, were HLA typed so that haplotypes associated with disease could be established. HLA-DR5 was linked to HLA-Bw44 or to HLA-Bw35 and to HLA-Cw4 in the majority of haplotypes obtained in the probands. Both HLA-Bw44, -DR5 and HLA-Bw35, -Cw4, -DR5 occurred more commonly in the proband haplotypes than in the control haplotypes. The frequency of the haplotype HLA-Bw44, -DR5 was 0.133 compared with 0.007 (X2 = 27.04, P less than 10(-6] and for HLA-Bw35, -Cw4, -DR5, it was 0.093 compared with 0.11 (X2 = 13.83, P = 0.0002). The relative risks were 20.77 and 9.23, respectively, versus 3.52 for HLA-DR5 alone. HLA-Bw44 occurred much more commonly in proband HLA-DR5 haplotypes (0.455) compared with control HLA-DR5 haplotypes (0.067) (X2 = 8.26, P less than 0.01). Not all HLA-DR5-bearing haplotypes predisposed equally to chronic iridocyclitis and early-onset pauciarticular juvenile rheumatoid arthritis.

Arthritis, Juvenile↗

PubMed1981

Influence of untreated chronic plastic iridocyclitis on intraocular pressure in leprous patients.

The intraocular pressures of a total of 1015 eyes of leprous patients who never had ophthalmological care or local eye treatment were measured. The patients were categorised according to the type of leprosy they had the eyes were categorised as without or with chronic plastic iridocyclitis. In patients with the tuberculoid and lepromatous types of leprosy the intraocular pressure was significantly lower in eyes with chronic plastic iridocyclitis than in unaffected eyes. It has been shown that chronic plastic iridocyclitis which remains untreated for many years results in significantly lower intraocular pressure.

Adult↗

PubMed1976

The risk of iridocyclitis in juvenile rheumatoid arthritis.

A retrospective study comparing 14 patients with juvenile rheumatoid arthritis (JRA) complicated by chronic iridocyclitis (Group I) with an equal number of JRA patients without this complication (Group II) was conducted to determine which factors might aid in the earlier diagnosis of chronic iridocyclitis. Eleven patients in Group I had oligoarticular disease compared to 5 in Group II. Antinuclear antibody was found in 13 patients in Group I compared to only 2 in Group II. Only one of nine patients tested in Group I for the histocompatibility antigen W-27 was positive. The patient with oligoarticular disease and a positive ANA test should be followed closely by the ophthalmologist for the development of chronic iridocyclitis.

Adolescent↗

PubMedDate not supplied

Chlorambucil in the treatment of iridocyclitis in juvenile rheumatoid arthritis.

A patient with chronic, progressive, iridocyclitis secondary to pauciarticular juvenile rheumatoid arthritis (JRA) is described. The patient's iridocyclitis was unresponsive to topical, systemic, and subtenon injections of corticosteroids, but did respond to low doses of chlorambucil. The use of immunosuppressives may be indicated in severe, unresponsive iridocyclitis secondary to JRA.

Arthritis, Juvenile↗

PubMed1999

Inflammatory arthritic process, iridocyclitis and immune response to articular and ocular antigens in Wistar rats injected with T. gondii trophozoites.

The present study deals with the potential role of T. gondii in inducing an arthritic inflammatory process. Wistar rats were injected subcutaneously (sc) into the right footpad with viable T. gondii trophozoites emulsified in incomplete Freund's adjuvant (IFA). The control group was injected with IFA. All parasite-injected animals developed a local inflammatory process characterized by hind limb swelling and marked restriction of ankle motility approximately 25 days after injection. Histopathogical studies of the joints, carried out 90 days after injection, revealed intense mononuclear infiltration, proliferation of granulation tissue, giant cells and necrosis in the synovia of 90% of T. gondii-injected rats. Strikingly, 40% (4/10) of the parasite-injected animals developed iridocyclitis, which was characterized by intense mononuclear infiltration around the iris-ciliary microvasculature in two animals and a slightly pronounced infiltrate of polymorphonuclear and mononuclear cells in two other animals. Antibodies to soluble T. gondii antigens (STAg) were detected in all parasite-injected rats. Antibodies against articular and ocular antigens such as proteoglycans, type II collagen, retinal S antigen and iris antigens were detected by ELISA in 40, 80, 70 and 70% of T. gondii -injected animals, respectively. Control animals injected with IFA failed to develop any articular or ocular process or humoral immune response. The present study demonstrated that footpad sc injection of Wistar rats with viable T. gondii trophozoites was able to induce a localized inflammatory arthritic process which, in some of the animals, was accompanied by iridocyclitis and immune response against articular and ocular components.

Animals↗

PubMed1994

Coccidioidomycosis iridocyclitis.

BACKGROUND: Coccidioidomycosis has reached epidemic proportions in the southwest region of the United States. Despite the greater numbers of cases, isolated anterior segment ocular coccidioidomycosis in the absence of systemic infection continues to be rare, although its incidence may be increasing. METHODS: Two patients without clinical evidence of systemic disease and one patient with previously treated pulmonary coccidioidomycosis had granulomatous iridocyclitis and iris nodules that were unresponsive to corticosteroid therapy. All three patients underwent iris biopsy, anterior chamber tap, and washout for histopathologic diagnosis of anterior segment disease, and all subsequently received systemic antifungal therapy. Two patients also received multiple intraocular injections of amphotericin B. RESULTS: Papanicolaou and hematoxylin-eosin-stained preparations of anterior chamber tap and biopsies of the iris in each of these patients showed fibrinopurulent or granulomatous inflammatory exudate with intact and disrupted Coccidioides spherules. Despite aggressive systemic and intraocular therapy, one patient required enucleation for a blind, painful eye. The other two patients continue to have limited visual acuity but with at least partial resolution of the intraocular lesions. CONCLUSIONS: Ocular coccidioidomycosis without clinical evidence of systemic involvement is rare. Isolated anterior segment disease is also uncommon; however, because of the current epidemic in the southwest region of the United States, ocular coccidioidomycosis should be considered in any patient who traveled through or lived in endemic areas and who has a granulomatous iridocyclitis associated with iris mass that is unresponsive to corticosteroid therapy.

Amphotericin B↗

PubMed1997

Bilateral iridocyclitis with retinal capillaritis in juveniles.

PURPOSE: The authors present clinical features of 18 juvenile patients with a new type of uveitis termed bilateral iridocyclitis with retinal capillaritis (BIRC). METHODS: The authors reviewed medical records of 18 consecutive patients who showed bilateral iridocyclitis with retinal capillary leakage but no systemic manifestations during an 11-year period from January 1985 to December 1995. RESULTS: Twelve of the 18 patients were female and the age at onset ranged from 9 to 17 years old. All patients had many cells in the anterior chamber and anterior vitreous, together with mutton fat keratic precipitates. Fluorescein angiography showed leakage from the optic disc and retinal capillaries, mainly in the midperiphery, which corresponded to retinal cloudiness. Macular edema was minimal, and all patients maintained good vision. The inflammation responded well topical, oral, and intravenous administration of corticosteroids, the choice of which was based on the extent of retinal inflammation. Human leukocyte antigen (HLA)-DR6 and HLA-Cw7 were associated significantly with the presence of BIRC (chi square test, P < 0.0001). CONCLUSIONS: Bilateral retinal capillaritis affecting capillaries in various areas of the retina and overlying retinal cloudiness with no distinct lesions are unique to these patients. Fluorescein angiography is essential for diagnosis of BIRC.

Acute Disease↗

PubMed1997

Surgical management of cataract and posterior chamber intraocular lens implantation in Fuchs' heterochromic iridocyclitis.

BACKGROUND: To determine the inflammatory course and level of visual rehabilitation after cataract extraction and posterior chamber lens implantation in patients with Fuchs' heterochromic iridocyclitis complicated by cataract. METHODS: In a clinical trial, 32 eyes (visual acuity of 20/160 or worse) of 30 patients underwent extracapsular cataract extraction (19 eyes) or lensectomy (13 eyes) accompanied by posterior chamber intraocular lens implantation. Indirect ophthalmoscopy was performed intraoperatively prior to intraocular lens implantation and the extent of vitreous haze was assessed. If vitreous haziness was 3+ or more, core vitrectomy (two eyes) or three-port pars plana deep vitrectomy (four eyes) was performed. RESULTS: After an average follow up of 14.4 months (6 to 24 months), there was no statistically significant increase in cell and flare in the anterior chamber and vitreous or in keratic precipitates compared with the preoperative status of the eyes. However, 12% of the eyes developed synechiae (anterior and/or posterior) in comparison to preoperative condition (p < 0.05). Eight-seven percent of the eyes gained visual acuity of 20/40 or better (P < 0.005). Using the logistic regression model, a higher level of preoperative inflammation was associated with reduced likelihood of gaining visual acuity of 20/25 or more (OR = 0.25, 95% CI 0.049, 1.255). The complications of surgery were synechiae, 12%; opaque posterior capsule, 12%; vitreous loss, 3%; chronic glaucoma, 3%; and retinal detachment, 3%. CONCLUSIONS: Implantation of a posterior chamber intraocular lens can be well tolerated in patients with Fuchs' heterochromic iridocyclitis. Vitrectomy, whenever indicated in addition to cataract extraction, improves visual rehabilitation.

Adolescent↗

PubMed2005

Lepromatous iridocyclitis.

A 36-year-old woman with no prior medical history presented with a unilateral decrease in vision and iridocyclitis to our hospital. External examination demonstrated multifocal, firm, elevated, non-tender skin nodules on the patient's face and left hand. In addition, slit-lamp biomicroscopy revealed gray, cheesy-appearing nodules on the iris surface of the affected eye. Anterior chamber paracentesis and pars plana vitrectomy did not reveal further information. Skin nodule biopsy, however, demonstrated multiple fragmented organisms within histiocytes, consistent with leprosy. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin and her vision returned to 20/20.

Adult↗

PubMedDate not supplied

Outcomes of treatment with immunomodulatory therapy in patients with corticosteroid-resistant juvenile idiopathic arthritis-associated chronic iridocyclitis.

PURPOSE: To describe the clinical outcome of patients with juvenile idiopathic arthritis (IA)-associated chronic iridocyclitis unresponsive to conventional therapy, in whom inflammation was eventually controlled using immunomodulatory therapy (IMT), and to determine if patients treated early with IMT have better visual acuity outcomes than those treated with corticosteroid alone. METHODS: Patients with JIA-associated chronic iridocyclitis receiving immunomodulatory therapy at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary between 1981 and 2001 were studied. INCLUSION CRITERIA: JIA with chronic corticosteroid-dependent uveitis; IMT for a minimum of one year; minimum follow-up of three years; inflammation eventually controlled for a minimum of six consecutive months by IMT. RESULTS: At last visit, 51% of eyes (23 eyes) had acuity of 20/20 to 20/40, 16% (7 eyes) had 20/50 to 20/100, and 33% (15 eyes) had 20/200 or less. In patients whose chronic inflammation was eventually controlled within three years from onset of the uveitis, final bilateral vision was maintained within 20/20 to 20/30, except for a patient whose one eye had poor vision at initial consultation. When acuities at the end of the follow-up period of patients treated early with IMT were compared with acuities at the initial consultation of patients treated late with IMT, with duration of uveitis matched for each patient, visual acuities of those treated early were statistically significantly better than those treated late with IMT (p < 0.005 right and left eyes pooled; p = 0.0075 best eyes; p = 0.0375 worst eyes). CONCLUSIONS: We noted improvement or maintenance of visual acuity (86%) during the course of follow-up of patients with treatment-resistant JIA-associated uveitis treated with effective IMT. However, only IMT given early in the disease course was noted to be associated with bilateral visual acuity of 20/30 or better.

Adolescent↗

PubMed1991

Influence of untreated chronic plastic iridocyclitis on intraocular pressure in leprosy patients.

The intraocular pressures of a total of 286 eyes of patients with lepromatous and borderline lepromatous leprosy who never had regular ophthalmological care or local eye treatment were measured. The patients were categorised according to the type of leprosy they had, and the eyes were categorised as without or with chronic plastic iridocyclitis. In patients with lepromatous and borderline lepromatous types of leprosy the intraocular pressure was significantly lower in eyes with chronic plastic iridocylitis 10.1 (3.6) mmHg than in both unaffected eyes 11.0 (3.2) mmHg and control eyes 13.5 (2.5) mmHg. It has been shown that chronic plastic iridocyclitis which remains untreated for years results in a lower intraocular pressure than normal.

Adult↗

PubMed1996

Psoriatic arthritis and hypopyon-iridocyclitis. Possible mechanism of the association of psoriasis and anterior uveitis.

BACKGROUND: We present a 32-year-old Japanese man with psoriatic arthritis who developed recurrent episodes of hypopyon-iridocyclitis associated with exacerbations of the arthropathy. OBJECTIVE: To evaluate the mechanism of the association between psoriasis and uveitis, we analyzed the rheological characteristics of the patient's peripheral blood neutrophils during attacks and during remissions. METHODS: The rheological activity of neutrophils was determined by the micropore filtration method. It was expressed as micropore filtration time when a neutrophil-erythrocyte suspension passes through a micropore filter (pore size 5 microns). RESULTS: The micropore filtration time in this patient was longer than that of healthy control subjects (p < 0.01) and of psoriatic patients without uveitis (p < 0.05); it was also longer during the appearance of the eye disorder with the exacerbation of psoriatic arthritis than during remissions. CONCLUSIONS: Activated neutrophils in the peripheral blood of our patient were probably responsible for the attacks of hypopyon-iridocyclitis as well as the exacerbation of psoriatic skin lesions and/or arthritis.

Adult↗