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Uveitis and Immunological Disorders pp 9–18Cite as

Acute A nterior Uveitis and HLA-B27: 2 What's New?

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Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Acute anterior uveitis (AAU) is by far the most common form of uveitis [6]. It is characterized by a breakdown in the blood–aqueous barrier and acute inflammation of the iris and ciliary body. Immunopathologically, there is up-regulation of cell adhesion molecules on the uveal vasculature and aqueous humor expression of pro-inflammatory cytokines such as tumor necrosis factor (TNF)-α, interferon (IFN)-γ and chemokines that selectively recruit and activate inflammatory cells (neutrophils, monocytes and lymphocytes) into the uvea and anterior chamber (AC). These cells are visible clinically on slit lamp biomicroscopy. The breakdown in the blood–ocular barrier results in leakage of serum proteins from the uveal vasculature into the AC, which is visible on biomicroscopy as aqueous flare and fibrin formation. Keratic precipitates (KPs) represent inflammatory cells that have precipitated on the corneal endothelium. Thus AAU is a prototypical inflammatory disease in which the clinician is uniquely able to visualize the inflammatory response in vivo and all of its sequelae using the slit lamp biomicroscope, and to correlate it with the immunopathological process.

About 50% of all cases of AAU are associated with the presence of HLA-B27, a class I major histocompatibility complex (MHC) [8]. HLA-B27-associated AAU represents a distinct clinical phenotype that may be associated with severe intraocular inflammation as well as systemic inflammatory diseases such as the seronegative spondyloarthropathies (SpA). There has been some recent progress in our understanding of the clinical features and the immunopathogenesis of this group of diseases. The aim of the present chapter is to highlight these advances for the clinician managing patients suffering from AAU.

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Authors and Affiliations

  1. Laboratory of Ocular Immunology Inflammatory Diseases Research Unit, School of Medical Sciences University of New South Wales, Sydney, Australia

    John H. Chang, Peter J. McCluskey & Denis Wakefield

  2. Department of Ophthalmology, St Vincent's Hospital, Sydney, Australia

    John H. Chang, Peter J. McCluskey & Denis Wakefield

  3. Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, Australia

    Peter J. McCluskey

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© 2009 Springer-Verlag Berlin Heidelberg

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Chang, J.H., McCluskey, P.J., Wakefield, D. (2009). Acute A nterior Uveitis and HLA-B27: 2 What's New?. In: Uveitis and Immunological Disorders. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69459-5_2

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  • DOI: https://doi.org/10.1007/978-3-540-69459-5_2

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-69458-8

  • Online ISBN: 978-3-540-69459-5

  • eBook Packages: MedicineMedicine (R0)

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