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Ocular Involvement in Systemic Vasculitis Associated With Perinuclear Antineutrophil Cytoplasmic Antibodies
Arch Ophthalmol. 2004;122:786-787.
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Antineutrophil cytoplasmic antibody (ANCA) formation to myeloperoxidase or perinuclear (p-ANCA) is infrequent in ocular disease and is reported in approximately 10% of patients with Wegener granulomatosis 1-2 as opposed to cytoplasmic (c-ANCA) positivity (antibodies to proteinase 3), which is well recognized. Higher levels of p-ANCA are also identified in microscopic polyangiitis, Churg-Strauss syndrome, inflammatory bowel disease, and crescentic glomerulonephritis. The sensitivity and specificity of both tests are high for a vasculitic process frequently associated with a systemic disease that requires prompt immunosuppressive therapy.1-2
We report 4 cases of p-ANCA positivity showing a spectrum of severe ocular involvement. Two patients had been systemically unwell previously, but it was the ocular disease that prompted ANCA measurement.
Report of Cases.
Case 1. A 76-year-old man had a 12-month history of red smarting eyes. Examination revealed bilateral peripheral ulcerative keratitis with normal visual acuity and no proptosis. Investigations revealed chronic renal failure and positive levels of p-ANCA (1/160) . . . [Full Text of this Article]
Comment.
Samantha S. Dandekar, MRCOphth;
Niro N. Narendran, MRCOphth;
Beth Edmunds, FRCOphth, MD;
Elizabeth M. Graham, FRCP, FRCOphth
London, England
Corresponding author and reprints: Samantha S. Dandekar, MRCOphth, Department of Clinical Ophthalmology, Professional Unit, Moorfield's Eye Hospital, City Road, London EC1V 2PD, England (e-mail: s.dandekar@ucl.ac.uk).
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