Nonsteroidal anti-inflammatory drug therapy in chronic childhood iridocyclitis.

The adjunctive use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of chronic iridocyclitis was evaluated in 14 patients, eight with juvenile rheumatoid arthritis and six with idiopathic iridocyclitis. In all patients, the activity of the iridocyclitis improved with the addition of NSAIDs to their treatment regimens, permitting reduction in the dose of corticosteroid drugs. These data suggest that NSAID therapy may have an adjunctive role in the treatment of chronic iridocyclitis in childhood.

Characterization of the choroidal mast cell.

The experimental studies performed on nonpigmented rat choroids and the review of the important literature covered in this thesis seem to justify the following statements: 1. Mast cells are present in the choroid in significant numbers. 2. Mast cell numbers vary considerably from one individual to another and from one location in the choroid to another. 3. The major concentration of mast cells in the uvea is in the posterior choroid. 4. The mast cells of the choroid have a preferential location along arterial vessels. 5. Choroidal mast cell population density apparently decreases with senescence. 6. Mast cell products are present in sufficient quantity to exert substantial effects on physiologic, immunologic, and inflammatory responses in the choroid. 7. Choroidal mast cell products are released with appropriate stimulation and share some properties with the connective-tissue mast cell. 8. Choroidal mast cell demonstrate enough differences to suggest that a local differentiation may be present and may represent a locally controlled modulating effect for choroidal physiologic, immunologic, and inflammatory reactions.

Childhood sarcoidosis manifesting as juvenile rheumatoid arthritis.

Sarcoidosis in childhood may manifest primarily as arthropathy and uveitis, mimicking juvenile rheumatoid arthritis. The characteristic appearance and course of the inflammation at these sites, particularly the uveitis, is often a major clue to correct diagnosis. These children generally do not have the fulminant systemic manifestations such as pulmonary disease usually ascribed to sarcoidosis.

Lymphoma of the vitreous associated with renal transplantation and immunosuppressive therapy.

A renal transplant patient presented with a uveitis unresponsive to high doses of steroids. A pars plana vitrectomy was performed for diagnosis. Light and transmission electron microscopy confirmed the diagnosis of lymphoma of the vitreous. Six percent of the renal transplant recipients develop tumors. This frequency is 100 times greater than the general population. Reticulum cell sarcoma is the predominant type being 350 times more common in renal transplant recipients than in the general population. The patient was taking immunosuppressive drugs which depress the immunologic surveillance. Antigenic neoplastic cells may arise by somatic mutations and may proliferate producing neoplasms with loss of the surveillance mechanism. The case presented illustrates that persons immunosuppressed may develop an eye tumor presenting as uveitis.

HLA-B7 in presumed ocular histoplasmosis maculopathy.

Sixty-four patients that fulfill the clinical criteria of the presumed ocular histoplasmosis syndrome were typed for common histocompatibility antigens. The clinical criteria included the presence of multiple peripheral punched out choroidal atropic scars, a clear vitreous, and compatible macular disciform lesions in at least one eye. Thirty-four patients were found to have HLA-B7, which is statistically significant at the p less than 0.005 level when compared to a normal population. Though this is statistically significant, other factors must be involved, as there still remain many patients with this clinical picture who do not demonstrate a common histocompatibility antigen.

Primary aberrant oculomotor regeneration due to intracranial aneurysm.

Two elderly patients had unilateral ophthalmoparesis and retrobulbar pain. Both had subtle lid signs of aberrant regeneration of the third nerve without proceding acute oculomotor paralysis, and both were found to have intracranial aneurysms. Although primary aberrant oculomotor regeneration has been reported previously in patients with aneurysms and meningiomas, the diagnostic importance of this sign in the elderly has not been emphasized. The presence of lid elevation on downgaze associated with slowly progressive ophthalmoplegia in patients aged 65 or older suggests aneurysm in or near the cavernous sinus.

Association of presumed ocular histoplasmosis with HLA-B7.

Thirty-one white patients who fulfilled the clinical criteria of the syndrome recognized as presumed ocular higtoplasmosis were typed for common histocompatibility antigens. These clinical criteria included the presence of multiple peripheral punched out choroidal atrophic scars, compatible macular disciform lesion in at least one eye, and clear vitreous. Seventeen out of 31 patients were found to have HLA-B7, which is statistically significant at the P less than .005 level when compared to a normal population. More patients should be tested to establish this correlation more firmly. Though this is statistically significant, other factors must be involved as there still remain many patients who fulfill the clinical criteria but do not demonstrate a common histocompatibility antigen.

Complications of chronic cyclitis.

Follow-up examinations, ranging from four to more than 20 years, were performed on 100 patients with chronic cyclitis whose ages at onset were from 4 to 58 years. Cataracts were found in 42% of eyes and macular disease secondary to macular edema in 28% of eyes. Band keratopathy, glaucoma, retinal detachment, retinoschisis, vitreous hemorrhage, retinal hemorrhage, and vessels leaving the disk margin were also noted. The complications resulting in decreased vision in chronic cyclitis were macular edema in active cases and macular degenerative changes in the late inactive stages. Of all eyes with final visual acuity of 6/12 (20/40) or less, 74% had permanent, late macular changes secondary to earlier cystoid macular edema. Vitreous opacities or cells, or both, caused decreased visual acuity in the early active stages of chronic cyclitis but were not major factors in the ultimate visual prognosis in the late inactive stages. At the final examination, vitreous opacities caused a visual loss in only 9% of the eyes that had visual acuity of 6/12 (20/40) or less. It was difficult to determine whether corticosteroids caused cataract formation and glaucoma.

Immunosuppressive treatment of uveitis.

Ten out of 31 cases of severe corticosteroid-resistant uveitis showed a good clinical response to systemic chlorambucil therapy. Cases of Behcet's syndrome, sympathetic ophthalmia, chronic cyclitis, and rheumatoid sclerouveitis seem to be in the most favorable categories to be considered for cytotoxic-immunosuppressive therapy.