101
|
Smith SC. The red eye: information for ophthalmic nurses and technicians. INSIGHT (AMERICAN SOCIETY OF OPHTHALMIC REGISTERED NURSES) 2012; 37:5-8. [PMID: 22439350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
102
|
Opremcak EM. Scleritis--Wegener's granulomatosis. INSIGHT (AMERICAN SOCIETY OF OPHTHALMIC REGISTERED NURSES) 2012; 37:13. [PMID: 23256431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
103
|
Payne JF, Srivastava SK, Wells JR, Grossniklaus HE. Rosai-Dorfman disease simulating nodular scleritis and panuveitis. ACTA ACUST UNITED AC 2011; 129:518-20. [PMID: 21482883 DOI: 10.1001/archophthalmol.2011.56] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
104
|
Okura T, Miyoshi KI, Jotoku M, Enomoto D, Irita J, Nagao T, Ito R, Higaki J. A patient with myeloperoxidase antineutrophil cytoplasmic antibody-positive polyangiitis who developed sensorineural hearing loss and scleritis. Intern Med 2011; 50:1725-8. [PMID: 21841333 DOI: 10.2169/internalmedicine.50.4953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old woman was admitted to our hospital because of sudden hearing loss. She was treated with intratympanic dexamethasone, but her hearing impairment progressed. After admission, she developed scleritis of her left eye. Laboratory findings included elevated white blood cell count and C-reactive protein level, microhematuria, and proteinuria. Serology was positive for myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA), but negative for proteinase 3 (PR3)-ANCA. Renal biopsy revealed a single glomerulus with extensive glomerular tuft necrosis, indicating necrotizing vasculitis. She was diagnosed with MPO-ANCA-associated polyangiitis. ANCA-related polyangiitis should be considered in the differential diagnosis of sudden deafness or scleritis.
Collapse
|
105
|
Sen HN, Sangave AA, Goldstein DA, Suhler EB, Cunningham D, Vitale S, Nussenblatt RB. A standardized grading system for scleritis. Ophthalmology 2010; 118:768-71. [PMID: 21093921 DOI: 10.1016/j.ophtha.2010.08.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 08/11/2010] [Accepted: 08/12/2010] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study evaluated the performance of a standardized grading system for scleritis using standard digital photographs. DESIGN Cross-sectional interobserver agreement study. PARTICIPANTS Photo archives from the National Eye Institute. METHODS Three uveitis specialists from 3 different centers graded 79 randomly arranged images of the sclera with various degrees of inflammation. Grading was done using standard screen resolution (1024×768 pixels) on a 0 to 4+ scale in 2 sessions: (1) without using reference photographs and (2) with reference to a set of standard photographs (proposed grading system). The graders were masked to the order of images, and the order of images was randomized. Interobserver agreement in grading the severity of inflammation with and without the use of grading system was evaluated. MAIN OUTCOME MEASURES Interobserver agreement. RESULTS The proposed grading system for assessing activity in scleritis demonstrated a good interobserver agreement. Interobserver agreement (pooled κ) was poor (0.289) without photographic guidance and improved substantially when the "grading system" with standardized photographs was used (κ = 0.603). CONCLUSIONS This system of standardized images for scleritis grading provides significantly more consistent grading of scleral inflammation in this study and has clear applications in clinical settings and clinical research.
Collapse
|
106
|
Kirkwood BJ, Kirkwood RA. Episcleritis and scleritis. INSIGHT (AMERICAN SOCIETY OF OPHTHALMIC REGISTERED NURSES) 2010; 35:5-8. [PMID: 21189795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This article will briefly discuss episcleritis and scleritis as clinical entities. Both are forms of ocular inflammation but have different clinical, therapeutic and prognostic implications. Episcleritis is a self-limited disease, causing mild discomfort and infrequently requiring therapeutic intervention. Scleritis is a painful, inflammatory process, commonly associated with systemic disorders and requires systemic anti-inflammatory therapy. It is important to be able to distinguish between the two clinical conditions, as prompt initiation of therapy for scleritis can be sight saving.
Collapse
|
107
|
Akalin T, Demirag MD, Tezcan ME, Ozturk MA. Scleritis and sudden hearing loss associated with familial Mediterranean fever. Clin Exp Rheumatol 2010; 28:S103-S104. [PMID: 20868588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 07/14/2010] [Indexed: 05/29/2023]
|
108
|
Kim JH, Joo YB, Kim J, Min JK. A case of hypertrophic cranial pachymeningitis presenting with scleritis in a patient with undifferentiated connective tissue disease. J Korean Med Sci 2010; 25:966-9. [PMID: 20514324 PMCID: PMC2877233 DOI: 10.3346/jkms.2010.25.6.966] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 09/10/2009] [Indexed: 11/22/2022] Open
Abstract
Hypertrophic cranial pachymeningitis (HCP) is an uncommon disorder that causes a localized or diffuse thickening of the dura mater and has been reported to be infrequently associated with systemic autoimmune disorders such as Wegener's granulomatosis, rheumatoid arthritis, sarcoidosis, Behçet's disease, Sjögren syndrome, and temporal arteritis. Here, we report a case of HCP initially presented with scleritis and headache in a patient with undifferentiated connective tissue disease (UCTD). HCP was initially suspected on brain magnetic resonance imaging and defined pathologically on meningial biopsy. Immunologic studies showed the presence of anti-RNP antibody. After high dose corticosteroid therapy, the patient's symptoms and radiologic abnormalities of brain were improved. Our case suggested that HCP should be considered in the differential diagnosis of headache in a patient with UCTD presenting with scleritis.
Collapse
|
109
|
Pedroza-García EM, Reynoso-von Drateln C, Márquez-Pérez P, Neri-Gutiérrez E, Puebla-Mora AG. [Necrotizing scleritis and recurrent erythema nodosum: a diagnostic challenge]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2010; 48:331-335. [PMID: 21192909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The necrotizing scleritis and recurrent erythema nodosum, two clinical entities difficult to diagnose and which represent a challenge to the physician. Tuberculosis produces both processes by an immune reaction of delayed hypersensitivity type IV to various antigenic components of mycobacteria. Most tuberculosis patients have no ocular history of pulmonary or systemic disease in up to 50 % and no evidence of pathology in the chest radiograph. An adequate treatment leads to a favorable prognosis. It occurs when the diagnosis of infection is made on time. We describe the case of a woman with necrotizing scleritis associated with recurrent erythema nodosum secondary to infection with Mycobacterium tuberculosis complex.
Collapse
|
110
|
Raiji VR, Palestine AG, Parver DL. Scleritis and systemic disease association in a community-based referral practice. Am J Ophthalmol 2009; 148:946-50. [PMID: 19837380 DOI: 10.1016/j.ajo.2009.07.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 07/16/2009] [Accepted: 07/16/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the association between scleritis and systemic disease in a non-university, non-tertiary referral practice and to describe our experience with scleritis treatment. DESIGN Retrospective chart review. METHODS The medical records of patients with scleritis between 2001 and 2007 were reviewed for associated systemic disease. RESULTS In our series of 86 patients with scleritis, 55 patients (64.0%) had isolated scleritis while 31 patients (36.0%) had associated systemic-disease. Twenty-six patients (83.9%) with systemic disease had diagnosed systemic disease at the time of initial scleritis presentation, while 5 patients (16.1%) were diagnosed following systemic work-up. Those diagnosed after systemic work-up were more likely to have systemic vasculitic disease as opposed to a rheumatic or infectious disease. Patients with and without associated systemic disease were likely to require systemic therapy at similar rates (93.5% and 92.7%, respectively). Five patients with steroid-refractory scleritis were treated with infliximab (Remicade; Centocor Inc, Horsham, Pennsylvania, USA) and all responded without evidence of adverse effect. Seven patients were treated with mycophenolate mofetil (CellCept; Roche Laboratories, Nutley, New Jersey, USA), of which three improved. CONCLUSIONS The association between scleritis and systemic disease in a community-based referral practice may be lower than in tertiary referral or university-based centers. Although thorough systemic disease evaluation is warranted in scleritis patients, most patients with associated systemic disease will have such a diagnosis prior to the development of scleritis. The need to institute aggressive systemic therapy cannot be predicted by the presence of an associated systemic disease. Infliximab and mycophenolate mofetil are useful additions to the scleritis practitioner's armamentarium for steroid-refractory scleritis.
Collapse
|
111
|
Gungor IU, Ariturk N, Beden U, Darka O. Necrotizing Scleritis due to Varicella Zoster Infection: A Case Report. Ocul Immunol Inflamm 2009; 14:317-9. [PMID: 17056468 DOI: 10.1080/09273940600899890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To report a case with necrotizing scleritis due to varicella-zoster infection. METHODS The patient records were evaluated. The present literature was investigated using MEDLINE. A six-year-old boy with varicella infection was admitted to our clinic with redness, pain, and lid edema on the right eye. Slit lamp examination revealed lid edema, purulent secretion, conjunctival injection and chemosis, and inferotemporal scleral necrosis. Sclera was avascular and the conjunctiva was spontaneously detached from sclera in the necrotic region. RESULTS Systemic and topical acyclovir treatment was started and a rapid improvement achieved in signs and symptoms. CONCLUSIONS Ophthalmic manifestations of varicella infection are potentially blinding especially in the absence of appropriate diagnosis and medical intervention. Distinctive skin eruptions are specifically helpful in the early diagnosis of the disease.
Collapse
|
112
|
Abstract
Posterior scleritis is a serious ocular inflammatory and potentially blinding disorder. It is uncommon and often under-recognized due to its varied presentations, and general ophthalmologists are not familiar with it. Posterior scleritis may be idiopathic or associated with systemic diseases. Visual disturbances such as blurring or distortion are the commonest symptoms. There may be pain, tenderness, and deep-seated discomfort in and around the orbit. One study reported a 49% recurrence rate of posterior scleritis. Posterior scleritis responds well to systemic nonsteroidal anti-inflammatory agents, systemic steroids, and immunosuppressive agents. Recurrences are known to occur despite therapy. However, multiple recurrences in posterior scleritis are uncommon. We report a patient with posterior scleritis who had one episode in the right eye and four episodes in the left eye over a 35-month period.
Collapse
|
113
|
Daniel E, Gangaputra S, Kempen JH, Jabs DA. Recurrent Nodular Scleritis Preceding an Adult TINU Syndrome. Ocul Immunol Inflamm 2009; 14:239-40. [PMID: 16911986 DOI: 10.1080/09273940600826612] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To describe the occurrence of nodular scleritis in a patient developing tubulointerstitial nephritis and uveitis (TINU) syndrome. DESIGN Observational case report. METHOD The case notes of a 57-year-old female presenting with recurrent nodular scleritis, who later developed interstitial nephritis with bilateral uveitis, were reviewed. RESULTS Common and established causes of scleritis were not present in an adult who developed the TINU syndrome a decade later. CONCLUSIONS Although scleritis has not been reported as a tubulointerstitial nephritis-associated ocular inflammation, it may be part of the possible spectrum of ocular inflammation occurring as part of the TINU syndrome.
Collapse
|
114
|
Oz O, Lee DH, Smetana SM, Akduman L. A case of infected scleral buckle with Mycobacterium chelonae associated with chronic intraocular inflammation. Ocul Immunol Inflamm 2009; 12:65-7. [PMID: 15209466 DOI: 10.1076/ocii.12.1.65.28069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To describe a unique case of chronic intraocular inflammation secondary to scleral buckle infection with Mycobacterium chelonae that was successfully treated with buckle explantation. METHODS Case report. RESULTS A 59-year-old male with a history of retinal detachment repair at the age of 41 presented with chronic, recurrent intraocular inflammation responsive to topical corticosteroids. Conjunctival erosion with exposure of the scleral buckle occurred five months after initial presentation. The scleral buckle was removed and cultured. After three weeks of postoperative topical tobramycin and dexamethasone treatment, the patient has remained symptom-free without medications. The explanted material grew acid-fast bacilli later identified as M. chelonae. CONCLUSIONS This case describes a new finding of chronic intraocular inflammation associated with a scleral buckle infected with M. chelonae and the successful resolution of extraocular infection and intraocular inflammation after buckle removal.
Collapse
|
115
|
Pang CE, Teoh SCB. Anterior uveitis as a clinical presentation of orbital inflammatory disease in an adult. Singapore Med J 2009; 50:e229-e231. [PMID: 19644605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report an unusual case of orbital inflammatory disease presenting as anterior uveitis in an adult. A 35-year-old Chinese man presented with acute anterior uveitis unresponsive to topical steroids, and progressed to manifest optic disc swelling and posterior scleritis. Computed tomography showed a mass-like soft tissue swelling within the intraconal fat indenting the posterior medial aspect of the globe. The diagnosis of orbital inflammatory disease was made, and the patient was treated with systemic corticosteroids with prompt resolution of symptoms and signs. Anterior uveitis can be considered an unusual ophthalmic manifestation of orbital inflammatory disease in adults.
Collapse
|
116
|
Dotchin S, Lakosha H, Heathcote JG, Dickinson J. Uveal metastasis from testicular choriocarcinoma presenting as scleritis. Can J Ophthalmol 2009; 44:210-1. [PMID: 19491960 DOI: 10.3129/i08-182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
117
|
Jensen JE, Fledelius HC, Prause JU, Scherfig E. An unusual ophthalmic tumour in a 5-year-old boy. Acta Ophthalmol 2009:110-2. [PMID: 1332385 DOI: 10.1111/j.1755-3768.1992.tb04941.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A rare tumour in a 5-year-old boy is presented and discussed. In time and location the story had two parts (Fig. 1): 1) a conjunctival granuloma at the nasal limbus of the right eye was surgically removed. 2) a few months later a huge lesion presented in the posterior segment of the same eye. Was it an ocular tumour with extension to the orbit or an orbital process with impression or invasion of the eye? Repeated surgical biopsies have indicated nodular scleritis of the posterior eye segment as the definitive diagnosis.
Collapse
|
118
|
Vorob'eva OK, Razumova II, Ambartsumian AR. [Differential diagnosis of treatment of episcleritis and scleritis]. Vestn Oftalmol 2009; 125:14-17. [PMID: 19517824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of the present investigation was to develop an optimal approach to rehabilitating patients with episcleritis and scleritis of various etiology. The paper summarizes the results of examination and treatment in 128 patients (142 eyes) with the acute chronic course of the diseases. To specify the etiopathogenesis of a disease, the patients were examined by a rheumatologist, an immunologist, a virologist, a phthisiatrician, an ENT specialist, and a roentgenologist. Rhinofrequency ultrasound biomicroscopy was made in the diagnosis of scleral inflammatory diseases. Ultrasound studies (ultrasound biomicroscopy and B-scanning of the eye) were additionally conducted. Complex therapy produced a marked positive clinical effect in 124 patients (138 eyes). During 5 years, immunological parameters improved in all the examined. Thus, episcleritis and scleritis are an overall immunological disorder and frequently associated with infections. Current laboratory clinical and instrumental studies considerably enhance the efficiency of the diagnosis and, hence, treatment of these diseases.
Collapse
|
119
|
Gheorghe A, Pandelescu M, Muraru C. [Scleromalacia perforans. Rheumatoid arthritis--case report]. OFTALMOLOGIA (BUCHAREST, ROMANIA : 1990) 2009; 53:105-109. [PMID: 19899555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The authors present the case of a 73-year-old patient who comes in our clinic because of the existence of a tumoral formation pigmented and elevated, situated in the temporal side of the right eye and because of decreasing of her visual acuity at both eyes, as well as foreign body eye sensation, tearing, light sensitivity redness of the eye. The ophthalmological examination establishes the diagnosis of the right eye: Scleromalacia perforans, scleral temporal nodule considering the chronic, systemic inflammatory invalidated disorder, rheumatoid arthritis fourth stage. The purpose of this case presentation is represented by the rarity of this type of ocular manifestation presented in late stages of rheumatoid arthritis.
Collapse
|
120
|
Cheng S, Vu P. Recurrent orbital myositis with radiological feature mimicking thyroid eye disease in a patient with Crohn's disease. Orbit 2009; 28:368-370. [PMID: 19929661 DOI: 10.3109/01676830903104751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Orbital myositis is an extremely rare extra-intestinal manifestation of Crohn's disease. Herein we describe a patient with self-limiting episodes of episcleritis and uveitis prior to the diagnosis of Crohn's disease, and subsequent development of recurrent orbital myositis with radiological features mimicking thyroid eye disease.
Collapse
|
121
|
Inamadar AC, Anitha B. HIV-seropositive patient with Sweet's syndrome and nodular scleritis, showing dramatic response after adding dapsone to systemic corticosteroid therapy. Int J Dermatol 2008; 47:836-8. [PMID: 18717866 DOI: 10.1111/j.1365-4632.2008.03648.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
122
|
Abstract
Inflammatory conditions belong to the most important diseases of the orbit. Children and adolescents are mostly affected and the most common cause is secondary pathogen invasion from acute sinusitis. However in adults most cases involve idiopathic orbital inflammation, previously termed pseudotumor orbitae. Clinical presentation may include painful exophthalmus, skin redness and warming, chemosis and disturbed eye motility. The challenge for imaging investigations, mainly a combination of CT scanning and MRI, is to distinguish inflammatory from malignant conditions, to define the extent of lesions and to document possible complications, such as cavernous sinus thrombosis, meningoencephalitis or cerebral abscesses. Serious potential consequences of orbital infections, including loss of vision or death, are still a risk factor and must be averted by avoidance of delays in diagnosis and appropriate clinical management.
Collapse
|
123
|
Chua J, Lim L. Systemic Wegener's granulomatosis with severe orbito-ocular involvement. Singapore Med J 2008; 49:e259-e262. [PMID: 18946592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Orbito-ocular involvement in Wegener's granulomatosis is the result of both focal ischaemic vasculitis and granulomatous soft tissue inflammation. Necrotising keratoscleritis and orbital inflammation are two most characteristic ophthalmic presentations. We describe a 56-year-old man with systemic limited Wegener's granulomatosis, presenting with pulmonary fibrosis, pansinusitis and left mastoiditis. This was complicated by the development of a left severe necrotising anterior scleritis, peripheral ulcerative keratitis and orbital apex syndrome. Both c-ANCA and anti-PR3 were positive. Despite mainstay systemic immunosuppressive therapy with cyclophosphamide and prednisolone, the visual prognosis remained very poor. This was largely due to the presence of an irreversible ischaemic optic neuropathy, extensive corneoscleral melt and corneal neovascularisation. This case highlights the possible extent of orbital and ocular surface involvement in Wegener's granulomatosis, and hence the importance of vigilance by the physician.
Collapse
|
124
|
Tomita M, Shimmura S, Tsubota K, Shimazaki J. Postkeratoplasty Atopic Sclerokeratitis in Keratoconus Patients. Ophthalmology 2008; 115:851-6. [PMID: 17884169 DOI: 10.1016/j.ophtha.2007.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 06/28/2007] [Accepted: 07/11/2007] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To estimate the incidence of and investigate possible risk factors for postkeratoplasty atopic sclerokeratitis in keratoconus patients undergoing keratoplasty. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Two hundred forty-seven eyes with keratoconus. METHODS We reviewed the medical records of all keratoplasty cases of keratoconus between May 2000 and December 2005 at Tokyo Dental College Ichikawa General Hospital. The incidence and clinical details of cases consistent with postkeratoplasty atopic sclerokeratitis were recorded. MAIN OUTCOME MEASURES Cases with acute sclerokeratitis during the early postoperative period were retrospectively evaluated. RESULTS A total of 247 keratoconus eyes were followed at our clinic after keratoplasty (mean follow-up, 18.5+/-13.0 months). Thirty-five eyes of 29 patients (14.2%) had a history of atopic dermatitis, of which 6 eyes of 5 patients (2.4%) developed postkeratoplasty atopic sclerokeratitis. Mean age of postkeratoplasty atopic sclerokeratitis patients was 29 years (range, 23-39). The mean period between keratoplasty and onset of postkeratoplasty atopic sclerokeratitis was 26 days (range, 11-41). Loosening of running sutures and wound leakage were observed in 3 eyes; persistent epithelial defects in 3 eyes; and graft melting in 2 eyes, 1 of which was perforated. Preoperative atopic blepharitis and corneal neovascularization were identified as risk factors for postkeratoplasty atopic sclerokeratitis. CONCLUSIONS Postkeratoplasty atopic sclerokeratitis is a potentially severe complication in atopic patients undergoing keratoplasty. Systemic immunosuppression may be considered in patients with active blepharitis and corneal neovascularization.
Collapse
|
125
|
|