Abstract
Accurate diagnosis of uveitis is of great importance since the treatment for the various uveitis entities may differ considerably. In a large number of cases the clinical picture is sufficient to make an adequate diagnosis. There are cases in which the diagnosis cannot be made on clinical grounds alone and support is needed from laboratory tests. Only a limited number of tests have been proven to be useful as a diagnostic or prognostic aid. These include HLA-B27 typing in patients presenting with anterior uveitis and testing for angiotensin converting enzyme and lysozyme in case of suspected sarcoid uveitis. Toxoplasma serology is only useful to exclude the diagnosis and a positive test has very low specific value.
Analysis of local intraocular antibody production is a valuable tool to confirm a suspected clinical diagnosis in uveitis. It is now possible to analyse paired serum and aqueous samples for the presence of specific antibodies against toxoplasma, cytomegalovirus, herpes simplex virus and varicella zoster virus using commercially available kits.
Of the patients retrospectively diagnosed as having toxoplasma chorioretinitis 75% were shown to have a positive antibody coefficient indicating specific intraocular antibody production. Local antibody production in the eye directed against CMV confirmed the suspected diagnosis of CMV retinitis in 50% of the AIDS patients investigated. Until now we have not been able to measure local antibody production against herpes simplex virus (26 samples tested). Two of three patients with acute retinal necrosis had a positive antibody coefficient against varicella zoster virus. Both of these patients even had a higher titre in the aqueous than in serum. Since the choice of treatment, in infectious uveitis, depends on the causative organisms, it is very important to confirm a suspected clinical diagnosis with aqueous humor analysis.
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Kijlstra A, Linssen A, Ockhuizen Th, Baarsma GS, Dandrieu MR, Tjoa St, de Graauw J, Christiaans BJ, de Jong PTVM, Dekker-Saeys AJ, Feltkamp TWE : Diagnostic tests in uveitis. In Saari KM ed. Uveitis Update. Amsterdam, Elsevier Sci Publ B.V. 1984: 421–25.
Kijstra A, Rothova A, Baarsma GS, Zaal MJM, Fortuin ME, Schweitzer CMC, Glasius E, de Jong PTVM : Computer registration of uveitis patients. Doc Ophthalmol 1987, 67: 139–43.
Baarsma GS, La Heij E, Glasius E, de Vries J, Kijlstra A : The predictive value of serum angiotensin converting enzyme and lysozyme levels in the diagnosis of ocular sarcoidosis. Am J Ophthalmol 1987, 104: 211–7.
Rothova A, van Knapen F, Baarsma GS, Kruit PJ, Loewer-Sieger DH, Kijlstra A : Serology in ocular toxoplasmosis. Br J Ophthalmol 1986,70:615–22.
Kijlstra A, Hoekzema R, Van der Lelij A, Doekes G, Rothova A : Humoral and cellular immune reactions against retinal antigens in clinical disease. Curr Eye Res 1990, 9 (Suppl): 85–9.
Klok AM, de Vries J, Rothova A, Zaal MJM, Schweitzer CMC, Bos JD, Kijlstra A : Antibodies against ocular and oral antigens in BehÇet's disease associated with uveitis. Curr Eye Res 1989, 8: 957–62.
Kijlstra A, Luyendijk L, Baarsma GS, Rothova A, Schweitzer CMC, Timmerman Z, de Vries J, Breebaart AC : Aqueous humor analysis as a diagnostic tool in toxoplasma uveitis. Int Ophthalmol 1989, 13: 383–6.
Kijlstra A, van den Horn GJ, Luyendijk L, Baarsma GS, Schweitzer CMC, Zaal MJM, Timmerman Z, Beintema M, Rothova A : Laboratory tests in uveitis: new developments in the analysis of local antibody production. Doc Ophthalmol 1990, (in press).
Luyendijk L, van der Horn GJ, Visser OHE, Suttorp-Schulten MSA, van de Biesen PR, Rothova A, Kijlstra A : Detection of locally produced antibodies to herpes viruses in aqueous of patients with acquired immune deficiency syndrome (AIDS) or acute retinal necrosis syndrome (ARN). Curr Eye Res 1990, 9 (Suppl): 7–11.
Dussaix E, Cerqueti PM, Pontet F, Bloch-Michel E : New approaches to the detection of locally produced antiviral antibodies in the aqueous of patients with endogenous uveitis. Ophthalmolog-ica 1987, 194: 145–9.
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Kijlstra, A. The value of laboratory testing in uveitis. Eye 4, 732–736 (1990). https://doi.org/10.1038/eye.1990.104
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DOI: https://doi.org/10.1038/eye.1990.104
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