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Mónica Delgado Riveira, Nicolás Alejandre Alba; UVEITIS IN PSORIASIC PATIENTS: A DESCRIPTIVE STUDY. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1865.
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© ARVO (1962-2015); The Authors (2016-present)
Psoriasis is a chronic T cell-mediated autoimmune disease, but its pathogenesis remains unknown. Since viral infections appear to be increased in patients with psoriasis, viral antigens have been proposed as potential triggers. The aim of our study was to describe features of eye inflammation in patients with psoriasis and to compare them with previously described patterns of uveitis. We sought for findings that could support the influence of viruses in the development of uveitis in patients with psoriasis.<br />
We retrospectively evaluated 14 patients diagnosed with psoriasis (10 men and 4 women with an average age of 51 years), suffering an episode of uveitis. Of them, 50% had pustular psoriasis and 33% had psoriatic arthritis, while 2 patients had both.
Slit lamp revealed retro-keratic precipitates in 50% of the patients. All of them followed a similar pattern, consisting of pancorneal, white, thin and star-shaped lesions. Four out of the 7 patients with retro-keratic precipitates had an increased intraocular pressure. Nine out of the 14 patients had unilateral eye involvent. The most frequent diagnosis was Recurrent Acute Anterior Uveitis (RAAU) (43%).There was one patient diagnosed with Chronic Bilateral Ischemic Vasculitis (CBIV) and another with Chronic Intermediate Anterior Uveitis (CIAU). A sample of aqueous humor (AH) was available in 4 of the 14 patients. Interestingly, 2 of them yielded a positive result for type I HSV, as studied by genome amplification with polymerase chain reaction. The patient with CIAU had AH high CD4+ and CD8+ T cell counts, with an inverted CD4+/CD8+ ratio (0.69). In addition, vitreous humor from the patient with a CBIV showed also high CD4+ and CD8+ T counts, with a ratio of 1.37.
In our cohort, patients with psoriasis showed some characteristics resembling those of viral-induced uveitis. These included a predominantly unilateral involvement, presence of star-shaped retro-keratic precipitates, ocular hypertension and high local counts of CD4+ and CD8+ T cells. All these features have been found in patients with uveitis caused by cytomegalovirus, herpes simplex and rubella viral infections.<br /> In spite of the small sample size of our study, our findings point to an antiviral-like cell response during episodes of uveitis in patients with psoriasis, and abound in the global contribution of viral antigens to the pathogenesis of psoriasis.
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