HLA-B27 Associated Anterior Uveitis -Review- R2 이민아

HLA-B27 -Incidence 6~8% of the Caucasian population of the USA 50% of patient with AAU 90% of patient with AAU who have an associated spondyloarthropathy

HLA –B27 spondyloarthropathy 1. Ankylosing spondylitis:90~100% 2. Reiter’s syd: 70~90% 3. Inflammatory bowel dis: 6% 4. Psoriatic arthritis: 18~22%

HLA-B27 -Manifestation Systemic & dermographic -oral ulcer -genital ulcer -arthlagia -skin lesion

HLA-B27 -Manifestation Ocular manifestation -Typically unilateral -Severe -Higher recurrence -Higher incidence of post. Synechiae -Fibrous exudate in AC is common

ankylosing spondylitis incidence 2.5 to 3 Male: 1 Female Females have milder disease 96% have (+) HLA-B27

ankylosing spondylitis Geneal condition -chronic low back pain -fusion of axial skeleton , sacroilitis -arthritis in shoulder, hip, -restrictive lung dis -Aortic insufficiency -Cardiomegaly

sacroilitis

ankylosing spondylitis Ocular Manifestations Bilateral in 80%, but rarely simultaneous Recurrence Iritis Conjunctivitis

Anterior chamber reaction Blurring of vision Fibrin clot Posterior synechiae

ankylosing spondylitis Post. Seg. Lesion -rare in patient -acute panuveitis in 6%

ankylosing spondylitis treatment -If the disease is recognized and treated early, spinal deformity can be prevented -Physical therapy -NSAIDs

Reiter’ syd Most common cause of inflammatory oligoarthropathy in young males <classic triad> -arthritis ;asymmetric, episodic oligoarthritis affecting primarily the LE -urethritis -conjunctivitis:

Reiter’ syd Conjunctivitis Keratitis Iritis bilateral , mild, mucopurulent with papillary, follicular reaction Keratitis Multifocal punctate subepithelial and stromal infiltrates Iritis Mild, non-granulomatous

Reiter’ syd treatment Ocular Joint involvement Topical corticosterooids Mydriatic agents Joint involvement NSAIDs Immunosuppresive therapy

Psoriatic arthritis General condition -inflammatory arthritis: Involve of the distal interphalangeal joint Severely deforming, erosive radiologic changing, mono-arthritis occurs on extensor surface , RF(-) Cutaneous: erythematous, well demarcated macules with sivery scales

Psoriatic arthritis Ocular manifestation Conjunctivitis :20-30% Ant.uvetis: 7% Scleral dis: 2%

Diagnosis History Ophthalmic examination CBC/BC/U.A ESR/CRP Chest X-ray, Radiologic fiding :sacroiliac joing HLA-B27 typing DDx:VDRL, toxoplasma IgG, CMV, VZV , HSV Reumatoid factor ANA

Treatment Drug Topical: Steroid drops Methotrexate:10-25 mg/week Cyclosporine:5 mg/kg/day, oral Azathioprine:1-1.5 mg/kg/day, oral Cyclophosphamide 1-1.5 mg/kg/day, oral Topical: Steroid drops Cycloplegics Systemic: Corticosteroids Subtenon inj 보완!!!!

Asteroid Hyalosis

Definition and incidence A form of vitreous degeneration in which calcium soaps aggregate in vitreous body More prevalence in older patients with male to female ratio 2:1. Etiology is not clearly understood

Clinical features Symptoms: rarely affects patient's visual acuity even in cases of severe vitreous involvement. Signs: White to yellow-white small round to oval opacities suspended throughout the vitreous body 75 - 90% is found unilaterally Asteroid bodies move as the vitreous body moves and tend to return to their original positions

DDx. & management Differential diagnosis: amyloidosis and cholesterolosis bulbi. Management: No treatment is required. Vitrectomy may be indicated when oorvisualizationof the fundus causes retinal diseases diagnosis, follow-up and treatment difficult.