Tumour necrosis factor-alpha levels in aqueous humour and serum from patients with uveitis: the involvement of HLA-B27.

OBJECTIVE: To study the local and systemic levels of the tumour necrosis factor-alpha in patients with active uveitis and to determine the implication of TNF-alpha in rheumatological uveitis and to observe if this relationship is more significant in the B27 positive patients. PATIENTS AND METHODS: Patients were selected on the basis of a diagnosis of uveitis of any aetiology. Data from 23 patients were stratified into two categories according to the presence or absence of systemic rheumatic disease. The first group comprised nine patients with rheumatic disease; the second group contained 14 patients without rheumatic disease. The patients were also sub-classified into those who were HLA-B27 positive (14 patients) and those who were not. TNF-alpha levels in serum and aqueous humour from a group of 16 patients with uncomplicated cataracts were analysed as a control group. RESULTS: In the control group (n = 16) the serum TNF-alpha concentration was 13.1 +/- 2.9 pg/ml and the aqueous humour concentration of TNF-alpha was 0.56 +/- 1.53 pg/ml. In uveitis patients (n = 23) the serum TNF-alpha concentration was 35.35 +/- 26.77 pg/ml and the aqueous humour concentration of TNF-alpha was 15.1 +/- 1.70 pg/ml (p < 0.01). In HLA-B27 positive patients (n = 9) the serum TNF-alpha concentration was 45.56 +/- 34.17 pg/ml and the aqueous humour concentration of TNF-alpha was 15.89 +/- 0.93 pg/ml. In HLA-B27 negative patients (n = 14) the serum TNF-alpha concentration was 28.79 +/- 19.38 pg/ml and aqueous humour concentration of TNF-alpha was 14.57 +/- 1.91 pg/ml (p < 0.01). CONCLUSIONS: The concentration of TNF-alpha in aqueous humour in patients who are HLA-B27 positive is significantly greater than in those who are B27 negative. No significant differences in the concentrations of TNF-alpha in serum or aqueous humour in patients with or without rheumatic diseases were detected. TNF-alpha is a cytokine that may participate actively in the pathogenesis of clinical uveitis.

Scedosporium apiospermum keratitis.

A case of Scedosporium apiospermum keratitis is reported in a 65-year-old farmer referred for treatment of an extensive corneal ulcer in the left eye. Direct examination of scrapes revealed abundant filamentous septate hyphae; all cultures were consistently positive for the same fungus, identified later as Scedosporium apiospermum. The patient successfully responded to treatment with amphotericin B.

ICAM-1 expression on the surface of T lymphocytes in patients with uveitis: a comparative study between the eye and peripheral blood.

PURPOSE: We studied the surface expression of intracellular adhesion molecule 1 (ICAM-1) on peripheral and intra-ocular T lymphocytes in patients with active uveitis. METHODS: Two-colour flow-cytometric analysis was performed on cells isolated from aqueous humour and peripheral blood of 23 patients with active uveitis and 16 control patients who were to undergo cataract extraction, in order to determine the percentage of cells expressing CD4, CD8 and ICAM-1 (CD54) molecules. RESULTS: In the aqueous humour of patients with uveitis, we found an increase in the percentage of CD4+ and CD8+ lymphocytes, co-expressing the ICAM-1 molecule as compared to control patients (p < 0.0001). In peripheral blood, these uveitis patients exhibited a significant decrease in the percentage of CD4+ICAM-1+ (p = 0.0106) and CD8+ICAM-1+ (p = 0.0014) as compared to control subjects. The comparative study of cells from the aqueous humour and peripheral blood showed that the percentage of CD4+ICAM-1+ cells was higher in the aqueous humour (p < 0.0001). Comparison of the aqueous humour and peripheral blood for CD8+ICAM-1+ cells revealed no significant differences. In addition, we found a high negative correlation for the CD8+ICAM-1+ subset between the aqueous humour and peripheral blood. CONCLUSIONS: Our results suggest a greater local participation for CD4+ICAM-1+ cells but not for CD8+ICAM-1+ cells in the pathogenesis of uveitis.