Visual and symptomatic outcome of excimer phototherapeutic keratectomy (PTK) for corneal dystrophies.

PURPOSE: To determine the visual results and outcome of excimer laser phototherapeutic keratectomy (PTK) for corneal dystrophies. METHODS: Twenty-nine eyes of 19 patients who underwent excimer PTK for recurrent erosions and reduced vision due to corneal dystrophies, between February 1996 and July 1999, were reviewed. Data regarding the preoperative and postoperative best-corrected visual acuity (BCVA), change in spherical equivalent (SE), depth of excimer laser ablation, symptomatic relief, and incidence of recurrence were analysed by a retrospective chart review. RESULSTS: The range of follow-up was 12-48 months. Twenty-seven out of 29 eyes (93%) maintained or improved BCVA. All patients (17/17) were free of symptoms of recurrent erosions although two eyes needed repeat treatment to achieve this. In those eyes undergoing PTK for reduced vision, there was a trend towards a hyperopic shift postoperatively but this was not statistically significant. Five eyes showed recurrence of the dystrophy (Reis-Bücklers (one eye), Lattice (two eyes), and Granular (two eyes)) that required repeat treatment. Two of these eyes required a single repeat PTK procedure, and three eyes underwent three repeat treatments. There were no major complications during the follow-up period. CONCLUSIONS: Excimer PTK is a safe and effective procedure for relieving symptoms of recurrent erosions and improving visual acuity in patients with corneal dystrophies. Optimal visual results are achieved when treating more anterior disease. Multiple treatments are possible without significant detrimental effects for those patients with recurrence of their dystrophy.

Significance of anticardiolipin and anti-beta(2)-glycoprotein I antibodies in lupus nephritis.

OBJECTIVE: To investigate whether anticardiolipin (aCL) and anti-beta(2)-glycoprotein I (anti-beta(2)GPI) antibodies are associated with lupus nephritis (group II patients), and whether there are differences in the prevalence of these two autoantibodies between group II patients and patients with non-nephritis SLE (group I) and primary antiphospholipid syndrome (PAPS) patients (group III). METHODS: IgG and IgM aCL were measured in 31 patients and anti-beta(2)GPI in 30 patients with systemic lupus erythematosus (SLE) nephritis and 25 without SLE nephritis and in 36 PAPS patients by validated enzyme immunoassays. Relationships of anti-double-stranded DNA (anti-dsDNA) antibodies and antibodies to the collagenous region of C1q (anti-C1q) with SLE nephritis were also examined. RESULTS: The prevalence and levels were higher for aCL, but not for anti-beta(2)GPI, antibodies in group II than in group I patients. Absolute values of aCL and anti-beta(2)GPI in all three patient groups correlated with each other. The prevalences of aCL, anti-dsDNA and anti-C1q antibodies were significantly higher in group II than in group I and group III patients. CONCLUSION: The observations in this paper suggest that raised levels of aCL antibodies are associated with lupus nephritis. We were not able to demonstrate an association between anti-beta(2)GPI antibodies and kidney disease either in patients with lupus or in patients with primary antiphospholipid syndrome. In SLE, we demonstrated that the presence of anticardiolipin antibodies in conjunction with elevated levels of anti-dsDNA and anti-C1q antibodies is highly specific for glomerulonephritis in patients with lupus.

Similarities of specificity and cofactor dependence in serum antiphospholipid antibodies from patients with human parvovirus B19 infection and from those with systemic lupus erythematosus.

OBJECTIVE: To assess the phospholipid specificity and immunoglobulin isotype of antiphospholipid (aPL) antibodies in patients with acute parvovirus B19 infection. METHODS: Specificity of aPL and isotype distribution in the negatively charged phospholipids, cardiolipin and phosphatidyl serine, and in the neutral phospholipid, phosphatidyl ethanolamine, were measured in the sera of patients with acute parvovirus B19 infections (n = 12), in those with other acute viral infections (n = 10), and in those with syphilis (n = 15) by enzyme-linked immunosorbent assays. The dependence of anticardiolipin (aCL) binding on the presence of beta 2-glycoprotein I (beta 2-GPI) as a binding cofactor was assessed in these same groups, and was compared with sera from systemic lupus erythematosus (SLE) patients (n = 11) with raised aCL antibody reactivity. RESULTS: Antibodies against any of the 3 phospholipids were found in all 3 groups of patients with infections (B19 in 11 of 12 patients, other viral infections in 8 of 10 patients, and syphilis in 14 of 15 patients). B19 patients' sera contained predominantly IgG antibodies against the negatively charged phospholipids, cardiolipin and phosphatidyl serine, and differed in their specificity and isotype distribution from those found in the other 2 patient groups. B19-associated aCL increased their binding to antigen in the presence of beta 2-GPI as a binding cofactor, similar to aCL found in SLE patients, but unlike antibodies from patients with other viral infections or from those with syphilis. CONCLUSION: The results show the remarkable similarity in specificity of aPL antibodies between B19-infected patients and SLE patients, and raise the question of whether parvovirus infection may be a trigger for the development of aPL antibodies in autoimmune diseases.