Indian Journal of Ophthalmology

ARTICLES
Year
: 1982  |  Volume : 30  |  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

Correspondence Address:
R Singh
C-7, New Medical Enclave B.H.U., Varanasi-221005
India




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;30:391-397


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 1 ];30:391-397
Available from: http://www.ijo.in/text.asp?1982/30/4/391/29480


Full Text

Gammaglobulin and plasma cells in trabe­cular meshwork of glaucomatous eyes has been demonstrated (Becker, Keats and Coleman).[1] Further patients with glaucoma the lymphocytes have increased sensitivity to glucocorticoids (Bigger, Palmberg and Becker)[2]. Henley, Okas and Leopold[2] 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[3] has suggested that there is local production of antibodies within the eyes in response to antigenic stimulus. Further Aronson et a1[4] and Devron et al[5] 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 0.98) [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[7] 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[8].

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[9] 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

1Becker, B. Keats, E.U. Coleman, S L., 1972. Arch. Ophthalmol. 68 :643.
2Henley, W.L, Okas, S. Leopold, I.II., 1973, Am. J. Ophthalmol 76 : 60.
3Silverstein, A.H., 1974, Baltimore, Williams and Wilkins, Invest. Ophthalmol 13: 560.
4Aronson, S.B. McMaster, R.R.S., 1971, Arch. Ophthalmol. 86: 557.
5Devron, H. Char., 1972, Ophthalmol and Visual Science 16 :179.
6Bigger, J.F.; Palmberg, P.F. and Becker, 1972, Inv. Ophthalmol. 11, 83.
7Stephen, R., Waltman and Yarian, Da. 1978. Inv. Ophthalmol 13 : 695.
8Shigeaki Ohno, Samuel J. Kimura: G. Richard, Oconnor and D--vron, H. Char, 1977, Brit. J. Ophthal­mol. 62: 64.
9Rudolf, W., 1978, Amer. J. Ophthalmol. 86 : 39.