OCULAR MANIFESTATIONS IN PATIENTS WITH HTLV-I-ASSOCIATED INFECTION - A CLINICAL-STUDY OF 93 CASES

The purpose of this study was to confirm that ophthalmological feature s seen in patients in Martinique, French West Indies, could be linked to infection by HTLV-I. The authors studied 93 HTLV-I infected patient s divided into 70 patients with HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) and 23 asymptomatic HTLV I carriers. The y did a complete ophthalmological examination with an assessment of la crymal secretion by means of three tests: Shirmer 1, break-up time and rose Bengal. Some patients had a biopsy of secondary salivary glands. When possible, detection of HTLV-I antibodies was carried out in the aqueous humor. In 45 of the 93 patients (48.4%) the presence of dry ke ratoconjunctivitis was recorded. In 22 of these 45 cases, a biopsy of the secondary salivary glands showed the presence of lymphoplasmocytoi d infiltrations comparable to the glandular changes that occur with Go ugerot-Sjogren syndrome. Among the 93 patients, 15 cases of uveitis we re noted (16.1%) with 13 cases of anterior uveitis and 11 cases of vit ritis. The inflammation was bilateral in 9 cases (9/15=60%). Two cases of cotton wool spots, 3 cases of abnormalities in the distribution of the retinal pigment and 7 cases of corneal lesions were also noted. H igher levels of anti-HTLV-I antibodies were detected in the aqueous hu mor of 3 patients with uveitis. The coexistence of dry eye (keratoconj unctivitis), uveitis and retinal microangiopathy in patients who are s uffering from HAM/TSP could suggest the involvement of an autoimmune o r immunological mechanism in the physiopathology of the illness.