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ARTICLE
Year : 1963  |  Volume : 11  |  Issue : 1  |  Page : 9-12

Erythrocyte sedimentation rate in uveitis - a critical analysis


Institute of Ophthalmology, Aligarh and the Gandhi Eye Hospital, .Aligarh., India

Date of Web Publication28-Jan-2008

Correspondence Address:
S D Paul
Institute of Ophthalmology, Aligarh and the Gandhi Eye Hospital, .Aligarh.
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Paul S D. Erythrocyte sedimentation rate in uveitis - a critical analysis. Indian J Ophthalmol 1963;11:9-12

How to cite this URL:
Paul S D. Erythrocyte sedimentation rate in uveitis - a critical analysis. Indian J Ophthalmol [serial online] 1963 [cited 2020 Nov 25];11:9-12. Available from: https://www.ijo.in/text.asp?1963/11/1/9/38827

Table 5.

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Table 5.

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Table 4.

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Table 4.

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Table 3.

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Table 3.

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Table 2.

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Table 2.

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Table 1.

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Table 1.

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A survey of routine hospital practice brings to light the importance attached to erythrocyte sedimentation rate in. almost all cases of endogenous uveitis.

The importance of E. S. R. or the lack of it motivated this investigation in 120 cases of endogenous uveitis. These cases were classified into the granulomatous and non-granulomatous types as advocated by Woods (1956). Further clinical sub-divisions were made and the cases were classified according to the site of involvement of the uveal tract.

A review of literature indicates that the value attached to the E.S.R. pertaining to the correct diagnosis of uveitis is debatable.

The idea behind this investigation, therefore, has been either to support the institution of E.S.R. test or explode the myth attached to its importance.

Review of literature:

This time honoured test was investigated by Wolkowicz et al (1959) in 112 cases of Wills Hospital. The results reported by them indicated an elevation of E.S.R. in 40% of nongranulomatous uveitis and 22-29% elevation in granulomatous uveitis. The percentage of E.S.R. within the normal range was high in both granulomatous and non-granulomatous series.

Bedrosian (1957) in an earlier study reported an increase percentage in non-granulomatous type of uveitis as compared to the granulomatous types of uveitis.


  Material and Methods Top


120 cases of endogenous uveitis were investigated in this study. The cases were classified into the granulomatous or non-granulomatous types. The breakdown being guided by Woods classification of endogenous uveitis. Ancillary methods employed in establishing the clinical categories besides examination of the eye was the employment of the corneal biomicroscope and the ophthalmoscope. These clinical categories were further broken down into anterior, posterior and pan uveitis.

The behaviour pattern of the erythrocyte sedimentation rate in the clinical categories of uveitis was as follows:[Table - 2]

A further break-tip of the relation-ship in sexes was also investigated.[Table - 3]

An increase of over 10 mm per hour in the males and over 20 per hour in the females was employed as the criteria of elevation of the erythrocyte sedimentation rate.

It would, thus, appear from the above table that higher erythrocyte sedimentation rate in the females irrespective of granulornatous or nongranulomatous phases of the disease was an outstanding feature in this series.

The elevation of erythrocyte sedimentation rate in granulomatous 58% and non-granulomatous types (54%) of uveitis was a notable feature in this investigation. Bedrosion (1957) reported an increase of E.S.R. in the non-granulomatous types of uveitis as compared to the granulomatous disease.


  Discussion Top


The sedimentation rate is not diagnostic of any specific disease, it is of great help in evaluating the presence of infection in the body and the active stages of certain diseases. The settling time of the R.B.C. is known to be increased particularly in tuberculosis, pelvic inflammation, infected sinuses and teeth, acute rheumatic fever, rheumatoid arthritis and pregnancy. It is decreased in asthma, hay fever, urticaria and other allergic states, if infection is not associated.

The changes in the blood are mainly in the protein fraction of the plasma. The most important proteins to effect the rate are fibrinogen, gamma globulin and alpha two globulin. An increase in these proteins will increase the sedimentation rate. When these proteins are low the rate is retarded (Gradwohl-1956).

In Bedrosin's opinion the high E.S.R. in non-granulomatous series suggests the presence of systemic infection and a local hypersensitive reaction.

This hypersensitive reaction of the eye is probably not akin to the hypersensitivity of the hay fever group because that would retard the E.S.R. rather than increase it. In his opinion this type of hypersensitive reaction is similar to that which one finds in collagen group of diseases and the rheumatic groups. In these there is an increase in the anti streptolysin titer (Leopold and others-1954) as there is in iritis.

A comparative analysis with the work of Wolkowicz and others (1959) and Bedrosion (1957) is as follows:

The high incidence of normal E.S.R. in Wolkowicz et alia (60-76%) and Bedrosion (86%) is not in agreement with this investigation (54.40%)

A further break-down of the evaluation of sedimentation rate in different types of uveitis as compared with Wolkowicz et al is presented below:

An analysis of the data of this investigation indicates an increase in the incidence of elevated E.S.R. in granulomatous uveitis. Moreover, majority of over all cases show a normal range E.S.R. These findings are not in agreement with those reported by Wolkowicz and Bedrosion.

It is my endeavour to insist that Wood's classification of endogenous uveitis is the most sound classification propounded so far. Even though Ashton (1954) and co-workers and Bedrosion have thrown doubt on the correctness of Wood's classification based mainly on E.S.R.


  Conclusion Top


It is indicated in this investigation that the importance of E.S.R. is debatable. The increased percentage of normal range of E.S.R. in patients suffering from both types of uveitis confirms the view that E.S.R. may have some thing to do with general body infections but plays little or no role in the diagnosis of uveitis.[5]

 
  References Top

1.
Ashton N., (1954). Acta XVII. Cone. Ophth. 1196-1214-1230.  Back to cited text no. 1
    
2.
Bedrosion R. H., (1957). Amer. J. Ophth. 44: 393-395.  Back to cited text no. 2
    
3.
Grodwohl, (1956). Clinical Laboratory Methods and Interpretation. St. Louis Moshy.  Back to cited text no. 3
    
4.
Leopold, I. I3. & Dickinson T. G., (1954).  Back to cited text no. 4
    
5.
M. I. Wolkowicz, J. W. Hallet, I. H., Leopold, Q. A. Faria E. Wijewski, (1959), Amer. J. Ophth. 48: 502-510.  Back to cited text no. 5
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]



 

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