First Author: K.Skonieczna POLAND
Co Author(s): I. Grabska Liberek B. Terelak Borys M. Olesinska
Purpose:
The aim of study is to establish the potencial role for autoimmunity etiology of normal tension glaucoma.
Setting:
: 1. Ophthalmology Department, The Medical Centre of Postgraduate Education, Warsaw, Poland
2. Institute of Rheumatology, Department of Connective Tissue Diseases, Warsaw, Poland
Methods:
Till now 115 patients were enrolled to the study: 25 with normal tension glaucoma (NTG), 34 with primary open-angle glaucoma (POAG), 20 with autoimmunological rheumatic diseases (systemic lupus erythematosus, Sjögren`s syndrome, rheumatoid arthritis) and 36 control group of healthy subjects. All of the patients underwent ophthalmic examination (visual acuity, slit-lamp examination, tonometry, gonioscopy, direct ophthalmoscopy, pachymetry, automated static perimetry, optical coherence tomography of retinal nerve fiber layer and optical coherence tomography of macula) and blood tests. Blood was drawn from each patient and serum was examined for the presence of antinuclear antigens (ANA), antibodies to extractable nuclear antigens (ENA), immunoglobulin (IgG, IgA and IgM) levels, rheumatoid factor, anti-citrullinated protein antibodies (ACPA) and antiphospholipid antibodies (anticardiolipin antibodies IgG and IgM, beta2-glycoprotein I antibodies IgG and IgM, antiprotrombin antibodies IgG and IgM).
Results:
The mean level of ANA was the highest in the group of patients with rheumatic diseases – 404,4. In NTG group mean ANA level was – 70,4, in POAG group – 58,2, in control group – 44,4. None patient from NTG, POAG or control group had positive antibodies to ENA. The level of immunoglobulins IgG, IgM i IgA in four groups was similar and it was within normal limits. The mean level of rheumatoid factor was higher in POAG, rheumatic diseases group and control group. The mean level of APCA was higher only in serum of patients with rheumatic diseases. The mean level of antiphospholipid antibodies was approximately similar in each group. In the group of 20 patients with with autoimmunological rheumatic diseases examined, we found 2 patients (10%) with NTG and 6 patients with visual field loss. In control group there were no patients with NTG.
Conclusions:
The results support the hypothesis that patients with autoimmunological rheumatic diseases are susceptible to normal tension glaucoma. We do not have statistics comparing the level of antinuclear antigens, but a tendency of higher level of ANA among the NTG patients was noticed. It can suggest a potencial role for autoimmunity etiology of normal tension glaucoma. By the end of the study we will be able to state if humoral immune mechanism may have a role in the pathogenesis of optic neuropathy in patients with NTG.
Financial Disclosure:
None
