Elevated vitreous concentration of monoclonal immunoglobulin manifesting as schlieren in juvenile rheumatoid arthritis-associated uveitis

We report the clinical findings and analysis of the immunoglobulin (Ig) com position of the vitreous of a 10-year-old girl with juvenile rheumatoid art hritis-associated uveitis. The vitreous had a schlieren appearance at the t ime of pars plana lensectomy and vitrectomy. Analysis of the vitreous fluid revealed marked elevation of IgG, IgM, IgA, and albumin levels relative to vitreous fluids from control patients without uveitis. The immunoglobulin coefficients were also elevated for the IgG and IgM classes of immunoglobul ins. Immunofixation electrophoresis of the vitreous fluid revealed 2 distin ct bands of restricted electrophoretic mobility. These studies suggest that there may be local (intraocular) production of immunoglobulins as an immun ologic response in ocular inflammatory diseases such as juvenile rheumatoid arthritis-associated uveitis and that this immunologic response may be mon oclonal (possibly biclonal or oligoclonal) in nature.