|Year : 1982 | Volume
| Issue : 4 | Page : 391-397
Antinuclear antibodies in primary glaucoma and endogenous anterior uveitis
R Singh, DN Singh, VP Singh, PC Sen
Department of Ophthalmology and Microbiology, Institute of Medical Sciences, B.H. U Varanasi, India
C-7, New Medical Enclave B.H.U., Varanasi-221005
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh R, Singh D N, Singh V P, Sen P C. Antinuclear antibodies in primary glaucoma and endogenous anterior uveitis. Indian J Ophthalmol 1982;30:391-7
|How to cite this URL:|
Singh R, Singh D N, Singh V P, Sen P C. Antinuclear antibodies in primary glaucoma and endogenous anterior uveitis. Indian J Ophthalmol [serial online] 1982 [cited 2020 Apr 2];30:391-7. Available from: http://www.ijo.in/text.asp?1982/30/4/391/29480
Gammaglobulin and plasma cells in trabecular meshwork of glaucomatous eyes has been demonstrated (Becker, Keats and Coleman). Further patients with glaucoma the lymphocytes have increased sensitivity to glucocorticoids (Bigger, Palmberg and Becker). Henley, Okas and Leopold using leucocytic migration test as a measure of cellular immunology has reported about 30% glaucoma patients showed positive result. Thus it is quite evident from these observations that some immunological factor may play some role in the causation of primary glaucoma.
Recently in ophthalmic literature several studies have suggested possible abnormalities in immunologic factor in cases of endogenous uveitis. Silverstein has suggested that there is local production of antibodies within the eyes in response to antigenic stimulus. Further Aronson et a1 and Devron et al have reported altered immunologic response in uveitis.
Thus it was thought worthwhile to study the relationship of immunologic factor like antinuclear antibody (ANA) and intraocular pressure in patients of primary chronic simple glaucoma and in endogenous anterior uveitis.
| Materials and methods|| |
In the present study antinuclear antibodies were looked in the serum of 47 cases of primary glaucoma (22 border line, 25 proved cases of glaucoma and 23 control cases).
In another study ANA were looked in the serum of 40 cases of endogenous anterior uveitis (20 granulomatous and 20 non-granulomatous anterior uveitis) and 20 normal cases which were taken as control. Cases of both the sexes were included varying in age from 10-70 years. From the study point of view the cases were devided into three groups
Group A (Control) : There were patients of refractive error or cataract. They did not have any ocular infections acute or chronic. Then IOP was in the range of 15-20 mm of Hg (Schiotz) did not show any fields changes or glaucomatous cupping. There was no history of joint pain etc.
Group B . This group includes patients of proved and border line glaucoma. It is divided into two groups B 1 and B 2 .
Group B 1 (Border line glaucoma) : In the group patients complains of headache and difficulty in doing near work. There IOP ranges from 18 to 25 mm of Hg, fundus examination showed deep physiological cupping with nasal shift of blood vessels. Gonioscopic examinations showed depth of angle anterior chamber from grade I-grade IV (Schios classification). Provocative test like dark room and water drinking were positive in these cases.
Group B 2 (Proved glaucoma) : These were those patients who had IOP more than 30 mm of Hg (Schiotz) with typical central and peripheral fields defects. Ophthalmoscopic examination showed marked nasal shift of blood vessels, glaucomatous cupping with glaucomatous optic atrophy. Gonioscopic examination showed for narrow to wide angle.
Group C : (Endogenous anterior Uveitis cases) : This group is divided into two subgroups:
Group C 1 (Granulomatous anterior uveitis) : These were those patients came with slow and insodious onset, showed ciliary congestions, large and greasy K.P.'s minimal aqueous flare and heavy thick posterior synechia.
Group C 2 : These patients came with acute (abrupt) onset intense aqueous flare, descrete and pin point K.P.'s. Thin posterior synechia recurrence is common in these patients.
In all these patients any connective tissue or collagen disease like systemic lupus erythrometasis polyarthritis nodosa scleroderma are any history of exogenous infection were clinically excluded.
Before proceeding further for detection of antinuclear antibodies (ANA) all these patients were subjected for oblique illumination, visual acuity with and without glasses fundus examination. General examination of the eye to rule out any inflammation. Blood pressure, laboratory investigations like blood sugar (Fasting and postprandial), TLC, DLC and VORL.
Besides the detection cf ANA in the serurr it was also carried out in the aqueous humou in 6 patients of glaucoma (3 proved glaucoma and 3 border line glaucoma) and 8 patients o endogenous anterior uveitis (4 granulomatou and 4 non-granulomatous uveitis).
| Observations|| |
Antinuclear antibodies (ANA) reaction in serum was positive in control group, border line glaucoma and proved cases of glaucoma is shown in [Table - 1]. On statistical analysis it was found that in border line (p<0.01) and proved glaucoma (p <0.001) cases in comparison to control group it was highly significant [Table - 1]. On carrying out statistical analysis between open angle and narrow angle glaucoma patients it was observed that there was no significant variation (p > 0.98) [Table - 2].
In the patients with intraocular pressure less than 20 mm of Hg (Schiotz) the antinuclear antibody reaction was positive (30.4%) and in glaucoma patients intraocular pressure was more than 40 mm of Hg (Schiotz) antinuclear antibody were positive in 100% [Table - 3]. In small series of 8 glaucoma patients (3 border line, 3 proved glaucoma and 2 control) antinuclear antibodies (ANA) reaction was positive in serum and aqueous humour [Table - 4].
In another series of endogenous anterior uveitis patients antinuclear antibody reaction was positive in (30%) patients of non-granulomatous uveitis while all the cases of granulomatous uveitis and control did not show any positive antinuclear antibody reaction [Table - 5].
In another series ANA was negative both in serum and aqueous in granulomatous uveitis (4 cases) while in 4 non-granulomatous cases ANA was positive in serum of one patient and aqueous of 2 patients [Table - 6]. It was further observed that absolute lymphocyte count is significantly increased in granulomatous and non-granulomatous uveitis as compared to control [Table - 7].
The increase in absolute lymphocyte count in non-granulomatous uveitis cases may indicate immunologic activity in this group.
| Discussion|| |
In the present study our observation shows that antinuclear antibodies in primary glaucoma were positive in much more patients as compares to control group. (72.70% in border line glaucoma, 92% proved glaucoma and 13% control cases). Our these observations are in complete agreement with Stephens, Waltman and Devid Yarian (1974) who have also shown positive antinuclear antibody reaction indicating some possible disturbances in immune function in these patients. As also reported by Bigger palmberg and Becker 6 that lymphocytes are abnormally sensitive to predinisolone in viterio.
In the present observations the positive antinuclear antibodies were seen in 32(86.5%) out of 37 patients of open angle glaucoma and in 8(80%) out of 10 narrow angle glaucoma. These observations are in again agreement with the observation of Stephen, Waltman and Yarian who have also shown positive antinuclear antibody reaction in 44% open angle glaucoma patients.
It was further observed that higher the IOP, more strongly positive was antinuclear antibody reaction [Table - 3]. In another series of endogenous anterior uveitis antinuclear antibodies were positive in 6(30%) patients of non-granulomatous uveitis only while it was absent in granulomatous uveitis and normal patients. These observations are more or less similar to the observation of Shigeaki and Ohno et al.
In another series ANA Serum & aqueous was positive 50% cases of non granulomatous uveitis. These observations are in agreement with the observation of Rudolf Wilmer who have reported 215 cases out of 693 cases of endogenous uveitis positive for various antibodies in aqueous humour. Thus it is clear that there is production of local antibody in aqueous humour in cases of endogenous uveitis, as result of initial immunological disturbances.
The mean absolute lymphocyte count (ALC) was significantly increased in nongranulomatous uveitis [Table - 7]. This increase in ALC indicate immunological activity of some chronic infections in these patients. As clinical and routine laboratory investigations did not reveal any infection in those patients the increase in ALC was probably due to immunologic stimulation.
| Summary|| |
Detection of antinuclear antibodies (ANA) was carried out in normal persons, proved glaucoma patients border line glaucoma, patients, and in cases of endogenous anterior uveitis (granulomatous and non-granulomatous). The detection of ANA was done by Horse reddish peroxidase conjugated antibody technique. ANA was positive in (13%) in control cases, (72.7%) border line glaucoma patients and (92%) proved glaucoma patients. ANA reaction was positive in 30% patients of non-ganulomatous uveitis, while it was negative in normal and granulomatous uveitis. ANA reaction in aqueous humour was positive 50% case of non-granulomatous uveitis-while absent in aqueous of granulomatous uveitis.
Thus significant rise of ANA in chronic simple glaucoma and non-granulomatous anterior uveitis suggests the possibility of immune disturbances playing an important role in causation of these two diseases.
| References|| |
Becker, B. Keats, E.U. Coleman, S L., 1972. Arch. Ophthalmol. 68 :643.
Henley, W.L, Okas, S. Leopold, I.II., 1973, Am. J. Ophthalmol 76 : 60.
Silverstein, A.H., 1974, Baltimore, Williams and Wilkins, Invest. Ophthalmol 13: 560.
Aronson, S.B. McMaster, R.R.S., 1971, Arch. Ophthalmol. 86: 557.
Devron, H. Char., 1972, Ophthalmol and Visual Science 16 :179.
Bigger, J.F.; Palmberg, P.F. and Becker, 1972, Inv. Ophthalmol. 11, 83.
Stephen, R., Waltman and Yarian, Da. 1978. Inv. Ophthalmol 13 : 695.
Shigeaki Ohno, Samuel J. Kimura: G. Richard, Oconnor and D--vron, H. Char, 1977, Brit. J. Ophthalmol. 62: 64.
Rudolf, W., 1978, Amer. J. Ophthalmol. 86 : 39.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]