Diagnostic efficacy of elevated serum angiotensin-converting enzyme and lymphopenia between presumed sarcoid uveitis and presumed tubercular uveitis.

PURPOSE: To evaluate the diagnostic efficacy of elevated serum angiotensin-converting enzyme (sACE) and lymphopenia in presumed sarcoid and tubercular uveitis. METHODS: A single-centre retrospective study was conducted on a cohort of 755 adult patients with uveitis between January 2019 and June 2020. Demographic, clinical and laboratory data were retrieved from our hospital database. Measurements of serum angiotensin-converting enzyme (sACE) and lymphocyte counts were analysed. RESULTS: The mean age of the patients was 41 ± 13 years. Presumed sarcoid uveitis was diagnosed in 50 (7%) patients, presumed tubercular uveitis in 222 (29.4%) and other uveitic entities noted in 483 (64%). Intermediate and posterior uveitis were the most common anatomical diagnosis in presumed sarcoid uveitis (59% and 20%, respectively) and in presumed tubercular uveitis (46% and 38%, respectively). Elevated sACE was noted in 76% of presumed sarcoid uveitis and 46% in presumed tubercular uveitis. The combination of high serum angiotensin-converting enzyme along with lymphopenia was only in 17% in presumed sarcoid uveitis and 9.7% in presumed tubercular uveitis. sACE was found to be a significant risk factor for presumed sarcoid uveitis with an odds ratio of 3.603 (p < 0.002), and in presumed tubercular uveitis odds ratio was not significant with odds ratio of 1.19. Lymphopenia was not found to be a significant factor in both groups. CONCLUSION: Elevated sACE activity was an independent risk factor for presumed sarcoid uveitis over lymphopenia alone or in combination with lymphopenia.

Hyperhomocysteinemia and low methionine stress are risk factors for central retinal venous occlusion in an Indian population.

PURPOSE: The underlying cause of disturbed homocysteine metabolism is incompletely understood in young persons with central retinal vein occlusion (CRVO) with mild hyperhomocysteinemia (HHcys) and no other systemic disease in India. A 2-year prospective study was undertaken to determine whether HHcys is a risk factor for CRVO in an Indian population. METHOD: The prevalence of fasting HHcys was evaluated in a consecutive series of 29 patients with CRVO (mean age, 30 +/- 6 years) along with 57 age- and sex-matched control subjects (healthy subjects, mean age 27 +/- 5 years). Strict inclusion and exclusion criteria were used. Plasma levels of homocysteine (Hcys), methionine, cysteine, glutathione, B(12), and folate were measured. Multivariate logistic regression analysis was performed to determine the risk factors for CRVO. RESULT: Fifteen of 29 patients with CRVO (51.72%) exhibited HHcys (>15 muM). The mean Hcys level was significantly elevated in the patients with CRVO (19.1 +/- 13.1 muM) compared with that in the healthy control subjects (14.7 +/- 6.2 muM) with P = 0.04. The increased Hcys levels in CRVO cases was associated with decreased methionine (P = 0.052) and decreased B(12) (P = 0.001). A multivariate logistic regression analysis revealed an odds ratio of 1.9 (95% CI = 0.50-7.16) for Hcys and 15.9 for methionine (95%CI = 1.50-169.62; P = 0.022). CONCLUSION: Elevated Hcys and low methionine were risk factors for CRVO in an Indian population.