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Perray L, Ungerer L, Chazal T, Monnet D, Brézin A, Terrier B. [Scleritis and episcleritis]. Rev Med Interne 2023; 44:646-655. [PMID: 37344292 DOI: 10.1016/j.revmed.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
Scleritis and episcleritis are rare ocular inflammatory diseases but deserve to be known by internists because of their frequent association with systemic autoimmune diseases. It is important to distinguish them between because their prognosis, therapeutic management and potential complications are very different. Episcleritis represents a superficial ocular inflammation with usually benign visual prognosis, no complication with local treatment, and is associated with a systemic autoimmune disease in rare cases. In contrast, scleritis is a potentially serious ophthalmological condition that can threaten the visual prognosis in the absence of appropriate systemic treatment. It is associated with an underlying disease in 40-50% of cases, in particular a systemic autoimmune disease (25-35% of cases) or an infectious cause (5-10% of cases). Rheumatoid arthritis and systemic vasculitides, particularly antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides, are the main autoimmune causes of scleritis and episcleritis. Scleritis can reveal the underlying autoimmune disease and requires systematic etiological investigations. Aggressive, complicated, refractory forms or those associated with a systemic autoimmune disease require glucocorticoids or even immunosuppressants, and close collaboration between ophthalmologists and internists is required. The development of biologic agents offers new effective therapeutic tools in the management of these difficult cases.
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Affiliation(s)
- L Perray
- Service de médecine interne, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - L Ungerer
- Service de chirurgie plastique et reconstructrice, hôpital Saint-Louis, AP-HP, Paris, France
| | - T Chazal
- Service de médecine interne, hôpital fondation Adolphe-de-Rothschild, Paris, France
| | - D Monnet
- Service d'ophtalmologie, hôpital Cochin, AP-HP, Paris, France
| | - A Brézin
- Service d'ophtalmologie, hôpital Cochin, AP-HP, Paris, France
| | - B Terrier
- Service de médecine interne, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Ophthalmic manifestations in patients with collagen vascular disorders: a hospital-based retrospective observational study. Int Ophthalmol 2021; 41:2765-2775. [PMID: 33830371 DOI: 10.1007/s10792-021-01833-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/29/2021] [Indexed: 01/19/2023]
Abstract
AIM To study frequency and characteristics of ocular manifestations in Indian patients with collagen vascular disorders. METHODS The medical records of 73 patients (Males: Females 16:57) aged between 22 and 78 years (mean ± SD = 43.5 ± 12.9 years) with collagen vascular diseases were analyzed retrospectively for demography, subtypes of collagen vascular disease, and findings of complete ophthalmic examination. RESULTS Lupus erythematosus (LE) in 39(53.4%, (SLE 18, DLE 21), systemic sclerosis in 27(37%), dermatomyositis in 5(6.8%), and primary Sjögren's syndrome in 2(2.7%) patients, respectively, were observed. Only 35(47.9%) patients had ocular manifestations. In LE keratoconjunctivitis sicca (n = 6), keratitis (n = 5), severe blepharitis (n = 3), retinopathy (n = 2), and optic neuritis in one patient, respectively, were major ocular manifestations. Major abnormalities occurring in systemic sclerosis included restricted eyelid mobility of variable severity (n = 8), eyelid telangiectasia (n = 5), keratoconjunctivitis sicca (n = 6), cataract (n = 5), shallow fornices (n = 4), conjunctival surface disease (n = 4), and uveitis, keratitis, episcleritis in one patient each, respectively. One patient with dermatomyositis had heliotrope rash. Two patients with primary Sjögren's syndrome had keratoconjunctivitis sicca. CONCLUSIONS The study shows that LE frequently presented with keratoconjunctivitis sicca, retinopathy, and optic neuritis. Systemic sclerosis commonly develops eyelid immobility, blepharitis and telangiectasia, ocular surface disease and keratoconjunctivitis sicca, corneal abnormalities, and uveitis. A comprehensive ocular evaluation is imperative for early detection and management particularly of ocular surface disease, uveitis, and retinopathy to prevent potential sight-threatening complications. Limitations include retrospective study design and small number of patients for stratification.
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Kaya H, Karasu U, Martin Ç, Taşçi M, Pekel G. Measurements of scleral thickness and corneal optic densitometry in patients with systemic lupus erythematosus. Medicine (Baltimore) 2020; 99:e21467. [PMID: 32756168 PMCID: PMC7402759 DOI: 10.1097/md.0000000000021467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the scleral thickness and corneal parameters of patients with systemic lupus erythematosus (SLE). METHODS Forty-seven eyes of 47 SLE patients and 44 eyes of healthy controls were included in this cross-sectional study. Anterior segment optical coherence tomography (AS-OCT) was used to measure the corneal and scleral thickness. Scleral thickness (ST) was measured based upon the segmentation at 1000 to 5000 μm from the scleral spur. Pentacam HR was used to measure corneal parameters. RESULTS There was no statistically significant difference between SLE group and control group according to age and sex (P > .05). The ST measurements at all distances from scleral spur were found to be thicker in patients with SLE (P < .05). Central corneal thickness (CCT), cornea volume (CV), corneal densitometry (CD), and peripheral corneal thickness (PCT) measurements were similar between the groups (P > .05). CONCLUSION ST was thicker in SLE patients compared with healthy controls. AS-OCT seems helpful in selecting optimal sites for pharmaceutical or surgical intervention in SLE patients, since it shows thickness variations in anterior sclera.
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Affiliation(s)
| | - Uğur Karasu
- Rheumatology Department, Pamukkale University, Denizli, Turkey
| | | | - Murat Taşçi
- Rheumatology Department, Pamukkale University, Denizli, Turkey
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Lamarca-Mateu J, Salvador-Culla B, Gómez-Benlloch A, Barraquer R. Oral mucosa for reconstructive surgery in a case of severe inflammatory necrotizing sclero-uveitis. Indian J Ophthalmol 2020; 68:221-223. [PMID: 31856531 PMCID: PMC6951138 DOI: 10.4103/ijo.ijo_671_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this case is to show the efficacy of buccal mucosa as an alternative to treat a case of severe necrotizing sclero-uveitis (NSU) associated with ocular perforation. We show a severe inflammatory NSU case that did not improve with topical treatment and scleral patch. We performed a buccal mucosa graft taken from the lower lip with excellent functional and anatomical result, with no signs of relapse of the NSU after 2 years of follow-up. Buccal mucosa can be a safe, useful, and effective alternative for the reconstruction of the scleral wall.
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Bielefeld P, Saadoun D, Héron E, Abad S, Devilliers H, Deschasse C, Trad S, Sène D, Kaplanski G, Sève P. [Scleritis and systemic diseases: What should know the internist?]. Rev Med Interne 2018; 39:711-720. [PMID: 29496270 DOI: 10.1016/j.revmed.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/02/2018] [Indexed: 12/27/2022]
Abstract
Scleritis is an inflammatory disease of the sclera; outer tunic of the eye on which the oculomotor muscles are inserted. It can be associated with a systemic disease up to one time out of 3. These associated diseases are mainly rheumatoid arthritis, vasculitis, including granulomatosis with polyangiitis in the first line and spondyloarthropathies. Before mentioning such an etiology, it is necessary to eliminate an infectious cause, mainly herpetic, which is regularly underestimated. The classification of scleritis is clinical. We distinguish between anterior scleritis and posterior scleritis. Anterior scleritis is diffuse or nodular, usually of good prognosis. Anterior necrotizing scleritis with inflammation is often associated with an autoimmune disease, necrotizing scleritis without inflammation usually reflects advanced rheumatoid arthritis. The treatment of these conditions requires close collaboration between internists and ophthalmologists to decide on the use of corticosteroid therapy with or without immunosuppressors or biotherapies.
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Affiliation(s)
- P Bielefeld
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - D Saadoun
- Service de médecine interne, DHU I2B, inflammation, immunopathology, biotherapy, centre national de référence des maladies auto-immunes et systémiques rares, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie-Paris 6, AP-HP, 75013 Paris, France.
| | - E Héron
- Service de médecine interne, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75571 Paris cedex 12, France.
| | - S Abad
- Service de médecine interne, hôpital Avicenne, AP-HP, université Paris 13, Sorbonne Paris Cité, 93009 Bobigny cedex, France.
| | - H Devilliers
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - C Deschasse
- Service d'ophtalmologie, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, université de Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
| | - D Sène
- Service de médecine interne, GH Saint-Louis-Lariboisière-Fernand-Widal, hôpital Lariboisère, AP-HP, université Sorbonne Paris Cité Paris Diderot, 75475 Paris cedex 10, France.
| | - G Kaplanski
- Service de médecine interne et immunologie clinique, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université de Lyon, 69100 Lyon, France.
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Bottin C, Fel A, Butel N, Domont F, Remond AL, Savey L, Touitou V, Alexandra JF, LeHoang P, Cacoub P, Bodaghi B, Saadoun D. Anakinra in the Treatment of Patients with Refractory Scleritis: A Pilot Study. Ocul Immunol Inflamm 2017; 26:915-920. [DOI: 10.1080/09273948.2017.1299869] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C. Bottin
- Department of Ophthalmology, Pitie-Salpetriere Hospital, Paris, France
- Centre national de reference maladies oculaires inflammatoires rares, DHU vision et handicap, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - A. Fel
- Department of Ophthalmology, Pitie-Salpetriere Hospital, Paris, France
- Centre national de reference maladies oculaires inflammatoires rares, DHU vision et handicap, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - N. Butel
- Department of Ophthalmology, Pitie-Salpetriere Hospital, Paris, France
- Centre national de reference maladies oculaires inflammatoires rares, DHU vision et handicap, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - F. Domont
- Department of Internal Medicine and Clinical Immunology, Pitie-Salpetriere Hospital, Paris, France
- DHU Inflammation, Immunopathologie, Biotherapie, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - A. L. Remond
- Department of Ophthalmology, Pitie-Salpetriere Hospital, Paris, France
- Centre national de reference maladies oculaires inflammatoires rares, DHU vision et handicap, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - L. Savey
- Department of Internal Medicine and Clinical Immunology, Pitie-Salpetriere Hospital, Paris, France
- DHU Inflammation, Immunopathologie, Biotherapie, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - V. Touitou
- Department of Ophthalmology, Pitie-Salpetriere Hospital, Paris, France
- Centre national de reference maladies oculaires inflammatoires rares, DHU vision et handicap, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - J. F. Alexandra
- Department of Internal Medicine, Bichat Hospital, Paris, France
| | - P. LeHoang
- Department of Ophthalmology, Pitie-Salpetriere Hospital, Paris, France
- Centre national de reference maladies oculaires inflammatoires rares, DHU vision et handicap, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - P. Cacoub
- Department of Internal Medicine and Clinical Immunology, Pitie-Salpetriere Hospital, Paris, France
- DHU Inflammation, Immunopathologie, Biotherapie, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - B. Bodaghi
- Department of Ophthalmology, Pitie-Salpetriere Hospital, Paris, France
- Centre national de reference maladies oculaires inflammatoires rares, DHU vision et handicap, Universite Paris VI-Pierre et Marie Curie, Paris, France
| | - D. Saadoun
- Department of Internal Medicine and Clinical Immunology, Pitie-Salpetriere Hospital, Paris, France
- DHU Inflammation, Immunopathologie, Biotherapie, Universite Paris VI-Pierre et Marie Curie, Paris, France
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Agrawal R, Lee C, Gonzalez-Lopez JJ, Khan S, Rodrigues V, Pavesio C. Flurbiprofen: A Nonselective Cyclooxygenase (COX) Inhibitor for Treatment of Noninfectious, Non-necrotizing Anterior Scleritis. Ocul Immunol Inflamm 2015; 24:35-42. [PMID: 26308394 PMCID: PMC4813454 DOI: 10.3109/09273948.2015.1032308] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To analyze the safety and efficacy of a nonselective cyclo-oxygenase (COX) inhibitor in the management of noninfectious, non-necrotizing anterior scleritis. METHODS Retrospective chart review of 126 patients with non-necrotizing anterior scleritis treated with oral flurbiprofen (Froben®(Abbott Healthcare)) with (Group B, n = 61) or without (Group A, n = 65) topical steroids was performed and time to remission was plotted. RESULTS The observed incidence rate was 1.07 (95% CI: 0.57-1.99) per 1000 person-years with failure rate of 0.68 (95% CI: 0.22-2.12) per 1000 person-years in Group A and 1.41 (95% CI: 0.67-2.96) per 1000 person-years in Group B. The failure rate was 3.97 (1.89-9.34) per 1000 person-years with hazard ratio of 10.01 (95% CI: 2.52-39.65; p < 0.001) for patients with associated systemic disease. CONCLUSION To the of our best knowledge, this is the first and largest case series on the safety and efficacy of a nonselective COX inhibitor in the management of anterior scleritis.
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Affiliation(s)
- Rupesh Agrawal
- Moorfields Eye Hospital, London, UK
- Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Cecilia Lee
- Moorfields Eye Hospital, London, UK
- University of Washington, Seattle, WA, United States
| | - Julio J. Gonzalez-Lopez
- Moorfields Eye Hospital, London, UK
- Surgery Department, Universidad de Alcalá School of Medicine, Madrid, Spain
| | | | | | - Carlos Pavesio
- Moorfields Eye Hospital, London, UK
- Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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[Scleromalacia perforans secondary to ankylosing spondylitis: A case report]. J Fr Ophtalmol 2015; 38:e159-61. [PMID: 25976139 DOI: 10.1016/j.jfo.2015.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/18/2014] [Accepted: 01/05/2015] [Indexed: 11/20/2022]
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Michon A, Arlet JB, Ranque B, Passeron A, Chennebault H, Pouchot J, Kahn JE. Rien ne va plus. Rev Med Interne 2015; 36:225-8. [DOI: 10.1016/j.revmed.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/11/2014] [Indexed: 11/30/2022]
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