|Year : 1985 | Volume
| Issue : 3 | Page : 167-170
Serum immunoglobulin levels in endogenous uveitis : Before and after therapy
DK Sen, GS Sarin, Satya Pal, VK Sharma
Guru Nanak Eye Centre and Department of Microbiology, Maulana Azad Medical College, India
D K Sen
Maulana Azad Medical College Campus New Delhi-110 002
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sen D K, Sarin G S, Pal S, Sharma V K. Serum immunoglobulin levels in endogenous uveitis : Before and after therapy. Indian J Ophthalmol 1985;33:167-70
The aetiopathogenesis of endogenous uveitis, which is the cause of about 10 per cent of visual handicap, is not clearly understood. Clinical and experimental observations strongly suggest that immune mechanism may play a predominant role. Serum immunoglobulin levels indicate the degree of immunological response so far as humoral antibodies are concerned. Since endogenous uveitis is regarded to be the result of an immune reaction to one or more of a variety of antigens, some alteration of circulating antibodies may be expected in endogenous uveitis. The literature on serum immunoglobulin levels in uveitis is limited and the findings therein are contradictory,,,,,. Moreover, there is no study to our knowledge that has assessed the effect of treatment on the levels of serum immunoglobulins in endogenous uveitis.
The present study was, therefore, undertaken to find out the levels of serum immunoglobulins in patients with endogenous uveitis in India before and after effective therapy and evaluate the data statistically.
| Material and methods|| |
The study was carried out among 85 healthy subjects and 138 patients of endogenous uveitis who reported during their first attack of uveitis and who did not have any detectable systemic disease. The former group served as control and comprised subjects who had no evidence of ocular or systemic disease and attended the Guru Nanak Eye Centre, New Delhi, mainly for the purpose of refraction during the same period. The age and sex distribution of the healthy subjects and patients with endogenous uveities are given in [Table - 1]. The mean age in the control group was 33.6 years (range 13 to 64 years and that in patients with uveitis was 34.8 years (range 11 to 64 years). Types of uveitis and the number of patients in each type are given in [Table - 2]
The diagnosis of endogenous uveitis was established by detailed clinical examination including slit-lamp biomicroscopy and direct and indirect ophthalmoscopy. They were not receiving any treatment before reporting to us. For the estimation of serum immunoglobulins blood samples were drawn from the patients with endogenous uveitis on the day they reported for the first time before any therapy was instituted. The patients were treated with local and systemic steroids, oral phenylbutazone, mydriatics and cyclopegics. One hundred and thirteen patients with endogenous uveitis were available for follow up. The therapy was considered to be effective when all the signs, and symptoms of active inflammation completely subsided. In these patients serum immunoglobulins were reestimated 4 to 6 months after the completion of effective therapy.
The sera samples were stored at 20°C until needed. Quantitative estimation of serum IgA, IgG and IgM was done by single radial immunodiffusion technique. Monospecific goat antisera against heavy chain human IgA, IgG and IgM and their respective reference standards were obtained from Meloy Laboratories, Virginia, U.S.A. The immunoglobulin levels were calculated from the calibration curve constructed by incorporating three known concentrations of standard for every set of immunoglobulin determination.
| Observations|| |
[Table - 2] gives the mean level of the serum immunoglobulins in healthy subjects and in patients with different types of endogenous uveitis and [Table - 3] gives the comparison between serum immunoglobulin levels in patients with different types of endogenous uveitis and healthy subjects.
It may be seen that the mean serum IgM level was significantly raised in all the types of endogenous uveitis but the rise was comparatively much more in patients with acute anterior uveitis and acute posterior uveitis. TgG level was significantly raised only in cases of chronic posterior uveitis. IgA level was not altered in any of the categories of endogenous uveitis. [Table - 4] shows the serum immunoglobulin levels in 113 patients with various types of endogenous uveitis bfeore and after the treatment. [Table - 5] shows the comparison of serum immunoglobulin levels in these patients and in healthy subjects. It maybe noted that serum IgM level, which was high in all types of endogenous uveitis before treatment, fell significantly after the treatment, only in cases of acute anterior uveitis and acute posterior uveitis, where the rise in the level of IgM was much more as compared to chronic posterior uveitis. Serum IgG, which was found to be significantly raised in chronic posterior uveitis before therapy, fell significantly after the completion of effective therapy.
| Discussion|| |
The data obtained on the serum immunoglobulin levels in endogenous uveitis by different workers varied widely. Goodner found that the gamma globulin level was often raised in anterior uveitis and lowered in posterior uveitis,. Koliopoulos has reported that serum IgM levels were raised in uveitis other workers have found no change in serum immuno globulin level of uveitis, Raised serum IgA levels have been reported by Lajos in uveitis. Norn, on the other hand, showed that both serum IgA and IgG levels were often raised in uveitis than serum IgM levels. Present study shows that serum IgM level is high in patients with all types of uveitis studied. This agrees with the reports of Koliopoulos et a1, Aronson, Rahi et al, and Grob et al and is in disagreement with those of Norn, Lajos, Ghose et a1, and Muravieva et a1. It is possible that the immune response may differ from place to place as uveitis results from an allergic reaction to one or more of a variety of antigens. Present study also shows that serum IgG level is high in chronic posterior uveitis. It may be noted that serum IgM is preferentially represented early in its response to a course of immunisation and it is only later that IgG synthesis increases markedly. This may explain why serum IgM level rose further and the serum IgG level remained unaltered in acute anterior and acute posterior uveitis and IgG level in serum rose in chronic posterior uveitis, which has a slow and insidious course.
No published report is available on the serum immunoglobulin levels in patients with endogenous uveitis after effective therapy. In the present study, effective treatment brought down the level of serum IgM in cases of acute anterior and acute posterior uveitis where the rise was proportionately much higher before therapy. It is possible that the individuals who had developed uveitis had raised serum IgM levels since birth and in acute anterior and acute posterior uveitis it rose further as a result of the disease and only this rise fell to pretreatment high level after the effective therapy. This supports the observation of others who showed that serum IgM level was raised in anterior uveitis and suggested that some individuals who had raised serum IgM level since birth were liable to get endogenous uveitis The facts that high IgM level in acute anterior and acute posterior uveitis and high IgG level in chronic posterior uveitis fell significantly with therapy indicate that monitoring of serum i mmunoglobulin levels during the follow-up period in uveitis, both acute and chronic, may be helpful and may be taken as another parameter in assessing the effectivity of the therapy.
| Summary|| |
Serum immunoglobulin levels in 138 patients with endogenous uveitis were studied. Serum IgM level was found to be significantly elevated in all types of endogenous uveitis but the rise was proportionately more in patients with acute anterior and acute posterior uveitis. IgG level was significantly elevated only in patients with chronic posterior uveitis. There was no change in the serum IgA level in any of the types of uveitis. Effective treatment brought down the elevated IgM level in acute anterior and acute posterior uveitis and the elevated IgG level in chronic posterior uveitis more or less to the pre-treatment level.
| References|| |
Aronson, S.B. In AronEon. S.B., Gamble, C,N., Goodner, E.K. and C' Conor. G.R. (eds) 1968, Clinical methods in uveitis. C.V. Mosty Co., St Louis, p. 185.
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Goodner, E.K., 1961, Clinical methods in uveitis (ed.) Aronson, S.B. C.V. Mosby Co., St Louis, p. 196.
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[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]