T.F. Schlaegel

A review (1970-1980) of 28 presumptive cases of syphilitic uveitis.

We classified 1.1% of our uveitis cases from 1970 to 1980 as presumably caused by syphilis. We did not initially suspect syphilis in most of these 28 patients. None of the women and only half of the men had reactive VDRL tests. If the fluorescent-treponemal-antibody absorption test had not been used, three-fourths of these would have gone undiagnosed.

Bilateral Acute Retinal Necrosis

A 20-year-old woman lost all useful vision over a 2 1/2-month period as a result of a necrotizing and occlusive vasculitis of the retina. Treatment with prednisone, immunosuppressants, and aspirin was unsuccessful. No systemic manifestations of the disease were found and no cause was discovered. Kodachromes and fluorescein angiograms showed the progression in one eye from normal to near total retinal necrosis. The process began with a mild venous dilation and peripheral arteritis that progressed into an obliterative vasculitis with abrupt vessel dilation, hemorrhages, and retinal swelling. This was followed by necrosis and sloughing of the retina into the vitreous. Vitreous contraction and necrotic retina produced unrepairable retinal detachments.

The Role of the Isoniazid Therapeutic Test in Tuberculous Uveitis Paralysis

Of 38 cases of uveitis examined from 1970 to 1980 in which a tuberculous cause was considered, we classified 18 as presumed tuberculous on the basis of a positive response to isoniazid. We compared these patients to a control group who had a positive skin test but a negative response to the isoniazid therapeutic test. We found a family history of tuberculosis in seven of the 18 (P less than .05) and a more common (18 of 36 eyes) incidence of iridocyclitis (P less than .05) than of other types of uveitis. A uveitis patient who has a positive tuberculin skin test of any size or strength should undergo the isoniazid therapeutic test to ensure that a possible diagnosis of tuberculous uveitis is not missed. Tuberculosis should be suspected in both granulomatous and non granulomatous uveal lesions, especially in cases of chronic iridocyclitis.

The tuberculin skin test in the diagnosis of tuberculous uveitis.

Of 18 patients (seven men and 11 women, ranging in age from 15 to 63 years) with presumed tuberculous uveitis seen between 1970 and 1982, 11 had intermediate-strength tuberculin skin test responses of less than 10 mm of induration. Similarly, nine had intermediate-strength responses of less than 5 mm of induration. Thus, any response of erythema or induration may be significant in the diagnosis of tuberculous uveitis and evidence enough for further testing with an isoniazid therapeutic trial.

A comparison of the intraocular reactions of rabbits to yeast-phase and mycelial-phase histoplasmin*

Rabbits given intravitreal or suprachoroidal injections of yeast-phase or mycelial-phase histoplasmin developed endophthalmitis. The degree of this reaction could be influenced by intradermal injection of the antigen prior to intrabulbar injection. Intradermal injection of yeast-phase histoplasmin enhanced the endophthalmitis, whereas injection of mycelial-phase histoplasmin depressed it.