Fuchs' heterochromic iridocyclitis.
A 32-year-old man with Fuchs' heterochromic iridocyclitis is described, and a review of the pertinent medical literature is presented.
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A 32-year-old man with Fuchs' heterochromic iridocyclitis is described, and a review of the pertinent medical literature is presented.
Iridocyclitis is a common complication of juvenile rheumatoid arthritis. It affects particularly female patients with mono-oligoarthritis. A positivity of ANA-test is usually observed, representing a marker for the disease. The course is chronic, leading potentially to scarring and blindness. The insidious onset, often not parallel to arthritis, requires careful ophthalmologic examination of all patients at risk, in order to achieve early diagnosis and treatment.
As a method of treating iridocyclitis, cryotherapy, combined with the universally accepted systemic and topical treatment, is becoming important since it is able to alleviate the symptoms and to speed up the healing of the inflammatory condition of the iris and ciliary body.
The irides of two patients with Fuch's heterochromic iridocyclitis were investigated by electron microscopy. The main findings were abnormal melanocytes with relatively few, small, and at times immature melanin granules, abundance of plasma cells, and membranous degeneration of nerve fibers. The defective melanin production may be due to abnormal adrenergic innervation, either primary or secondary to the inflammatory process. The cause for this inflammatory reaction was not evident in this study.
The immune and carrageenin-induced models of iridocyclitis were elaborated. Characteristics of the dynamics and kinetics of the studied inflammatory processes were conducted on the basis of biochemical indices and of biomicroscopic observations of the anterior chamber of the eye. Evaluation of usefulness of the elaborated models of the uveitis for characterization of the therapeutic effectiveness of the drugs was based on the known antiinflammatory drugs.
In a model based on carrageenin-induced inflammation of the anterior eye chamber, prostaglandins and pronounced cellular infiltration appeared in the aqueous humor after six hours. The findings are discussed taking into account various sources of prostaglandins in the course of iridocyclitis.
Case report on a patient with unilateral, violent, hemorrhagic iridocyclitis following a gastro-intestinal infection caused by Yersinia enterocolitica. The disease entity of Yersinia infection and the diagnostic approach are described, with special consideration of its role in clarifying the etiology of uveitides.
The efficacy of the selected immunosuppressive drugs was studied on the model of iridocyclitis in the rabbit. Intensity of the inflammatory process was evaluated on the basis of biochemical parameters -- protein level and acute phase factors (seromucoid and sialic acid). All preparations used in the experiments indicated a decreasing exacerbation of inflammation as evaluated biochemically. Imuran showed the strongest effect while methotrexate, thiotepa and myleran were less effective.
The association between acute iridocyclitis (a.i.) and sacroiliitis/ankylosing spondylitis is well known. Since bone scintigraphy is a sensitive method of detecting sacroiliitis before radiologic evidence of this condition appears, we examined the role of scintiscanning in the investigation of sacroiliitis in patients with a.i. The sacroiliac-joint/sacrum ratio was determined in 30 control subjects and in 21 patients with a.i., who showed no radiologic signs of sacroiliitis. No discrimination between patients with a.i. and control subjects was obtained by scintigraphy, neither did we find any difference in the mean sacroiliac-joint/sacrum ratios between HLA-B-27-positive and HLA-B-27-negative individuals with a.i. This study does not support the claim that patients with a.i. often suffer from clinically and radiologically silent sacroiliitis which would be detected only by scintigraphy. According to our results, regular scintigraphic examinations of the sacroiliac joint in all patients with a.i. are not indicated.
The association between chronic iridocyclitis and pauciarticular disease in childhood is well recognized. In view of this important subset of childhood arthritis, a comparable entity was searched for in adults. Twenty-three rheumatologists and 149 ophthalmologists were contacted in the San Francisco Bay area regarding the possible presence of this association in their catchment area of several million adult individuals. Replies were received from 15 and 41, respectively. Following detailed questionnaire and clinical evaluation of potential patients, only 2 such subjects were identified. These probably reflect a chance occurrence of 2 prevalent conditions. The apparent absence of the iridocyclitis/oligoarthritis subset in adults is in stark contrast to the situation in children.
A case of chorioretinitis and iridocyclitis in a patient with progressive systemic sclerosis is reported and the literature on the ocular manifestations of the disease is briefly reviewed.
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