TY - JOUR
T1 - Skin biopsies in the evaluation of atypical optic neuropathies
AU - Bielory, L.
AU - Kupersmith, M.
AU - Warren, F.
AU - Bystryn, J.
AU - Frohman, L.
N1 - Funding Information:
O All correspondence to: Leonard Bielory, M.D., Division of Allergy and Immunology, Immuno-Ophthalmology Research Laboratory, U.M.D. - New Jersey Medical School, 90 Bergen Street, Doc 4700, Newark, N.J. 07103-2441, USA +Supported by grants from the: Fight for Sight - Research Division of the National Society to Prevent Blindness, Fund for the New Jersey Blind, Lions' Eye Research Foundation of New Jersey, and Research to Prevent Blindness, Inc. o Presented at the Second International Symposium on Ocular Inflammation, Jerusalem, Israel, 30 August-3 September, 1992.
PY - 1993
Y1 - 1993
N2 - Patients with atypical clinical presentations of common optic neuropathies such as optic neuritis (ON), anterior ischemic optic neuropathy (AION), or optic neuropathy of unknown etiology (UON) are difficult to distinguish from inflammatory autoimmune optic neuropathy (AON) which is typically associated with a poor visual prognosis, unless treated with high doses of corticosteroids and/or immunosuppressive agents. The authors retrospectively evaluated 34 patients [AON (n = 12); AION (n = 5); ON (n = 9); UON (n = 8)] with visual loss which deteriorated over weeks to months or followed an atypical course, for the presence of immunological markers suggestive of AON. These markers included serological testing for antiphospholipid (APA) and antinuclear (ANA) antibodies, and evaluation of histopathologic and immunofluorescent staining of skin biopsies. All patients underwent a skin biopsy. Four of the 12 patients with AON had urticarial cutaneous lesions which revealed leukocytoclastic and/or lymphohistiocytic vasculitis. Seven of the remaining eight AON patients had skin biopsies of non-lesional skin which revealed immunoreactant deposition. Seven of the 21 skin biopsies obtained from the non-AON patients had findings of vacuolization or mild perivascular infiltration of lymphocytes (n = 5) and immunofluorescent deposits (n = 2). Abnormal skin biopsies (92%;p = 0.0009) and circulating APA (82%; p = 0.013) were common in AON patients while ANA was not statistically increased in AON patients (p = 0.06) when compared to the remaining patients as a whole. AON patients typically demonstrate evidence of systemic autoimmune involvement, as manifested by cutaneous abnormalities such as urticarial vasculitis and/or immunoreactant deposition and circulating APA. These may serve as markers for identifying AON patients who may be treated with immunomodulatory agents.
AB - Patients with atypical clinical presentations of common optic neuropathies such as optic neuritis (ON), anterior ischemic optic neuropathy (AION), or optic neuropathy of unknown etiology (UON) are difficult to distinguish from inflammatory autoimmune optic neuropathy (AON) which is typically associated with a poor visual prognosis, unless treated with high doses of corticosteroids and/or immunosuppressive agents. The authors retrospectively evaluated 34 patients [AON (n = 12); AION (n = 5); ON (n = 9); UON (n = 8)] with visual loss which deteriorated over weeks to months or followed an atypical course, for the presence of immunological markers suggestive of AON. These markers included serological testing for antiphospholipid (APA) and antinuclear (ANA) antibodies, and evaluation of histopathologic and immunofluorescent staining of skin biopsies. All patients underwent a skin biopsy. Four of the 12 patients with AON had urticarial cutaneous lesions which revealed leukocytoclastic and/or lymphohistiocytic vasculitis. Seven of the remaining eight AON patients had skin biopsies of non-lesional skin which revealed immunoreactant deposition. Seven of the 21 skin biopsies obtained from the non-AON patients had findings of vacuolization or mild perivascular infiltration of lymphocytes (n = 5) and immunofluorescent deposits (n = 2). Abnormal skin biopsies (92%;p = 0.0009) and circulating APA (82%; p = 0.013) were common in AON patients while ANA was not statistically increased in AON patients (p = 0.06) when compared to the remaining patients as a whole. AON patients typically demonstrate evidence of systemic autoimmune involvement, as manifested by cutaneous abnormalities such as urticarial vasculitis and/or immunoreactant deposition and circulating APA. These may serve as markers for identifying AON patients who may be treated with immunomodulatory agents.
KW - Antinuclear antibodies
KW - Antiphospholipid antibodies
KW - Optic neuropathies
KW - Skin biopsies
UR - http://www.scopus.com/inward/record.url?scp=0042456289&partnerID=8YFLogxK
U2 - 10.3109/09273949309085023
DO - 10.3109/09273949309085023
M3 - Article
AN - SCOPUS:0042456289
SN - 0927-3948
VL - 1
SP - 231
EP - 242
JO - Ocular Immunology and Inflammation
JF - Ocular Immunology and Inflammation
IS - 3
ER -