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M. Patronas, J.A. Smith, G.F. Reed, G.A. Levy-Clarke, R.R. Buggage; Association Between Serum Immunoglobulin Levels and Corneal Abnormalities in Patients with HTLV-1 Related Disease . Invest. Ophthalmol. Vis. Sci. 2003;44(13):667.
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Background: Infection with HTLV-1 is endemic in Japan and the Caribbean. HTLV-1 is the established cause of adult T-cell leukemia/lymphoma (ATL), HTLV-1 associated myelopathy/Tropical Spastic Paraparesis (HAM/TSP) and HTLV-1 associated uveitis. Recently, corneal pathology has been recognized in predominantly non-Japanese withth asymptomatic HTLV-1 infection and established HTLV-1 diseases. It has been suggested that the corneal findings in these patients are a consequence of the hypergammaglobulinemia induced by the HTLV-1 infection or the ATL. Purpose: To investigate the association between serum immunoglobulin (Ig) levels and corneal pathology in patients with HTLV-1 related disease. Methods: Patients underwent a complete ophthalmic examination and slit lamp photography. Quantative serum Ig levels (IgG, IgM, IgA and IgE) were determined. Corneal abnormalities were described according to their appearance and location. Keratoconjunctivitis sicca (KCS) was defined as a Schirmer test without anesthesia <5 mm and a tear break up time<5 seconds. Associations between the corneal abnormalities, Ig levels and KCS were determined using the Fisher's exact test. Results: Of the 41 patients, 40 were of African descent, 24 had ATL and 17 had HAM/TSP. Visually insignificant, asymptomatic corneal opacities were identified in 15 patients; 13/24 (54%) with ATL and 2/17 (12%) with HAM/TSP. The opacities were most frequently located inferiorly or superiorly in the peripheral or anterior cornea. Other ocular surface findings included corneal haze corneal pigmentation, pinguecula, neovascularization, pterygia and corneal thinning. Two patients had anterior uveitis. KCS was diagnosed in 18/27 patients; 11/19 (58%) with ATL and 7/8 (88%) with HAM/TSP. Elevated serum Ig levels were found in 17/24 (71%) patients with ATL and 13/17 (76%) patients with HAM/TSP. For ATL patients 65% of those with elevated Ig had corneal opacities vs 29% with normal Ig, p>0.05. For HAM/TSP patients it was 15% vs 0%, p>0.05. Elevated IgG was most strongly associated with corneal opacities, p=0.015. 7/13 (54%) of patients with ATL and 6/7(86%) of patients with HAM/TSP had both elevated Ig and KCS, p>0.99. Conclusions: Elevated serum Ig levels were more closely associated with corneal opacities than with KCS. Although hypergammaglobulinemia could account for the corenal opacities in some of these patients, elevated serum Ig does not provide an explanation for the corneal abnormalities in all patients with HTLV-1 related disease.
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