Dong H. Shin

The Pigment Dispersion Syndrome

The pigment dispersion syndrome was noted in 10% of white and black subjects with and without glaucoma. This suggested pigment dispersion was not a high risk factor in the development of glaucoma. The HLA-B7 antigen was less prevalent and HLA-B13 and Bw17 antigens were significantly more prevalent in individuals with the pigment dispersion syndrome than in subjects without the syndrome. Either HLA-B13 or Bw17 antigen was found in 23 (77%) of 30 patients with the pigment dispersion syndrome and in only 13 (6%) of the 203 subjects without pigment dispersion. Pigmentary glaucoma was characterized by a significantly higher prevalence of combinations of HLA-B12 and B13 or HLA-B12 and Bw17 antigens as compared to the pigment dispersion syndrome without glaucoma, primary open-angle glaucoma, or the general population. This suggested that pigmentary glaucoma differed genetically from primary open-angle glaucoma and was a separate entity.

Low-Dose Methazolamide and Intraocular Pressure

Sixteen patients with increased intraocular pressure (over 20 mm Hg) received 25 and 50 mg of oral methazolamide, twice daily, during consecutive weeks and then 500 mg (Sequels) of acetazolamide. The two methazolamide regimens produced significant decreases in intraocular pressure. Acetazolamide treatment resulted in a greater decrease in intraocular pressure but more systemic acidosis and side effects.

Histocompatibility Antigens and Diabetic Retinopathy

Of 160 patients with onset of diabetes at or after 30 years of age, the 84 with no evidence of diabetic retinopathy were found to have significantly increased prevalences of HLA-Al and B8 when compared with the 76 with retinal complications or with the 282 healthy blood donors. In addition, in 90 patients with onset of diabetes before age 30 years, we could confirm the reported significant increase of HLA-B8 and decrease of B7, but no differences were noted between those juvenile-onset diabetics with and those without retinopathy.

The Prognostic Value of Hla-B12 and Hla-B7 Antigens in Patients by Increased Intraocular Pressure

The presence of the histocompatibility antigens HLA-B12 or HLA-B7 in 76 patients with increased intraocular pressure and a GG response to topical corticosteroids (intraocular pressure over 31 mm Hg after six weeks of topical 0.1% dexamethasone eyedrops, four times daily) correlated with the development of glaucomatous visual field loss. In close agreement with prevalences in patients with primary open-angle glaucoma, 14 (88%) of the 16 patients with increased intraocular pressure and a GG response who developed glaucomatous visual field loss had either HLA-B12 or B7 antigens. Fourteen (41%) of 34 patients with increased intraocular pressure and a GG response who had B12 or B7 antigens developed glaucomatous visual field loss but only two (5%) of 42 similar patients without either antigen had visual field loss. Other factors such as the initial intraocular pressure, the horizontal cup/disk ratio, and family history of glaucoma proved less valuable as prognostic indicators in this series.

The Association of Hla-B7 and Hla-B12 Antigens with Cup/Disk Ratio, Family History of Glaucoma, and Intraocular Pressure

The presence of either HLA-B7 or HLA-B12 antigens was associated with a higher prevalence of cup/disk ratios greater than 0.3 in the GG responders (intraocular pressure greater than 31 mm Hg after six weeks of topical dexamethasone 0.1%, four times daily) and in the combined NN-NG (intraocular pressure less than or equal to 31 mm Hg) groups. The presence of either antigen was associated with a higher prevalence of a family history of glaucoma in the GG group. N association was noted between the antigens and age, sex, race, or mean intraocular pressure in either of the groups studied.

Positive FTA-ABS Tests in Subjects with Corticosteroid-Induced Uveitis

Of 17 subjects who developed severe anterior nongranulomatous uveitis during or immediatelyy after testing with topical corticosteroid preparations, 14 (82%) had a positive fluorescent-treponemal-antibody absorption (FTA-ABS) test. No association was found between corticosteroid-induced uveitis and any specific HL-A locus.

Prognostic Value of HLA-A 3, BW 35, B 7, and B12 in Ocular Hypertension

The prevalences of HLA-A 3, BW 35, B 7 and B 12 in 80 Caucasian patients with ocular hypertension were intermediate between values found in ocular normotensives and in patients with primary open-angle glaucoma. The presence of HLA-B 7 or B 12 had significant predictive value for the development of glaucomatous damage to the optic nerve in patients with ocular hypertension. The HLA-A 3 antigen by itself, or in combination with B 7 and B 12 did not improve the prognostic value of the B 7 and B 12 antigens. Only one of the 20 white ocular hypertensives in this series with HLA BW 35 antigen developed glaucomatous visual field loss.

HLA in Primary Open-Angle Glaucoma

Histocompatibility antigen typing was carried out in 50 Caucasian patients with primary open-angle glaucoma (POAG) and 50 Caucasian ocular-normotensive subjects. HLA-A 3 was present in 46%, B7 in 52%, B12 in 50%, and either B7 or B12 in 88% of p,tients with POAG. These prevalences in POAG patients were significantly greater than in ocular-normotensive subjects (p less than 0.01, p less than 0.0005, p less than 0.001, and p less than less than 0.0005, respectively). The prevalences of A 3-B 7, A 3-B 12 and either combination were also significantly greater in POAG patients than in the ocular normotensives (p less than 0.005, p less than 0.005, and p less than 0.0005, respectively). HLA-BW 35 was noted to be in deficit in Caucasian POAG patients (8%) as compared to Caucasian ocular normotensives (32%; p less than 0.01).

Topical Corticosteroid Response and Retinopathy in Juvenile-onset Diabetes Mellitus

In a prospective study, 64 patients with insulin-dependent juvenile-onset diabetes mellitus were followed for eight to 12 years to determine if those with higher spontaneous intraocular pressures (IOPs) would be protected from the development of retinopathy. The patients were also classified initially as high (GG), intermediate (NG), or low (NN) responders on the basis of their IOP response to corticosteroid eyedrops. High responders were found to be considerably in excess (25 per cent) of the proportion found in the general population (6 per cent). Retinopathy developed significantly less often and was less severe in the high (GG) corticosteroid responders. Although the GG diabetics had significantly higher mean baseline IOPs than the less responsive NN and NG groups in each corticosteroid response category, the mean IOP of the group with retinopathy was not significantly different from that without retinopathy. This suggested that factors associated with the GG response other than increased IOP might be important in the relative resistance to diabetic retinopathy.