B Cell Anomalies in Autoimmune Retinopathy (AIR).

Purpose: Autoimmune retinopathy (AIR) is a retinopathy associated with unexplained vision loss presumably linked to circulating antiretinal antibodies; currently, however, there are no standardized criteria regarding the diagnosis, treatment strategy, or pathogenesis of this disease. The importance of B-lymphocyte immunophenotyping in the classification of AIR is unknown. Methods: We utilized 15-color multiparametric flow cytometry to identify aberrations in B cell subsets that may contribute to the pathophysiology of AIR. Luminex cytokine analysis was also performed on plasma samples from AIR patients. Results: Significant differences in AIR patients compared to individuals with other inflammatory conditions or healthy donors were found in the B cell memory compartment, including an increase in naïve B cells and a decrease in switched and unswitched memory B cells, which correlated with alterations in immunoglobulin secretion. Conclusions: These findings suggest that the maturation process of B cells may be impaired and that B cell immunophenotyping may help in understanding disease process in AIR.

Haematological, biochemical and inflammatory parameters in inactive Behçet's disease. Its association with red blood cell distribution width.

Red blood cell distribution width (RDW) has been shown to be associated with disease activity in several inflammatory disorders. However only one study to show this has been conducted in patients with Behçet's disease (BD). The aim of the present study was to analyse the association of RDW with BD and its main complications; i.e.; thrombosis and posterior uveitis. A second aim was to analyse the possible correlation between RDW and both haematological and inflammatory parameters. Eighty-nine patients with BD (48 males/41 females) and 94 controls (49 males/45 females) were included in the study. Patients were in an inactive phase of the disease, showing only minimum activity. RDW was statistically higher in patients than in controls (14.02 ± 1.32 vs. 13.15 ± 0.75; p < 0.001) as were CRP, fibrinogen, leucocytes and neutrophils (p < 0.001). No differences in haematimetric indices (MCV, MCH, MCHC) were observed (p > 0.05). RDW correlated negatively with haemoglobin, MCH and MCHC (p < 0.05), and directly with homocysteine (p < 0.01). No correlation was found between RDW and the several inflammatory parameters analysed (p > 0.05). The multivariate regression analysis revealed that haemoglobin and homocysteine were independent predictors of RDW (beta coefficient: -0.310; p = 0.003, beta coefficient: 0.379; p < 0.001, respectively). RDW >14 was associated with neither thrombosis nor uveitis (p = 0.935; p = 0.553, respectively). Our results indicate that BD patients show increased RDW when compared with controls. This increase seems to be related with haematimetric indices and with homocysteine levels. Lack of correlation with inflammatory markers may be due to the fact that patients were in an inactive phase of the disease.

Mean platelet volume does not seem to relate to thrombosis or posterior uveitis in Behçet's disease.

Behçet's disease (BD) is a chronic inflammatory disorder in which thrombosis and posterior ocular involvement occur in about 30% of patients, whose ethiology is unknown. It has not been established whether mean platelet volume (MPV), a marker of platelet activation, is involved in the pathogenesis of thrombotic events and posterior uveitis in these patients. We aimed to analyze whether there are differences in MPV in BD patients when compared with controls and its relation with the presence of thrombosis and posterior uveitis. We determined MPV and platelet count, along with C-reactive protein (CRP) and cardiovascular risk factors (because of their influence on MPV) in 89 BD patients (of which 24 had thrombosis and 23 had posterior uveitis) and 89 sex- and age-matched healthy controls. BD patients showed statistically higher MPV than controls: 10.98 ± 1.19 fL vs. 10.60 ± 1.21 fL (P = 0.044) and higher CRP: 5.9 ± 8.9 mg/L vs. 1.4 ± 1.7 mg/L (P = 0.001). The percentage of hyperlipemia and diabetes was higher in cases than in controls (P = 0.032, P = 0.013, respectively). No differences in MPV were observed when comparing: patients with and without thrombosis: 11.8 ± 1.27 fL vs. 10.94 ± 1.28 fL (P = 0.654); with and without posterior uveitis: 10.76 ± 1.18 fL vs. 11.03 ± 1.30 fL P = 0.398; with CRP and cardiovascular risk factors (P > 0.05). MPV correlated negatively with platelet count (r = -308, P < 0.01), but not with CRP (r = -0.22, P = 0.772). MPV seems to relate to neither thrombosis nor posterior uveitis in BD patients.

Inflammatory mediators and posterior segment involvement in ocular Behcet disease.

PURPOSE: To assess the serum level of mediators and their relation with posterior ocular involvement in patients with Behcet disease (BD). METHODS: This study was a prospective, institutional clinical trial including 43 patients with ocular BD. Patients were divided into two subgroups: those with active posterior segment involvement (Group A) and those with inactive ocular BD (Group B). Group A included patients with posterior uveitis (vitritis or chorioretinal involvement), while Group B included patients with no active intraocular inflammation within the last 3 months. Serum levels of interleukin (IL)-6, IL-8, tumor necrosis factor alpha (TNF-alpha), vascular endothelial growth factor (VEGF), and malondialdehyde (MDA) were measured by sandwich enzyme-linked immunosorbent assay and spectrophotometric assay and compared among the groups by independent sample t test and Mann-Whitney U-test. RESULTS: Serum levels of the mediators in Group A (IL-6 [23.1 pg/mL], IL-8 [161.1 pg/mL], TNF-alpha [30.5 pg/mL], VEGF [455.9 pg/mL], MDA [10.7 microm]) were found to be significantly higher than those in Group B (IL-6 [12.2 pg/mL], IL-8 [48.4 pg/mL], TNF-alpha [18.6 pg/mL], VEGF [138.0 pg/mL], MDA [5.1 microm]). CONCLUSIONS: This study demonstrated that increased serum levels of inflammatory mediators including IL-6, IL-8, TNF-alpha, VEGF, and MDA were possibly involved in the development of posterior uveitis in BD.

Basic parameters of thrombophilia in ocular Behçet disease with posterior segment involvement.

AIM: To assess basic thrombophilic parameters in both active and inactive periods of the ocular Behçet disease (BD) with posterior segment involvement in comparison with those in healthy adults as controls. METHOD: Thirty patients within the active period of the ocular BD with posterior segment involvement, 30 patients within the inactive period of the ocular BD with posterior segment involvement and 30 age-and sex-matched healthy controls were included in the study. Plasma protein C, free protein S, antithrombin III and activated protein C resistance were measured in the studied groups. RESULTS: Activated protein C resistance and antithrombin III levels were significantly altered in both active and inactive ocular BD patients when compared with those in the controls (p<0.05), whereas protein C and free protein S levels were not significantly changed within both groups (p>0.05). There was no difference among the active and inactive groups of BD for all of the studied blood tests (p>0.05). CONCLUSION: Activated protein C resistance together with increased antithrombin III plasma levels are associated with the posterior segment involvement in ocular BD based on the assessment of basic thrombophilic tests.

Serum cytokine levels in active uveitis and remission.

Serum levels of interleukin(IL)-8, IL-6, and (TNF)-alpha were measured in 25 patients during active uveitis and uveitis in remission and compared to age-matched controls. Levels of IL-8 and IL-6 were significantly elevated in patients with active disease and were decreased during remission. IL-8 levels were highest in patients with anterior uveitis, with greatest difference between active disease and remission. No consistent pattern was observed for TNF-alpha. In conclusion, serum cytokine levels are elevated in active noninfectious uveitis. The rise in IL-8 may suggest innate immune mechanisms in the acute disease, while IL-6 participates in modulation of inflammation in the chronic disease.

Malignant uveitis masking a lymphocytic lymphoma.

A multitude of diseases can present as posterior bilateral uveitis. In most cases, the cause of pericardial effusion can be determined, but in some instances, the cause is not apparent even after making a systematic and complete diagnostic evaluation. We report here an unusual case of a patient who had a B-cell lymphochytic lymphoma, which presented as bilateral posterior uveitis. The diagnosis by biopsy is described, as is the role of multiple test in the diagnosis of bilateral uveitis.

Malignant uveitis masking a lymphocytic lymphoma

A multitude of diseases can present as posterior bilateral uveitis. In most cases, the cause of pericardial effusion can be determined, but in some instances, the cause is not apparent even after making a systematic and complete diagnostic evaluation. We report here an unusual case of a patient who had a B-cell lymphochytic lymphoma, which presented as bilateral posterior uveitis. The diagnosis by biopsy is described, as is the role of multiple test in the diagnosis of bilateral uveitis (AU)

Anti-toxoplasma serotitres in uveitis and ocular toxoplasmosis.

This study was based on anti-toxoplasma serotitres obtained from 80 normal healthy adults and 103 consecutive patients with anterior, posterior and panuveitis over a 42 month period. Twelve out of 80 (15%) normal healthy sera were found to have low titres (1:64 to 1:256), while 3 (3.8%) had high titres (1:1024 or higher). The distribution of serotitres in patients with clinical toxoplasmosis was significantly different from the population sample (p less than 0.001, chi-squared test). Similarly, the distribution of serotitres in patients with posterior uveitis (of which 28 out of 54 were clinically ocular toxoplasmosis) having serotitres of 1:1024 or greater, was found to be significantly different from the normal population (p less than 0.001, Chi-squared test), but not statistically different from those with clinical ocular toxoplasmosis. Hence, anti-toxoplasma serotitre is useful as a diagnostic screening tool only in patients with posterior uveitis. It is also useful in confirming cases of suspected clinically positive ocular toxoplasmosis in our local population.

[Determining the level of malondialdehyde in patients with different types of tuberculous uveitis]. / Opredelenie malonovogo dial'degida u bol'nykh s razlichnym tipom techeniia tuberkuleznogo uveita.

A clinical follow-up of 52 tuberculous uveitis patients showed that the choice of an appropriate plan of pathogenetic treatment and prognosis of the disease outcome requires differentiation of types of a tuberculous process in the eye. A new method has been suggested for determining the type of the tuberculous uveitis course by studying changes in the blood content of malonic dialdehyde (increase, decrease or absence of changes).