Bilateral diffuse uveal melanocytic proliferation in a patient with cancer-associated retinopathy

PURPOSE

To describe a patient with bilateral diffuse uveal melanocytic proliferation (BDUMP) and cancer-associated retinopathy (CAR).

DESIGN

Interventional case report.

METHODS

A 66-year-old woman developed progressive vision loss 4 months after total hysterectomy. Ophthalmologic examination, Western blot test of sera and aqueous humor, and immunohistochemistry of carcinoma cells were performed.

RESULTS

Testing revealed BDUMP and severe retinal dysfunction. Autoantibodies against recoverin and heat shock cognate protein 70 (hsc 70) were detected in serum. Cytoplasmic immunoreactivity for recoverin and hsc 70 was observed in endometrioid carcinoma cells.

CONCLUSIONS

Simultaneous cases of BDUMP and CAR are rare. Aberrantly expressed recoverin and hsc 70 triggered serum autoantibody production, which caused photoreceptor degeneration.

Trials of vaccination against experimental autoimmune uveoretinitis with a T-cell receptor peptide

T lymphocytes which mediate several experimental autoimmune diseases, including encephalomyelitis (EAE) and uveoretinitis (EAU) in Lewis rats, preferentially utilize V beta 8 gene product in their receptor. Vaccination against a V beta 8.2-derived peptide was reported to inhibit EAE induction and we report here on the effect of vaccination with this peptide on the development of EAU. Experimental rats were pretreated with the V beta 8.2 peptide, emulsified in adjuvant (CFA), whereas control animals were untreated or injected with saline in CFA. Rats of all groups were immunized 30 or 40 days later with the immunopathogenic antigen, emulsified in Mycobacterium-enriched CFA. Vaccination with CFA emulsions containing either the V beta 8.2 peptide or saline, remarkably inhibited the development of the tested diseases, as compared to the untreated controls. Vaccination with the V beta 8.2 peptide had variable effects in this study on disease development: it inhibited the S-antigen-induced EAU more than did treatment with CFA in four out of six experiments, had a similar effect to that of CFA in one experiment and enhanced the disease in another experiment. Conversely, vaccination with the V beta 8.2 peptide slightly enhanced the EAU induced by the interphotoreceptor retinoid-binding protein (IRBP), or its dominant determinant, in three of four experiments and had no apparent effect in the fourth experiment. In addition, we could not reproduce the reported protective effect of vaccination with the V beta 8.2 peptide against induction of EAE. Vaccination with the V beta 8.2 peptide also had no clear effect on the development of humoral or cellular immune responses against S-antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comprehensive immunologic evaluation of patients with uveal and retinal pathology]

Clinical and immunologic examinations of 120 patients with central tapetoretinal abiotrophy, central serous choriopathy, central choroiditis, endogenic uveitis, thrombosis of the central retinal vein have revealed deviations in the T and B immunity systems and in autoimmune reactions to retinal S antigen, to uveopigmented antigens, and to human hepatic intracellular lipoprotein, as against the controls. The findings evidenced an imbalance of the T and B immunity parameters: reduced counts of T lymphocytes, theophylline-sensitive T suppressors, elevated immunoregulatory cell index, increased counts of B lymphocytes, circulating immune complexes, and blood serum immunoglobulins A and G. No essential shifts in leukocyte adhesion and antibody-dependent K cell cytotoxicity were found. The detected shifts are characteristic of the immune disorders common for various forms of uveoretinal abnormalities.

Retinal pigment epithelial tear in reactive lymphoid hyperplasia of uvea

A 76-year-old patient developed cystic exudative retinal detachment with many yellowish subretinal precipitates and a large retinal pigment epithelial (RPE) tear in midperiphery of the right eye in the course of polyclonal hypergammaglobulinemia. The left eye showed localized RPE detachment in the posterior pole which gradually extended. Systemic steroid administration reduced the subretinal precipitates to some extent, but suspicion of malignancy led to enucleation of the right eye after unsuccessful diagnostic vitrectomy. A histopathological study revealed massive infiltration of the uvea with plasma cells and small lymphocytes but no abnormal cells. This is the first report to show the association of an RPE tear with reactive lymphoid hyperplasia of the uvea.

HLA typing in birdshot chorioretinopathy

We examined 49 patients with birdshot chorioretinopathy in whom HLA typing had been performed. Of these 49 patients, 47 (95.9%) had the HLA-A29 antigen. The HLA-B12 (B44) antigen was also significantly associated with the disease, but this antigen is known to be in linkage disequilibrium with the antigen HLA-A29. The HLA-A2 antigen was less frequent in patients with birdshot chorioretinopathy than in the control group of normal European individuals (20% as compared to 44.6%).

Corneal crystalline deposits and drusenosis associated with IgA-kappa chain monoclonal gammopathy

An unusual case is presented in which corneal deposits in mid-to-deep stroma with Doyne's posterior pole drusenosis are the initial signs of an IgA-kappa monoclonal gammopathy. The case has several unique features. Corneal deposits have been described previously with IgG and IgM-kappa light chain gammopathies, but to our knowledge have not been described before with IgA-kappa monoclonal gammopathy. Corneal stromal deposits and associated macular drusen have been described with IgM monoclonal gammopathy, but not previously with IgA monoclonal gammopathy. Bietti described superficial perilimbal corneal deposits with fundus albipunctatus, whereas the present case shows diffuse central deep corneal deposits with macular drusen.

Toxocara-specific antibody in the serum and aqueous humor of a patient with presumed ocular and visceral toxocariasis

Rarely have concurrent ocular and systemic toxocariasis been reported in the literature. We describe a patient with serologically proven visceral toxocariasis who had a granulomatous lesion in the iris, small rod-like lesions in the retina, and in whom Toxocara-specific antibodies were also demonstrated in the aqueous humor. Two older siblings of this patient also had demonstrable serum antibody to Toxocara. The ocular manifestations resolved rapidly with corticosteroid and thiabendazole therapy and the initial leucocytosis, hepatomegaly, and elevated IgM level were normal at 3.5 months. These changes might be attributed to either the thiabendazole and prednisone therapy or to the natural history of this disease.

Inhibition of macrophage migration by choroidal malignant melanoma-associated antigens in patients with unveal melanoma

The specific cell-mediated immunity of the lymphocytes of eight patients with choriodal malignant melanoma (MM) to four extracts of choroidal MM-associated antigens was tested with the aid of the MIF technique. Seven of the patients with choroidal MM responded to at least one of the four extracts used, whereas patients with choroidal nevus or carcinoma as well as healthy controls did not respond to any of the MM choroidal extracts. There was no response to iris extracts obtained from the enucleated eyes with MM in any of the subjects tested.

The HLA and ABO antigens in pigment dispersion syndrome

We found no statistically significant differences in phenotype frequencies of the 36 different HLA antigens or the ABO antigens when we compared 27 white patients with pigment dispersion syndrome (18 without glaucoma and nine with glaucoma) with 323 white controls. An increase was suggested in the incidence of B7 in patients without glaucoma, and of B13 among patients with glaucoma.

Herpes simplex uveitis in immune rabbits. Priming effect of nonherpetic uveitis

Systemic immunization of rabbits with herpes simplex virus (HSV) had two opposite effects on the outcome of subsequent efforts to produce primary HSV uveitis, the difference depending on whether or not the rabbits had had nonherpetic uveitis before the HSV challenge. In normal eyes, systemic immunization with HSV provided complete protection against the production of primary uveitis by an intraocular injection of HSV; but in eyes that had had a bout of experimentally induced nonherpetic uveitis before the challenge, the same systemic immunization was not protective. In these eyes, an immune-mediated uveal inflammation developed. Nonherpetic uveitis had apparently "primed" the eyes of the HSV-immune rabbits for subsequent immune-mediated HSV uveitis.

Immunological studies in patients with malignant melanoma of the uvea

Antibodies directed against different components of ocular melanoma cells were identified by indirect immunofluorescence in the sera of 12 patients with histologically proven malignant melanoma of the uvea. Antibodies reacing with autologous surface membrane antigens were found only in the sera of the 5 patients with the smallest tumors. The sera from most of the patients with small, large, or extraocular tumor contained antibodies directed against autologous cytoplasmic components while about one-half of the tests for antibodies reacting with allogeneic cytoplasmic antigens were positive. The incidence of positive tests with cytoplasmic antigens, in 67 patients with clinically diagnosed benign uveal nevi and 56 other individuals not showing evidence of proliferative lesions of uveal melanocytes, was 25%.

Rubeosis iridis generated by insulin hypersensitivity

There are important similarities between human and experimental monkey rubeosis iridis. We believe that we have developed a useful primate model to study iris neovascularization and that the possible role of immunity to insulin in the pathogenesis of human diabetic rubeosis iridis warrants further detailed consideration.