Limited gallium scans and angiotensin converting enzyme in granulomatous uveitis.

The use of serum angiotensin converting enzyme (ACE) and limited gallium scans of the head, neck, and chest for patients with granulomatous uveitis is described. Mean serum ACE activity was elevated in patients with granulomatous uveitis regardless of the presence of systemic sarcoidosis. Furthermore, pathologic gallium uptake was noted in lacrimal glands, parotid glands, and lungs in some cases. These results indicate that sarcoidosis may be more common than previously believed in these patients.

Uveitis associated with sarcoidosis and angiotensin converting enzyme.

We evaluated serum angiotensin converting enzyme activity in three groups of patients as follows: 20 patients with systemic sarcoidosis and ophthalmic manifestations of the disease (Group 1); 27 patients with granulomatous uveitis and no evidence of systemic sarcoidosis (Group 2); and 17 patients with well-defined uveitis syndromes, both granulomatous and nongranulomatous (Group 3). Serum angiotensin converting enzyme activity in control subjects was 22.0 +/- 0.7 nanomol/min/ml (mean +/- S.E.). Compared to control subjects, serum angiotensin converting enzyme activity was significantly increased in Groups 1 and 2 for patients not using corticosteroids (57.9 +/- 7.4 and 41.5 +/- 4.4 nanomal/min/ml, respectively) as well as those using corticosteroids (40.3 +/- 5.1 and 35.6 +/- 4.8 nanomal/min/ml). Enzyme activity was not significantly different from controls for Group 3. Our study shows that the increase of serum angiotensin converting enzyme activity in some patients with granulomatous uveitis is strong evidence of sarcoid uveitis even in the absence of clinicoradiographic or histologic findings of systemic sarcoidosis.

Angiotensin-converting enzyme in sarcoid uveitis.

The diagnosis of ocular sarcoid is presumptive in the absence of systemic disease. The association of elevated serum angiotensin-converting enzyme (ACE) levels with active systemic sarcoid has been well described. With a sensitive fluorimetric assay for ACE, we found that five of ten chronic granulomatous uveitis patients without systemic sarcoid had elevated serum ACE levels. None of ten patients with uveitis of known etiology had elevated serum ACE levels. We believe that the association of an elevated serum ACE level with chronic granulomatous uveitis suggests the diagnosis of ocular sarcoid.

Uveitis associated with sarcoidosis and angiotensin converting enzyme.

Sarcoid uveitis is usually a presumptive diagnosis based on the simultaneous presence of uveitis and clinicoradiographic or histologic findings of sarcoidosis. The elevation of serum ACE in some patients with granulomatous uveitis is strongly presumptive of sarcoid uveitis even in the absence of these findings. Serum ACE may prove to be a useful indicator of ocular sarcoid in the absence of otherwise undetectable systemic disease.

Anterior uveitis in geographic or serpiginous choroiditis.

A 51-year-old man and a 45-year-old man had geographic or serpiginous choroiditis and anterior uveitis as shown by ophthalmoscopy and fluorescein angiography. Anterior uveitis, a previously undescribed feature of this disease, was found in both patients. Despite clear-cut evidence of inflammatory disease, corticosteroid therapy generally proved to be ineffective.

HLA antigens and toxoplasmic retinochoroiditis.

HLA (Human Leukocyte-A) antigens of 20 patients with toxoplasmic retinochoroiditis were determined by the standard microlymphocyte cytotoxicity test to see if these patients have different immunogenetic backgrounds from the normal controls. The results showed that there were no significant differences between the patients and the normal controls.

Vogt-Koyanagi-Harada syndrome.

We studied 51 patients who developed Vogt-Koyanagi-Harada (V-K-H) syndrome after corticosteroid therapy. The final visual acuity was better than 6/15 (20/50) in 50%, and less than 6/60 (20/200) in 25% of the patients. The severity and extraocular manifestations of this disease also appeared to be less than observed in patients before the clinical use of corticosteroids. Corticosteroid therapy probably altered the clinical picture in this disease, although other possibilities, including a skewed patient population, may account for these differences.

HLA antigens and uveitis.

We have studied the antigen frequencies in a group of adult patients with acute and chronic iridocyclitis and chronic, cyclitis. In patients with iridocyclitis a statistically significant increased incidence of HLA-B27 was noted, even in those patients without joint or systemic disease. Patients with chronic iridocyclitis also were noted to have an increased incidence of B27; however, those patients with chronic cyclitis did not. On the basis of HLA-B27 studies there appears to be a fundamental difference between adult and juvenile iridocyclitis.

HLA antigens and antinuclear antibody titres in juvenile chronic iridocyclitis.

HLA antigen frequencies and antinuclear antibody titres were studied in 43 patients with juvenile chronic iridocyclitis. We did not detect an increased incidence of HLA-B27 in patients having chronic iridocyclitis associated with juvenile rheumatoid arthritis or in patients with "chronic iridocyclitis in young girls". Both groups of patients had a statistically significant increased incidence of antinuclear antibodies. However, these antibodies were detected more frequently in patients with chronic iridocyclitis associated with JRA than in patients with "chronic iridocyclitis in young girls".

Oculogenital transmission of type 2 herpes simplex virus in adults.

Type 2 (genital) herpes simplex virus (HSV-2) was isolated from three patients (two adults and an 11-year-old girl) with acute ocular infections. Two of these patients had acute blepharoconjunctivitis and one had acute keratoconjunctivitis. Genital herpes infections had preceded the eye infections in the two adults. This was not the case in the 11-year-old, but she had been in close contact with her sister who had apparently had the genital disease. The study strongly suggests transmission of HSV-2 from the genital site to the eye.

Optic disk neovascularization associated with chronic uveitis.

Disk neovascularization associated with chronic uvetitis occurred in five patients. The uveitis was most frequently diagnosed as chronic cyclitis, with a marked inflammatory cell response in the vitreous body. Using direct and indirect ophthalmoscopy, slit-lamp biomicroscopy with the Goldmann contact lens, perimetry, and fluorescein angiography and angioscopy, we found no areas of vascular occlusion or nonperfusion. Inflammation probably produced chemical mediators capable of traveling to the optic disk and inducing neovascular proliferation, in the absence of retinal vascular occlusion.

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.

Acute ocular infection by type 2 herpes simplex virus in adults.

Acute ocular infections in two adults were caused by type 2 herpes simplex virus (HSV) ("genital herpesvirus"). One patient had an acute blepharoconjunctivitis, the other an acute keratoconjunctivitis. Genital infections had preceded the eye infections, and type 2 HSV was isolated from the eyes of both patients and from the genital lesions of one patient. This strongly suggests transmission of type 2 HSV from the genital site to the eye.

Iridocyclitis associated with juvenile rheumatoid arthritis.

In a study of 45 patients, those with monarticular and pauciarticular juvenile rheumatoid arthritis, and with antinuclear antibodies, were likely also to have chronic, persistent iridocyclitis. In cases where iridocyclitis was present, topical mydriatics were used to prevent formation of posterior synechiae. Topical corticosteroids were used but discontinued if the uveitis failed to respond. Despite the generally poor prognosis for the vision of these patients, surgery for complicated cataract was often successful.