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de Figueiredo LQ, de Andrade Lopes FO, Franco AS, Giardini HAM, Guedes LKN, Bonfiglioli KR, Shimabuco AY, de Medeiros Ribeiro AC, Domiciano DS. Scleromalacia perforans as an early manifestation of late-onset rheumatoid arthritis: a case-based review. Rheumatol Int 2024; 44:1165-1173. [PMID: 37925382 DOI: 10.1007/s00296-023-05494-0] [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: 06/21/2023] [Accepted: 10/11/2023] [Indexed: 11/06/2023]
Abstract
Rheumatoid arthritis is a chronic autoimmune disease that can affect different organs beyond the joints. Ocular involvement includes keratoconjunctivitis sicca, peripheral ulcerative keratitis (PUK), episcleritis, scleritis, anterior uveitis, and corneal impairment. The most severe form of scleritis, scleromalacia perforans, is an aggressive ophthalmic manifestation that can potentially lead to blindness, usually occurring in late stages of disease. We report a case of an elderly woman in which this severe ocular manifestation occurred early on disease onset, differing from most of the previously reported cases of scleromalacia perforans. Ocular symptoms started concomitantly with the polyarthritis and other extra-articular manifestations, including rheumatoid nodules and vasculitic skin lesions. Ocular disease progressed due to patient's loss to follow-up, requiring pulse therapy with methylprednisolone. However, despite treatment, right eye enucleation was required due to melting of the corneal patch with uveal exposition. The patient was then treated with rituximab with improvement of systemic disease. The present case reinforces that, although rare, this complication is severe and must be promptly diagnosed and aggressively treated to improve prognosis of ocular and systemic RA.
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Affiliation(s)
- Letícia Queiroga de Figueiredo
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Fernanda Oliveira de Andrade Lopes
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - André Silva Franco
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Henrique Ayres Mayrink Giardini
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Lissiane Karine Noronha Guedes
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Karina Rossi Bonfiglioli
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Andrea Yukie Shimabuco
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Ana Cristina de Medeiros Ribeiro
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Diogo Souza Domiciano
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil.
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Hecquet S, Valnet Rabier MB, Lepelley M, Verhoeven F, Delbosc B, Avouac J, Prati C, Gauthier AS, Wendling D. Ophthalmic adverse events under tofacitinib and baricitinib: Case analysis of the European Pharmacovigilance Database. Joint Bone Spine 2023; 90:105483. [PMID: 36370964 DOI: 10.1016/j.jbspin.2022.105483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Sophie Hecquet
- Department of Rheumatology, Besançon University Medical Center, Besançon, France; EA 4267 "PEPITE", FHU Increase, Bourgogne-Franche Comte University, UFR SMP, Besançon, France
| | | | - Marion Lepelley
- Department of Pharmacovigilance, Grenoble University Medical Center, Besançon, France
| | - Frank Verhoeven
- Department of Rheumatology, Besançon University Medical Center, Besançon, France; EA 4267 "PEPITE", FHU Increase, Bourgogne-Franche Comte University, UFR SMP, Besançon, France
| | - Bernard Delbosc
- Department of Ophthalmology, Besançon University Medical Center, Besançon, France
| | - Jérôme Avouac
- Department of Rheumatology, Cochin University Hospital, Paris, France
| | - Clément Prati
- Department of Rheumatology, Besançon University Medical Center, Besançon, France; EA 4267 "PEPITE", FHU Increase, Bourgogne-Franche Comte University, UFR SMP, Besançon, France
| | - Anne-Sophie Gauthier
- Department of Ophthalmology, Besançon University Medical Center, Besançon, France
| | - Daniel Wendling
- Department of Rheumatology, Besançon University Medical Center, Besançon, France; EA 4266 "EPILAB", Bourgogne-Franche Comte University, UFR SMP, Besançon, France.
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Sota J, Girolamo MM, Frediani B, Tosi GM, Cantarini L, Fabiani C. Biologic Therapies and Small Molecules for the Management of Non-Infectious Scleritis: A Narrative Review. Ophthalmol Ther 2021; 10:777-813. [PMID: 34476773 PMCID: PMC8589879 DOI: 10.1007/s40123-021-00393-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/24/2021] [Indexed: 01/06/2023] Open
Abstract
Scleritis refers to a wide spectrum of ocular conditions ranging from mild to sight-threatening scleral inflammation that may compromise visual function and threaten the anatomical integrity of the ocular globe. Most aggressive forms like necrotizing or posterior scleritis are often difficult-to-treat cases, refractory to conventional treatment. The association with systemic diseases, namely rheumatoid arthritis, Sjögren syndrome, granulomatosis with polyangiitis, and relapsing polychondritis, may have prognostic implications as well. A better understanding of the pathogenesis of ocular inflammatory diseases have paved the way to more effective and targeted treatment approaches. In this regard, a growing body of evidence supports the potential role of biologic agents in the management of non-infectious scleral inflammation, either idiopathic or in a background of immune-mediated systemic disorders. Biologic agents such as anti-tumor necrosis factor agents, interleukin-1 and interleukin-6 inhibitors as well as CD20 blockade have displayed promising results. More specifically, several studies have reported their ability to control scleral inflammation, reduce the overall scleritis relapses, and allow a glucocorticoid-sparing effect while being generally well tolerated. Anecdotal reports have also been described with other biologic agents including abatacept, ustekinumab, daclizumab, and alemtuzumab as well as targeted small molecules such as tofacitinib. Further studies are warranted to fully elucidate the role of biologic agents in non-infectious scleritis and investigate specific areas with the aim to administer treatments in the context of personalized medicine. This review summarizes the available data regarding clinical trials, small pilot studies, and real-life experience of the last two decades reporting the use of biologic agents in the management of non-infectious scleritis.
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Affiliation(s)
- Jurgen Sota
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinics, University of Siena, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Matteo-Maria Girolamo
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinics, University of Siena, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinics, University of Siena, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy.
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Promelle V, Goeb V, Gueudry J. Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. J Clin Med 2021; 10:jcm10102118. [PMID: 34068884 PMCID: PMC8156434 DOI: 10.3390/jcm10102118] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 01/06/2023] Open
Abstract
Episcleritis and scleritis are the most common ocular inflammatory manifestation of rheumatoid arthritis. Rheumatoid arthritis (RA) accounts for 8% to 15% of the cases of scleritis, and 2% of patients with RA will develop scleritis. These patients are more likely to present with diffuse or necrotizing forms of scleritis and have an increased risk of ocular complications and refractory scleral inflammation. In this review we provide an overview of diagnosis and management of rheumatoid arthritis-associated episcleritis and scleritis with a focus on recent treatment perspectives. Episcleritis is usually benign and treated with oral non-steroidal anti- inflammatory drugs (NSAIDs) and/or topical steroids. Treatment of scleritis will classically include oral NSAIDs and steroids but may require disease-modifying anti-rheumatic drugs (DMARDs). In refractory cases, treatment with anti TNF biologic agents (infliximab, and adalimumab) is now recommended. Evidence suggests that rituximab may be an effective option, and further studies are needed to investigate the potential role of gevokizumab, tocilizumab, abatacept, tofacitinib, or ACTH gel. A close cooperation is needed between the rheumatology or internal medicine specialist and the ophthalmologist, especially when scleritis may be the first indicator of an underlying rheumatoid vasculitis.
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Affiliation(s)
- Veronique Promelle
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
- EA 7516 CHIMERE, Université de Picardie Jules Verne, 80025 Amiens, France;
- Correspondence: ; Tel.: +1-416-813-8942
| | - Vincent Goeb
- EA 7516 CHIMERE, Université de Picardie Jules Verne, 80025 Amiens, France;
- Department of Rheumatology, Centre Hospitalier Universitaire Amiens Picardie, 80054 Amiens, France
| | - Julie Gueudry
- Department of Ophthalmology, Hospital Charles Nicolle, 76000 Rouen, France;
- EA7510, UFR Santé, Rouen University, F-76000 Rouen, France
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Romano C, Esposito S, Ferrara R, Cuomo G. Tailoring biologic therapy for real-world rheumatoid arthritis patients. Expert Opin Biol Ther 2020; 21:661-674. [PMID: 33147106 DOI: 10.1080/14712598.2021.1847268] [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: 10/23/2022]
Abstract
Introduction: The cornerstone of rheumatoid arthritis (RA) therapy relies on the treat-to-target strategy, which aims at dampening inflammation as soon as possible in order to achieve persistent low disease activity or, ideally, remission, according to validated disease activity measures. Traditional disease-modifying antirheumatic drugs (DMARDs) may be chosen in monotherapy or in combination as first-line therapy; in case of an unsatisfactory response after a 3-6-month trial, biologic therapy may be commenced.Areas covered: Real-life RA patients may present with concomitant comorbidities/complications or be in peculiar physiological states which raise more than one question as to which biotherapy may be more well suited considering the whole clinical picture. Therefore, a thorough literature search was performed to identify the most appropriate biologic therapy in each setting considered in this review.Expert opinion: Here we provide suggestions for the use of biologic drugs having a predictable better outcome in specific real-world conditions, so as to ideally profile the patient to the best of the current knowledge.
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Affiliation(s)
- Ciro Romano
- Department of Medicine, Clinical Immunology Outpatient Clinic, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Sergio Esposito
- Department of Medicine, Clinical Immunology Outpatient Clinic, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Roberta Ferrara
- Department of Medicine, Clinical Immunology Outpatient Clinic, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Giovanna Cuomo
- Department of Medicine, Clinical Immunology Outpatient Clinic, "Luigi Vanvitelli" University of Campania, Naples, Italy
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Benchérifa S, Amine B, El Binoune I, Rostom S, Bahiri R. Two cases of perforated corneal ulcers complicating rheumatoid arthritis treated successfully by biological therapy. BMC Rheumatol 2020; 4:6. [PMID: 32055765 PMCID: PMC7006420 DOI: 10.1186/s41927-019-0108-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/01/2019] [Indexed: 11/21/2022] Open
Abstract
Background Peripheral ulcerative keratitis (PUK) is a severe inflammatory ocular disease that can affect patients with a long history of rheumatoid arthritis (RA). The use of biotherapy has revolutionized the treatment of the RA and has provided encouraging outcomes especially in the treatment of PUK reported in few cases. In this article, we describe the case of two patients with the history of perforated corneal ulcer complicating RA treated successfully by biologic agents. Case presentation Case 1: A 45-year-old woman was diagnosed for over 17 years with sero-positive RA refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). She had received one cycle of Rituximab with clinical and biological failure. In July 2017, she presented an active RA flare with a painful left eye and a decreased visual acuity. Ocular examination revealed a corneal perforation in the left eye and a pre-perforation in the right eye. She received an emergency bolus of methylprednisolone 1 g/day during three consecutive days and was followed by Infliximab. After thirteen months, Infliximab was effective on the rheumatic disease and on the corneal involvement as it stopped its gradual perforation in the right eye, and stabilized corneal ulcer in the left eye. Case 2: A 68-year-old man had been diagnosed since 2010 with sero-positive RA refractory to csDMARDs complicated in July 2017 by corneal perforation in the right eye. He was hospitalized for his ocular involvement and his active RA. He received an emergency bolus of methylprednisolone 500 mg/day during three consecutive days and was followed by Rituximab. After six months, we observed the stabilization of the right eye corneal damage and the resolution of articular symptoms. Conclusions Our cases suggest the efficacy of Infliximab (case 1) and Rituximab (case 2) as a treatment of this severe and destructive keratolysis of the cornea complicating an active RA allowing to plan corneal graft. This positive therapeutic response will contribute to increase literature reports of this therapy success.
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Affiliation(s)
- Sara Benchérifa
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
| | - Bouchra Amine
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
| | - Imane El Binoune
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
| | - Samira Rostom
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
| | - Rachid Bahiri
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
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Clavel G, Gabison E, Semerano L. Corneal and scleral involvement in inflammatory rheumatic disease: Rheumatologists and ophthalmologists exchanging views. Joint Bone Spine 2019; 86:699-705. [DOI: 10.1016/j.jbspin.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
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Biologic therapy for refractory scleritis: a new treatment perspective. Int Ophthalmol 2015; 35:903-12. [DOI: 10.1007/s10792-015-0124-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/23/2015] [Indexed: 12/12/2022]
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Watanabe R, Ishii T, Yoshida M, Takada N, Yokokura S, Shirota Y, Fujii H, Harigae H. Ulcerative keratitis in patients with rheumatoid arthritis in the modern biologic era: a series of eight cases and literature review. Int J Rheum Dis 2015; 20:225-230. [DOI: 10.1111/1756-185x.12688] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ryu Watanabe
- Department of Hematology and Rheumatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Tomonori Ishii
- Department of Hematology and Rheumatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Masaaki Yoshida
- Department of Hematology and Rheumatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Naoko Takada
- Department of Ophthalmology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Shunji Yokokura
- Department of Ophthalmology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yuko Shirota
- Department of Hematology and Rheumatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Hiroshi Fujii
- Department of Hematology and Rheumatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology; Tohoku University Graduate School of Medicine; Sendai Japan
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Wakefield D, Di Girolamo N, Thurau S, Wildner G, McCluskey P. Scleritis: Immunopathogenesis and molecular basis for therapy. Prog Retin Eye Res 2013; 35:44-62. [PMID: 23454614 DOI: 10.1016/j.preteyeres.2013.02.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 02/10/2013] [Accepted: 02/15/2013] [Indexed: 12/19/2022]
Abstract
Scleritis is a heterogeneous group of diseases characterized by inflammation of the sclera, which may be due to local or systemic infections or immune mediated diseases. Numerous studies over the last decade have lead to significant progress in understanding the pathogenesis and treatment of this severe and potentially blinding disease. Immunological investigations of non-infectious scleritis and associated diseases have indicated that scleritis is an autoimmune disease and studies on the nature of the local inflammatory response have revealed the prominent role of T and B cells and cytokines, such as TNF-alpha, which in turn has resulted in clinical trials showing the effectiveness of local steroid treatment, anti-TNF and anti-B cell therapy. The widespread use of imaging has led to the realization that posterior scleritis is more common than previously recognized and testing for ANCA antibodies has revealed the prominent role of immune mechanisms in a subset of patients with scleritis and associated systemic vasculitis.
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Affiliation(s)
- Denis Wakefield
- School of Medical Sciences, UNSW Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
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Restrepo JP, Molina MP. Successful treatment of severe nodular scleritis with adalimumab. Clin Rheumatol 2010; 29:559-61. [PMID: 20155432 DOI: 10.1007/s10067-009-1368-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 12/23/2009] [Indexed: 11/26/2022]
Abstract
Ocular features may occur in longstanding rheumatoid arthritis. Among them, scleritis represents the most frequent manifestation of ophthalmologic rheumatoid disease. There are three types of anterior scleritis: diffuse, nodular, and necrotizing with and without inflammation (scleromalacia perforans). Nodular scleritis is the second cause of anterior scleritis representing 20% of all types of scleritis. The conventional treatment of nodular scleritis consists in topical steroids and DMARDS. In severe cases, the therapy with immunosuppressive agents to avoid complications is necessary. We describe a 46-year-old woman presented right nodular scleritis with rheumatoid arthritis. She was treated initially with topical steroids and DMARDs but was unable to received systemic steroids due to left open angle glaucoma in the opposite eye. After an ocular exacerbation, we initiated adalimumab with complete resolution of nodular scleritis. This is the first report of adalimumab in the treatment of nodular scleritis. Adalimumab could be a good alternative in patients with severe nodular scleritis who fail to have conventional treatment with DMARDs and unable to receive systemic steroids.
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Affiliation(s)
- Juan P Restrepo
- Universidad del Quindío, Cra 15 # Calle 12 Norte, Armenia, Quindío, Colombia.
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Abalos Medina GM, Gónzalez Domínguez J, Ruiz Villaverde G, Raya Alvarez E. [Infliximab in the treatment of necrotizing scleritis associated to seropositive rheumatoid arthritis]. Med Clin (Barc) 2009; 134:235-6. [PMID: 19359007 DOI: 10.1016/j.medcli.2009.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
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Nizam S, Johnstone A, Green M, Gough A. Necrotising scleritis and connective tissue disease--three cases and a review. Clin Rheumatol 2008; 28:339-41. [PMID: 19052835 DOI: 10.1007/s10067-008-1054-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 11/13/2008] [Indexed: 11/28/2022]
Abstract
Necrotising scleritis is a severe form of anterior scleritis which is known to be associated with connective tissue disease but has not previously been reported in association with limited scleroderma. It is often a difficult condition to treat and without adequate early intervention leads to significant morbidity including visual loss. We report three cases of necrotising scleritis, two occurring in the context of previously unreported associations and a third case to compare presentation of the condition and highlight difficulties in management.
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Affiliation(s)
- Sharmin Nizam
- Academic Unit of Musculoskeletal Medicine, Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds LS74SA, UK.
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Morley AMS, Pavesio C. Surgically induced necrotising scleritis following three-port pars plana vitrectomy without scleral buckling: a series of three cases. Eye (Lond) 2007; 22:162-4. [PMID: 17304259 DOI: 10.1038/sj.eye.6702708] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM To document the presentation, management, and prognosis of three cases of surgically induced necrotising scleritis (SINS) following three-port-pars plana vitrectomy (PPV) without scleral buckling. To discuss potential pathogeneses and treatments. METHODS An interventional case series of three patients presenting to a tertiary referral unit over a 6-month period. RESULTS All cases were male, presenting within 6 weeks of PPV, with scleral necrosis around a sclerotomy site. Wound microbiology and systemic vasculitis screens were negative. Two cases had underlying systemic disease and had undergone previous ocular surgery. The necrosis resolved in all with aggressive immunosuppression. CONCLUSIONS SINS following PPV is a rare occurrence requiring prompt and aggressive immunosuppression. Differentiation from an infective postoperative process is essential. The pathogenesis is poorly understood but may share features with classic SINS including hypersensitivity and ischaemia.
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Affiliation(s)
- A M S Morley
- Uveitis Service, Moorfields Eye Hospital, London, UK.
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