Anni Karma

Course and Outcome of Ocular Sarcoidosis

In a series of 281 patients with histologically confirmed sarcoidosis, 79 initially had ophthalmic sarcoid manifestations. Of 22 patients with uveitis, 21 were seen regularly as long as the inflammation was active, and 71 of the 79 patients (90%) underwent a follow-up study five to 16 years (mean, nine years) later and using the same protocol. In the 21 patients with uveitis, the disease exhibited either a monophasic course (eight patients) with favorable visual outcome or a relapsing course (13 patients) with severe visual loss in five eyes. Thirty-three patients showed chronic ophthalmic changes at the follow-up examination, including conjunctival granulomas (13 patients), lacrimal gland involvement (22 patients), uveitis (four patients), and involvement of lacrimal passages (three patients). In 15 of these 33 patients, the general physical examination and the chest x-ray showed no evidence of systemic sarcoidosis. However, the serum angiotensin converting enzyme level was increased in a significantly greater proportion of these 15 patients than in the patients assessed as totally recovered from sarcoidosis.

Chlamydial antibodies in patients with previous acute anterior uveitis

PURPOSE To determine the prevalence of antibodies to Chlamydia pneumoniae, C. trachomatis, and C. pneumoniae heat shock protein (Cpn Hsp60) in patients with acute anterior uveitis (AAU) and in sex- and age-matched healthy control subjects. METHODS Altogether 64 patients with previous AAU were examined at the Helsinki University Eye Hospital from September through December 1999. Serum specimens from the patients and sex- and age-matched healthy control subjects were tested for antibodies to C. pneumoniae and C. trachomatis by a specific microimmunofluorescence test and for antibodies to Cpn Hsp60 by enzyme immunoassay (EIA). RESULTS The prevalence of antibodies to C. pneumoniae (69% vs. 72%) and C. trachomatis (11% vs. 6%) did not differ significantly between the patients and control subjects, nor did the level of IgG antibodies to Cpn Hsp60 (median EIA unit, 65 vs. 48). The levels of IgA antibodies to Cpn Hsp60 were significantly higher in the patients with AAU than in the control subjects (median EIA unit, 18 vs. 10; two-tailed Wilcoxon signed rank test, P = 0.0001). CONCLUSIONS The high frequency of IgA antibodies to Cpn Hsp60 in patients with past AAU indicates that such patients may have persisting or recurrent infections due to C. pneumoniae. This finding suggests that C. pneumoniae may play a role in the pathogenesis of AAU.

Conjunctival biopsy in sarcoidosis

in 177 c a s e s . Gastrointestinal and lumbosacral X-rays had occasionally diagnostic significance in i r i t i s . Of the 495 c a s e s with undetermined aetiology, 40 had leucocytosis ( -lO.OOO), 74 abnormal differential, 148 increased ( ~ 2 0 ) ESR, 20 pyelonephritis, 14 pulmonary infections, 59 sinusitis and 23 dental afflictions. We found 10 famil ies with two c a s e s of i r i t i s in the same family. Determination of the HL-A antigens in four families showed the antigen 27 (haplotype 2.27) in a l l cases of i r i t i s and in 22 of 33 healthy family members (Saari et a l . 1975). We conclude that it i s useful to determine leucocytes, differential, ESR, AST, chest , s inus and dental X-rays in a l l types of uveitis; and in addition ASTA, rheumatoid factor and ur inalysis and, when needed, gastrointestinal and lumbosacral X-rays in i r i t is ; and toxoplasma serology in chorioretinitis. The resu l t s showed that the susceptibility to i r i t i s i s a familial d i sorder developing after cer ta in provocations. Thus a l so a focal infection may provoke i r i t i s .

OPHTHALMOLOGIC AND GENETIC ASPECTS OF WILSON'S DISEASE: Hepatolenticular Degeneration

The study comprised two pairs of siblings with Wilsons disease and the 44 family members living in the same locality. Ophthalmologic examination as well as determination of serum copper and caeruloplasmin concentration were performed on all subjects. In the patients with Wilsons disease a liver biopsy specimen was examined by light microscopy. The last of the four cases had no physical sign of the disease. In the three symptomatic patients the finding that led to the diagnosis was the Kayser‐Fleischer ring. The asymptomatic patient had no such ring.

DARK ADAPTATION IN DICHROMATS AND ANOMALOUS TRICHROMATS

Dark adaptation involves a rapid cone adaptation followed by a slower rod adaptation. The photochemical reactions and nerve mechanisms in rod adaptation are incompletely known, and even less is known about cone adaptation. If the dark adaptation of a healthy subject is plotted on a semilogarithmic scale, the curve takes a given shape. This shape is governed by the retinal region measured, the insensity, duration and wave-length of the preadaptation light, and the duration and wave-length of the light stimulus. Denden (1964, 1966 and 1967) (1, 2, 3) reported on studies of dichromats and anomalous trichromats and their dark adaptation to white light. The results varied, and no conclusive differences compared with the normal adaptation curves emerged. The purpose of the present study was to discover whether this method was capable of bringing to light differences in the adaptation curves of dichromats and anomalous trichromats, compared with normal curves.