Initial trabeculectomy with mitomycin C in eyes with uveitic glaucoma with inactive uveitis

PURPOSE

To analyse clinical outcomes of trabeculectomy with mitomycin C (MMC) in eyes with uveitic glaucoma (UG) with inactive uveitis and compare them to those in eyes with primary open-angle glaucoma (POAG).

DESIGN

Retrospective non-randomized comparative interventional case series.

METHODS

A total of 53 eyes with UG and 80 eyes with POAG that received MMC trabeculectomy as an initial ocular surgery with average follow-up of 5.4 years were reviewed retrospectively. The intraocular pressure (IOP) control and persistence of filtering bleb were analysed using the Kaplan-Meier life-table method based on two definitions of successful IOP control, ie complete success (IOP<or=15 mm Hg without anti-glaucoma medications) and qualified success (IOP<or=15 mm Hg with topical anti-glaucoma medications). The incidences of postoperative complications were also examined.

RESULTS

Complete success rate for postoperative IOP control at 5 years after trabeculectomy was 57.1+/-7.5% (mean+/-SE) in UG, being comparable to that in POAG (53.7+/-6.1%), and those of qualified success was 64.7+/-7.0 and 65.9+/-5.5% (P=0.60 and 0.53) respectively. Persistence of filtrating blebs was shorter in UG than in POAG (P=0.031). Postoperative inflammation in UG was associated with worse postoperative IOP control and loss of filtering bleb (P=0.027 and 0.021). Postoperative long-standing ocular hypotony was more frequent in UG (P=0.0063).

CONCLUSIONS

An MMC trabeculectomy for UG with inactive uveitis as an initial ocular surgery had IOP control comparable to that for POAG, suggesting that pre-existing uveitis itself is not a risk factor for failure of a filtering surgery.

Heterogeneity of the fibre sequence in subgenus C adenoviruses

AIMS

To determine the nucleotide sequences of adenovirus (Ad) types 1 and 6 fibre genes; to clarify the molecular basis of the distinct haemagglutination properties of subgenus C Ads and their phylogenetic relations.

METHODS

Human Ad1 and Ad6 fibre genes were sequenced from genomic DNA by direct sequencing. Primer selection was based on alignment of the fibre gene of human Ad serotypes Ad2 and Ad5. Fibre based subgenus C specific polymerase chain reaction (PCR) was performed to check for deletions in field isolates of Ad6, as revealed by sequence analysis of the Ad6 prototype. A phylogenetic tree was constructed from the predicted amino acid (AA) sequences of the fibre gene of important Ads.

RESULTS

Ad1 and Ad6 comprise 1746 and 1584 nucleotides, encoding 582 and 528 AA, respectively. Ad6 showed deletions in motifs 15-17 (51 AA) of the shaft when compared with Ad1, Ad2, and Ad5. Subgenus C specific PCR with both prototype and field isolates also showed deletions in Ad6. In the shaft and knob, AA homology was 58.82-72.91% and 68.89-74.59%, respectively. The tail was 100% conserved. Phylogenetically, Ad1 and Ad6, including Ad2 and Ad5, formed a subgenus specific cluster, like other serotypes.

CONCLUSIONS

The fibre gene (including the knob region) of subgenus C Ads is heterogeneous, providing the molecular basis for lack of crossreactivity in the haemagglutination inhibition test. This heterogeneity could be helpful in fibre based genotyping of subgenus C field isolates. Phylogeny might be useful for subgenus specific identification of important field strains.

Serological and genetic characterisation of a unique strain of adenovirus involved in an outbreak of epidemic keratoconjunctivitis

AIMS

To characterise a novel strain of adenovirus (Ad) type Ad8 (genome type Ad8I) involved in an epidemic keratoconjunctivitis (EKC) outbreak in Hiroshima city using serological testing and sequence analysis of the fibre and hexon gene.

METHODS

A neutralisation test (NT) was performed in microtitre plates containing a confluent monolayer of A549 cells using 100 tissue culture infectious doses of virus and type specific antisera. The haemagglutination inhibition test was also carried out in microtitre plates with rat erythrocytes using four haemagglutination units of virus and twofold dilutions of serum. The fibre gene was sequenced by generating overlapping polymerase chain reaction products or by direct sequencing of genomic DNA. Primer selection was based on alignment of the fibre genes of human adenovirus serotypes Ad8, Ad19, Ad37, Ad9, and Ad15 available from Gene Bank.

RESULTS

The virus strain was specifically neutralised by anti-Ad8 antibodies, although there was a major crossreaction with anti-Ad9 antibodies. Haemagglutination was equally inhibited by anti-Ad8 and anti-Ad9 antibodies. The predicted amino acid sequences of the hypervariable regions (HVRs) of the Ad8I hexon gene showed higher homology with Ad9 (83.3%) than with Ad8 (62.0%). However, the Ad8I fibre knob was more homologous to Ad8 (94.4%) than to Ad9 (91.6%).

CONCLUSIONS

Ad8I is a unique strain of adenovirus because of its lower genomic homology with Ad8, major crossreactivity with Ad9 in NT, and mixed genetic organisation of HVRs of the hexon gene. These factors may have enabled the virus to circumvent acquired immunity, resulting in the outbreak.

Characterisation of hexon and fibre genes of a novel strain of adenovirus involved in epidemic keratoconjunctivitis

AIMS

To characterise a novel strain (M86) of adenovirus (Ad) involved in epidemic keratoconjunctivitis (EKC).

METHODS/RESULTS

The virus strain was neutralised by antisera to both Ad35 and Ad11. Restriction endonuclease analysis of genomic DNA showed 98% and 88% homology with Ad11 and Ad35, respectively. The deduced amino acid sequence of the hypervariable regions of (HVRs) of the hexon gene showed a higher homology with Ad35 (94.4%) than with Ad11 (83.7%). However, it was 100% homologous to Ad35 in HVRs 1, 2, 3, and 6 and to Ad11 in HVRs 4 and 6. In the fibre knob, the isolate was more homologous to Ad11 (99.4%) than to Ad35 (29.1%).

CONCLUSION

This novel strain of adenovirus showed similarities with both Ad11 and Ad35. The isolation of a novel strain like Ad35+11 is important because of its association with EKC.

Genetic characterisation of adenovirus type 8 isolated in Hiroshima city over a 15 year period

AIMS

To investigate the genetic differences among the strains of adenovirus type 8 (Ad8) circulating in Hiroshima city, Japan, and to study their circulation pattern.

METHODS

One hundred and twenty nine strains of adenovirus type 8 (Ad8) were isolated in Hiroshima City over a 15 year period (1983-97) from patients with keratoconjunctivitis, and analysed with six restriction enzymes-BamHI, HindIII, PstI, SacI, SalI, and SmaI-to investigate possible relations among the isolates and their genetic variability. Seven hypervariable regions of the hexon gene that carry the type specific epitope were also sequenced to investigate the variation among the genome types.

RESULTS

Restriction endonuclease analyses yielded three known genome types (Ad8A, 13 samples; Ad8B, seven samples; and Ad8E, 35 samples) and a novel genome type (Ad8I, 74 samples). Ad8A, Ad8B, and Ad8E were closely related, with 96% homology, whereas Ad8I had only 71% homology. Ad8A, Ad8B, and Ad8E shared 91.8% and 96.4% homology with regard to their amino acid and nucleotide sequences, respectively, with the isolate 1127 (accession no X74663). However, when compared with Ad8A, Ad8B, Ad8E, and isolate 1127, Ad8I shared only 62.7% and 69.9% homology with regard to amino acid and nucleotide sequences, respectively. Ad8A, Ad8B, and Ad8E had a unique 31 amino acid deletion in the hypervariable region 1 of the hexon gene, whereas Ad8I had a 33 residue deletion. The Ad8E strain that circulated from 1984 to 1995 was stable among the study population. Ad8I was isolated from an outbreak of epidemic keratoconjunctivitis in 1995 and was also isolated from sporadic cases until 1997.

CONCLUSIONS

These results confirmed that genetic variability occurs in Ad8 in the microenvironment and revealed the emergence of a new genome type (Ad8I).

Ultrasound biomicroscopic study of sclerotomy sites after implantation of sustained release drug devices

BACKGROUND/AIMS

To evaluate the potential of ultrasound biomicroscopy (UBM) as a tool to study the precise location and changes of sclerotomy sites of the eye with an intraocular drug delivery device.

METHODS

Eight eyes of six patients (13 sites) who received ganciclovir implants were examined by UBM. Examinations were performed 1-26 months (mean 12.8 months) postoperatively. Serial transverse and radial sections of the anterior ciliary body around the sclerotomy sites were obtained.

RESULTS

The ganciclovir implant contour was successfully viewed using an UBM with high reflectivity. Three implants were deviated anteriorly and they were very close to the ciliary body and the lens (anterior deviation), while four implants were deviated posteriorly and away from the lens (posterior deviation). The other six implants were located at the appropriate position as intended. A solitary homogeneous mass with a medium reflectivity around the suture tab was observed at 12 out of 13 sites in seven eyes. Thick membranes extending from sclerotomy sites to the ora serrata were found at two sites in two eyes.

CONCLUSION

UBM is helpful in detecting abnormal manifestations around ganciclovir implants and is a valuable tool to assess the changes of the sclerotomy sites of the sustained released intraocular devices.

An ocular cat-scratch disease patient positive for cytoplasmic anti-neutrophil cytoplasmic antibody

BACKGROUND

We report a case of ocular cat-scratch disease with permanent vision reduction in a patient who was cytoplasmic anti-neutrophil cytoplasmic antibody (C-ANCA) positive.

METHODS

Case report and review of the literature.

RESULTS

While taking steroids and antibiotics, a 52-year-old man with uveitis associated with cat-scratch disease developed retinal vein occlusion and a macular exudate. His final visual acuity was poor because of residual macular degeneration and optic atrophy. Serum C-ANCA increased and decreased in parallel with ocular inflammatory activity.

CONCLUSION

C-ANCA is an indicator of vasculitis and may be useful as an indicator of severe cat-scratch disease.

Ocular and systemic factors relevant to diabetic keratoepitheliopathy

PURPOSE

This study examines the contribution of ocular and systemic factors to diabetic keratoepitheliopathy.

METHODS

The presence and severity of keratoepitheliopathy was investigated in 114 eyes of patients with diabetes and 59 eyes of patients without diabetes. The ocular factors examined were the status of the lipid layer of the tear fluid assessed with the specular reflection video-recording system, corneal sensitivity using the Cochet-Bonnet method, tear volume by the cotton thread test, tear film stability by tear breakup time, and grade of diabetic retinopathy. The systemic factors examined included patient age, hemoglobin A1c value, and duration of diabetes mellitus. Multivariate regression analysis was performed to assess the factors related to keratoepitheliopathy.

RESULTS

The incidence of keratoepitheliopathy was 22.8% and 8.5% in patients with and without diabetes, respectively. Ocular measures, such as nonuniformity of tear lipid layer, corneal sensitivity, and tear breakup time, were significantly worse in patients with diabetes than in patients without diabetes ( p < 0.05). Multivariate regression analysis showed that the status of the tear lipid layer was significantly relevant to diabetic keratoepitheliopathy ( p < 0.05).

CONCLUSION

Qualitative abnormalities in tear secretion seem relevant to the development of diabetic keratoepitheliopathy. The tear lipid layer interference pattern may yield useful information for the elucidation of the mechanism and treatment of diabetic keratoepitheliopathy.

Rapid detection and typing of oculopathogenic strain of subgenus D adenoviruses by fiber-based PCR and restriction enzyme analysis

PURPOSE

To develop a new detection and typing method of oculopathogenic strains of subgenus D adenoviruses directly from conjunctival scrapings by a combination of polymerase chain reaction (PCR) and restriction enzyme analysis (REA).

METHODS

A new PCR method using primer pairs of AF2/AR2, which are specific for the fiber genes, were developed to amplify 1150-bp products from nine oculopathogenic prototypes of subgenus D adenoviruses. Amplicons were cleaved with three restriction enzymes: DdeI, HinfI, and RsaI. Clinical specimens of 102 conjunctival scrapings were also evaluated by this PCR method. Restriction patterns of prototypes were used for the typing of clinical samples. Detection limit was determined by the PCR amplification of a known amount of purified adenovirus serotype 8 DNA.

RESULTS

A novel PCR method based on the fiber genes allowed the amplification of nine oculopathogenic serotypes of subgenus D (Ad8, Ad9, Ad15, Ad17, Ad19, Ad22, Ad28, Ad37, and Ad39). As little as 38.4 fg of adenovirus type 8 could be detected by this method. Positive results were obtained from 48 of 102 samples (47%) by both hexon- and fiber-based PCR, whereas only 29 of 102 (28.4%) yielded positive results by culture isolation/neutralization test (NT). All positive specimens (29 samples) of culture isolation and PCR-RFLP methods showed positive results by our new fiber-based PCR method, and no positive products were detected from other subgenus of adenovirus or nonadenoviral DNA.

CONCLUSIONS

A newly developed fiber-based PCR-REA method for the detection and typing of adenoviruses is faster than any former PCR methods. This all-in-1-day detection and typing method will be quite useful to the rapid diagnosis of subgenus D adenovirus infection.

A case of multiple sclerosis with granulomatous uveitis in Japan--use of the antilipoarabinomannan (LAM)-B test in differential diagnosis

PURPOSE

To report a patient with multiple sclerosis and associated with granulomatous uveitis, and how anti-lipoarabinomannan (LAM)-B antibody can play a key role in differential diagnosis.

METHODS

Case report.

RESULTS

A 35-year-old Japanese woman with multiple sclerosis, diagnosed 3 years ago, presented with blurred vision in her left eye. Ophthalmological examinations revealed granulomatous iridocyclitis in her left eye and retinal periphlebitis in both eyes. The diagnosis of tuberculosis was suspected because of a positive tuberculin skin test. However, a further examination by an anti-LAM-B antibody test excluded active tuberculosis. Her clinical findings were thought most likely to be caused by multiple sclerosis and treated with corticosteroids.

CONCLUSION

We should consider the possibility of multiple sclerosis as the underlying origin in patients with granulomatous uveitis. A measurement of anti-LAM-B antibody titer may be useful in the differential diagnosis of granulomatous uveitis.

Glycemic control and lens transparency in patients with type 1 diabetes mellitus

PURPOSE

To assess quantitatively the cumulative effect of hyperglycemia on lens transparency in patients with juvenile type 1 diabetes mellitus.

METHODS

Subjects were 30 patients (30 eyes) with type 1 diabetes mellitus who had well-documented records on the duration of diabetes mellitus and condition of glycemic control from the onset. They were 35 years of age or younger (mean, 26.0 years), had a history of type 1 diabetes mellitus at least 5 years (mean, 8.4 years), had corrected visual acuity of 20/20 or better, and showed no clinically apparent cataract on slit-lamp examination. Twenty-one eyes of 21 subjects served as age-matched normal controls. They were 35 years of age or younger (mean, 25.7 years), had no diabetes mellitus, had corrected visual acuity of 20/20 or better, and showed no signs of cataract on slit-lamp examination. The degree of lens opacity was quantified using the anterior eye segment analysis system based on the Scheimpflug principle. An index was created to represent the cumulative effect of long-term glycemic control (hyperglycemic accumulation) by multiplying the average hemoglobin A(1c) value and the number of months from the onset.

RESULTS

The patients with diabetes mellitus exhibited significantly greater degree of lens opacity than the normal controls (P =.017, Mann-Whitney U-test). Among the patients with diabetes mellitus, the lens opacity was greater in eyes with retinopathy than those without retinopathy (P =.011). Multiple regression analysis revealed that only the index of hyperglycemic accumulation significantly correlated with the degree of lens opacity (P =.042).

CONCLUSION

Accumulated effect of hyperglycemia is related to the lens transparency in patients with diabetes.

Anterior capsular contraction after cataract surgery in eyes of diabetic patients

AIM

To investigate change in the area of anterior capsular opening (ACO) after cataract surgery and its relation to the degree of postoperative anterior inflammation in patients with diabetes mellitus (DM).

METHODS

31 eyes of 31 patients with DM and 30 eyes of 30 normal controls scheduled to undergo cataract surgery were examined prospectively. The area of ACO was measured with an anterior eye segment analysis system (EAS-1000) on the day following surgery and 3, 6, and 12 months after surgery. Comparative analyses were made on the area of ACO relative to the presence of DM and diabetic retinopathy (DR). The percentage reduction of area of ACO was calculated from values 1 day and 12 months after surgery, and multiple regression analysis was performed on the presence of DM, patient age, ACO area on the first postoperative day, and aqueous flare intensity 1 day and 12 months after surgery.

RESULTS

The area was significantly smaller in the DM group at 3 (p=0.015, Student's t test), 6 (p=0.011), and 12 (p=0.010) months postoperatively. Patients having DR showed significantly smaller ACO area than the non-DR group 3 (p=0.039), 6 (p=0.033), and 12 (p=0.028) months after surgery. Multiple regression analysis revealed that presence of DM (p=0.003) and aqueous flare intensity 12 months after surgery (p=0.039) significantly correlated with the percentage reduction of area of ACO. Age, ACO area at 1 day postoperatively, and aqueous flare intensity immediately after surgery were not relevant to ACO contraction.

CONCLUSIONS

Anterior capsular contraction after cataract surgery was greater in eyes of DM patients, especially in those with DR and increased permeability of the blood-aqueous barrier.

Optic disk pallor and retinal atrophy in Sotos syndrome (cerebral gigantism)

PURPOSE

To report a case of Sotos syndrome (cerebral gigantism) with megalophthalmos, optic disk pallor, and retinal atrophy.

METHODS

Case report.

RESULTS

A 22-year-old man was diagnosed with Sotos syndrome with optic atrophy. His corneal diameters were 13 mm horizontally, and his optic disks were pale. His retinal vessels were attenuate in diameter, and small white spots were found on the retina. The results of a Goldmann visual field test were normal. His visually evoked potential to flash stimuli showed extended latent times and normal amplitudes. Keratometry was 40.5 diopters (8.33 mm) in both eyes. The axial length was 25.9 mm in the right eye and 25.4 mm in the left eye.

CONCLUSION

Sotos syndrome may be associated with optic disk pallor and retinal atrophy.

Bilateral choroidal metastases secondary to uterocervical carcinoma of the squamous cell type

PURPOSE

To report a patient with bilateral choroidal metastases secondary to uterocervical carcinoma of the squamous cell type.

METHODS

Case report.

RESULTS

A 55-year-old woman complained of visual field loss and decreasing vision. Seven months earlier, uterocervical carcinoma of the squamous cell type was diagnosed and treated with chemotherapy and irradiation. Serous retinal detachment and choroidal masses were present in both eyes. Retinal detachment was lessened in both eyes after radiotherapy. The patient died of respiratory insufficiency 3 months after the appearance of choroidal metastases. At autopsy, there was no second cancer to cause the choroidal metastases. Tumor embolization was present in the choriocapillaries.

CONCLUSION

Choroidal metastasis may develop from hematogenous spread of uterocervical squamous cell carcinoma.

Influence of rapid glycemic control on lens opacity in patients with diabetes mellitus

PURPOSE

To report the influence of rapid glycemic control on lens opacity in patients with diabetes mellitus.

METHODS

In a prospective study, nine patients with adult onset diabetes mellitus and glycosylated hemoglobin values over 9% were divided into two groups, rapid glycemic control and slow glycemic control groups, based on the time course of glycosylated hemoglobin values after the initiation of glycemic control. The lens thickness and opacity were measured using the anterior eye segment analysis system.

RESULTS

One week after onset of treatment, the lens in rapid glycemic control group became significantly thicker than in pretreatment, but returned to the baseline level at the subsequent measurement points. The lens opacity index in the rapid glycemic control group increased significantly (P <.01, paired t test) 4 months after the glycemic control, which persisted throughout the 1-year study period. The lens thickness and opacity in the slow glycemic control group did not change significantly.

CONCLUSION

It was suggested that rapid glycemic control can induce an irreversible increase in lens opacification.

Human leukocyte antigens in forms of leprosy among Japanese patients

Human leukocyte antigens (HLA) class II alleles were analyzed among Japanese leprosy patients to ascertain whether immunogenetic differences exist among the leprosy classification forms of Ridley and Jopling. Ninety-three unrelated Japanese leprosy patients (21 lepromatous, 24 borderline lepromatous, 17 mid-borderline, 26 borderline tuberculoid, 5 tuberculoid) and 114 healthy control subjects were investigated. The frequencies of HLA-DRB1*1501, -DRB5*0101, -DQA1*0102 and DQB1*0602 were significantly increased in all of the Japanese leprosy patients. The frequencies of HLA-DRB1*0405, -DQA1*03 and -DQB1*0401 were significantly decreased in the Japanese patients after correction of the p value. Conversely, there were no significantly different distributions of the HLA-DRB1, -DRB5, -DQA1, DQB1 alleles in the five subgroups of these patients. We conclude that HLA class II alleles were not associated with the form of leprosy. Other HLA, a non-HLA gene, and/or environmental factors may play a critical role in the different manifestations of leprosy.

HLA-B27 subtypes and HLA class II alleles in Japanese patients with anterior uveitis

PURPOSE

Some patients with anterior uveitis (AU) have ankylosing spondylitis (AS) and are HLA-B27 class I-positive. The purpose of this study was to investigate whether there are differences in HLA at the allele level among each group of patients with AU.

METHODS

Seventy-three patients with AU were studied. They were classified into three groups: 31 with AS-associated AU, 14 with HLA-B27-associated AU, and 28 with idiopathic AU. Three control groups without AU were used: 138 random subjects, 33 HLA-B27-positive healthy subjects, and 19 HLA-B27-positive patients with AS. DRB1 and DQB1 genotyping was performed using polymerase chain reaction (PCR)-single-strand conformation polymorphism (PCR-SSCP) and PCR-restriction fragment length polymorphism. HLA-B27 subtype was determined by PCR-SSCP.

RESULTS

There was no difference in the frequency of any class I antigen except HLA-B27 among the patients studied. The frequencies of HLA-DR12 in AS-associated AU and HLA-DR1 in HLA-B27-associated AU showed an increase. In HLA-B27-associated AU, DRB1*0101 and DQB1*0501 were increased compared with HLA-B27-positive control subjects. When HLA-B27 subtype distribution was compared among the groups, the proportion of B*2704 was significantly lower in HLA-B27-associated AU (P = 0.037), however, such a difference was not present in AS-associated groups.

CONCLUSIONS

These results indicated that B*2704 seemed to be less susceptible to AU compared with B*2705 in Japanese subjects. The increase of HLA-DR12 and HLA-DR1 in AU may be caused by linkage disequilibrium with B*2704 and B*2705, respectively.

Herpes simplex virus in the trabeculum of an eye with corneal endotheliitis

PURPOSE

To report an eye with corneal endotheliitis and increased intraocular pressure in which the trabeculum demonstrated immunoreactivity for herpes simplex virus.

METHOD

Case report. A 62-year-old man presented with increased intraocular pressure, keratic precipitates, and corneal stromal edema in his left eye. The tissue excised during trabeculectomy was immunohistochemically examined for herpetic viruses.

RESULT

Immunoreactivity for herpes simplex virus was identified in the trabeculum.

CONCLUSION

Herpes simplex virus may cause trabeculitis and increased intraocular pressure in patients with corneal endotheliitis.

Immunogenetics of uveitis in leprosy

PURPOSE

To identify any possible determinants in the development of uveitis in leprosy patients.

METHODS

Human leukocyte antigen (HLA) class I and II antigen, and HLA class II genotypings were analyzed among Japanese leprosy patients. Ninety-three unrelated Japanese leprosy patients (46 patients with a history of uveitis and 47 patients without uveitis) and 114 healthy control subjects were investigated.

RESULTS

The occurrence of HLA-DR2 was significantly higher in patients with uveitis (78.3%) than in those without uveitis (57.4%; odds ratio = 2.7, P<.05) and in the controls (33.3%; odds ratio = 7.2, P<.0000005, Pc<.00005). The occurrence of HLA-DR4 was significantly lower in patients with uveitis (15.2%) than in those without it (38.3%; odds ratio = 0.29, P<.05) and in the controls (46.5%; odds ratio = 0.21, P<.0005, Pc<.05). Furthermore, the frequencies of DR2-positive and DR4-negative genotypes were significantly higher in patients with uveitis (69.6%) than in those without it (38.3%; odds ratio = 3.7, P<.005) and in the controls (21.9%; odds ratio = 8.1, P<.00000005). At the genomic level, the occurrence of HLA-DQB1*0302 was significantly lower in the patients with uveitis (8.7%) than in those without it (25.5%; odds ratio = 0.28, P<.05). The distribution of HLA-DRB1 and DQA1 alleles was not significantly different between the patients with and those without uveitis. However, the frequencies of DRB1*1501-positive, as well as DRB1*0405- and DQB1*0302-negative genotypes were significantly higher in the patients with uveitis (47.8%) than in those without it (25.5%; odds ratio = 2.7, P<.05) and in the controls (8.8%; odds ratio = 9.5, P<.00000005).

CONCLUSIONS

Our results suggest that HLA Class II genes confer susceptibility to or protection from leprous uveitis.

TAP polymorphism is not associated with ankylosing spondylitis and complications with acute anterior uveitis in HLA-B27-positive Japanese

HLA-B27 is associated with the etiology of ankylosing spondylitis (AS) and acute anterior uveitis (AAU). Transporter associated with antigen processing (TAP) 1 and TAP2 polymorphism influences the range of peptide presented by HLA class I molecules. In this report, contribution of TAP polymorphism to the susceptibility to AS and AAU was studied in HLA-B27-positive Japanese individuals. Patients were classified into three groups: 16 AS patients, 14 AAU patients and 22 patients with both AS and AAU. Twelve HLA-B27-positive healthy individuals were included as a control. TAP polymorphism was detected by PCR-RFLP methods. Significant differences in frequencies of TAP1 alleles were not found between patient groups. None of the TAP2 frequencies showed increased or decreased frequencies compared with HLA-B27-positive healthy controls. In comparison with a random Japanese control, TAP2D allele frequency was significantly increased in the AAU group, but failed to reach a significant level in a group consisting of the AAU-only patients and the patients with both AS and AAU. All of the patient groups were noted to have a significantly increased prevalence of the TAP2H allele as compared to random controls; however, the higher frequency of this allele was detected in HLA-B27 healthy controls as well. These observations suggest a linkage disequilibrium between TAP2D, TAP2H and HLA-B27 in Japanese.

Immunogenetics of episcleritis in leprosy

Human leukocyte antigens (HLA) were analyzed among Japanese leprosy patients to identify any possible determinants in the development of episcleritis in leprosy patients. Seventy-nine Japanese leprosy patients (33 patients with history of episcleritis and 46 patients without episcleritis) and 114 healthy control subjects were investigated. Human leukocyte antigen-class I and class II specificities were determined serologically by the standard microcytotoxicity test. The HLA-DRB1, -DRB5, -DQA1, and -DQB1 genotypings were performed by using the polymerase chain reaction (PCR)-single strand conformation polymorphism and PCR-restriction fragment length polymorphism analyses. The frequency of HLA-Cw3 was significantly increased among the patients with episcleritis (66.7%) compared to patients without episcleritis (43.5%; odds ratio = 2.6, P < 0.05). The frequency of HLA-DR4 was significantly decreased among the patients with episcleritis (15.2%) compared to patients without episcleritis (39.1%; odds ratio = 0.28, P < 0.05) and the controls (46.5%; odds ratio = 0.21, P < 0.001). At the genomic level, frequencies of the HLA-DRB1*0405, -DQB1*0401, and -DQB1*0302 alleles were significantly decreased among the patients with episcleritis (0%, 0%, and 6.1%, respectively) compared to patients without episcleritis (15.2%, 13.0%, and 26.1%, respectively; odds ratio = 0.07, 0.09, and 0.18, P < 0.05). HLA-DRB1*0405 and -DQB1*0401 were also significantly decreased among the patients with episcleritis compared to the controls (29.8% and 29.8%; odds ratio = 0.04, P < 0.0001). Our results suggest that HLA-Cw3 antigen confers the susceptibility to the development of episcleritis among Japanese leprosy patients. Concurrently, the DRB1 (the -DBR1*0405), and/or DQB1 (the -DQB1*0401 and -DQB1*0302) alleles might provide protection against leprous episcleritis.

[Human leukocyte antigens and episcleritis in leprosy (Hansen's disease)]

Human leukocyte antigens (HLA) were analyzed in Japanese leprosy patients to ascertain whether immunogenetic differences exist between leprosy patients with episcleritis (ES) and those without it. The subjects were 79 Japanese leprosy patients, including 33 patients with a past history of ES, and 49 patients without ES. Controls were 114 healthy subjects. A standard microcytotoxicity test was used for typing HLA-A, -B, -C, -DR and -DQ antigens. HLA-DRB1 and DQB1 genotypings were performed by using the polymerase chain reaction (PCR)-single strand conformation polymorphism and PCR-restriction fragment length polymorphism methods. The occurrence of HLA-Cw3 was significantly greater in the patients with ES (66.7%) than in those without ES (43.5%; odds ratio = 2.6, p < 0.05). The occurrence of HLA-DR4 was significantly lesser in the patients with ES (15.2%) than in those without ES (39.1%; odds ratio = 0.28, p < 0.05) and the controls (46.5%; odds ratio = 0.21, p < 0.005). At the genomic level, the occurrence of HLA-DRB1*0405, DQB1*0401, and DQB1*0302 was significantly lesser in the patients with ES (0%, 0% and 6.1%, respectively) than in those without ES (15.2%, 13.0%, and 26.1%, respectively; odds ratio = 0.07, 0.09 and 0.18, p < 0.05). HLA-DRB1*0405 and DQB1*0401 were also significantly lesser in the patients with ES than in the controls (29.8% and 29.8%; odds ratio = 0.04, p < 0.0001). Our results suggest that HLA-Cw3 causes susceptibility to episcleritis in Japanese patients with leprosy, whereas DR4 (DRB1*0405), DQB1*0401, and DQB1*0302 provide some protection against leprous episcleritis.

[HLA class II alleles and leprosy (Hansen's disease) classified by WHO-MDT criteria]

Human leukocyte antigens (HLA) class II alleles were analyzed in Japanese leprosy patients to ascertain whether immunogenetic differences exist among the forms of leprosy in classification of World Health Organization-recommended multidrug therapy (WHO-MDT). The subjects were 86 unrelated Japanese leprosy patients, including 62 multibacillary leprosy (MBL), 24 paucibacillary leprosy (PBL). Controls were 114 unrelated healthy subjects. Genotyping of HLA class II alleles was performed by using the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and PCR-restriction fragment length polymorphism (RFLP) methods. The frequencies of HLA-DRB1* 1501, * 1502 and DRB5* 0101,* 0102 and DQA1* 0102 and DQB1* 0602 were significantly increased in the whole patients (44.2%, 34.9%, 44.2%, 34.9%, 53.4% and 41.9%, respectively) as compared with the control subjects (14.0%, 21.1%, 14.0%, 21.1%, 27.2% and 13.2%, respectively). On the other hand, the frequencies of HLA-DRB1* 0405, * 0803, * 0901 and DQA1* 03 and DQB1* 0401 were significantly decreased in the whole patients (10.5%, 5.8%, 16.3%, 41.9% and 9.3%, respectively) as compared with the control subjects (29.8%, 17.5%, 30.7%, 78.1% and 29.8%, respectively). When MBL and PBL patients were compared, the frequencies of HLA-DRB1* 1501, DRB5* 0101 and DQB1* 0602 were significantly increased in the MBL patients (51.6%, 51.6% and 48.4%, respectively) as compared with the PBL patients (25.0%, respectively). Our results suggest that HLA-DRB1* 1501, DRB5* 0101 and DQB1* 0602 contribute to the susceptibility to the Japanese MBL.

[Anterior uveitis with ankylosing spondylitis and HLA]

We investigated the relationship between anterior uveitis with ankylosing spondylitis (AS) and human leukocyte antigen (HLA) alleles. Forty patients were studied, 19 with anterior uveitis and 21 without it. No deviation in the frequencies of HLA-B27 antigen and related alleles were observed between the two groups of patients. Twelve cases (63.2%) with anterior uveitis had expressed HLA-DR8 (DRB1 0803). On the other hand, only 1 case had expressed the same antigen and this difference was statistically significant (relative risk: 34.3 Pc < 0.007) as we reported previously. We found HLA-DR8 was a candidate for susceptibility to anterior uveitis in AS.

[HLA and uveitis in leprosy]

In order to investigate the role of immunogenetic factors in the pathogenesis of uveitis in leprosy, human leukocyte antigens (HLA) were analyzed among leprotics with and without uveitis. The subjects were 85 Japanese leprosy patients, 44 with uveitis and 41 without uveitis. Controls were 138 healthy subjects. A modified two-stage complement dependent microcytotoxicity test was used for typing HLA-A, -B, -C, -DR and -DQ antigens. The occurrence of HLA-DR2 antigen was significantly increased in patients as a whole (69.4%), and in the patients with uveitis (79.5%) as compared with the control subjects (35.5%). The association with DR2 was even stronger in the patients with uveitis (odds ratio = 7.1, Pc < 0.000005) than in the patients as a whole (odds ratio = 4.1, Pc < 0.0001). On the other hand, HLA-DR53 antigen was significantly decreased in the patients as a whole (43.5%) and in the patients with uveitis (36.4%) as compared with the control subjects (69.6%). No significant difference in the distribution of HLA antigens was observed in the patients without uveitis. Our results suggest that HLA-DR2 contributes to the susceptibility to uveitis in Japanese leprosy patients.

[HLA-DR2 alleles and uveitis in leprosy]

In order to investigate the role of immunogenetic factors in the pathogenesis of uveitis in leprosy, HLA antigens were analyzed between the leprotics with and without uveitis. Sixty-five Japanese leprosy patients comprised 32 with uveitis and 33 without uveitis. Controls consisted of 138 healthy subjects. A lymphocyte cytotoxicity test was used for typing HLA-A, -B, -C, -DR and -DQ antigens. HLA-DR2 genotyping was performed by the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and PCR-restriction fragment length polymorphism (RFLP) methods. The frequency of HLA-DR2 antigen was significantly increased in the patients with uveitis as compared with the control subjects (Pc < 0.0005), whereas HLA-DR53 antigen was significantly decreased (Pc < 0.05). At the genomic level the frequency of HLA-DRB1*1501 was significantly increased in the patients with uveitis and without uveitis as compared with that in the controls. The association with DRB1*1501 was even stronger in patients with uveitis (odds ratio = 7.1, Pc < 0.000005) than in the patients without uveitis (odds ratio = 4.1, Pc < 0.005). Our results suggest that HLA-DRB1*1501 contribute to the susceptibility to uveitis in the Japanese with leprosy.

HLA-DR8 and acute anterior uveitis in ankylosing spondylitis

OBJECTIVE

To identify possible factors in the development of acute anterior uveitis (AUU) in patients with ankylosing spondylitis (AS).

METHODS

We investigated HLA antigens serologically, and HLA-DRB1*08 alleles by polymerase chain reaction-restriction fragment length polymorphism, in 42 Japanese AS patients with and without AAU.

RESULTS

Thirty-six of the AS patients (85.7%) had HLA-B27. Thirteen (65%) of the 20 patients with AAU had HLA-DR8, whereas only 1 (4.5%) of the 22 patients without AAU had DR8. The difference was statistically significant (Pcorr < 0.001).

CONCLUSION

Our data suggest that HLA-B27 is strongly associated with AS in Japanese patients and that HLA-DR8 is important for the development of AAU in Japanese patients with AS.

[A case of Sneddon syndrome]

Sneddon syndrome is a clinical entity that is characterized by livedo reticularis and cerebrovascular lesions and is considered to be a subtype of antiphospholipid antibody syndrome. Central retinal artery occlusion is one of the ophthalmic complications of this syndrome and its prognosis of visual acuity is generally poor. We report here a 50-year-old man with Sneddon syndrome who had recurrent central retinal artery occlusion with recovery of visual function after each episode.

HLA class II genes in Vogt-Koyanagi-Harada disease

PURPOSE

Vogt-Koyanagi-Harada disease (VKH) is an autoimmune disorder causing a bilateral diffuse granulomatous uveitis, often with several associated extraocular manifestations. Strong association of human leukocyte antigens (HLA) antigens with the disease has been documented. The details of all HLA class II genotypes were investigated in Japanese patients with VKH to demonstrate the immunogenetic background of the disease.

METHODS

Human leukocyte antigen tissue typing was performed in 57 Japanese patients with VKH by the modified two-stage complement-dependent microcytotoxicity method. DNA analyses were done by polymerase chain reaction (PCR)-single-strand conformation polymorphism and PCR-restriction fragment-length polymorphism methods.

RESULTS

The frequencies of HLA-DR4 and HLA-DQ4 were 93% and 83% among the patients with VKH, compared with 43% and 32% among the controls, respectively (relative risks, 17.4 and 9.9; Pc < 1.0 x 10(-10)). At the genomic level, all patients had the HLA-DQA1*0301 genotype, which was present in only 67% of the normal controls (relative risk, 56.5; Pc < 1.0 x 10(-5)). With allelic combinations, -DQA1*0301/-DR4 showed the greatest relative risk ratio. Conversely, DQB1*0604 genotype was not detected among the patients.

CONCLUSION

It can be postulated that VKH is a disease of combined allelic predisposition in which DQA1*0301 acts as the primary and HLA-DR4 acts as an additive factor in the development of the disease. Based on the negative association of DQB1*0604, we propose that DQB1*0604 provides considerable protection, possibly by altering other factors in the pathogenesis of VKH in the Japanese.

[Relation between the clinical course of Vogt-Koyanagi-Harada's disease and human leukocyte antigen (HLA)-DR4 subtypes]

Vogt-Koyanagi-Harada's disease (VKH) is an autoimmune disorder affecting melanocyte-containing tissues. VKH is strongly related to human leukocyte antigen (HLA)-DR4, a heterogeneous HLA specificity consisting of at least 12 different genotypes. The disease has two types: prolonged and non-prolonged, depending upon the clinical course. Fifty-four Japanese patients comprising 27 with the prolonged type, 15 with the non-prolonged type, and 12 new cases of VKH were included in this study. Ninety-three percent of the patients with all types had HLA-DR4. All 27 patients with the prolonged type had either the DRB1*0405 or *0410 genotype, and the non-prolonged type included two DR4-negative and four DRB1*0405 and *0410 negative patients. Our results indicate that the clinical course of VKH is determined partly by the patient's HLA genotype.

Influence of HLA-DRB1 gene variation on the clinical course of Vogt-Koyanagi-Harada disease

PURPOSE

To investigate the difference, if any, in the immunogenetic backgrounds between two clinical subtypes of Vogt-Koyanagi-Harada disease (VKH).

METHODS

HLA-DR4 gene variations were investigated in 46 Japanese patients, 28 with the prolonged type and 18 with the nonprolonged type of VKH. HLA-DR4 genes were amplified with polymerase chain reaction (PCR) and then analyzed for its variation with single-strand conformation polymorphism (SSCP) and restriction fragment length polymorphism (RFLP) methods.

RESULTS

Significant differences were found in the DR4 gene variation in the two clinical subtypes. All the patients with the prolonged type had either the DRB1*0405 or DRB1*0410 variant, whereas 39% of the patients with the nonprolonged type had neither of them. This difference in frequency was statistically highly significant (P = 0.00059, Pc = 0.0041). DRB1*0405 was also more frequent in the prolonged type (93%) than in the nonprolonged type (56%) (P = 0.0044, Pc " 0.030). In the prolonged type, relative risk was highest for DRB1*0405/0410 (128), whereas in the nonprolonged type it was highest for DR4 (8.6).

CONCLUSION

This preliminary study showed that DR4 gene variants differed significantly between the two subtypes of VKH, suggesting that the clinical course of VKH is determined partly by the patient's HLA-DR gene variation.

Analysis of human leukocyte antigen HLA-DR beta amino acid sequence in Vogt-Koyanagi-Harada syndrome

Vogt-Koyanagi-Harada syndrome (VKH) is a systemic disorder involving many organ systems, including the eye, the ear, the skin, and the meninges. One of the important clinical features of the disease is its strong association with histocompatibility antigens HLA-DR4 and HLA-Dw15. To investigate this association at the DNA level, the polymerase chain reaction technique was used. The DR beta 1 DNA sequence was analyzed to determine which part played the most significant role in the disease process. Although the number of patients studied was small, these data showed that these probes were useful in investigating the HLA-DR subtypes related to VKH. All but one patient (19 of 20) had a specific sequence encoding amino acids 70 and 71 of the HLA-DR beta 1 molecule. The data suggest that the sequence that encodes for amino acids 70 and 71 and adjacent ones of the HLA-DR beta 1 molecule could contribute to disease susceptibility.

An HLA-D region restriction fragment associated with refractory Behçet's disease

We examined the association between HLA-DQ and refractory Behçet's disease at the genomic DNA level. Using a restriction endonuclease Taq I and a DQ beta cDNA probe, we identified the 1.9 kb DQ beta restriction endonuclease fragment tightly associated with refractory Behçet's disease. This observation indicates that genomic HLA-DQ variations affect the development of refractory Behçet's disease.

HLA antigens in Behçet's disease with refractory ocular attacks

HLA class I, II, and III antigens were studied in Japanese patients with Behçet's disease with refractory ocular attacks. In addition to the increased frequency of B51, DQw3, especially TA10-negative DQw3, was increased and DQw1 was decreased significantly in this subgroup of Behçet's disease. As for complement markers, C4A Q0 was increased. A rare variant of BF S07 was first observed in Japanese. Although the mechanism for the DQw3 association is obscure, a possible hypothesis is that an immune-response or immune-suppression gene linked to the DQ antigens modulates the disease severity and the efficacy of treatments.