1. HLA-B27 Associated Anterior Uveitis
-Review-
R2 이민아

2. 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

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

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

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

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

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

8. sacroilitis

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

10. Anterior chamber reaction
Blurring of vision
Fibrin clot
Posterior synechiae

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

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

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

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

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

16. 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

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

18. 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

19. 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!!!!

20. Asteroid Hyalosis

21. 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

22. 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
% is found unilaterally
Asteroid bodies move as the vitreous body moves and tend to return to their original positions

23. 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.