Autoimmune inflammation of the eye and pathogenesis of ACAID in cataracts with coexistent glaucoma

1. Autoimmune inflammation of the eye and pathogenesis of ACAID in cataracts with coexistent glaucoma Artashes Zilfyan PhD Scientific-Research Center of the Yerevan State Medical University after M. Heratsi, Yerevan, Armenia and Medical Center “Shengavit”, Yerevan, Armenia.

2. Introduction • The term “ocular immune privilege” implies the entire complex of regional immune cell-mediated and humoral reactions aimed to prevent development of inflammatory and dystrophic processes in membranes and liquids of the eye in a wide range of ophthalmic diseases. Peyman, G., Lee, P., Seal, D.V. Endophthalmitis – diagnosis and management. Taylor & Francis, London: 2004, pp 1 – 270[191] Niederkorn, J. Y.: Immune privilege and immune regulation in the eye. Adv Immunol. 48, 1990, 191 – 226[198] Streilein, J. W.: Ocular immune privilege and the faustian dilemma. Invest Ophthalmol Vis Sci 37, 1996, 1940 – 1950 • At the same time , this term reflects first of all the state of “local immune homeostasis” under conditions of normal functioning of the eye • The entire cascade of local protective-adaptive mechanisms is aimed to formation of immunological process, which altogether is defined as anterior chamber associated immune deviation (ACAID) Wilbanks, G.A., Streilein, J.W. Studies on the induction of anterior chamber – associated immune deviation (ACAID). I. Evidence that an antigen-specific, ACAID-inducing, cell-associated signal exists in the peripheral blood. J. Immunol. 146:2610, 1991

3. Purpose • To reveal in aqueous humour (AH) of the eye immune factors ( CD4, CD8, IgG) excreted in extra-barrier membranes of an eye under mechanisms of ACAID (anterior chamber associated immune deviation) in case of cataract on the background of open angle glaucoma

4. Methods • The AH of patients with senile cataract (Group I) and complicated cataract on the background of open angle glaucoma (Group II) was studied. • Extraction of anterior chamber humour was performed intraoperatively during microcoaxial phacoemulsification. • In each Group of patients operated at Medical Center “Shengavit” by 32 AH samples were analyzed to determine CD4, CD8 and IgG.

5. Methods • Appropriate kits were used to determine the content of CD4, and CD8 (“DRG-International Inc.”, USA-Germany) in AH. Immune-enzyme analyses (ELISA) were performed on spectrophotometer “Stat-Fax” (USA) at 420-450 nm. Determination of immunoglobulin G class was done according to Manchini. • The results were analyzed using Student’s criteria

6. Results • No IgG was revealed in AH of Group I patients. • In Group II, IgG was revealed in AH of 78% cases patients and made 39.7±5.9 UI/ml. Relatively high level of CD4 (26.1±4.3 unit/ml) and low CD8 (21.75±5.6 unit/ml) were revealed in AH of Group II, as compared to those in Group I: CD4=10.7±2.1 unit/ml (0.005>p>0.0005); CD8 = (52.7±6.5 unit/ml) (0.005>p>0.0005).

7. Results • In postoperative period at 12 patients the Group II had signs of anterior uveitis, with +1-+3 cells in anterior chamber. At the end of the first week autoimmune inflammation was corrected with the use of corticosteroids and nonsteroid antiiflammatory medications.

8. Patient from group II had signs of anterior uveitis, with +1-+3 cells and fibrin in anterior chamber

9. Patient from group II had signs of anterior aseptic uveitis, with +3-+4 cells, fibrin and hypopion in anterior chamber

10. Conclusion • In AH of Group II patients alongside with cytotoxic lymphocites (CD8) activity decrease, there were revealed relatively high levels of CD4 and IgG, which already at the early post-operative period might become risk factors for induction of autoimmune aggression as a response to bearing of antigen determinants of lens. • This type of autoimmune inflammation differed from TASS evidence and endophthalmitis

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