The association of systemic disorders with Vogt-Koyanagi-Harada and sympathetic ophthalmia.
ABSTRACT The aim of this work is to determine the systemic diseases and malignancy associated with Vogt-Koyanagi-Harada (VKH) disease compared to sympathetic ophthalmia (SO).
We conducted a retrospective comparative observational clinical study where the medical records of patients with the diagnosis of VKH and SO from 1999-2009 were reviewed. The study was carried out at the King Khaled Eye Specialist Hospital and The Eye Center in Riyadh, Saudi Arabia. Investigators recorded the age, gender, history of trauma, associated systemic disorders, and ocular and systemic manifestations. Patients were examined by an ophthalmologist as well as an internist.
A total of 316 patients were included: 256 patients had VKH and 60 patients had SO. The age range in the VKH group was 3-62 years with a mean age of 29 ± 13 years. The age range in the SO group was 4-90 years with a mean age of 36 ± 20 years. The mean follow-up period of patients with VKH was 58 ± 50 months and patients with SO was 61 ± 54 months. Out of 256 patients with VKH, there were 41 (16%) with systemic disorders. Comparatively, out of 60 patients with SO, no associated systemic autoimmune disorders or tumors were encountered. The difference between the VKH and SO groups was statistically significant (p = 0.003).
VKH and SO are autoimmune disorders targeting melanin-bearing cells. Both diseases are characterized by immunologic dysregulation. We found a statistically significant association of systemic disorders and malignancy with VKH compared to SO. This finding may suggest that the two disorders may have different etiology with similar ocular and systemic manifestations.
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ABSTRACT: To determine the functional properties and cytokine production profiles of melanoma specific cytotoxic T lymphocytes (CTLs) induced from peripheral blood leucocytes of two patients with Vogt-Koyanagi-Harada disease (VKH). Melanoma specific CTL lines were established by long term coculture with a human melanoma cell line (P-36). Cytotoxic activity against P-36 was measured by 51Cr release. The involvement of human leucocyte antigen (HLA) class I or class II molecules in the cytotoxicity of the CTL lines against P-36 was analysed using anti-HLA class I or anti-HLA class II monoclonal antibody (MAb). Surface molecules of CTL lines were analysed by flow cytometry using MAbs specific for CD4, CD8, CD16, CD25, CD56, HLA-DR, T cell antigen receptor (TCR) alpha beta and TCR gamma delta. Cytokine production and soluble interleukin 2 receptor (sIL-2R) secretion were determined by enzyme linked immunosorbent assays. mRNAs of cytokines were analysed using reverse transcription polymerase chain reaction (RT-PCR). CTLs showed strong cytotoxic activity against P-36. The CTL activity of the cell lines against P-36 was inhibited by the anti-HLA-DR MAb, whereas the MAb specific for monomorphic determinants of HLA-A, B, and C failed to block lytic activity. Flow cytometry identified the following surface molecules: CD4+, CD8-, CD16-, CD25+, CD56-, HLA-DR+, TCR alpha beta +, and TCR gamma delta-. CTLs constitutively produced a high level of IL-6. IL-6 production and sIL-2R secretion of CTLs were enhanced when CTLs were stimulated with P-36. CTLs also produced high levels of interferon gamma (IFN-gamma) and IL-2, but not IL-4. mRNAs of IL-2 and IFN-gamma were detected by RT-PCR in the CTLs. Melanoma specific HLADR restricted T helper 1 (Th1) CTLs may play a role in the immunopathogenesis of VKH.British Journal of Ophthalmology 12/1996; 80(11):1002-8. · 2.73 Impact Factor
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ABSTRACT: The main objective of this study was to determine the causes of uveitis at a referral center in Riyadh, Saudi Arabia. We carried out a retrospective review of clinical records of 200 uveitis cases referred to The Eye Center, a referral center in Riyadh, Saudi Arabia. There were 120 (60%) males and 80 (40%) females with an age range of 7 to 91 years and a mean age of 35 (SD +/- 17). Patients had complete ophthalmic and medical examinations. Laboratory studies were requested whenever indicated. Patients were followed up for a minimum of 12 months. In the period 1995-2000, we encountered 200 cases of uveitis among a total of 20,191 consecutive new cases, yielding a prevalence of 1%. Acute anterior uveitis of undetermined origin was found in 58 (29%) of 200 patients. There were 13 (6.5%) cases of Behçet's disease, 7 (3.5%) of Fuchs' heterochromic iridocyclitis, 6 (3%) of sarcoidosis, and 5 (2.5%) patients had Vogt-Koyanagi-Harada syndrome (VKH). Among the infectious causes, herpetic uveitis was found in 32 (16%) patients, tuberculosis in 21 (10.5%), and toxoplasmosis in 13 (6.5%) cases. Seventeen (8.5%) cases were of miscellaneous origin and in 28 (14%) cases the etiologic diagnosis was undetermined. Acute anterior uveitis of undetermined origin was the most common cause of uveitis, followed by Behçet's disease. Herpetic uveitis was the most common infectious cause of uveitis. Ocular tuberculosis and toxoplasmosis were found to be common causes of infectious uveitis at this referral center in Saudi Arabia.Ophthalmic Epidemiology 11/2002; 9(4):239-49. · 2.18 Impact Factor
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ABSTRACT: To discover a relationship between Vogt-Koyanagi-Harada (VKH) syndrome and Sjögren syndrome. Observational case-control study. Sixteen Italian patients with VKH syndrome and 16 controls with diffuse uveitis underwent tear analysis and rheumatologic evaluation. Biopsy specimens of the minor salivary glands were obtained or salivary gland scintigraphy was performed in patients with xerostomia. The Schirmer test (P <.0001), break-up time (P <.0001), the Ferning test (P <.001), and fluorescein and rose bengal staining (P <.0001) resulted in changes in VKH. Biopsy was positive in two patients and scintigraphy in four. Human leukocyte antigen DR4 was found in 68.75% of VKH cases and in 83.3% of the cases with Schirmer test less than 3 mm. The incidence of keratoconjunctivitis sicca was higher in VKH syndrome patients than in controls. Two patients satisfied the criteria for Sjögren syndrome, and two others had scintigraphy indicative of salivary gland involvement. The association of these two autoimmune disorders is suggested by the low incidence of VKH syndrome in Italy and might be related to HLA DR4.American Journal of Ophthalmology 04/2004; 137(4):769-70. · 3.63 Impact Factor