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Liao A, Vasseneix C, Rali A, Ward L, Fernandes AF, Patel PS, O’Keefe G, Shantha JG, Yeh S. Visual Morbidity and Outcomes of Scleritis Associated with Intraocular Inflammation Compared to Isolated Scleritis. Ocul Immunol Inflamm 2024; 32:947-954. [PMID: 36780586 PMCID: PMC10423300 DOI: 10.1080/09273948.2022.2164726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 02/15/2023]
Abstract
PURPOSE To compare visual outcomes, ocular complications and therapies for patients with scleritis-associated intraocular inflammation (SAI) and patients with isolated scleritis (IS). RESULTS A total of 52 patients (36 with SAI and 16 with IS) were reviewed. Mean age (standard deviation) at presentation was 48.4 years old (± 15.4) in the SAI group and 53 years old (± 17.1) in the IS group (p = .37). Visual acuity was worse at presentation and last visit for patients with SAI compared to IS (p = .04). Patients in the SAI group developed greater posterior segment complications than in the IS group (p = .002). CONCLUSIONS Scleritis with intraocular inflammation was associated with a higher rate of visual morbidity compared to isolated scleritis. More aggressive management strategies may be needed for patients who present with scleritis associated with inflammation.
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Affiliation(s)
- Albert Liao
- Emory Eye Center, Uveitis Service, Emory University School of Medicine, Atlanta, GA, USA
| | - Caroline Vasseneix
- Emory Eye Center, Uveitis Service, Emory University School of Medicine, Atlanta, GA, USA
| | - Aditya Rali
- Emory Eye Center, Uveitis Service, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Ward
- Department of Epidemiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Purnima S. Patel
- Emory Eye Center, Uveitis Service, Emory University School of Medicine, Atlanta, GA, USA
| | - Ghazala O’Keefe
- Emory Eye Center, Uveitis Service, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica G. Shantha
- Emory Eye Center, Uveitis Service, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven Yeh
- Emory Eye Center, Uveitis Service, Emory University School of Medicine, Atlanta, GA, USA
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
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Cai X, Hong N, Li H, Jiang B, Fang J, Shao J, Liang H, Shen Y. Idiopathic Hypertrophic Cranial Pachymeningitis with Scleritis and Optic Disc Involvement: a Case Report and Literature Review. Ocul Immunol Inflamm 2024; 32:1111-1116. [PMID: 36888977 DOI: 10.1080/09273948.2023.2183221] [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: 09/27/2022] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
This report describes a case of idiopathic hypertrophic cranial pachymeningitis (IHCP) with scleritis and optic disc involvement. The patient was a 56-year-old woman with chief complaints of fever, headache, binocular pain, and redness. Biochemical and immunological indicators, cranial magnetic resonance imaging, and relevant ophthalmological examinations were employed for evaluation. Infectious and neoplastic causes were excluded. Typical meningeal thickening and enhancement on magnetic resonance imaging revealed IHCP. Diffuse hyperaemia and oedema of the conjunctiva and the T-shape sign on the B-scan suggested anterior and posterior scleritis, respectively. Abnormalities in fundus photography, optical coherence tomography, and visual field examination suggested optic disc involvement. After anti-infection and steroid therapy, the patient's temperature returned to normal and the symptoms of headache, binocular pain, and redness improved. Neurologists and ophthalmologists should consider the combination of IHCP with scleritis in their differential diagnosis when patients complain of headache accompanied by ocular pain and redness.
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Affiliation(s)
- Xuecheng Cai
- Department of Ophthalmology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, People's Republic of China
| | - Nan Hong
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Huiyan Li
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Bo Jiang
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jianxia Fang
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jiechao Shao
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hui Liang
- Department of Neurology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ye Shen
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Morrison T, Gottman M, Do T, Rosenbaum JT, Ghetie D, Friedman M. Scleritis and Development of Immune-Mediated Disease: A Retrospective Chart Review. J Rheumatol 2024; 51:825-830. [PMID: 38302174 DOI: 10.3899/jrheum.2023-0788] [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] [Accepted: 12/15/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Scleritis may be idiopathic or caused by trauma, infections, or an immune-mediated disease (IMD). Our study aimed to understand the relationship between scleritis and IMD, including presenting characteristics, serologies, and treatment course. Understanding these associations may allow clinicians to risk-stratify patients and predict their clinical and treatment course. METHODS We conducted a retrospective chart review of 341 patients with scleritis seen at a tertiary care center between January 1, 2005, and December 31, 2020. Demographics, scleritis characteristics, treatment response, recurrence, and serologic data were compared among patients with idiopathic and IMD-associated scleritis. RESULTS Among patients with scleritis seen, 145 patients (43%) had an associated IMD, most commonly rheumatoid arthritis (RA; 39%), vasculitis (21%), or inflammatory bowel disease (14%). In most cases, the IMD diagnosis predated the scleritis presentation (63%), though vasculitis cases were more likely to develop during or after scleritis episodes. There were no significant differences in demographics or treatment failures among patients with scleritis with and without associated IMDs. Patients with IMDs were more likely to have a recurrence of scleritis (62% vs 49%, P = 0.02). CONCLUSION At our ophthalmology center, 43% of patients with scleritis had an associated IMD, and most patients with an IMD were symptomatic from this disease prior to scleritis presentation. RA was the most commonly associated condition and typically predated the scleritis, whereas vasculitis was more likely diagnosed during or after the scleritis episode. Scleritis among patients with IMD is more likely to recur compared to scleritis that is idiopathic.
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Affiliation(s)
- Tessalyn Morrison
- T. Morrison, MD, MPH, Department of Medicine, University of Vermont Medical Center, Burlington, Vermont;
| | - Moriah Gottman
- M. Gottman, MS, School of Medicine, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Toan Do
- T. Do, MD, Department of Allergy and Immunology, University of California San Diego, San Diego, California
| | - James T Rosenbaum
- J.T. Rosenbaum, MD, Legacy Health Systems, Portland, Oregon, now with Corvus Pharmaceuticals, Burlingame, California
| | - Daniela Ghetie
- D. Ghetie, MD, M. Friedman, MD, Department of Medicine, Division of Rheumatology, Oregon Health & Science University, Portland, Oregon, now with Alpine Immune Sciences, Seattle, Washington, USA
| | - Marcia Friedman
- D. Ghetie, MD, M. Friedman, MD, Department of Medicine, Division of Rheumatology, Oregon Health & Science University, Portland, Oregon, now with Alpine Immune Sciences, Seattle, Washington, USA
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Akada M, Muraoka Y, Morooka S, Ishihara K, Kogo T, Akaike N, Nakanishi K, Yamao Y, Hata M, Tsujikawa A. Blood flow alterations in cavernous sinus dural arteriovenous fistula: Optical coherence tomography angiography findings. Am J Ophthalmol Case Rep 2024; 34:102066. [PMID: 38741579 PMCID: PMC11090056 DOI: 10.1016/j.ajoc.2024.102066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose This case report details the diagnostic process for a patient with an initial diagnosis of scleritis who was unresponsive to typical treatment modalities, culminating in the identification of a cavernous sinus dural arteriovenous fistula (CS-DAVF). The case highlights the role of anterior segment optical coherence tomography angiography (OCTA) in the diagnosis of this vascular anomaly and in monitoring the response to treatment. Observations A 45-year-old man with persistently elevated intraocular pressure (IOP) and ocular congestion in the left eye was unresponsive to treatment for scleritis. The persistent ocular symptoms and new-onset tinnitus prompted further investigation. Anterior segment OCTA revealed vascular anomalies, and magnetic resonance imaging confirmed a CS-DAVF. The patient underwent endovascular treatment for the CS-DAVF. This intervention led to a significant reduction in IOP in the left eye and the resolution of ocular congestion. Conclusions and importance This case highlights the diagnostic complexities of ophthalmic symptoms that mimic those of other conditions. Furthermore, it demonstrates the essential role of anterior segment OCTA in the accurate diagnosis and effective management of CS-DAVF and highlights the need for comprehensive diagnostic approaches in ophthalmology.
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Affiliation(s)
- Masahiro Akada
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Morooka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Ishihara
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Kogo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Natsuki Akaike
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazumasa Nakanishi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Ruiz-Lozano RE, Ramos-Dávila EM, Colorado-Zavala MF, Quiroga-Garza ME, Azar NS, Mousa HM, Perez VL, Sainz-de-la-Maza M, Foster CS, Rodriguez-Garcia A. Clinical Course and Outcomes of Autoimmune Versus Non-Autoimmune Surgically Induced Scleral Necrosis: A Multicentric Comparative Study. Ocul Immunol Inflamm 2024:1-7. [PMID: 38759224 DOI: 10.1080/09273948.2024.2349914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND To analyze the clinical course and outcomes of autoimmune vs. non-autoimmune surgically induced scleral necrosis (SISN). METHODS Multicentric, retrospective, comparative cohort study. Eighty-two eyes of 70 patients with SISN were classified according to pathogenic mechanism into autoimmune vs. non-autoimmune. Main outcome measures included necrosis onset, type of surgery, associated systemic disease, visual acuity, and treatment were analysed in patients followed for ≥ 6 months. RESULTS Forty-six (65.7%) patients were women, and the median age was 66 (range: 24-90) years. Most patients (82.9%) had unilateral disease. The median time between surgery and SISN onset was 58 (1-480) months. Thirty-one (37.8%) eyes were classified as autoimmune, and 51 (62.2%) as non-autoimmune SISN. Autoimmune SISN was associated with a shorter time between the surgical procedure and SISN onset than non-autoimmune cases (median of 26 vs. 60 months, p = 0.024). Also, autoimmune SISN was associated with cataract extraction (93.5% vs. 25.5%, p < 0.001), severe scleral inflammation (58.1% vs. 17.6%, p < 0.001), and higher incidence of ocular complications (67.7% vs. 33.3%, p = 0.002) than non-autoimmune cases. Remission was achieved with medical management alone in 44 (86.3%) eyes from the non-autoimmune and in 27 (87.1%) from the autoimmune group (p = 0.916). Surgical management was required in 11 (13.4%) eyes, including two requiring enucleations due to scleral perforation and phthisis bulbi. CONCLUSIONS Eyes with autoimmune SISN had a higher rate of cataract surgery, severe scleral inflammation, and ocular complications. Early SISN diagnosis and appropriate management, based on clinical features and pathogenic mechanisms, are critical to avoid sight-threatening complications.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eugenia M Ramos-Dávila
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Maria F Colorado-Zavala
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Manuel E Quiroga-Garza
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nadim S Azar
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hazem M Mousa
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Victor L Perez
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - C Stephen Foster
- Harvard Medical School, Massachusetts Eye Research and Surgery Institute, Waltham, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
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Azzopardi M, Chong YJ, Sreekantam S, Barry RJ, Poonit N, Rauz S, Murray PI. Real-World Experience in the Use of Immunosuppression for the Management of Inflammatory Eye Disease. Ocul Immunol Inflamm 2024:1-10. [PMID: 38349962 DOI: 10.1080/09273948.2024.2311743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE Patients with sight-threatening inflammatory eye disease (IED) are maintained on systemic immunosuppression whilst in long-term clinical remission. There are no clear guidelines on the duration of remission before implementing treatment withdrawal. We present a real-world analysis on the use of immunosuppression in IED in long-term remission and consider strategies for withdrawal. METHODS Adult IED patients on systemic immunosuppression were categorised into four disease groups: Corneal Transplant Survival Strategies (CTSS), Ocular Surface Disease (OSD), Non-infectious Uveitis (NIU) and Scleritis. Patients with Behçet's disease were excluded. Data on systemic immunosuppressants and biologics used; duration of treatment; reasons for drug discontinuation; disease activity/remission status; duration of clinical remission with an emphasis on patients who had been in remission for a minimum of 24 months were captured. RESULTS Out of a total of 303 IED patients, 128 were on systemic immunosuppression with a clinical remission of their ocular disease for ≥24 months. The median duration of remission was 4-5 years with the longest duration of remission 22 years, and some patients on immunosuppression for up to 23 years. Sixty patients stopped at least one immunosuppressive agent without prior discussion with a health-care practitioner. CONCLUSION Progressive conditions, such as cicatrising conjunctivitis may require lifelong immunosuppression, but patients with NIU and Scleritis and those on CTSS, immunosuppression withdrawal should be considered if they remain in remission for 2 years. Any patient stopping a medication should be contacted immediately for counselling. These data will better inform patients, encourage adherence and aide formal guideline development.
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Affiliation(s)
- Matthew Azzopardi
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Yu Jeat Chong
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Sreekanth Sreekantam
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Robert J Barry
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Natraj Poonit
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Saaeha Rauz
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Philip I Murray
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Alghamdi AH. Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report. Cureus 2023; 15:e47057. [PMID: 38022063 PMCID: PMC10644324 DOI: 10.7759/cureus.47057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
A 46-year-old male, with no chronic medical illness, complained of pain, tearing, and redness for one-month duration, with no photophobia, discharge, or decrease in visual acuity. Examination revealed a small, painful, red swelling in the left sclera. Slit-lamp examination using a narrow bright slit beam revealed edema of the episcleral layer and injection of the superficial episcleral blood vessels. The rest of the anterior segment exam and fundoscopy were normal. The laboratory investigations and systemic workup were normal. The patient was initially treated with prednisolone acetate (Pred Forte) 1% every three hours per day for one week, and then four times per day for another week, and tapered gradually over eight weeks with systemic nonsteroidal anti-inflammatory drugs (NSAIDs) as diclofenac sodium for eight weeks with mild improvement of clinical symptoms, but the size of the lesion remained without any change and the patient started to have a relapse of symptoms at the end of the course. Topical tacrolimus drops of 0.1% concentration were prepared in the pharmacy under complete sterile precautions and were used four times per day for the following six weeks duration instead of the initial therapy (steroids and NSAIDs). Tacrolimus drops were then tapered gradually over another six weeks duration. The patient showed dramatic suppression of inflammation and exceptional remission of symptoms with complete resolution of the episcleritis. Topical tacrolimus is very effective in the treatment of nodular episcleritis, which is resistant to steroid therapy. Patients with nodular episcleritis suffer from prolonged bouts of inflammation that are characteristically more painful than the diffuse type and may be associated with other systemic diseases. The case is steroid-resistant nodular episcleritis, which did not respond to the usual treatment and showed a good response to treatment with tacrolimus, which was first introduced in episcleritis. Tacrolimus is being used in other ocular diseases, but its use in episcleritis is unique.
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Yan F, Liu Y, Zhang T, Shen Y. Identifying TNF and IL6 as potential hub genes and targeted drugs associated with scleritis: A bio-informative report. Front Immunol 2023; 14:1098140. [PMID: 37063831 PMCID: PMC10102337 DOI: 10.3389/fimmu.2023.1098140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundScleritis is a serious inflammatory eye disease that can lead to blindness. The etiology and pathogenesis of scleritis remain unclear, and increasing evidence indicates that some specific genes and proteins are involved. This study aimed to identify pivotal genes and drug targets for scleritis, thus providing new directions for the treatment of this disease.MethodsWe screened candidate genes and proteins associated with scleritis by text-mining the PubMed database using Python, and assessed their functions by using the DAVID database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were used to identify the functional enrichment of these genes and proteins. Then, the hub genes were identified with CytoHubba and assessed by protein-protein interaction (PPI) network analysis. And the serum from patients with active scleritis and healthy subjects were used for the validation of hub genes. Finally, the DGIdb database was used to predict targeted drugs for the hub genes for treating scleritis.ResultsA total of 56 genes and proteins were found to be linked to scleritis, and 65 significantly altered pathways were identified in the KEGG analysis (FDR < 0.05). Most of the top five pathways involved the categories “Rheumatoid arthritis,” “Inflammatory bowel disease”, “Type I diabetes mellitus,” and “Graft-versus-host disease”. TNF and IL6 were considered to be the top 2 hub genes through CytoHubba. Based on our serum samples, hub genes are expressed at high levels in active scleritis. Five scleritis-targeting drugs were found among 88 identified drugs.ConclusionsThis study provides key genes and drug targets related to scleritis through bioinformatics analysis. TNF and IL6 are considered key mediators and possible drug targets of scleritis. Five drug candidates may play an important role in the diagnosis and treatment of scleritis in the future, which is worthy of the further experimental and clinical study.
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Affiliation(s)
- Feiyue Yan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
- Frontier Science Center of Immunology and Metabolism, Medical Research Institute, Wuhan University, Wuhan, China
| | - Yizong Liu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tianlu Zhang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
- Frontier Science Center of Immunology and Metabolism, Medical Research Institute, Wuhan University, Wuhan, China
- *Correspondence: Yin Shen,
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Management of scleral melt. Ocul Surf 2023; 27:92-99. [PMID: 36549583 DOI: 10.1016/j.jtos.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022]
Abstract
Scleral melting, while rare, can lead to significant ocular morbidity. Several possible risk factors for scleral melt have been identified, such as infection, autoimmune disease, trauma, and post-surgical state, and these may act in combination with each other. Treatment should be tailored according to the etiology and severity of the scleral melt. Medical management may be indicated, especially in cases of autoimmune-related melt; however, surgical procedures are often necessary due to compromised ocular integrity and limited penetration of medications into the avascular sclera. An understanding of the surgical options available and their operative outcomes is particularly important when choosing the appropriate treatment protocol for each patient.
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10
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Veenis A, Haghnegahdar M, Ajlan R. Unilateral Episcleritis Following COVID-19 Booster Vaccination of a Crohn's Disease Patient: A Case Report and Review of the Literature. Int Med Case Rep J 2023; 16:91-96. [PMID: 36875803 PMCID: PMC9977905 DOI: 10.2147/imcrj.s398502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/28/2022] [Indexed: 02/26/2023] Open
Abstract
Purpose The Coronavirus Disease 2019 (COVID-19) pandemic spurred vaccine development and resulted in the development of the novel mRNA COVID-19 vaccine and with it, a growing public concern of vaccine side effects. There are reports of ocular inflammatory processes such as episcleritis being possible side effects of COVID-19 vaccination. Here we reported the first case of unilateral episcleritis in a Crohn's disease patient following her third mRNA COVID-19 vaccination booster shot. Patient and Methods A 27-year-old female presented with a 1-day history of right eye redness, itching, and burning. Patient reported developing these symptoms within 3-4 hours after vaccination. Her past medical history was relevant for Crohn's disease. Ophthalmic examination revealed right 2+ conjunctival injection that blanched with phenylephrine drops. Otherwise, her ophthalmic exam was unremarkable. The patient was started on artificial tears and ibuprofen 200 mg three times daily for one week. After one week all symptoms resolved, and ophthalmic examination was back to baseline. Conclusion This is the first case in the literature of ophthalmic side effects in a Crohn's disease patient after the third mRNA COVID-19 booster. Patients with Crohn's disease may respond differently to booster vaccination. This case report may help healthcare providers when counselling Crohn's disease patients about future COVID-19 mRNA vaccine side effects.
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Affiliation(s)
- Aaron Veenis
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Megan Haghnegahdar
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Radwan Ajlan
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USA
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Murthy SI, Das AV, Kammari P, Roy A, Basu S, Fernandes M, Rathi VM, Tyagi M. Patterns of Non-Infectious Scleritis across a Tertiary Eye Care Network Using the Indigenously Developed Electronic Medical Record System-eyeSmart. Ocul Immunol Inflamm 2022; 30:1733-1739. [PMID: 34255594 DOI: 10.1080/09273948.2021.1942497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To report the pattern of noninfectious scleritis across a tertiary eye-care network. METHODS A three-year retrospective review of patients diagnosed with noninfectious scleritis was performed. Data were retrieved using diagnostic terms assigned to scleritis through the in-house eyeSmart-electronic medical record system. RESULTS 1103 patients, with a mean age of 44.33 ± 14.38 years and a median follow-up of 199.5 days (range 32-685) were enrolled. Unilateral disease was noted in 85%. Diffuse anterior scleritis (n = 542, 42.51%) and nodular scleritis (n = 482, 38.12%) were the commonest subtypes. Systemic immune disease association was present in 65 (5.89%). Treatment at onset was topical corticosteroids (n = 372, 36.54%) followed by oral non-steroidal anti-inflammatory drugs (n = 351, 34.45%), oral corticosteroids in 184 (19.04%), and immunomodulators in 32 patients (3.54%). CONCLUSIONS This study depicts the pattern of various noninfectious scleritis in a large cohort of patients. The present study helped to further customize the electronic medical records to minimize several data capture limitations.
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Affiliation(s)
- Somasheila I Murthy
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L. V. Prasad Eye Institute, Hyderabad, India
| | - Priyanka Kammari
- Department of eyeSmart EMR & AEye, L. V. Prasad Eye Institute, Hyderabad, India
| | - Aravind Roy
- Department of Cornea & Anterior Segment Services, L. V. Prasad Eye Institute, Vijayawada, India
| | - Soumyava Basu
- Uveitis Service and Smt Kannuri Santhamma Vitreo-retinal Service, L. V. Prasad Eye Institute, Hyderabad, India
| | - Merle Fernandes
- Department of Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Vishakhapatnam, India
| | - Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care (GPRICARE), LVPEI, Hyderabad, India
| | - Mudit Tyagi
- Uveitis Service and Smt Kannuri Santhamma Vitreo-retinal Service, L. V. Prasad Eye Institute, Hyderabad, India
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12
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Pandey AK, Khan M, Singh A, Nair N. A case of bilateral sclerouveitis with secondary glaucoma right eye. Med J Armed Forces India 2022; 78:S312-S314. [PMID: 36147394 PMCID: PMC9485827 DOI: 10.1016/j.mjafi.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
Infectious scleritis is rare and most commonly herpetic in origin. We report an unusual bilateral subacute presentation of scleritis with uveitis and glaucoma which responded to treatment with acyclovir. A 47-year-old male coast guard personnel presented with 2 months history of bilateral red eye. He was initially managed elsewhere as conjunctivitis, and on examination had bilateral diffuse redness of the eyes persisting with phenylephrine, with scleral edema and mild globe tenderness. Investigations for underlying autoimmune systemic illness were normal. He showed inadequate response to topical steroids and cycloplegics and developed uveitis and glaucoma while on steroids. He was then given tablet acyclovir with antiglaucoma topical medications with which he showed rapid response and complete resolution. The case is being reported for highlighting this unusual bilateral presentation of scleritis with uveitis and glaucoma with possible viral etiology.
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Affiliation(s)
| | - M.A. Khan
- Professor & Head (Ophthalmology), Command Hospital (Air Force), Bengaluru, India
| | - Anirudh Singh
- Associate Professor (Ophthalmology), Command Hospital (Air Force), Bengaluru, India
| | - Nithya Nair
- Senior Resident (Ophthalmology), Command Hospital (Air Force), Bengaluru, India
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13
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Baquero-Ospina P, Paquentín-Jiménez R, Hubbe-Tena C, Concha-Del-Rio LE. Combined Ophthalmology and Rheumatology Evaluation in Systemic Autoimmune Diseases with Ocular Involvement: A Third Level Reference Center in Mexico. Ocul Immunol Inflamm 2022:1-7. [PMID: 35759649 DOI: 10.1080/09273948.2022.2079532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM A cross-sectional descriptive study to determine the frequency of ocular manifestations associated with systemic autoimmune diseases in a third-level hospital in Mexico. METHODS Records from 2014 to 2017 at the Inflammatory Eye Disease Clinic of the Asociación Para Evitar la Cegueraen México were examined by both an ophthalmologist and a rheumatologist on the same day. Diagnosis was achieved from initial ocular manifestations with later systemic assessment. RESULTS Out of 311 medical records, 276 were included, 75% of the patients were female. Keratoconjunctivitis sicca was the most frequent ocular manifestation (33.3%), followed by anterior uveitis (29.5%), scleritis (23.2%), and peripheral ulcerative keratitis (7.2%). The leading autoimmune diseases were spondyloarthritis (29%), rheumatoid arthritis (28.6%), primary Sjögren's syndrome (10.5%) and granulomatosis with polyangiitis (9.1%). 41.3% of systemic disease diagnoses were made after an initial ocular manifestation. CONCLUSIONS Inflammatory eye manifestations can imply systemic autoimmune diseases. It is crucial to suspect and confirm this association and provide timely interdisciplinary management.
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Affiliation(s)
- Pablo Baquero-Ospina
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, I.A.P, Mexico City, Mexico
| | - Rebeca Paquentín-Jiménez
- Community Service at Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, I.A.P, Mexico City, Mexico
| | - Claudia Hubbe-Tena
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, I.A.P, Mexico City, Mexico
| | - Luz Elena Concha-Del-Rio
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, I.A.P, Mexico City, Mexico
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14
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Patel PR, Farrell MC, Peshtani A, Berkenstock MK. Bilateral anterior and posterior scleritis in a patient with acute myelogenous leukemia. Am J Ophthalmol Case Rep 2022; 26:101497. [PMID: 35372712 PMCID: PMC8971595 DOI: 10.1016/j.ajoc.2022.101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 03/02/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Pujan R. Patel
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Ani Peshtani
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Meghan K. Berkenstock
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Corresponding author. Wilmer Eye Institute, 600 N. Wolfe St. Maumenee Third Floor Baltimore, MD, 21287, USA.
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15
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Goyal L, Ajmera K, Pandit R. Reoccurring Episcleritis and the Role of Antioxidants. Cureus 2022; 14:e24111. [PMID: 35530867 PMCID: PMC9073074 DOI: 10.7759/cureus.24111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/05/2022] Open
Abstract
Episcleritis is an irritation of the episclera of our eyes. Episclera is a thin layer of tissue present between the conjunctiva and sclera. There are mainly four causes of episcleritis: an allergic response, autoimmune, vascular disease, or infections. The symptoms are redness, erythema, discomfort in the eyes, and clear discharge. It can sometimes be painful as well. In this case presentation, we will discuss the role of vitamin c in the prevention and reoccurrence of autoimmune episcleritis.
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Affiliation(s)
- Lokesh Goyal
- Hospital Medicine, Christus Spohn, Corpus Christi, USA
| | - Kunal Ajmera
- Hospital Medicine, Calvert Health Medical Center, Prince Frederick, USA
| | - Ramesh Pandit
- Internal Medicine, Drexel College of Medicine, Philadelphia, USA
- Hospital Medicine, Crozer Chester Medical Center, Upland, USA
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16
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Liberman P, Burkholder BM, Thorne JE, Berkenstock MK. Effectiveness of Difluprednate for the Treatment of Anterior Scleritis. Am J Ophthalmol 2022; 235:172-177. [PMID: 34547279 DOI: 10.1016/j.ajo.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To describe the effectiveness and side effect profile of difluprednate therapy in a series of patients with anterior scleritis. DESIGN Retrospective, interventional case series. METHODS Data collected from all patients with anterior scleritis who used difluprednate as a single treatment agent from January 1, 2018, to January 1, 2020, including demographics, scleritis type, presence of nodules or necrosis, changes in scleritis activity, intraocular pressure (IOP), number of difluprednate drops used, best-corrected visual acuity (BCVA), and lens status. The primary outcome was clinical resolution of scleritis. Secondary outcomes included BCVA loss ≥2 lines, change in lens status or cataract surgery, and IOP ≥24 mm Hg. RESULTS Twenty-five patients (35 eyes) were analyzed. The median age was 60 years (range 13-78); 60% were female; 64% were White. Forty percent had bilateral disease, and 44% of patients had an associated systemic disease. The majority of eyes (66%) had diffuse anterior scleritis. Eighty-three percent of eyes achieved resolution of scleritis, with a median time of resolution of 6 weeks. Eyes treated with an initial dose of ≥4 times daily were more likely to achieve disease resolution (hazard ratio [HR] = 3.43, 95% confidence interval [CI] 1.19, 9.88, P = .02). Nine eyes had IOP elevation. Four eyes lost ≥2 lines of BCVA, and 1 due to cataract progression. One eye underwent cataract surgery. CONCLUSIONS Difluprednate alone may effectively treat non-infectious anterior scleritis with a tolerable side effect profile.
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17
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Jan RL, Ho CH, Wang JJ, Tseng SH, Chang YS. Associations between Sjögren Syndrome, Sociodemographic Factors, Comorbid Conditions, and Scleritis in a Taiwanese Population-Based Study. J Pers Med 2022; 12:jpm12010105. [PMID: 35055420 PMCID: PMC8778815 DOI: 10.3390/jpm12010105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/24/2021] [Accepted: 01/11/2022] [Indexed: 01/19/2023] Open
Abstract
This nationwide, population-based, retrospective, matched case–control study included 111,960 newly diagnosed patients with scleritis who were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification code 379.0, selected from the Taiwan National Health Insurance Research Database. Demographic characteristics, Sjögren syndrome, and comorbid conditions within 1 year before the scleritis diagnosis were examined using univariate logistic regression analyses, and a paired t-test was used for continuous variables. Adjusted logistic regression was used to compare the prognosis odds ratio (OR) of the patients with scleritis with the controls. After adjustment for confounders, patients with Sjögren syndrome were remarkably more likely to have scleritis than the controls (OR = 33.53, 95% confidence interval (CI) = 27.43–40.97, p < 0.001). Other conditions found to have increased odds of scleritis included post ocular pterygium, glaucoma, and scleral surgery (OR = 4.01, 95% CI = 3.64–4.43; OR = 3.16, 95% CI = 2.24–4.47; OR = 6.83, 95% CI = 5.34–8.74, respectively); systemic infections, such as syphilis, tuberculosis, and a human herpes viral infection (OR = 4.01, 95% CI = 2.93–5.50; OR = 2.24, 95% CI = 1.94–2.58; OR = 8.54, 95% CI = 8.07–9.03, respectively); and systemic diseases, such as rheumatoid arthritis, granulomatous vasculitis, systemic lupus erythematosus, ankylosing spondylitis, and gout (OR = 2.93, 95% CI = 2.66–3.23; OR = 7.37, 95% CI = 3.91–13.88; OR = 3.18, 95% CI = 2.63–3.85; OR = 5.57, 95% CI = 4.99–6.22; OR = 2.84, 95% CI = 2.72–2.96, respectively). The results strongly support an association between Sjögren syndrome, post ocular surgery, systemic infection disease, systemic autoimmune disease, and scleritis.
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Affiliation(s)
- Ren-Long Jan
- Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan 736, Taiwan;
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan 711, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan; (C.-H.H.); (J.-J.W.)
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan; (C.-H.H.); (J.-J.W.)
- Department of Anesthesiology, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Sung-Huei Tseng
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
- Department of Ophthalmology, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Yuh-Shin Chang
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan 711, Taiwan
- Department of Ophthalmology, Chi Mei Medical Center, Tainan 710, Taiwan
- Correspondence: ; Tel.: +886-6-281-2811 (ext. 55075)
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18
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Nishio Y, Taniguchi H, Takeda A, Hori J. Immunopathological Analysis of a Mouse Model of Arthritis-Associated Scleritis and Implications for Molecular Targeted Therapy for Severe Scleritis. Int J Mol Sci 2021; 23:341. [PMID: 35008766 PMCID: PMC8745222 DOI: 10.3390/ijms23010341] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 12/20/2022] Open
Abstract
Scleritis involves inflammation of the sclera, which constitutes 75% of the wall of the eye. This pathology is often seen as an ocular lesion associated with systemic inflammatory diseases. Severe types of scleritis such as posterior scleritis require urgent immunosuppressive treatments, including molecularly targeted therapies to avoid permanent visual impairment. Which molecules should be selected as targets has remained unclear. To clarify the pathogenesis of scleritis and propose appropriate target molecules for therapy, we have established novel animal model of scleritis by modifying the Collagen-II Induced Arthritis (CIA) model. Immunization twice with collagen II emulsified with complete Freund's adjuvant (CFA) caused arthritis and scleritis. The clinical appearance resembled human diffuse scleritis. Histopathological analysis suggested that macrophages, plasma cells, deposition of immune complexes, and growth of blood and lymphatic vessels are involved in the pathogenesis of CIA-associated scleritis. In addition, we analysed the background diseases of posterior scleritis and responses to molecularly targeted therapies as a case series study. We inferred from both the animal model and case series study that targets should not be T cells, but factors inhibiting macrophage activity such as tumor necrosis factor (TNF) and interleukin (IL)-6, and molecules suppressing antibody-producing cells such as CD20 on B cells should be targeted by molecularly targeted therapies.
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Affiliation(s)
| | | | | | - Junko Hori
- Department of Ophthalmology, Nippon Medical School, Tama-Nagayama Hospital, Tokyo 2068512, Japan; (Y.N.); (H.T.); (A.T.)
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19
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TOPTAN M, ÇADIRCI D, KOÇAKOĞLU Ş. Clinical Characteristics in Patients Presenting with Red Eye. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.974600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Murthy SI, Das S, Deshpande P, Kaushik S, Dave TV, Agashe P, Goel N, Soni A. Differential diagnosis of acute ocular pain: Teleophthalmology during COVID-19 pandemic - A perspective. Indian J Ophthalmol 2020; 68:1371-1379. [PMID: 32587167 PMCID: PMC7574141 DOI: 10.4103/ijo.ijo_1267_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 02/06/2023] Open
Abstract
Ocular pain is a common complaint which forces the patient to seek immediate medical attention. It is the primeval first response of the body to any severe condition of the eye such as trauma, infections and inflammation. The pain can be due to conditions directly affecting the eye and ocular adnexa; or indirect which would manifest as referred pain from other organ structures such as the central nervous system. Paradoxically, there are several minor and non-sight threatening conditions, which also leads to ocular pain and does not merit urgent hospital visits. In this perspective, we intend to provide guidelines to the practising ophthalmologist for teleconsultation when a patient complains of pain with focus on how to differentiate the various diagnoses that can be managed over teleconsultation and those requiring emergency care in the clinic. These guidelines can decrease unnecessary hospital visits, which is the need of the hour in the pandemic era and also beyond. Patients who are under quarantine and those who are unable to travel would be benefitted, and at the same time, the burden of increased patient load in busy hospital systems can be reduced.
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Affiliation(s)
- Somasheila I Murthy
- Department of Cornea, The Cornea Institute, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Sujata Das
- Department of Cornea and Anterior Segment, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Sushmita Kaushik
- Department of Glaucoma, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarjani Vivek Dave
- Department of Ophthalmic Plastic Surgery, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Prachi Agashe
- Department of Pediatric Ophthalmology, Strabismus and Neurophthalmology K.B. Haji Bachooali Eye Hospital and Agashe Hospital, Mumbai, Maharashtra, India
| | - Nupur Goel
- Crystal Clear Eye Institute and Apex, Mumbai, Maharashtra, India
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21
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Khodriss C, Chraibi F, Zarriq S, Bennis A, Abdellaoui M, Benatiya Andaloussi I. [Anterior necrotizing scleritis secondary to cytomegalovirus infection: A case report]. J Fr Ophtalmol 2020; 43:e283-e285. [PMID: 32600989 DOI: 10.1016/j.jfo.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 11/26/2022]
Affiliation(s)
- C Khodriss
- Service d'ophtalmologie, hôpital Omar-Drissi, CHU de Hassan II Fès, Maroc.
| | - F Chraibi
- Service d'ophtalmologie, hôpital Omar-Drissi, CHU de Hassan II Fès, Maroc
| | - S Zarriq
- Service d'ophtalmologie, hôpital Omar-Drissi, CHU de Hassan II Fès, Maroc
| | - A Bennis
- Service d'ophtalmologie, hôpital Omar-Drissi, CHU de Hassan II Fès, Maroc
| | - M Abdellaoui
- Service d'ophtalmologie, hôpital Omar-Drissi, CHU de Hassan II Fès, Maroc
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22
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Vergouwen DPC, Rothova A, Berge JCT, Verdijk RM, van Laar JAM, Vingerling JR, Schreurs MWJ. Current insights in the pathogenesis of scleritis. Exp Eye Res 2020; 197:108078. [PMID: 32504648 DOI: 10.1016/j.exer.2020.108078] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
Scleritis is a sight-threatening inflammation characterized by severe pain and redness of the eye. It can cause blindness by severe complications like scleral and corneal necrosis, keratitis, and uveitis. The pathogenesis of scleritis is largely unknown due to a combination of the rarity of the disease, the little available human tissue-based research material, and the lack of animal models. The immune system is assumed to play a crucial role in the pathogenesis of scleritis. Multiple clues indicate probable antigenic stimuli in scleritis, and the involvement of matrix metalloproteinases in the destruction of scleral tissue. In this article we review the current insights into the pathogenesis of scleritis, and we suggest new hypotheses by implementing knowledge of systemic autoimmune disease pathogenesis. Understanding the pathogenesis of scleritis is crucial to improve the clinical management, as well as to find novel treatment modalities.
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Affiliation(s)
- D P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - A Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R M Verdijk
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A M van Laar
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Section Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J R Vingerling
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M W J Schreurs
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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23
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Dereli Can G, Akcan G, Can ME, Akdere ÖE, Çaylı S, Şimşek G, Gümüşderelioğlu M. Surgical and Immunohistochemical Outcomes of Scleral Reconstruction with Autogenic, Allogenic and Xenogenic Grafts: An Experimental Rabbit Model. Curr Eye Res 2020; 45:1572-1582. [PMID: 32366164 DOI: 10.1080/02713683.2020.1764976] [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] [Indexed: 01/08/2023]
Abstract
Purpose: Choukroun's platelet-rich fibrin (PRF), a second-generation platelet concentrate, has unique morphological and chemical features and may be considered as a scaffold for scleral reinforcement and regeneration. The purpose of this study was to compare the use of xenogenic human-derived amniotic membrane (HAM), allogenic sclera, and autogenic PRF in rabbit lamellar scleral defect model with respect to both anatomical and immunohistochemical improvement. Methods: A total of 45 adult New Zealand rabbits were randomized into five groups: normal control; without surgical procedure, negative control; scleral defect model (SDM), xenogenic HAM; SDM+HAM graft, allogenic sclera; SDM+allogenic sclera graft, autogenic PRF; SDM+autogenic PRF graft. Clinical findings, Hematoxylin&Eozin (HE), Masson Trichrome, Verhoeff Acid Fuchsin, Transforming Growth Factor β Receptor 1, Fibroblast Growth Factor, Bone Morphogenetic Protein 2, collagen type 1, aggrecan, and Matrix Metalloproteinase 2 were evaluated. Results: Ocular surface inflammation was significantly lower in normal control and autogenic PRF groups (p < .001). Graft was avascular and not integrated to scleral wound area in 25% rabbits of allogenic sclera group (p = .02), was out of the scleral wound in 33.3% rabbits of xenogenic HAM group (p > .05), all the grafts were at the normal location and viable in autogenic PRF group. The inflammation and vascularization in autogenic PRF group was significantly lower than negative control and xenogenic HAM groups in HE (p < .001). The collagen score of negative control and xenogenic HAM groups were significantly lower than normal control (p < .001) and autogenic PRF (p < .001) groups. There were insignificant differences between allogenic sclera and autogenic PRF groups (p > .05). For immunohistochemistry, the closest values to normal control group were detected in autogenic PRF group for all immunomarkers. Conclusion: Autogenic PRF showed superior features via its excellent anatomical and chemical composition for scleral regeneration when compared to single-layered xenogenic HAM and allogenic sclera grafts.
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Affiliation(s)
- Gamze Dereli Can
- Department of Ophthalmology, Bursa Yüksek Ihtisas Training and Research Hospital , Bursa, Turkey
| | - Gülben Akcan
- Department of Histology and Embryology, Ankara Yıldırım Beyazıt University, Medical Faculty , Ankara, Turkey
| | - Mehmet Erol Can
- Department of Ophthalmology, Bursa City Hospital , Bursa, MD, Turkey
| | - Özge Ekin Akdere
- Department of Bioengineering, Hacettepe University Institute of Science and Engineering , Ankara, Turkey
| | - Sevil Çaylı
- Department of Histology and Embryology, Ankara Yıldırım Beyazıt University, Medical Faculty , Ankara, Turkey
| | - Gülçin Şimşek
- Department of Pathology, Keçiören Training and Research Hospital , Ankara, MD, Turkey
| | - Menemşe Gümüşderelioğlu
- Department of Bioengineering, Hacettepe University Institute of Science and Engineering , Ankara, Turkey.,Department of Chemical Engineering, Hacettepe University Faculty of Engineering , Ankara, Turkey
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24
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Kandarakis SA, Petrou P, Papakonstantinou E, Spiropoulos D, Rapanou A, Georgalas I. Ocular nonsteroidal inflammatory drugs: where do we stand today? Cutan Ocul Toxicol 2020; 39:200-212. [PMID: 32338073 DOI: 10.1080/15569527.2020.1760876] [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] [Indexed: 01/05/2023]
Abstract
Since their first introduction in ophthalmology, the use of NSAIDs (nonsteroidal anti-inflammatory drugs) has been exponentially expanded, with numerous therapeutic applications. Despite their controversial history, they have proven their efficacy as anti-inflammatory agents in a variety of diseases. Nowadays, NSAIDs are part of surgical protocols of the most commonly performed ophthalmic operations, such as cataract or ocular surgery. They are universally implicated in the management of conjunctivitis, retinal and choroidal disease and miscellaneous inflammatory diseases. Moreover, although linked with serious adverse events and toxicities, their therapeutic magnitude in Ophthalmology should not be affected. This review systematically portrays the variety of ocular NSAIDs available to date, along with their differences in their way of action, indications and potential side effects in various ophthalmologic conditions.
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Affiliation(s)
- S A Kandarakis
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - P Petrou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - E Papakonstantinou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - D Spiropoulos
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - A Rapanou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - I Georgalas
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
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25
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Ingaralingam S, Rauz S, Murray PI, Barry RJ. Effectiveness of pharmacological agents for the treatment of non-infectious scleritis: a systematic review protocol. Syst Rev 2020; 9:54. [PMID: 32164765 PMCID: PMC7068966 DOI: 10.1186/s13643-020-01314-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Non-infectious scleritis is a potentially sight-threatening condition in which the sclera, the white outer layer of the eye, becomes inflamed. Whilst scleritis can be infective, the majority of cases are due to non-infectious causes, often occurring in association with an underlying systemic autoimmune or auto-inflammatory condition. Thorough systemic work-up is crucial to identify disease aetiology and exclude infection; however, a significant proportion of disease remains idiopathic with the underlying cause unknown. Non-infectious scleritis is normally managed with systemic corticosteroid and immunosuppression, yet there is no widely agreed consensus on the most appropriate therapy, and no national or international guidelines exist for treatment of non-infectious scleritis. METHODS Standard systematic review methodology will be used to identify, select and extract data from comparative studies of pharmacological interventions used to treat patients with non-infectious scleritis. Searches of bibliographic databases (Cochrane Library, MEDLINE, CINAHL and EMBASE) and clinical trial registers will be employed. No restrictions will be placed on language or date of publication. Non-English articles will be translated where necessary. The primary outcome of interest will be disease activity measured by reduction in scleritis grading according to standardised grading systems. Secondary outcomes will include change in best corrected visual acuity, reduction in concurrent dose of systemic corticosteroid, time to treatment failure, adverse events and health-related quality of life. Risk of bias assessment will be conducted appropriate to each study design. Study selection, data extraction and risk of bias assessment will be completed by two reviewers independently. Data will be presented in a table and a narrative synthesis will be undertaken. Meta-analysis will be performed where methodological and clinical homogeneity exists. Subgroup and sensitivity analysis will be undertaken if appropriate. DISCUSSION Many studies have investigated the effectiveness of pharmacological agents used in the management of non-infectious scleritis. A systematic review is needed to collate and analyse this evidence. Findings of this systematic review will help guide ophthalmologists managing patients with non-infectious scleritis and may form the basis for evidence-based recommendations for future clinical practice and encourage standardisation of treatment protocols. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019125198.
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Affiliation(s)
- Sathana Ingaralingam
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QU, UK
| | - Saaeha Rauz
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QU, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QU, UK
| | - Robert J Barry
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QU, UK. .,Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Scleral Patch Graft With a Suture Reinforcement Technique in Surgical Management of Necrotizing Scleritis With Ectasia. Cornea 2018; 37:933-935. [PMID: 29664747 DOI: 10.1097/ico.0000000000001598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a technique for reducing and reinforcing scleral thinning in cases of necrotizing scleritis with ectasia. METHODS Descriptive report of a surgical technique in 2 surgical cases with a video. RESULTS Successful repair and reduction in uveal prolapse from scleral thinning in 2 cases of necrotizing scleritis with ectasia with a suturing technique using overlapping (weave) compressive suturing over a scleral patch. CONCLUSIONS In cases of necrotizing scleritis with ectasia in which there is perforation or prolapsing uvea, this technique should be considered.
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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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Sands DS, Chan SCY, Gottlieb CC. Methotrexate for the treatment of noninfectious scleritis. Can J Ophthalmol 2018; 53:349-353. [PMID: 30119788 DOI: 10.1016/j.jcjo.2017.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/09/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess corticosteroid-sparing and inflammation control in patients with noninfectious scleritis treated with methotrexate. DESIGN Retrospective review. PARTICIPANTS Patients who received methotrexate treatment for noninfectious scleritis and who had 12 months of follow-up after treatment initiation were included in this review. METHODS The clinical records of noninfectious scleritis patients presenting at the University of Ottawa Eye Institute between September 1, 2010 and December 31, 2014 treated with methotrexate were retrospectively reviewed. Seventeen patients (21 eyes) were included in the study. Main outcome included inflammation control and corticosteroid-sparing success. Secondary outcomes were reduction of immunosuppression load and best-corrected visual acuity. RESULTS The proportion of eyes with corticosteroid-sparing success was 69.2% at 3 months and 92.3% at 12 months. The proportion of eyes that achieved inflammation control was 61.9% at 3 months and 90.5% at 12 months. The corticosteroid immunosuppression load at treatment start was 1.9 ± 2.07 and at 12 months was 0.48 ± 1.03 (p < 0.01). There was no statistically significant difference in best-corrected visual acuity. CONCLUSIONS The treatment of noninfectious scleritis with methotrexate appears to be effective at both achieving steroid-sparing success and controlling inflammation during 12 months of therapy. Immunosuppression load decreased significantly over 12 months of therapy while best corrected visual acuity was stable.
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Affiliation(s)
- David S Sands
- Faculty of Medicine, University of Ottawa, Ottawa, Ont..
| | - Stephanie C Y Chan
- Faculty of Medicine, University of Ottawa, Ottawa, Ont.; University of Ottawa Eye Institute, Ottawa, Ont
| | - Chloe C Gottlieb
- Faculty of Medicine, University of Ottawa, Ottawa, Ont.; University of Ottawa Eye Institute, Ottawa, Ont.; Ottawa Hospital Research Institute, Ottawa, Ont
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Abstract
"Red eye" is used as a general term to describe irritated or bloodshot eyes. It is a recognizable sign of an acute/chronic, localized/systemic underlying inflammatory condition. Conjunctival injection is most commonly caused by dryness, allergy, visual fatigue, contact lens overwear, and local infections. In some instances, red eye can represent a true ocular emergency that should be treated by an ophthalmologist. A comprehensive assessment of red eye conditions is required to preserve the patients visual function. Severe ocular pain, significant photophobia, decreased vision, and history of ocular trauma are warning signs demanding immediate ophthalmological consultation.
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Affiliation(s)
- Andreina Tarff
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 400 North Broadway, Suite 4001, Baltimore, MD 21231, USA
| | - Ashley Behrens
- Division of Comprehensive Eye Care, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 400 North Broadway, Suite 4001, Baltimore, MD 21231, USA.
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Frings A, Geerling G, Schargus M. Red Eye: A Guide for Non-specialists. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:302-312. [PMID: 28530180 PMCID: PMC5443986 DOI: 10.3238/arztebl.2017.0302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 08/18/2016] [Accepted: 12/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Red eye can arise as a manifestation of many different systemic and ophthalmological diseases. The physician whom the patient first consults for this problem is often not an ophthalmologist. A correct assessment of the urgency of the situation is vitally important for the planning of further diagnostic evaluation and treatment. METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed in August 2016 as well as on the authors' own clinical and scientific experience. RESULTS Primary care physicians typically see 4-10 patients per week who complain of ocular symptoms. Most of them have red eye as the major clinical finding. A detailed history, baseline ophthalmological tests, and accompanying manifestations can narrow down the differential diagnosis. The duration and laterality of symptoms (uni- vs. bilateral) and the intensity of pain are the main criteria allowing the differentiation of non-critical changes that can be cared for by a general practitioner from diseases calling for elective referral to an ophthalmologist and eye emergencies requiring urgent ophthalmic surgery. CONCLUSION The differential diagnosis of red eye can be narrowed down rapidly with simple baseline tests and targeted questioning. Patients with ocular emergencies should be referred to an ophthalmologist at once, as should all patients whose diagnosis is in doubt.
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Affiliation(s)
- Andreas Frings
- Department of Ophthalmology, Düsseldorf University Hospital
| | - Gerd Geerling
- Department of Ophthalmology, Düsseldorf University Hospital
| | - Marc Schargus
- Department of Ophthalmology, Düsseldorf University Hospital
- Ophthalmological Medical Center Schweinfurt, Eye Hospital Schweinfurt-Gerolzhofen
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Gilani CJ, Yang A, Yonkers M, Boysen-Osborn M. Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician. West J Emerg Med 2017; 18:509-517. [PMID: 28435504 PMCID: PMC5391903 DOI: 10.5811/westjem.2016.12.31798] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/30/2016] [Indexed: 11/22/2022] Open
Abstract
Patients commonly present with an acute red eye to the emergency department (ED). It is important to distinguish between benign and sight-threatening diagnoses. Here we provide a comprehensive overview on the acute red eye in the ED.
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Affiliation(s)
| | - Allen Yang
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California
| | - Marc Yonkers
- University of California, Irvine, Medical Center, Gavin Herbert Eye Institute, Department of Ophthalmology, Irvine, California
| | - Megan Boysen-Osborn
- University of California, Irvine, Medical Center, Department of Emergency Medicine, Orange, California
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Murray PI, Rauz S. The eye and inflammatory rheumatic diseases: The eye and rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis. Best Pract Res Clin Rheumatol 2016; 30:802-825. [DOI: 10.1016/j.berh.2016.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 02/01/2023]
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