John V. Forrester

Inflammatory choroidal neovascular membrane in presumed ocular Lyme borreliosis

Introduction:  Lyme disease is a multisystemic disease with protean ocular manifestations. We describe the occurrence of inflammatory choroidal neovascular membrane (CNVM) in two patients suffering from presumed Lyme disease.

Resolution of juvenile idiopathic arthritis-associated uveitis after development of common variable immunodeficiency

Purpose To describe the occurrence of common variable immunodeficiency (CVID) in a patient with juvenile idiopathic arthritis (JIA) and JIA-associated uveitis. Methods/Results Case report. A 29-year-old woman was followed-up since the age of 10 years because of right eye JIA-associated recurrent anterior uveitis. She was treated with steroids and immunosuppressants with good control of uveitis and arthritis. At the age of 17 years, she did not experience any further relapse of uveitis or arthritis and both diseases were considered to be in remission. Concomitantly, she started to have recurrent infections and later she underwent splenectomy because of autoimmune hemolytic anemia and thrombocytopenia. Liver biopsy disclosed granulomatous hepatitis. She was ultimately diagnosed with CVID at the age of 23 years when her blood tests revealed neutropenia and severe panhypogammaglobulinemia. She has been treated since then with intravenous immunoglobulins with good control of the disease. Since the development of CVID, she has had no relapses of uveitis or arthritis during a follow-up period of 12 years. Conclusions Common variable immunodeficiency (CVID) is the most common primary immunodeficiency where defective antibody formation is the most common feature with B-cell differentiation failure. Ocular complications have been rarely documented and included bacterial conjunctivitis, retinal vasculitis and multifocal choroiditis. We herein report on the occurrence of JIA-associated uveitis as a comorbid manifestation of CVID. We speculate a role for B cells in the pathogenesis of JIA and JIA-associated uveitis here, as this patient had total remission of both conditions with the onset of CVID.

Uveitis associated with immunoglobulin E-mediated allergic diseases.

Atopic dermatitis and food allergy are typically associated with elevated IgE levels. Ocular involvement in atopic dermatitis is usually limited to the ocular surface and ocular adnexae. We herein report on the unusual association of these two conditions with uveitis in two patients and describe the ocular and systemic outcome following the institution of systemic immunosuppression.

Immunotherapy for ocular inflammatory disease

Uveitis has been defined as inflammation of the uveal tract (iris, ciliary body, or choroid).More recently it has been recharacterised as intraocular inflammation (IOI) since many forms of uveitis involve intraocular structures such as the retina,vitreous, and even the lens(Forrester et al. 1998).

Cyclosporin A and intraocular inflammatory disease

Although the benefits of cyclosporin A (CsA) therapy in various transplantation procedures had been clearly recognized for some time, the introduction of CsA to ophthalmology did not occur until 1980 when the drug was used on an experimental model of autoimmune ocular inflammation, namely experimental autoimmune uveoretinitis (EAU)1. That it was not first used for transplantation management in ophthalmology was in part due to the low rate of corneal graft rejection compared to renal or cardiac graft rejection and, if rejection did occur, it was often controlled satisfactorily with topical steroids provided it was diagnosed sufficiently early. However, the early use of CsA in EAU also reflected a continuing major clinical problem in ophthalmology, namely endogenous posterior uveitis. Posterior uveitis, a significant cause of blindness in the USA and other countries2, is probably autoimmune in nature, at least in some of its clinical forms, and is often refractory to treatment even with systemic steroids. Some special forms of uveitis such as Behcet’s disease are highly prevalent in certain geographical regions such as the Middle East, Turkey and Japan, and represent a considerable morbidity in these countries.