Immunopathology of scleritis.
Conjunctival and scleral biopsies from 25 patients with necrotizing scleritis and 5 patients with recurrent nonnecrotizing scleritis were studied by histopathologic, immunofluorescence, and immunoperoxidase techniques. Vasculitis with fibrinoid necrosis and neutrophil invasion of the vessel wall was present in 75% of the scleral and 52% of the conjunctival specimens. Vascular immunodeposits were found in 93% of the scleral and 79% of the conjunctival tissue tested by immunofluorescence techniques. A dramatic increase in the number of inflammatory cells over normal controls was detected in both tissues by immunoperoxidase techniques. In the conjunctival epithelium, there were significantly more T-helpers, macrophages, and B cells. In the conjunctival substantia propria, there were significantly more T cells of all types, macrophages, and B cells. Likewise, scleral specimens showed an increase over controls of T cells of all types and macrophages. HLA-DR expression was dramatically increased in both tissues. Immune-complex-mediated vasculitis plays a pivotal role in the pathogenesis of necrotizing scleritis and recurrent nonnecrotizing scleritis. Induced HLA-DR expression on ocular nonimmune cells and T cell controlled responses also may participate.
Fong
L P
LP
Uveitis and Immunology Service, Massachusetts Eye and Ear Infirmary, Boston.
Sainz de la Maza
M
M
Rice
B A
BA
Kupferman
A E
AE
Foster
C S
CS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000936:Antigen-Antibody Complex / Q000276:immunology; D001327:Autoimmune Diseases / Q000473:pathology; D001402:B-Lymphocytes / Q000276:immunology; D001706:Biopsy; D003228:Conjunctiva / Q000276:immunology* / Q000473:pathology; D005260:Female; D005455:Fluorescent Antibody Technique; D006684:HLA-DR Antigens / Q000276:immunology; D006801:Humans; D007124:Immunoenzyme Techniques; D008264:Macrophages / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012590:Sclera / Q000276:immunology* / Q000473:pathology; D015423:Scleritis / Q000276:immunology* / Q000473:pathology; D013601:T-Lymphocytes / Q000276:immunology; D006377:T-Lymphocytes, Helper-Inducer / Q000276:immunology
D000936:Antigen-Antibody Complex; D006684:HLA-DR Antigens