IMMUNOPATHOLOGIC STUDY OF THE CONJUNCTIVA IN PATIENTS WITH BEHCET-DISEASE

Purpose: Even though conjunctiva is not primarily involved in patients with uveitis due to Behcet disease, it may reflect the immunopatholog ic process when inflammation is induced by biopsy of conjunctiva, a ph enomenon similar to the induced inflammation at skin pathergy sites. M ethods: Conjunctival biopsy specimens obtained 48 hours after a 2-mm b iopsy of the epibulbar conjunctiva in 26 Turkish patients with inactiv e ocular Behcet disease and 9 Turkish patients with inactive idiopathi c uveitis were studied by immunoperoxidase using a panel of monoclonal antibodies: anti-CD1, -CD3, -CD4, -CD5, -CD14, -CD22, -CD25, and -CD6 7, HLA-DR, E-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1). Results: Immunopathology of the conjunctival specimens obtained at the time of first biopsy was not significantly different between the Behcet disease and the idiopa thic uveitis groups. The second-biopsy specimens of the patients with Behcet disease showed significantly greater numbers of T cells (CD3+, CD4+) and granulocytes (CD67+) as well as HLA-DRS and ICAM-1 + cells i n the substantia propria. Vascular endothelium of the conjunctiva in a patient with Behcet disease had significantly more pronounced express ion of the adhesion molecules, E-selectin, and ICAM-1. None of the con junctival specimens in either group showed VCAM-1 positivity. Conclusi ons: These results show that a more intense antigen-independent inflam mation develops with recruitment of both neutrophils and T lymphocytes of helper/inducer phenotype in the conjunctiva of patients with Behce t disease in response to surgical trauma. Increased expression of E-se lectin and ICAM-1 in the conjunctiva of patients with Behcet disease m ay suggest a critical role for these adhesion molecules in the initial events of inflammation.