Samuel J. Kimura

Vogt-Koyanagi-Harada Syndrome

We studied 51 patients who developed Vogt-Koyanagi-Harada (V-K-H) syndrome after corticosteroid therapy. The final visual acuity was better than 6/15 (20/50) in 50%, and less than 6/60 (20/200) in 25% of the patients. The severity and extraocular manifestations of this disease also appeared to be less than observed in patients before the clinical use of corticosteroids. Corticosteroid therapy probably altered the clinical picture in this disease, although other possibilities, including a skewed patient population, may account for these differences.

Iridocyclitis Associated with Juvenile Rheumatoid Arthritis

In a study of 45 patients, those with monarticular and pauciarticular juvenile rheumatoid arthritis, and with antinuclear antibodies, were likely also to have chronic, persistent iridocyclitis. In cases where iridocyclitis was present, topical mydriatics were used to prevent formation of posterior synechiae. Topical corticosteroids were used but discontinued if the uveitis failed to respond. Despite the generally poor prognosis for the vision of these patients, surgery for complicated cataract was often successful.

Complications of Chronic Cyclitis

Follow-up examinations, ranging from four to more than 20 years, were performed on 100 patients with chronic cyclitis whose ages at onset were from 4 to 58 years. Cataracts were found in 42% of eyes and macular disease secondary to macular edema in 28% of eyes. Band keratopathy, glaucoma, retinal detachment, retinoschisis, vitreous hemorrhage, retinal hemorrhage, and vessels leaving the disk margin were also noted. The complications resulting in decreased vision in chronic cyclitis were macular edema in active cases and macular degenerative changes in the late inactive stages. Of all eyes with final visual acuity of 6/12 (20/40) or less, 74% had permanent, late macular changes secondary to earlier cystoid macular edema. Vitreous opacities or cells, or both, caused decreased visual acuity in the early active stages of chronic cyclitis but were not major factors in the ultimate visual prognosis in the late inactive stages. At the final examination, vitreous opacities caused a visual loss in only 9% of the eyes that had visual acuity of 6/12 (20/40) or less. It was difficult to determine whether corticosteroids caused cataract formation and glaucoma.

Uveitis Associated with Sarcoidosis and Angiotensin Converting Enzyme

We evaluated serum angiotensin converting enzyme activity in three groups of patients as follows: 20 patients with systemic sarcoidosis and ophthalmic manifestations of the disease (Group 1); 27 patients with granulomatous uveitis and no evidence of systemic sarcoidosis (Group 2); and 17 patients with well-defined uveitis syndromes, both granulomatous and nongranulomatous (Group 3). Serum angiotensin converting enzyme activity in control subjects was 22.0 +/- 0.7 nanomol/min/ml (mean +/- S.E.). Compared to control subjects, serum angiotensin converting enzyme activity was significantly increased in Groups 1 and 2 for patients not using corticosteroids (57.9 +/- 7.4 and 41.5 +/- 4.4 nanomal/min/ml, respectively) as well as those using corticosteroids (40.3 +/- 5.1 and 35.6 +/- 4.8 nanomal/min/ml). Enzyme activity was not significantly different from controls for Group 3. Our study shows that the increase of serum angiotensin converting enzyme activity in some patients with granulomatous uveitis is strong evidence of sarcoid uveitis even in the absence of clinicoradiographic or histologic findings of systemic sarcoidosis.

Optic Disk Neovascularization Associated with Chronic Uveitis

Disk neovascularization associated with chronic uvetitis occurred in five patients. The uveitis was most frequently diagnosed as chronic cyclitis, with a marked inflammatory cell response in the vitreous body. Using direct and indirect ophthalmoscopy, slit-lamp biomicroscopy with the Goldmann contact lens, perimetry, and fluorescein angiography and angioscopy, we found no areas of vascular occlusion or nonperfusion. Inflammation probably produced chemical mediators capable of traveling to the optic disk and inducing neovascular proliferation, in the absence of retinal vascular occlusion.

Anterior Uveitis in Geographic or Serpiginous Choroiditis

A 51-year-old man and a 45-year-old man had geographic or serpiginous choroiditis and anterior uveitis as shown by ophthalmoscopy and fluorescein angiography. Anterior uveitis, a previously undescribed feature of this disease, was found in both patients. Despite clear-cut evidence of inflammatory disease, corticosteroid therapy generally proved to be ineffective.

Limited Gallium Scans and Angiotensin Converting Enzyme in Granulomatous Uveitis

The use of serum angiotensin converting enzyme (ACE) and limited gallium scans of the head, neck, and chest for patients with granulomatous uveitis is described. Mean serum ACE activity was elevated in patients with granulomatous uveitis regardless of the presence of systemic sarcoidosis. Furthermore, pathologic gallium uptake was noted in lacrimal glands, parotid glands, and lungs in some cases. These results indicate that sarcoidosis may be more common than previously believed in these patients.

Oculogenital transmission of type 2 herpes simplex virus in adults

Type 2 (genital) herpes simplex virus (HSV-2) was isolated from three patients (two adults and an 11-year-old girl) with acute ocular infections. Two of these patients had acute blepharoconjunctivitis and one had acute keratoconjunctivitis. Genital herpes infections had preceded the eye infections in the two adults. This was not the case in the 11-year-old, but she had been in close contact with her sister who had apparently had the genital disease. The study strongly suggests transmission of HSV-2 from the genital site to the eye.

Uveitis in children.

The treatement of children who have this serious disease requires more than specific or nonsecific therapy. Every affected child needs the combined care of his mother, the nurse, the pediatrician, and the ophthalmologist.