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Vitale A, Caggiano V, Martin-Nares E, Frassi M, Dagna L, Hissaria P, Sfriso P, Hernández-Rodríguez J, Ruiz-Irastorza G, Monti S, Tufan A, Piga M, Giardini HAM, Lopalco G, Viapiana O, De Paulis A, Triggianese P, Vitetta R, de-la-Torre A, Fonollosa A, Caroni F, Sota J, Conticini E, Sbalchiero J, Renieri A, Casamassima G, Wiesik-Szewczyk E, Yildirim D, Hinojosa-Azaola A, Crisafulli F, Franceschini F, Campochiaro C, Tomelleri A, Callisto A, Beecher M, Bindoli S, Baggio C, Gómez-Caverzaschi V, Pelegrín L, Soto-Peleteiro A, Milanesi A, Vasi I, Cauli A, Antonelli IPDB, Iannone F, Bixio R, Casa FD, Mormile I, Gurnari C, Fiorenza A, Mejia-Salgado G, Kawakami-Campos PA, Ragab G, Ciccia F, Ruscitti P, Bocchia M, Balistreri A, Tosi GM, Frediani B, Cantarini L, Fabiani C. Orbital/ocular inflammatory involvement in VEXAS syndrome: Data from the international AIDA network VEXAS registry. Semin Arthritis Rheum 2024; 66:152430. [PMID: 38554594 DOI: 10.1016/j.semarthrit.2024.152430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/24/2024] [Accepted: 03/07/2024] [Indexed: 04/01/2024]
Abstract
VEXAS syndrome is a recently described monogenic autoinflammatory disease capable of manifesting itself with a wide array of organs and tissues involvement. Orbital/ocular inflammatory manifestations are frequently described in VEXAS patients. The objective of this study is to further describe orbital/ocular conditions in VEXAS syndrome while investigating potential associations with other disease manifestations. In the present study, twenty-seven out of 59 (45.8 %) VEXAS patients showed an inflammatory orbital/ocular involvement during their clinical history. The most frequent orbital/ocular affections were represented by periorbital edema in 8 (13.6 %) cases, episcleritis in 5 (8.5 %) patients, scleritis in 5 (8.5 %) cases, uveitis in 4 (6.8 %) cases, conjunctivitis in 4 (6.8 %) cases, blepharitis in 3 (5.1 %) cases, orbital myositis in 2 (3.4 %) cases. A diagnosis of systemic immune-mediated disease was observed in 15 (55.6 %) cases, with relapsing polychondritis diagnosed in 12 patients. A significant association was observed between relapsing polychondritis and orbital/ocular involvement in VEXAS syndrome (Relative Risk: 2.37, 95 % C.I. 1.03-5.46, p = 0.048). Six deaths were observed in the whole cohort of patients after a median disease duration of 1.2 (IQR=5.35) years, 5 (83.3 %) of which showed orbital/ocular inflammatory involvement. In conclusion, this study confirms that orbital/ocular inflammatory involvement is a common finding in VEXAS patients, especially when relapsing polychondritis is diagnosed. This makes ophthalmologists a key figure in the diagnostic process of VEXAS syndrome. The high frequency of deaths observed in this study seems to suggest that patients with orbital/ocular involvement may require increased attention and more careful follow-up.
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Affiliation(s)
- Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Valeria Caggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Eduardo Martin-Nares
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Micol Frassi
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy
| | - Lorenzo Dagna
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Milan, Italy
| | - Pravin Hissaria
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia; Department of Immunopathology, SA Pathology, Adelaide, Australia
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine, University of Padua, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Padua, Italy
| | - José Hernández-Rodríguez
- Clinical Unit of Autoinflammatory Diseases, Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic of Barcelona [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], University of Barcelona, Barcelona, Spain
| | - Guillermo Ruiz-Irastorza
- Faculty of Medicine and Nursery, University of the Basque Country, UPV/EHU, Leioa, Biscay, Spain; Autoimmune Diseases Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Biscay, Spain
| | - Sara Monti
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Pavia, Italy; Department of Internal Medicine and Therapeutics, Università di Pavia, Italy
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University Hospital, Ankara, Turkiye
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - Henrique A Mayrink Giardini
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Giuseppe Lopalco
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Policlinic Hospital, University of Bari, Bari, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Rosetta Vitetta
- Unit of Rheumatology, ASL VC Sant' Andrea Hospital, Vercelli 13100, Italy
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alex Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Federico Caroni
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena 53100, Italy
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Edoardo Conticini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Jessica Sbalchiero
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Alessandra Renieri
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Medical Genetics, Department of Medical Biotechnologies, University of Siena, Siena, Italy; Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy; Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Giulia Casamassima
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Medical Genetics, Department of Medical Biotechnologies, University of Siena, Siena, Italy; Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy; Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Ewa Wiesik-Szewczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| | - Derya Yildirim
- Department of Internal Medicine, Division of Rheumatology, Gazi University Hospital, Ankara, Turkiye
| | - Andrea Hinojosa-Azaola
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy
| | - Corrado Campochiaro
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Milan, Italy
| | - Alessandro Tomelleri
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Milan, Italy
| | - Alicia Callisto
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
| | - Mark Beecher
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
| | - Sara Bindoli
- Rheumatology Unit, Department of Medicine, University of Padua, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Padua, Italy
| | - Chiara Baggio
- Rheumatology Unit, Department of Medicine, University of Padua, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Padua, Italy
| | - Verónica Gómez-Caverzaschi
- Clinical Unit of Autoinflammatory Diseases, Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic of Barcelona [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], University of Barcelona, Barcelona, Spain
| | - Laura Pelegrín
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Adriana Soto-Peleteiro
- Faculty of Medicine and Nursery, University of the Basque Country, UPV/EHU, Leioa, Biscay, Spain; Autoimmune Diseases Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Biscay, Spain
| | - Alessandra Milanesi
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Pavia, Italy; Department of Internal Medicine and Therapeutics, Università di Pavia, Italy
| | - Ibrahim Vasi
- Department of Internal Medicine, Division of Rheumatology, Gazi University Hospital, Ankara, Turkiye
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | | | - Florenzo Iannone
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Policlinic Hospital, University of Bari, Bari, Italy
| | - Riccardo Bixio
- Rheumatology Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Italy
| | - Francesca Della Casa
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Ilaria Mormile
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alessia Fiorenza
- Unit of Rheumatology, ASL VC Sant' Andrea Hospital, Vercelli 13100, Italy
| | - Germán Mejia-Salgado
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Perla Ayumi Kawakami-Campos
- Department of Ophthalmology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gaafar Ragab
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt; Faculty of Medicine, Newgiza University, 6th of October City, Egypt
| | - Francesco Ciccia
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Monica Bocchia
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena 53100, Italy
| | - Alberto Balistreri
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gian Marco Tosi
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy.
| | - Claudia Fabiani
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy.
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Kalogeropoulos D, Afshar F, Antonakis S. Exudative retinal detachment and SLE-associated scleritis. Eur J Ophthalmol 2024; 34:NP129-NP130. [PMID: 38419486 DOI: 10.1177/11206721241235859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
| | - Farid Afshar
- Eye Unit, University Hospital Southampton, Southampton, UK
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Moumen A, Belamlih H, Benabedlfedil Y, Derrou S, Lemhadi M, Safi S, El Guendouz F. Bacterial scleritis secondary to osteitis in a diabetic patient. J Fr Ophtalmol 2024; 47:103931. [PMID: 37666739 DOI: 10.1016/j.jfo.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Affiliation(s)
- A Moumen
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco.
| | - H Belamlih
- Radiology Department, Moulay Ismail Military Hospital of Meknes, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - Y Benabedlfedil
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - S Derrou
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - M Lemhadi
- Ophthalmology Department, Moulay Ismail Military Hospital of Meknes, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - S Safi
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - F El Guendouz
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
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Doukkali S, Hébert M, Dirani A, Saab M. Bilateral posterior scleritis associated with consecutive panuveitis following the influenza vaccine. Can J Ophthalmol 2024; 59:e189-e191. [PMID: 37925163 DOI: 10.1016/j.jcjo.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/25/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Sihame Doukkali
- Blessed Sacrament Hospital, CHU de Québec-Université Laval, Quebec, QC
| | - Mélanie Hébert
- Blessed Sacrament Hospital, CHU de Québec-Université Laval, Quebec, QC
| | - Ali Dirani
- Blessed Sacrament Hospital, CHU de Québec-Université Laval, Quebec, QC
| | - Marc Saab
- Charles-LeMoyne Hospital, University of Sherbrooke, Greenfield Park, QC..
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Heck K, Malinina S, Palmowski A. Scleritis and Intraorbital Inflammation following Oral and Intravenous Bisphosphonates in a 66-Year-Old Man. Klin Monbl Augenheilkd 2024; 241:426-428. [PMID: 38653272 DOI: 10.1055/a-2229-2946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Katharina Heck
- Eye Clinic, University Hospital Basel, Basel, Switzerland
| | | | - Anja Palmowski
- Eye Clinic, University Hospital Basel, Basel, Switzerland
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Raneri M, Fossataro F, Martines F, Maione G, Pece A. DIFFUSE POSTERIOR SCLERITIS ASSOCIATED WITH HUMAN LEUKOCYTE ANTIGEN-B14* MANAGED WITH MULTIMODAL IMAGING: CASE REPORT AND REVIEW OF THE LITERATURE. Retin Cases Brief Rep 2024; 18:255-258. [PMID: 36730595 DOI: 10.1097/icb.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To report a case of posterior scleritis in a human leukocyte antigen (HLA)-B*14-positive patient, highlighting the crucial role of multimodal imaging and of autoimmune systemic disease screening for the diagnosis. METHODS Case report. RESULTS A 73-year-old woman, complaining of ocular discomfort in right eye, presented conjunctival hyperemia, keratic precipitates involving the anterior segment and four chorioretinal elevations with macular folds at fundus examination. Multimodal imaging and systemic diagnostic workup were performed. While awaiting results, topical corticosteroid was prescribed. Four days later, worsening of exudative chorioretinal was detected. Except for erythrocyte sedimentation rate, tests were negative, whereas molecular typing of HLA genes was positive for HLA-B*14. Diagnosis of posterior scleritis was confirmed by ultrasound examination while diagnosis of ankylosing spondylitis was made by rheumatologist. The patient was given systemic corticosteroid, and one month later, the posterior segment was unremarkable. CONCLUSION HLA-B*14 may configure as a causal factor, so autoimmune systemic disease screening should rule this out in the management of posterior scleritis, which should be diagnosed on the basis of multimodal imaging.
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Affiliation(s)
- Marco Raneri
- Eye Clinic, Melegnano Hospital, Vizzolo Predabissi, Italy
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Takayama T, Inoda S, Takahashi H, Tsukii R, Yoshida H, Kasuya Y, Nagaoka K, Takahashi R, Arai Y, Kawashima H. Scleritis following intravitreal brolucizumab injection: a case series. J Med Case Rep 2024; 18:80. [PMID: 38419100 PMCID: PMC10902930 DOI: 10.1186/s13256-024-04402-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND This study reports the first cases of scleritis following intravitreal brolucizumab (IVBr) injection for nAMD, emphasizing the need to be aware of the possibility of scleritis following IVBr injections. CASE PRESENTATION Case 1. A 74-year-old Japanese man with nAMD complained of conjunctivitis and decreased vision in the right eye 8 days after his eighth IVBr injection. Examination revealed scleritis without anterior inflammation. Topical 0.1% betamethasone and 0.3% gatifloxacin eye drops were started. The scleritis worsened in the following 2 weeks and became painful. He underwent sub-Tenon's capsule triamcinolone acetonide (STTA) injection. Two days later, he returned with a complaint of severe vision loss. Fundus examination revealed retinal artery occlusion, vasculitis, and vitreous opacity in the right eye. Vitreous surgery was performed. CASE 2 An 85-year-old Japanese woman with nAMD in the right eye complained of reddening of the eye 27 days after her fifth IVBr injection. Examination showed conjunctivitis and scleritis without anterior inflammation in the right eye. She was started on 0.1% fluorometholone and 0.5% levofloxacin hydrate eye drops. The scleritis worsened in the following 3 weeks. Her treatment was switched to 0.1% betamethasone eye drops. One month later, the scleritis had improved and a sixth IVBr injection was administered. There was no worsening of the scleritis at that time. However, 1 month after a seventh IVBr injection, she complained of severe hyperemia and decreased vision. Fundus examination revealed vitreous opacification. She underwent STTA, and the vitreous opacity improved in 24 days. Case 3. A 57-year-old Japanese man with nAMD complained of pain and decreased vision in the right eye 21 days after a fourth IVBr injection. Examination revealed scleritis with high intraocular pressure but no anterior chamber or fundus inflammation. STTA and topical eye drops were performed. One month later, scleritis improved but visual acuity didn't due to progression of nAMD. CONCLUSIONS Intraocular inflammation following IVBr injection may progress to the posterior segment. Scleritis can occur after IVBr injection, and topical eye drops alone may not be sufficient for initial treatment. Clinicians should consider the possibility of scleritis in patients with worsening inflammation after IVBr injection.
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Affiliation(s)
- Takuya Takayama
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan
| | - Satoru Inoda
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan.
| | - Hidenori Takahashi
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan
| | - Rika Tsukii
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan
| | - Hana Yoshida
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan
| | - Yuka Kasuya
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan
| | - Kosuke Nagaoka
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan
| | - Ryota Takahashi
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan
| | - Yusuke Arai
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0431, Japan
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8
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Özbek Z, Lebe B, Kayabaşı M, Saatci AO. Embedded Episcleral Foreign Body Mimicking Nodular Anterior Scleritis. Turk J Ophthalmol 2024; 54:46-48. [PMID: 38385320 PMCID: PMC10895169 DOI: 10.4274/tjo.galenos.2023.37460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/18/2023] [Indexed: 02/23/2024] Open
Abstract
A 56-year-old man was referred to our clinic for unilateral nodular scleritis unresponsive to systemic corticosteroids. A localized, nodular hyperemia on the nasal bulbar conjunctiva surrounding a central cyst-like lesion together with vascular engorgement was observed on slit-lamp examination of the left eye. No abnormal fundoscopic findings were noted. Surgical exploration revealed an embedded episcleral brown colored, soft to touch, splinter-like organic foreign body (FB) which was confirmed by the histopathological examination. Nodular hyperemia resolved during the postoperative follow-up period, and mild scar tissue accompanied by scleral thinning developed in the left nasal bulbar conjunctiva. Ocular injury associated with FBs may cause significant ocular morbidity depending on the nature and location of the FB. Severe visual disability may occur if left untreated. Subconjunctival FBs are rare and may present with a clinical picture mimicking episcleritis or scleritis. History of trauma involving a FB should always be assessed for an accurate differential diagnosis and appropriate management of patients with anterior scleritis.
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Affiliation(s)
- Zeynep Özbek
- Dokuz Eylul University Faculty of Medicine, Department of Ophthalmology, İzmir, Türkiye
| | - Banu Lebe
- Dokuz Eylul University Faculty of Medicine, Department of Pathology, İzmir, Türkiye
| | - Mustafa Kayabaşı
- Dokuz Eylul University Faculty of Medicine, Department of Ophthalmology, İzmir, Türkiye
| | - Ali Osman Saatci
- Dokuz Eylul University Faculty of Medicine, Department of Ophthalmology, İzmir, Türkiye
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9
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Perray L, Nguyen Y, Clavel Refregiers G, Chazal T, Héron E, Pouchelon C, Dunogué B, Costedoat-Chalumeau N, Murarasu A, Régent A, Puéchal X, Thoreau B, Lifermann F, Graveleau J, Hié M, Froissart A, Baudet A, Deroux A, Lavigne C, Puigrenier S, Mesbah R, Moulinet T, Vasco C, Revuz S, Pugnet G, Rieu V, Combes A, Brézin A, Terrier B. ANCA-associated scleritis: impact of ANCA on presentation, response to therapy and outcome. Rheumatology (Oxford) 2024; 63:329-337. [PMID: 37233203 DOI: 10.1093/rheumatology/kead252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES To describe the characteristics, treatment and outcome of isolated ANCA-associated scleritis at diagnosis compared with idiopathic scleritis with negative ANCA tests. METHODS This retrospective multicentre case-control study was performed within the French Vasculitis Study Group (FVSG) network and in three French tertiary ophthalmologic centres. Data from patients with scleritis without any systemic manifestation and with positive ANCA results were compared with those of a control group of patients with idiopathic scleritis with negative ANCA tests. RESULTS A total of 120 patients, including 38 patients with ANCA-associated scleritis and 82 control patients, diagnosed between January 2007 and April 2022 were included. The median follow-up was 28 months (IQR 10-60). The median age at diagnosis was 48 years (IQR 33-60) and 75% were females. Scleromalacia was more frequent in ANCA-positive patients (P = 0.027) and 54% had associated ophthalmologic manifestations, without significant differences. ANCA-associated scleritis more frequently required systemic medications, including glucocorticoids (76% vs 34%; P < 0.001), and rituximab (P = 0.03) and had a lower remission rate after the first- and second-line treatment. Systemic ANCA-associated vasculitis (AAV) occurred in 30.7% of patients with PR3- or MPO-ANCA, after a median interval of 30 months (IQR 16.3-44). Increased CRP >5 mg/l at diagnosis was the only significant risk factor of progression to systemic AAV [adjusted hazard ratio 5.85 (95% CI 1.10, 31.01), P = 0.038]. CONCLUSION Isolated ANCA-associated scleritis is mostly anterior scleritis with a higher risk of scleromalacia than ANCA-negative idiopathic scleritis and is more often difficult to treat. One-third of patients with PR3- or MPO-ANCA scleritis progressed to systemic AAV.
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Affiliation(s)
- Laura Perray
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | | | - Thibaud Chazal
- Department of Internal Medicine, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Emmanuel Héron
- Department of Internal Medicine, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Clara Pouchelon
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Bertrand Dunogué
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | | | - Anne Murarasu
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Benjamin Thoreau
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | | | - Julie Graveleau
- Department of Internal Medicine, Centre Hospitalier de Saint Nazaire, Saint Nazaire, France
| | - Miguel Hié
- Department of Internal Medicine, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Antoine Froissart
- Department of Internal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Antoine Baudet
- Department of Internal Medicine, Centre Hospitalier d'Annecy, Annecy, France
| | - Alban Deroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Christian Lavigne
- Department of Internal Medicine, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sébastien Puigrenier
- Department of Internal Medicine, Centre Hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Rafik Mesbah
- Department of Nephrology, Centre Hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Thomas Moulinet
- Department of Internal Medicine, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Claire Vasco
- Department of Internal Medicine, Centre Hospitalier de Libourne, Libourne, France
| | - Sabine Revuz
- Department of Internal Medicine, Centre Hospitalier Universitaire Saint Pierre, La Réunion, Saint Pierre, France
| | - Grégory Pugnet
- Department of Internal Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Rieu
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anaïs Combes
- Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France
| | - Antoine Brézin
- Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
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10
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Tarsia M, Grosso S, Fabiani C. Bilateral scleritis at the onset of macrophage activation syndrome. Am J Ophthalmol 2024; 258:e5. [PMID: 37984753 DOI: 10.1016/j.ajo.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Maria Tarsia
- Clinical Paediatrics, Department of Molecular Medicine and Development, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", viale Bracci 16, 53100 Siena, Italy
| | - Salvatore Grosso
- Clinical Paediatrics, Department of Molecular Medicine and Development, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", viale Bracci 16, 53100 Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Policlinico "Le Scotte", viale Bracci 16, 53100 Siena, Italy.
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11
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Negretti GS, Zeiger JS, Cherkas E, Shields CL. Posterior scleritis following COVID-19 vaccination or infection simulating uveal melanoma in 8 consecutive patients. Eye (Lond) 2024; 38:185-191. [PMID: 37422535 PMCID: PMC10764359 DOI: 10.1038/s41433-023-02656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVES To determine clinical features and outcomes of posterior scleritis masquerading as uveal melanoma following vaccination against COVID-19 and/or COVID-19 infection. SUBJECTS/METHODS All patients with posterior scleritis referred to our service to rule out intraocular tumour between February 2021 and June 2022, who previously had COVID-19 vaccination and/or infection (n = 8). A retrospective detailed review of patient charts and imaging was carried out. RESULTS Previous COVID-19 vaccination was documented in 6 patients (75%) and previous COVID-19 infection and vaccination in 2 patients (25%). Demographic features included mean age of 59 years (median 68, range 5-86 years), white race (n = 7, 87%), and male sex (n = 5, 63%). Mean visual acuity at presentation was 0.24 LogMAR (median 0.18, range 0.0-0.70). The main presenting symptom was blurred vision with pain (n = 5, 63%). Features that suggested scleritis and not uveal melanoma included pain (n = 6, 75%), anterior scleritis (n = 3, 38%), disc oedema (n = 1, 13%), choroidal detachment (n = 3, 38%), choroidal folds (n = 3, 38%), diffusely thickened scleral wall on ultrasonography (n = 2, 25%), Tenon's oedema (n = 5, 63%), and scleral nodule with medium/high internal reflectivity on ultrasonography (n = 4, 50%). Follow-up information at mean of 2 months (range 0.25-7 months) revealed visual acuity at date last seen was mean 0.30 LogMAR (median 0.29, range 0.0-0.54). By 2 months, resolution of "tumour" was noted in 5/6 (83%) patients with follow-up. CONCLUSIONS Posterior scleritis following COVID-19 vaccination and/or infection can masquerade as choroidal melanoma. At 2 months duration, partial or complete resolution of features with minimal visual consequence was noted.
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Affiliation(s)
- Guy S Negretti
- Shields and Shields, MD, PC, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer S Zeiger
- Shields and Shields, MD, PC, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elliot Cherkas
- Shields and Shields, MD, PC, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
- Casey Eye Institute, OHSU, Portland, OR, USA
| | - Carol L Shields
- Shields and Shields, MD, PC, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.
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12
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Lee PSY, Freedman RL, Abrams G, Lin X, Bahl RS. Surgically Induced Scleritis Associated With Suture Hypersensitivity Following Strabismus Surgery. J Pediatr Ophthalmol Strabismus 2024; 61:e4-e6. [PMID: 38306237 DOI: 10.3928/01913913-20231214-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
A 67-year-old woman with history of mild suture hyper-sensitivity presented with localized scleritis after strabismus surgery. After infection was ruled out, the patient was prescribed topical and systemic non-steroidal anti-inflammatory drugs and systemic steroids, which led to full clinical resolution. [J Pediatr Ophthalmol Strabismus. 2024;61(1):e4-e6.].
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13
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Perray L, Ungerer L, Chazal T, Monnet D, Brézin A, Terrier B. [Scleritis and episcleritis]. Rev Med Interne 2023; 44:646-655. [PMID: 37344292 DOI: 10.1016/j.revmed.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
Scleritis and episcleritis are rare ocular inflammatory diseases but deserve to be known by internists because of their frequent association with systemic autoimmune diseases. It is important to distinguish them between because their prognosis, therapeutic management and potential complications are very different. Episcleritis represents a superficial ocular inflammation with usually benign visual prognosis, no complication with local treatment, and is associated with a systemic autoimmune disease in rare cases. In contrast, scleritis is a potentially serious ophthalmological condition that can threaten the visual prognosis in the absence of appropriate systemic treatment. It is associated with an underlying disease in 40-50% of cases, in particular a systemic autoimmune disease (25-35% of cases) or an infectious cause (5-10% of cases). Rheumatoid arthritis and systemic vasculitides, particularly antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides, are the main autoimmune causes of scleritis and episcleritis. Scleritis can reveal the underlying autoimmune disease and requires systematic etiological investigations. Aggressive, complicated, refractory forms or those associated with a systemic autoimmune disease require glucocorticoids or even immunosuppressants, and close collaboration between ophthalmologists and internists is required. The development of biologic agents offers new effective therapeutic tools in the management of these difficult cases.
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Affiliation(s)
- L Perray
- Service de médecine interne, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - L Ungerer
- Service de chirurgie plastique et reconstructrice, hôpital Saint-Louis, AP-HP, Paris, France
| | - T Chazal
- Service de médecine interne, hôpital fondation Adolphe-de-Rothschild, Paris, France
| | - D Monnet
- Service d'ophtalmologie, hôpital Cochin, AP-HP, Paris, France
| | - A Brézin
- Service d'ophtalmologie, hôpital Cochin, AP-HP, Paris, France
| | - B Terrier
- Service de médecine interne, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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14
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Chauhan K, Murthy SI, Mitra S. Demystifying nocardial scleritis. BMJ Case Rep 2023; 16:e255730. [PMID: 38011958 PMCID: PMC10685915 DOI: 10.1136/bcr-2023-255730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Affiliation(s)
- Khushboo Chauhan
- Academy for eye care education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sanchita Mitra
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
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15
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Singh A, Maharana A, Nagarajan S, Sachan S. Bilateral Necrotizing Scleritis with Scleral Melt associated with Herpes Simplex Infection: A Case Report. Rom J Ophthalmol 2023; 67:403-407. [PMID: 38239423 PMCID: PMC10793367 DOI: 10.22336/rjo.2023.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/22/2024] Open
Abstract
Objective (Aim): The article is a case report of a very rare case of bilateral herpes simplex virus infection associated with bilateral necrotizing scleritis with scleral melt in an elderly north Indian female of lower middle socioeconomic status. Methods: A 65-year-old female presented to our clinic with a wide variety of presentations ranging initially from neurotropic corneal ulcer to necrotizing scleritis with scleral melt for 2 years. The patient records were evaluated and computed. A PubMed literature search on herpes scleritis was conducted and reviewed. Results: A keen sense of judgment, timely management, and patient counseling are crucial for a rapid and favorable outcome. Conclusions: Bilateral necrotizing scleritis with scleral melt can be a rare atypical presentation of herpes simplex keratitis. In such atypical cases, diagnosis may be challenging. Associated clinical findings, history of herpes keratitis, which may be recurrent, and response to antiviral drugs, may give clues towards the diagnosis in such atypical cases. In addition to this, surgical intervention should not be delayed if it seems inevitable. Abbreviations: RE = right eye, LE = left eye, BCL = bandage contact lens, KP = keratic precipitate, mm = millimeter, mg = milligram.
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Affiliation(s)
- Arti Singh
- Department of Ophthalmology, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Ashutosh Maharana
- Department of Ophthalmology, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Srishti Nagarajan
- Department of Ophthalmology, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Shubhi Sachan
- Department of Ophthalmology, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India
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16
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Yu SN, Talsania SD. Acute-onset surgically induced necrotizing scleritis after strabismus surgery. J AAPOS 2023; 27:293-295. [PMID: 37625780 DOI: 10.1016/j.jaapos.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 08/27/2023]
Abstract
Surgically induced necrotizing scleritis (SINS) is an uncommon but devastating complication that may occur days to years after ocular surgery. We report the case of a 32-year-old man who underwent uncomplicated strabismus surgery for large-angle exotropia and developed SINS characterized by painless scleral inflammation, choroidal exposure, and globe ectasia within days of surgery. Work-up revealed no associated infectious process or underlying systemic inflammatory condition. Clinical resolution occurred with oral immunosuppression alone, without need for graft.
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Affiliation(s)
- Sarah N Yu
- Department of Ophthalmology, Columbia University, New York
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17
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Mitamura M, Kase S, Yamashita Y, Hirooka K, Ishida S. Alterations in choroidal circulatory dynamics and choroidal thickness before and after treatment in posterior scleritis. BMC Ophthalmol 2023; 23:382. [PMID: 37726746 PMCID: PMC10508002 DOI: 10.1186/s12886-023-03140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Posterior scleritis is an inflammatory reaction of the sclera that occurs posterior to the ora serrata. The aim of this study was to present a case of posterior scleritis and to analyze choroidal circulatory and structural changes using laser speckle flowgraphy (LSFG) and optical coherence tomography (OCT), respectively. CASE PRESENTATION A 64-year-old man presented to our department because of hyperemia of the left eye for one week, diplopia, ocular pain, and distorted vision when looking leftward. At an initial examination, his best-corrected visual acuity was 1.0 Oculi uterque (OU), with mild conjunctival hyperemia oculus dexter (OD) and marked ciliary hyperemia oculus sinister (OS). Color fundus photographs revealed a cluster of choroidal folds extending from the macula to the inferior retinal region OS. Swept-Source OCT showed choroidal thickening OD, and bacillary layer detachment and paracentral middle maculopathy on the paracentral side of the optic nerve papilla, suggesting severe inflammation. Fluorescein angiography showed hyperfluorescence in the optic disc and window defects around the macula OU. Indocyanine green angiography showed mottled choroidal vascular hyperpermeability findings in the late stage. B-mode echography displayed thickening of the posterior wall of the left eye. Orbital magnetic resonance imaging showed the thickened posterior eyeball. The patient was diagnosed with posterior scleritis, and 30 mg of oral prednisolone was then given and tapered off over the next 4 months. The hyperemia and intraocular inflammation resolved after the treatment. The rate of change in macular blood flow assessed by the mean blur rate on LSFG was 20.5% and 20.2% decrease OD and OS, respectively, before and after treatment. The central choroidal thickness showed 8.8% and 37.8% decrease OD and OS, respectively. CONCLUSION Posterior scleritis complicated with choroiditis was suggested to show different choroidal circulatory dynamics from those in other choroidal inflammations.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Yui Yamashita
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
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18
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Lamas-Francis D, Llovo-Taboada J, Navarro D, Touriño R, Rodríguez-Ares T. Necrotizing scleritis due to Hormographiella aspergillata. Eur J Ophthalmol 2023; 33:NP71-NP74. [PMID: 35915985 DOI: 10.1177/11206721221118209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the management and outcome of a case of necrotizing scleritis due to Hormographiella aspergillata. METHODS Case report. RESULTS A 79-year-old woman developed scleral inflammation following accidental trauma with a gorse plant in her left eye. An abscess formed at the site of the injury, which was surgically drained. Filamentous fungi were identified from the abscess contents, and oral voriconazole and topical voriconazole and natamycin drops were prescribed. Phenotypic analysis confirmed the presence of Hormographiella aspergillata, with low minimum inhibitory concentrations (MIC) for voriconazole and amphotericin B. Two weeks later the patient presented with an area of necrotizing scleritis which required surgical debridement and scleral grafting. Three months later, the scleral inflammation had resolved leaving an area of scleromalacia. CONCLUSIONS Hormographiella aspergillata is a common environmental fungus that has recently emerged as a human pathogen and a rare cause of scleritis. To the best of our knowledge, this is the first report of scleritis in which a pure culture of H. aspergillata was obtained. Successful management poses a challenge as there are limited reports on antifungal susceptibility and a combination of medical and surgical treatment is often required.
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Affiliation(s)
- David Lamas-Francis
- Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Llovo-Taboada
- Department of Microbiology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniel Navarro
- Department of Microbiology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rosario Touriño
- Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Teresa Rodríguez-Ares
- Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
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19
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Savino G, Gambini G, Scorcia G, Comi N, Fossataro C, Stanislao Rizzo. Orbital myositis and scleritis after anti-SARS-CoV-2 mRNA vaccines: A report of three cases. Eur J Ophthalmol 2023; 33:NP29-NP34. [PMID: 36062603 PMCID: PMC9444811 DOI: 10.1177/11206721221123780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To report three cases of ocular myositis and scleritis, bilateral scleritis and unilateral single muscle myositis after mRNA COVID-19 vaccination. METHODS Case series of three patients who presented to the Orbit Outpatient Service of Fondazione Policlinico Universitario A. Gemelli with a history of unilateral proptosis, diplopia and pain, bilateral red eye and pain during eye movements and unilateral proptosis and inconstant diplopia respectively with onset 5-10 days after m-RNA COVID-19 vaccine. A thorough hematologic work up and orbital contrast enhanced magnetic resonance imaging (MRI) in patients with proptosis was performed. RESULTS Patients were females, 64, 58 and 45 years old respectively. MRI showed enlargement of all right rectus muscles, with both muscle belly and insertion involvement in the first case associated to right scleritis. A bilateral scleritis was diagnosed in the second patient and a single muscle myositis in the third patient. Serological tests excluded thyroid diseases. The first and second patient were treated respectively with oral and topical glucorticoids with a complete clinical response. Two 2 cycles of oral non-steroidal anti-inflammatory drugs were administered to the third patient with a partial response. CONCLUSION As far as we know these are the first report of orbital myositis and scleritis presenting after mRNA BNT162b2 vaccine (Pfizer/BioNTech) and mRNA-1273-(Moderna) vaccine, an uncommon effect of a likely autoimmune reaction triggered by the virus antigen.
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Affiliation(s)
- Gustavo Savino
- Ophthalmology Unit, “Fondazione Policlinico Universitario A. Gemelli IRCCS”, Rome, Italy
- Catholic University “Sacro Cuore”, Rome, Italy
| | - Gloria Gambini
- Ophthalmology Unit, “Fondazione Policlinico Universitario A. Gemelli IRCCS”, Rome, Italy
- Catholic University “Sacro Cuore”, Rome, Italy
| | - Giovanni Scorcia
- Department of Ophthalmology, Magna Græcia University, Catanzaro, Italy
| | - Nicolino Comi
- Azienda Ospadaliera Universitaria Mater Domini, Catanzaro, Italy
| | - Claudia Fossataro
- Ophthalmology Unit, “Fondazione Policlinico Universitario A. Gemelli IRCCS”, Rome, Italy
- Catholic University “Sacro Cuore”, Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, “Fondazione Policlinico Universitario A. Gemelli IRCCS”, Rome, Italy
- Catholic University “Sacro Cuore”, Rome, Italy
- Department of Ophthalmology, Magna Græcia University, Catanzaro, Italy
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Goduni L, Fan KC, Laura DM, Uhr JH, Chhablani J, Sridhar J. Nocardia Scleritis Progressing to Endophthalmitis in the Setting of Scleral Buckle Extrusion. Ophthalmic Surg Lasers Imaging Retina 2023; 54:497-499. [PMID: 37708223 DOI: 10.3928/23258160-20230815-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
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21
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Delarbre D, Boudin L, Métivier D, Defuentes G, Morvan JB. Bilateral scleritis and aseptic meningitis leading to a diagnosis of papillary thyroid carcinoma. J Fr Ophtalmol 2023; 46:e245-e247. [PMID: 37085369 DOI: 10.1016/j.jfo.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/30/2022] [Indexed: 04/23/2023]
Affiliation(s)
- D Delarbre
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France.
| | - L Boudin
- Service d'oncologie, hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - D Métivier
- Unité de médecine nucléaire, hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - G Defuentes
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - J-B Morvan
- Service d'otorhinolaryngologie, hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
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Awan MA, Mohsin F, Ahmed A, Sarwar MS, Hashmi T. Nodular Posterior Scleritis With Associated Choroiditis Masquerading As A Choroidal Tumour: A Case Report. J PAK MED ASSOC 2023; 73:1903-1905. [PMID: 37817710 DOI: 10.47391/jpma.7895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
A case of nodular posterior scleritis in a 25-year-old male who presented with a 14-day history of unilateral decline in vision, pain, and redness in his right eye. Slit lamp examination of the right eye revealed dilated episcleral vessels present nasally as well as a choroidal mass at the nasal periphery of the fundus, associated with choroidal oedema. Systemic evaluation and imaging of the choroidal mass were performed to rule out choroidal tuberculoma and choroidal metastasis. Ultrasound B-scan of the right eye showed marked thickening of the nasalsclera resulting in sympathetic choroidal oedema without the characteristic T-sign. Nodular posterior scleritis with associated choroiditis, was diagnosed without any underlying systemic illness. The patient was immediately started on systemic steroids and later on subcutaneous Methotrexate as advised by the rheumatologist, to which he responded well and his vision significantly improved from 6/60 to 6/9, gradually during his treatment course.
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Affiliation(s)
- Muhammad Amer Awan
- Department of Ophthalmology, Shifa International Hospital, Islamabad, Pakistan
| | - Fatima Mohsin
- Department of Ophthalmology, Shifa International Hospital, Islamabad, Pakistan
| | - Abdullah Ahmed
- Fourth Year MBBSStudent, AllamaIqbal MedicalCollege,Lahore, Pakistan
| | | | - Tahir Hashmi
- Department of Rheumatology, Shifa International Hospital, Islamabad, Pakistan
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Woodward R, Konda SM, Grewal DS. Autoimmune Inflammatory Eye Disease: Demystifying Clinical Presentations for the Internist. Curr Allergy Asthma Rep 2023; 23:471-479. [PMID: 37436637 DOI: 10.1007/s11882-023-01088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE OF REVIEW Provide a framework for recognizing key symptoms and clinical findings in patients with autoimmune inflammatory eye disease. RECENT FINDINGS The most common manifestations of autoimmune inflammatory eye disease are episcleritis, scleritis, uveitis (anterior, intermediate, posterior, and panuveitis), and keratoconjunctivitis sicca. Etiologies can be idiopathic or in association with a systemic autoimmune condition. Referral of patients who may have scleritis is critical for patients presenting with red eyes. Referral of patients who may have uveitis is critical for patients presenting often with floaters and vision complaints. Attention should also be directed to aspects of the history that might suggest a diagnosis of a systemic autoimmune condition, immunosuppression, drug-induced uveitis, or the possibility of a masquerade condition. Infectious etiologies should be ruled out in all cases. Patients with autoimmune inflammatory eye disease may present with ocular or systemic symptoms alone, or in combination. Collaboration with ophthalmologists and other relevant specialists is vital to optimal long-term medical care.
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Affiliation(s)
- Richmond Woodward
- Department of Ophthalmology, Duke University School of Medicine, 2351 Erwin Road, Durham, NC, 27701, USA
| | - Sri Meghana Konda
- Department of Ophthalmology, Duke University School of Medicine, 2351 Erwin Road, Durham, NC, 27701, USA
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University School of Medicine, 2351 Erwin Road, Durham, NC, 27701, USA.
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Sanjay S, Handa A, Kawali A, Shetty R, Bhakti Mishra S, Mahendradas P. Scleritis and Episcleritis following Coronavirus Disease (COVID-19) Vaccination. Ocul Immunol Inflamm 2023; 31:1184-1190. [PMID: 36884356 DOI: 10.1080/09273948.2023.2182324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/09/2023] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Coronavirus disease (COVID-19) vaccines have been reported to have ocular side effects including scleritis and episcleritis. PURPOSE To report scleritis and episcleritis within a month following administration of COVID-19 vaccine. METHODS Retrospective case series. RESULTS 15 eyes of 12 consecutive patients with scleritis and episcleritis from March 2021 to September 2021 were included. The mean time of onset of symptoms in patients with scleritis was 15.7 days (range, 4-30) and for episcleritis it was 13.2 days (range 2-30). Patients received COVISHIELD™ (10 patients) and COVAXIN™ (2 patients). Five patients had denovo inflammation and seven had recurrent inflammation. Episcleritis patients were treated with topical steroids and systemic COX2 inhibitors while patients with scleritis were treated with topical steroids/oral steroids/antiviral medications depending on the aetiology. CONCLUSION Scleritis and episcleritis following COVID-19 vaccination are milder and do not require intensive immunosuppression except in rare cases.
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Affiliation(s)
- Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ashit Handa
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
- Department of Retina, Narayana Nethralaya, Bangalore, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Rohit Shetty
- Department of Neuro-ophthalmology, Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Sai Bhakti Mishra
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
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Gallagher K, Al-Janabi A, Wang A. The ocular manifestations of relapsing polychondritis. Int Ophthalmol 2023; 43:2633-2641. [PMID: 36856986 DOI: 10.1007/s10792-023-02662-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Relapsing polychondritis (RPC) is a rare, multi-system, inflammatory disorder. Ocular disease is estimated to occur in 14-67% of patients with RPC, and any ocular structure can be affected. Published case reports and series of RPC were analysed to determine the frequency and nature of the ocular manifestations of RPC, including the age and gender distribution. METHODS A literature search of the MEDLINE database for case reports and series on RPC was conducted in October 2021 using search terms [relapsing polychondritis (MeSH Major Topic)] OR [relapsing polychondritis (Title/Abstract)]. Articles were included if the diagnosis of RPC was confirmed using established diagnostic criteria and if the paper described the clinical features of patients with RPC. RESULTS 546 articles (454 case reports and 92 case series) described the clinical features in a total of 2414 patients with RPC. 49% of patients with RPC had ocular involvement, and this was a presenting feature in 21%. The most common ocular manifestations were scleritis (32%), episcleritis (31%) and uveitis (23%). CONCLUSION Many patients with RPC will be seen by an ophthalmologist during the course of their disease. Knowledge and awareness of RPC and its ocular manifestations is therefore essential to enable the ophthalmologist to make the diagnosis.
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Affiliation(s)
- Kevin Gallagher
- Ysbyty Cwm Rhondda Hospital, Cwm Taf Morgannwg University Health Board, Tonypandy, CF40 2LX, Wales, UK.
| | - Ahmed Al-Janabi
- Ysbyty Cwm Rhondda Hospital, Cwm Taf Morgannwg University Health Board, Tonypandy, CF40 2LX, Wales, UK
| | - Aijing Wang
- Ysbyty Cwm Rhondda Hospital, Cwm Taf Morgannwg University Health Board, Tonypandy, CF40 2LX, Wales, UK
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Bechara I, Mercado C, Muñoz-Ortiz J, Montoya A. Characterization of patients with ocular pain evaluated with ultrasound. Eur J Ophthalmol 2023; 33:1718-1723. [PMID: 36539998 DOI: 10.1177/11206721221146670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND The cause of ocular pain in the quiet eye is challenging to diagnose. It is a common complaint in the ophthalmology clinic and there are no actual guidelines on the exams that should be ordered initially. We decided to characterize patients with eye pain and normal ophthalmological examination who underwent ocular ultrasound, their findings, and systemic work-up. METHODS A retrospective chart review of patients who underwent ocular ultrasound due to ocular pain and no clinical findings on initial slit-lamp examination. We evaluated patient characteristics and analyzed systemic work-up results in contrast to ocular ultrasound findings. RESULTS Two hundred and three patients with normal slit-lamp examination and ocular pain were evaluated using ocular ultrasound at Clinica Barraquer. Most of the patients were women (88.7%), and 55% were older than 50 years. Nearly all of the patients had echographic findings, 87.7% of patients showed evidence of scleral scars, from which 66.5% had signs of activity, and 42.9% had thickened extraocular muscles. In general, most patients with ocular pain had normal results on systemic work-up, but the patients who did have positive results tended to have echographic findings. CONCLUSION Posterior inflammation is present in most patients with ocular pain in a quiet eye, and echography is an optimal tool to identify this. There is a tendency towards abnormal autoimmune test results and echographic findings. This should be considered in the initial work-up of these patients, given the importance of early diagnosis and the threat of vision loss with severe inflammation.
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Affiliation(s)
- Isabella Bechara
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia
| | - Carolina Mercado
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia
| | - Juliana Muñoz-Ortiz
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia
| | - Alicia Montoya
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia
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Corbitt K, Nowatzky J. Inflammatory eye disease for rheumatologists. Curr Opin Rheumatol 2023; 35:201-212. [PMID: 36943695 PMCID: PMC10461883 DOI: 10.1097/bor.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This review provides a framework for understanding inflammatory eye disease diagnosis, differential diagnosis, and management for rheumatologists. Uveitis, scleritis, episcleritis, peripheral ulcerative keratitis, and orbital inflammation are all discussed. The goal is to facilitate the development of approaches to inflammatory eye diseases that will help rheumatologists co-manage these patients with eye care providers specializing in ocular inflammation. RECENT FINDINGS In recent years, studies have aimed to advance biologic treatments and define standard-of-care therapy. Inflammatory eye diseases are highly heterogeneous and often rare, which poses significant challenges to their research and the interpretation of existing data. To date, glucocorticoids, mycophenolate, methotrexate, and TNF inhibitors remain the mainstay of treatment options for many of these diseases. SUMMARY Patients with inflammatory eye diseases require multidisciplinary care for best outcomes, frequently including rheumatologists. Understanding the differentials, diagnostics, and treatment are essential to preserving vision in these patients. The diverse nature of the disease processes within this field requires focusing on specific disease phenotypes and endotypes in research and clinical practice.
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Affiliation(s)
- Kelly Corbitt
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
| | - Johannes Nowatzky
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology, NYU Langone Behçet’s Disease Program, NYU Ocular Rheumatology Program
- New York University Grossman School of Medicine, Department of Pathology
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28
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Niederer RL, Wong ABC, Ma T, Chew S, Sims J. Predictors of glaucoma in patients with uveitis and scleritis. Eye (Lond) 2023; 37:1254-1257. [PMID: 35610358 PMCID: PMC10101954 DOI: 10.1038/s41433-022-02101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/28/2022] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To examine risk factors for development of glaucoma in a large cohort of subjects with uveitis and scleritis. METHODS Retrospective review of subjects diagnosed with uveitis or scleritis between 2006 and 2019 at Auckland District Health Board. Subjects were excluded if they had glaucoma due to another cause. Main outcome measure was development of glaucoma. Data for local steroid use was not available. RESULTS 3462 eyes of 2414 subjects were included in the study. Mean follow-up was 5.7 years (total follow-up time 19,897 eye years). Median age was 44.3 years and 1189 (49.3%) were female. Glaucoma developed in 222 eyes (6.3%) during the follow-up. Five-year cumulative risk of glaucoma was 6.2% (CI 5.0-7.5%) for anterior uveitis, 5.4% (CI 3.2-9.0%) for intermediate uveitis, 1.6% (CI 0.4-6.7%) for posterior uveitis, 8.7% (CI 6.5-11.7%) for panuveitis, and 3.2% (CI 1.0-9.5%) for scleritis. Five-year cumulative risk of glaucoma was lowest in HLA-B27 uveitis at 0.9% (CI 0.4-2.1%) and highest in viral uveitis 15.1% (CI 10.1-22.3%), sarcoidosis 9.9% (CI 6.1-15.9%) and tuberculosis 9.7% (CI 5.4-17.0%). On multivariate analysis, risk factors for development of glaucoma were older age at presentation, higher presenting intraocular pressure, chronic inflammation, and cystoid macular oedema. CONCLUSIONS Glaucoma is a common complication of uveitis and scleritis and was more frequent in older subjects, high presenting IOP, chronic inflammation and those with cystoid macular oedema. Local steroid therapy contributes to this, but is not quantifiable in this study. Targeted screening is required to avoid irreversible progression of glaucomatous optic neuropathy.
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Affiliation(s)
- R L Niederer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand.
- Department of Ophthalmology, Faculty of Medical & Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - A B C Wong
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - T Ma
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - S Chew
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - J Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
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Vergouwen DPC, Ten Berge JC, Guzel C, van den Bosch TPP, Verdijk RM, Rothova A, Luider TM, Schreurs MWJ. Scleral Proteome in Noninfectious Scleritis Unravels Upregulation of Filaggrin-2 and Signs of Neovascularization. Invest Ophthalmol Vis Sci 2023; 64:27. [PMID: 36930145 PMCID: PMC10036950 DOI: 10.1167/iovs.64.3.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Purpose Scleritis is a severe inflammatory ocular disorder with unknown pathogenesis. We investigated healthy sclera as well as sclera affected by noninfectious scleritis for differentially expressed proteins using a mass spectrometry approach. Methods We collected scleral samples of enucleated eyes due to severe noninfectious scleritis (n = 3), and control scleral tissues (n = 5), all exenterated eyes for eyelid carcinomas (n = 4), or choroidal melanoma (n = 1) without scleral invasion. Samples were prepared for the nano liquid-chromatography mass spectrometer (LC-MS), data were analyzed using proteomics software (Scaffold), and is available via ProteomeXchange (identifier PXD038727). Samples were also stained for immuno-histopathological evaluation. Results Mass spectrometry identified 629 proteins within the healthy and diseased scleral tissues, whereof collagen type XII, VI, and I were the most abundantly expressed protein. Collagen type II-XII was also present. Filaggrin-2, a protein that plays a crucial role in epidermal barrier function, was found upregulated in all scleritis cases. In addition, other epithelial associated proteins were upregulated (such as keratin 33b, 34, and 85, epiplakin, transglutaminase-3, galectin 7, and caspase-14) in scleritis. Further, upregulated proteins involved in regulation of the cytoskeleton (vinculin and myosin 9), and housekeeping proteins were found (elongation factor-2 and cytoplasmic dynein 1) in our study. Upregulation of filaggrin-2 and myosin-9 was confirmed with immunohistochemistry, the latter protein showing co-localization with the endothelial cell marker ETC-related gene (ERG), indicating neovascularization in scleral tissue affected by scleritis. Conclusions We found upregulation of filaggrin-2 and signs of neovascularization in scleral tissue of patients with noninfectious scleritis. Further research, ideally including more scleritis cases, is needed to validate our findings.
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Affiliation(s)
- Daphne 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
| | - Josianne C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Coskun Guzel
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Thierry P P van den Bosch
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert M Verdijk
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Theo M Luider
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco W J Schreurs
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Susarla G, Chan W, Li A, Davoudi S, Ahmadi T, Sathe S, Tom L, Papaliodis GN, Mercader JM, Leong A, Sobrin L. Mendelian Randomization Shows a Causal Effect of Low Vitamin D on Non-infectious Uveitis and Scleritis Risk. Am J Ophthalmol 2022; 244:11-18. [PMID: 35948088 DOI: 10.1016/j.ajo.2022.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/03/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To investigate a causal relationship between Vitamin D levels and non-infectious uveitis and scleritis using Mendelian randomization (MR) techniques. DESIGN Two-sample Mendelian randomization case-control study. METHODS The study setting was a biobank of an academic, integrated health care system. The patient population comprised 375 case patients with a non-infectious uveitis and/or scleritis diagnosis and no diagnosis of infectious, trauma-related, or drug-induced uveitis/scleritis. In addition, there were 4167 controls with no uveitis or scleritis diagnosis. Causal effect estimates of low 25-hydroxy Vitamin D (25OHD) on uveitis/scleritis risk were calculated. RESULTS We found an association of genetically decreased 25OHD with uveitis/scleritis risk (odds ratio [OR] = 2.16, 95% CI = 1.01-4.64, P = .049, per SD decrease in log25OHD). In a first sensitivity MR analysis excluding the genetic variants that are unlikely to have a role in biologically active 25OHD, effect estimates were consistent with those from the primary analysis (OR = 2.38, 95% CI =1.06-5.36, P = 0.035, per SD of log25OHD). Furthermore, in a second sensitivity analysis using only the 6 variants within the CYP2R1 locus (which encodes 25OHD hydroxylase, the liver enzyme responsible for converting Vitamin D to 25OHD), genetically decreased 25OHD was strongly associated with increased uveitis/scleritis risk (OR = 6.42, 95% CI = 3.19-12.89, P = 1.7 × 10-7, per SD of log25OHD). CONCLUSIONS Our findings suggest a causal relationship between low Vitamin D levels and higher risk of non-infectious uveitis and scleritis. Vitamin D supplementation may be a low-cost, low-risk intervention to mitigate non-infectious uveitis and scleritis risk, and should be explored in a prospective trial.
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Affiliation(s)
- Gayatri Susarla
- From the Retina Department (G.S., W.C., A.L., S.D., T.A., S.S., L.S.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Weilin Chan
- From the Retina Department (G.S., W.C., A.L., S.D., T.A., S.S., L.S.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ashley Li
- From the Retina Department (G.S., W.C., A.L., S.D., T.A., S.S., L.S.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Samaneh Davoudi
- From the Retina Department (G.S., W.C., A.L., S.D., T.A., S.S., L.S.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tina Ahmadi
- From the Retina Department (G.S., W.C., A.L., S.D., T.A., S.S., L.S.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Shaleen Sathe
- From the Retina Department (G.S., W.C., A.L., S.D., T.A., S.S., L.S.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lisa Tom
- Department of Ophthalmology (L.T.), University of Miami Health System, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - George N Papaliodis
- Uveitis Department (G.N.P.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Josep M Mercader
- Diabetes Unit and Center for Genomic Medicine (J.M.M.), Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Medicine (J.M.M., A.L.), Harvard Medical School, Boston, Massachusetts, USA; Programs in Metabolism and Medical and Population Genetics (J.M.M., A.L.), Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Aaron Leong
- Department of Medicine (J.M.M., A.L.), Harvard Medical School, Boston, Massachusetts, USA; Programs in Metabolism and Medical and Population Genetics (J.M.M., A.L.), Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Diabetes Unit (A.L.), Endocrine Division, Massachusetts General Hospital, Boston, Massachusetts, USA; Division of General Internal Medicine (A.L.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucia Sobrin
- From the Retina Department (G.S., W.C., A.L., S.D., T.A., S.S., L.S.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
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Hao Z, Dang H, Gao X, Zhang C, Deng A, Tan Y, Ding G. Successful control of scleritis caused by Nocardia farcinica: A case report. Medicine (Baltimore) 2022; 101:e31481. [PMID: 36397417 PMCID: PMC9666110 DOI: 10.1097/md.0000000000031481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
RATIONALE Nocardia farcinica is an opportunistic pathogen that rarely causes ocular infections. This study reviewed a case of N. farcinica-mediated scleritis involving the corneal limbus. PATIENT CONCERNS A 56-year-old man was admitted to the Department of Keratology of Jinan Second People's Hospital due to "a red and swollen right eye accompanied with severe pain for >1 month." He denied any history of hypertension, diabetes, systemic immune diseases and eye surgery. DIAGNOSES Corneal defect and scleral necrosis were observed by slit lamp. Combination of anterior segment optical coherence tomography and ophthalmic ultrasound biomicroscopy was used for diagnosis and evaluation of corneal and scleral conditions. Culture and metagenomic sequencing verified that the pathogen of scleritis was N. farcinica. INTERVENTIONS The patient was treated by sulfacetamide sodium eye drops, oral administration of sulfamethoxazole tablets, amikacin anterior chamber flushing, scleral debridement, and allogeneic scleral transplantation. OUTCOMES The disease was successfully controlled. LESSONS Infectious scleritis caused by N. farcinica is extremely rare. Culture of pathogenic microorganisms remains to be the gold standard for the diagnosis of infectious eye diseases. Metagenomic sequencing shows potential promise in the diagnosis of infectious eye diseases. N. farcinica is sensitive to sulfonamides and amikacin.
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Affiliation(s)
- Zhongkai Hao
- Department of Ophthalmology, School of Clinical Medicine, Weifang Medical University, Weifang, China
- Department of Ophthalmology, Jinan Second People’s Hospital, Jinan, China
| | - Hui Dang
- Department of Ophthalmology, Jinan Second People’s Hospital, Jinan, China
| | - Xin Gao
- Department of Ophthalmology, Jinan Second People’s Hospital, Jinan, China
| | - Chenming Zhang
- Department of Ophthalmology, School of Clinical Medicine, Weifang Medical University, Weifang, China
- Department of Ophthalmology, Jinan Second People’s Hospital, Jinan, China
- * Correspondence: Chenming Zhang, Department of Ophthalmology, Jinan Second People’s Hospital, Jinan 250200, China (e-mail: )
| | - Aijun Deng
- Department of Ophthalmology, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Yue Tan
- Department of Ophthalmology, Jinan Second People’s Hospital, Jinan, China
| | - Gang Ding
- Department of Ophthalmology, Jinan Second People’s Hospital, Jinan, China
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Wang J, Zhang Q, Shi W, Pang Y, Li S. Peripheral ulcerative keratitis, nodular episcleritis, and pulmonary nodules as the initial signs of rheumatic arthritis: A Case Report. Front Immunol 2022; 13:1048889. [PMID: 36439152 PMCID: PMC9686418 DOI: 10.3389/fimmu.2022.1048889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Background Rheumatoid vasculitis (RV) is a rare but potentially devastating complication of rheumatoid arthritis (RA). It typically occurs in patients with extra-articular manifestations. Here we reported a case of PUK with nodular episcleritis and pulmonary nodules that occurred in the same patient without joint involvement. Case presentation A 43-year-old Chinese woman, exhibited a partial crescent-shaped marginal corneal ulcer in the right eye at admission and the ulcer developed rapidly into nearly 360-degree ulcers in both eyes within one week. Nodular episcleritis was observed in the right eye. Conjunctival biopsy revealed vasculitis. Her rheumatoid factor (RF) and anti-cyclic citrullinated protein antibody were positive, while anti-neutrophilic cytoplasmic antibody (c-ANCA) and anti-protease 3 were negative. Pulmonary nodules were found, without joint involvement. The ocular condition did not relieve under the topical and systemic use of corticosteroids, or under other immunosuppressive agents until the infliximab therapy. PUK recurrence was observed after the discontinuation of infliximab. Conclusions Rapidly deteriorated PUK with nodular episcleritis and pulmonary nodules occurred in the same patient is a special case of RA without joint involvement. This case reinforces the concept that RV may be the initial sign of RA. Infliximab can be used to prevent further progress of RA-related PUK in some refractory cases.
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Affiliation(s)
- Jingting Wang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Qin Zhang
- Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases, and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Weiyun Shi
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Yilin Pang
- Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases, and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Suxia Li
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan, China
- *Correspondence: Suxia Li,
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Reddy AK, Kolfenbach JR, Palestine AG. Ocular manifestations of rheumatoid arthritis. Curr Opin Ophthalmol 2022; 33:551-556. [PMID: 36165413 DOI: 10.1097/icu.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article summarizes the pathophysiology of rheumatoid arthritis and common ocular manifestations that it is associated with: keratoconjunctivitis sicca, episcleritis, scleritis, and peripheral ulcerative keratitis. RECENT FINDINGS Newer biologic agents are being used to effectively treat rheumatoid arthritis and its ocular manifestations. SUMMARY The eye is a frequent extra-articular site of inflammation in patients with rheumatoid arthritis. Ocular involvement can range from more benign conditions such as keratoconjunctivitis sicca and episcleritis, to potentially vision and globe-threatening diseases like scleritis and peripheral ulcerative keratitis. Clinicians should be aware of these ophthalmic manifestations and the various treatment options that are available. Coordination between ophthalmology and rheumatology is helpful in the treatment of these patients.
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Affiliation(s)
| | - Jason R Kolfenbach
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Mase Y, Kubo A, Matsumoto A, Masuda K, Kadoya M, Koizumi K, Sotozono C, Kondo M. Posterior scleritis with choroidal detachments and periaortitis associated with IgG4-related disease: A case report. Medicine (Baltimore) 2022; 101:e29611. [PMID: 35866779 PMCID: PMC9302307 DOI: 10.1097/md.0000000000029611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND IgG4-related diseases (IgG4-RDs) are known to disrupt the functioning of multiple organs and are usually associated with mass lesions. Periaortitis, an inflammation of the adventitia and tissues surrounding the aorta, is an example of an IgG4-RD. In ophthalmology, an enlargement of the lacrimal gland is a well-known IgG4-RD, and scleritis has also been reported to be an IgG4-RD although it is rare. We report our findings in a case with periaortitis and posterior scleritis that were present at the same time, and they responded well to systemic steroid therapy. PATIENTS CONCERNS A 79-year-old man with dementia and Lewy bodies was referred to our hospital because of uveitis in both eyes that did not respond to topical steroid therapy. DIAGNOSIS We found anterior scleritis in the right eye and uveitis with shallow anterior chambers in both eyes. B-mode echography showed choroidal detachments (CDs) and a T sign in the right eye. The CDs were assumed to have progressed to the posterior scleritis which then caused the severe vision reduction. The patient was referred to the Internal Medicine Department because the systemic inflammatory disease was suspected due to the high levels of C-reactive protein (CRP) and the fast erythrocyte sedimentation rate. Systemic CT scans showed periaortitis only at the lumbar region. Because of the high levels of IgG4, the patient was diagnosed with IgG4-RD. INTERVENTIONS The patient received intravenous and oral steroid therapy. The first 125 mg of methylprednisolone (mPSL) for 3 days was intravenous, after which it was switched to oral prednisolone (PSL) therapy and the dosage was gradually reduced. OUTCOMES The posterior scleritis and periaortitis responded well to the systemic steroid therapy. One year and a half after the onset of the disease, the patient is still taking 5 mg of PSL. CONCLUSIONS Scleritis with multiple CDs and periaortitis were strongly suspected to be due to IgG4-RD although no definitive diagnosis was made by biopsy of the lesions. Clinicians should be aware that IgG4-RD should be considered as one of the causes of posterior scleritis.
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Affiliation(s)
- Yoko Mase
- Department of Ophthalmology, Mie University Graduate School of Medicine, Mie, Japan
- Department of Ophthalmology, Kinan Hospital, Mie, Japan
- *Correspondence: Yoko Mase (e-mail: )
| | - Akiko Kubo
- Department of Ophthalmology, Kinan Hospital, Mie, Japan
| | - Akane Matsumoto
- Department of Ophthalmology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Kosuke Masuda
- Department of Internal Medicine, Kinan Hospital, Mie, Japan
| | - Masatoshi Kadoya
- Department of Rheumatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Kan Koizumi
- Department of Ophthalmology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Mie, Japan
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Saraf SS, Leveque TK, Kim JB, Nash RW, Pepple KL, Olmos de Koo LC. IDIOPATHIC PENETRATION OF CILIA INTO THE POSTERIOR SEGMENT PRESENTING AS SECTORAL SCLERITIS WITH PROGRESSIVE INTRAOCULAR INFLAMMATION. Retin Cases Brief Rep 2022; 16:452-456. [PMID: 32459699 PMCID: PMC9213081 DOI: 10.1097/icb.0000000000001006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report two cases of idiopathic intraocular cilia presenting as sectoral scleritis with progressive intraocular inflammation. METHODS Both patients were treated with intravitreal antibiotics and underwent pars plana vitrectomy where the cilia were removed and identified on histopathology. RESULTS One patient developed a retinal detachment while being treated for presumed endophthalmitis. The intraocular cilium was discovered during pars plana vitrectomy. In the second case, the cilium was detected on dilated fundus exam and was believed to be the cause of the patient's scleritis and vitritis. Therapeutic vitrectomy was performed. In both cases, the cilia were positively identified on histopathology. CONCLUSION Idiopathic intraocular penetration of cilia should be considered in the differential diagnosis of sectoral scleritis with progressive intraocular inflammation.
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Affiliation(s)
- Steven S. Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington; and
| | - Thellea K. Leveque
- Department of Ophthalmology, University of Washington, Seattle, Washington; and
| | - Joon-Bom Kim
- Department of Ophthalmology, University of Washington, Seattle, Washington; and
| | | | - Kathryn L. Pepple
- Department of Ophthalmology, University of Washington, Seattle, Washington; and
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Goh HY, Che Daud CMB, Santhirathelagan C, Retnasabapathy S. Primary Low Grade Follicular Lymphoma of the Conjunctivae Mimicking Nodular Anterior Scleritis: A Case Report. Clin Med Res 2022; 20:111-113. [PMID: 35478097 PMCID: PMC9242737 DOI: 10.3121/cmr.2022.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022]
Abstract
Conjunctival lymphomas are rare entities and may present with non-specific ocular signs that resemble inflammation. They may mimic common ocular pathologies, leading to a delay in diagnosis and treatment. The treatment options of conjunctival lymphomas should be tailored to individuals due to their indolent nature compared to other adnexal lymphomas. Herein, the authors report a case of a primary follicular conjunctival lymphoma in a patient who presented with signs and symptoms of nodular anterior scleritis. The final histology of the conjunctiva lesion revealed primary follicular lymphoma. The patient was managed conservatively with active surveillance.
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Affiliation(s)
- Hui Yin Goh
- Department of Ophthalmology, Hospital Sungai Buloh, Jalan Hospital, Buloh, Selangor, Malaysia
| | | | | | - Shamala Retnasabapathy
- Department of Ophthalmology, Hospital Sungai Buloh, Jalan Hospital, Buloh, Selangor, Malaysia
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Abstract
PURPOSE To describe a patient with a painful red-eye syndrome and a choroidal mass lesion that was diagnosed after multimodal imaging with a vortex vein ampulla varix induced by a nodular posterior scleritis. METHODS Retrospective case report documented with fluorescein angiography, indocyanine green angiography, b-mode ultrasound, fundus imaging, and swept-source optical coherence tomography. RESULTS A 24-year-old man presented with a painful red eye and sudden onset blurred vision. Fundus exam disclosed macular choroidal folds and a nonpigmented mass lesion at the inferior equator. Swept-source optical coherence tomography showed enlarged choroidal vessels with fluid in the suprachoroidal space under the central macula and a hyporeflective lobulated choroidal cavity in the inferior temporal retina. Multimodal imaging with contrast dyes showed a dilated vortex vein ampulla with early hyperfluorescence and a complete washout in late acquisitions on indocyanine green. The patient recovered uneventfully after a short-course administration of oral nonsteroidal anti-inflammatory drugs, disclosing irregular scleral nodules on swept-source optical coherence tomography that remained stable over a twelve-month follow-up. CONCLUSION This report suggests that nodular posterior scleritis can induce a vortex vein ampulla varix and contributes to a better understanding of the pathophysiology of this entity. We further suggest that in a diagnostic puzzling scenario the inflammatory syndrome should be treated before attempting to perform a chorioretinal biopsy.
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Affiliation(s)
- Diogo Cabral
- Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal ; and
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Vanda Nogueira
- Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal ; and
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38
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Mudie LI, Reddy AK, Patnaik JL, Pecen P, Kim E, Cole K, Palestine AG. Evaluation of the SUN Classification Criteria for Uveitides in an Academic Uveitis Practice. Am J Ophthalmol 2022; 241:57-63. [PMID: 35469789 DOI: 10.1016/j.ajo.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the new Standardization of Uveitis Nomenclature (SUN) classification criteria for uveitides by applying them to patients in an academic uveitis practice. DESIGN Evaluation of classification criteria. METHODS The charts of all patients attending the uveitis service at the University of Colorado Hospital between January 1, 2013, and December 31, 2020, were reviewed. Patients with scleritis, ocular cicatricial pemphigoid, and peripheral ulcerative keratitis were excluded. We attempted to classify each patient's uveitis using the SUN classification criteria. Classification attempts were made within the relevant anatomical or infectious categories for their pathology but did not necessarily have to match their clinical diagnosis by a uveitis specialist. We recorded whether classification was possible as well as their clinical diagnosis by a uveitis specialist. RESULTS All patients attending the uveitis clinic at our academic institution between January 1, 2013, and December 31, 2020, were reviewed. Of the 1143 patients with uveitis, 572 (50.0%) had a disease that was not listed in the SUN classification system, and so no attempt to classify these patients was possible. Of the remaining 571 patients, 522 (91.4%) were able to be classified by SUN and in 492 (94.3%) of the 522 cases, their SUN classification matched their clinical diagnosis by a uveitis specialist. CONCLUSIONS Half of the patients at an academic uveitis practice had a disease for which no SUN classification criteria existed. In cases where classification by SUN could be attempted, the system performed well and generally agreed with their clinical diagnosis.
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Affiliation(s)
- Lucy I Mudie
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Amit K Reddy
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Jennifer L Patnaik
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Paula Pecen
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA; Carolina Eye Associates (P.P.), Greensboro, North Carolina, USA
| | - Emmeline Kim
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Kaylee Cole
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Alan G Palestine
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA.
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Richardson-May J, Chihaia M, Rashid M. Surgically-induced necrotising scleritis complicated by Nocardia infection following routine cataract surgery. BMJ Case Rep 2022; 15:e247784. [PMID: 35140098 PMCID: PMC8830200 DOI: 10.1136/bcr-2021-247784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
Abstract
Necrotising scleritis is a rare, inflammatory condition with potentially devastating visual consequences. It can be associated with inflammatory and infectious causes, and has been linked to several different ocular procedures. We present a difficult case of a patient with surgically-induced necrotising scleritis following routine phacoemulsification cataract surgery, who developed a secondary Nocardia bacterial infection. He required a number of surgical interventions and prolonged antibiotic therapy, suffering recurrent scleral abscesses. A literature review accompanies our case report. Prompt recognition and adequate investigation for underlying inflammatory and infective causes are vital to maintain integrity of the globe and ensure suitable treatment of this challenging condition.
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Affiliation(s)
- James Richardson-May
- Ophthalmology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Madalina Chihaia
- Ophthalmology, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Mohammed Rashid
- Ophthalmology, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
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Kingston EJ, Zagora SL, Symes RJ, Raman P, McCluskey PJ, Lusthaus JA. Infective Necrotizing Scleritis After XEN Gel Stent With Mitomycin-C. J Glaucoma 2022; 31:129-132. [PMID: 34731869 DOI: 10.1097/ijg.0000000000001959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to report a case of infective necrotizing scleritis following XEN Gel Stent with mitomycin-C. METHODS Case report. This is a case report of a 68-year-old woman. RESULTS XEN Gel Stent glaucoma surgery enhanced with mitomycin-C 0.04% and combined with cataract surgery was performed at a regional center to manage the patient's primary open-angle glaucoma. Past medical history was significant for rheumatoid arthritis requiring treatment with methotrexate and adalimumab. Periocular pain and swelling developed 14 months after the initial operation, followed by a rapid deterioration of visual acuity to 20/60, intraocular pressure of 4 mm Hg, and worsening pain 5 months later. On initial presentation to Sydney Eye Hospital, 180 degrees of scleral necrosis was evident with a moderate anterior segment inflammatory reaction and a large temporal choroidal effusion due to hypotony. Empirical hourly topical ofloxacin and cephalothin 5% drops, with oral moxifloxacin, were initiated. Conjunctival swab grew Staphylococcus aureus and Staphylococcus lugdunensis. Significant clinical improvement occurred, but the XEN Gel Stent became exposed after 9 days of treatment with worsening hypotony. Urgent surgical revision was performed to remove the XEN Gel Stent and apply a tutoplast plug with overlying amniotic membrane graft. Intraocular pressure gradually improved over 6 weeks to 15 mm Hg with reversal of hypotonous changes, and visual acuity stabilized at 20/40. CONCLUSIONS To our knowledge, this is the first reported case of necrotizing scleritis following XEN Gel Stent insertion. It is a reminder that infection should always be the primary differential diagnosis in patients with surgical-induced necrotizing scleritis.
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Affiliation(s)
| | - Sophia L Zagora
- Department of Ophthalmology, Sydney Eye Hospital
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard J Symes
- Department of Ophthalmology, Sydney Eye Hospital
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Pushpa Raman
- Department of Ophthalmology, Sydney Eye Hospital
| | - Peter J McCluskey
- Department of Ophthalmology, Sydney Eye Hospital
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jed A Lusthaus
- Department of Ophthalmology, Sydney Eye Hospital
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Matsuura K, Terasaka Y. Diffuse anterior and posterior scleritis with multiple iris granular deposits following pterygium excision. Rom J Ophthalmol 2022; 65:399-402. [PMID: 35087985 PMCID: PMC8764424 DOI: 10.22336/rjo.2021.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/20/2022] Open
Abstract
Surgically induced necrotizing scleritis has been reported after several types of ophthalmic surgeries; however, not many cases are reported following pterygium surgery (PS). A 79-year-old woman underwent primary pterygium excision and conjunctival autograft transportation with mitomycin C in her left eye. 18 months postoperatively, diffuse anterior and posterior scleritis was noted; however, scleral necrosis was not apparent. Multiple granular deposits were observed on the surface of the iris. The deposits, aqueous humor, and vitreous were examined. Since there were no signs of infection or malignancy, the patient was diagnosed with scleritis with intraocular inflammation following PS. Necrosis was accompanying at the surgical site in most cases of scleritis following PS. However, the scleral necrosis of the surgical site was not significant in our case. Posterior scleritis associated with PS has never been reported. This is the first report of anterior diffuse scleritis accompanied by posterior scleritis following PS. Abbreviations: PS = pterygium surgery, SINS = surgically induced necrotizing scleritis, MMC = mitomycin C, ANCA = antineutrophil cytoplasmic antibody
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Ciotoracu AC, Dimăncescu MG, Mitulescu TC, Haralambie CI, Iorga AM, Busuioc C, Predețeanu D. A clinical case of recurrent episcleritis as the initial manifestation of granulomatosis with polyangiitis. Rom J Ophthalmol 2022; 65:386-390. [PMID: 35087982 PMCID: PMC8764435 DOI: 10.22336/rjo.2021.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a type of small-sized blood vessel vasculitis that predominantly affects the upper airways, lungs and kidneys and associates with the presence of anti-neutrophil cytoplasmic antibodies (ANCA). Nevertheless, any organ of the body can be affected by GPA, including the eye. Occasionally, ocular involvement can be the initial manifestation, thus representing an essential clue for the physician in the early diagnosis of the disease. We present the case of a 53-year-old woman in whom recurrent episcleritis was the first sign of a multisystem disease. All further investigations led to the final diagnosis of GPA. The remission induction therapy chosen by the rheumatologist consisted of intravenous cyclophosphamide (CP) and methylprednisolone pulse-therapy, followed by oral glucocorticoids (GC). Based on the favorable clinical and paraclinical evolution, induction therapy was replaced by remission maintenance therapy. Azathioprine (AZA) was initiated and oral GC were continued, with dose tapering. Complete remission of episcleritis was observed. Abbreviations: GPA = granulomatosis with polyangiitis, EGPA = eosinophilic granulomatosis with polyangiitis, MPA = Microscopic polyangiitis, ANCA = Anti-neutrophil cytoplasmic antibodies, c-ANCA = ANCA to proteinase-3, p-ANCA = ANCA to myeloperoxidase, ELISAs = antigen-specific enzyme-linked immunosorbent assays, ENT = ear, nose, throat, CP = cyclophosphamide, NSAIDs = nonsteroidal anti-inflammatory drugs, AZA = azathioprine, GC = glucocorticoids
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Affiliation(s)
- Andra Carmina Ciotoracu
- Department of Rheumatology and Internal Medicine, “Sfânta Maria” Clinical Hospital, Bucharest, Romania
| | | | | | | | - Ana-Maria Iorga
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
| | - Constantin Busuioc
- Department of Pathology, “Prof. Dr. Matei Balș” National Institute of Infectious Diseases, Bucharest, Romania
| | - Denisa Predețeanu
- Department of Rheumatology and Internal Medicine, “Sfânta Maria” Clinical Hospital, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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43
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Yano H, Kinjo M. Letter to the Editor: Scleritis and Aortitis in Early Rheumatoid Arthritis. J Clin Rheumatol 2021; 27:S885. [PMID: 34407029 DOI: 10.1097/rhu.0000000000001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hiroyuki Yano
- Division of Rheumatology, Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan
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Yano H, Kinjo M. Scleritis and Aortitis in Early Rheumatoid Arthritis. J Clin Rheumatol 2021; 27:S628-S629. [PMID: 33492029 DOI: 10.1097/rhu.0000000000001697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hiroyuki Yano
- From the Division of Rheumatology, Department of Internal Medicine, Okinawa Chubu Hospital, Okinawa, Japan
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Martín-Nares E, Delgado-de la Mora J, Martínez-Benítez B, Hernandez-Molina G. Aortitis in Rheumatoid Arthritis: Think on Overlapping IgG4-related Disease: Scleritis and Aortitis in Early Rheumatoid Arthritis. J Clin Rheumatol 2021; 27:S863. [PMID: 34294662 DOI: 10.1097/rhu.0000000000001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Foster LD, Nyugen M, Margolin E. Conjunctivitis, episcleritis and anterior uveitis as the first presenting features of granulomatosis with polyangiitis. BMJ Case Rep 2021; 14:e243558. [PMID: 34706910 PMCID: PMC8552167 DOI: 10.1136/bcr-2021-243558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/03/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a rare disorder characterised by inflammation of small-sized and medium-sized blood vessels that result in damage to various organ systems, but it most commonly affects the respiratory tract and kidneys. It is one of the few entities that can present with ocular inflammation as well as renal impairment at the same time. We describe a case of a 38-year-old man with conjunctivitis, episcleritis, anterior uveitis as a first manifestation of GPA. His presentation with red eye and anterior uveitis prompted further workup, which revealed acute renal failure (creatinine 442 mmol/L), elevated inflammatory markers (erythrocyte sedimentation rate of 85 mmol/hour and C reactive protein of 72 mg/L), and a c-antineutrophil cytoplasmic antibody titre >8. An urgent renal biopsy was performed demonstrating necrotising crescentic glomerulonephritis, which led to the final diagnosis of GPA. Treatment induction with intravenous methylprednisolone and plasmapheresis followed by an oral prednisone taper and intravenous rituximab infusions leading to resolution of all symptoms and normalisation of kidney function. This report highlights conditions that can present with both ocular inflammation and renal dysfunction with a focus on GPA and its ocular manifestations.
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Affiliation(s)
- Lucas Donato Foster
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Michael Nyugen
- Department of Ophthalmology and Vision Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Maksimova MK, García EM, Renedo IO, García JJC, Del Río BJ, Vicente LR, Del Río Mayor JL. Atypical posterior scleritis mimicking an amelanotic choroidal melanoma. A case report. Rom J Ophthalmol 2021; 65:282-285. [PMID: 35036653 PMCID: PMC8697777 DOI: 10.22336/rjo.2021.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: To describe a clinical case of atypical posterior scleritis mimicking an amelanotic choroidal melanoma. Method: Observational case report of a 54-year-old woman who presented to the emergency department with photophobia and blurred vision in her left eye for three days. The development of a raised hypopigmented lesion superior to the papilla with choroidal folds and without vitritis simulated an amelanotic choroidal melanoma. Differential diagnosis took into consideration other compatible entities, including choroidal masses or orbital pseudotumor. Results: The patient was subject to full clinical examination, laboratory test, optical coherence tomography, orbital echography, and magnetic resonance imaging. Treatment with oral prednisone showed a significant improvement in all clinical and anatomical parameters. Discussions: Posterior scleritis is characterized by great clinical variability and sometimes can simulate an amelanotic choroidal melanoma. Performing an appropriate differential diagnosis of a large amelanotic lesion is the most important point during a routine ocular examination due to the implications for the patient. Conclusions: Posterior scleritis is a rare and incompletely understood inflammatory disease that affects the posterior part of the sclera. It can be associated with a range of conditions and very often is underdiagnosed. In about one third of the cases, it is related to some systemic disease, especially to autoimmune entity, so it may require a multidisciplinary approach. This case highlighted the importance of a solid differential diagnosis and an early treatment in order to help prevent the appearance of complications that can limit not only the visual outcome of the patient but even his survival in the most extreme cases. Abbreviations: LE = left eye; RE = right eye; BCVA = best corrected visual acuity; BO = both eyes; IOP = intraocular pressure; OCT = optical coherence tomography; MRI = Magnetic Resonance Imaging
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Sinha P, Sinha U, Raj A, Pati BK. Bilateral endogenous endophthalmitis complicated by scleral perforation: an unusual presentation. BMJ Case Rep 2021; 14:e244547. [PMID: 34548299 PMCID: PMC8458360 DOI: 10.1136/bcr-2021-244547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 11/04/2022] Open
Abstract
Endogenous endophthalmitis complicated by necrotising scleritis has rarely been reported in the literature. We, hereby, report a case of bilateral scleral perforation with endogenous endophthalmitis in an 87-year-old female patient with diabetes who presented as bilateral orbital cellulitis. Systemic workup ruled out autoimmune aetiology. The culture and sensitivity of exudates exuding from the scleral perforation showed Escherichia coli The Patient was managed conservatively with parenteral and topical antibiotics along with steroid, but the vision could not be salvaged. The report emphasizes on atypical presentation of endogenous endophthalmitis. In old and immunosuppressed individuals presenting with a clinical picture of bilateral orbital cellulitis with profound vision loss, endogenous endophthalmitis should be ruled out.
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Affiliation(s)
- Prerna Sinha
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Upasna Sinha
- Department of Radiology, AIIMS Patna, Patna, Bihar, India
| | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Binod Kumar Pati
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar, India
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Agarwal R, Bafna RK, Chetan C, Sharma N. Case Report: Subconjunctival Triamcinolone Acetate-associated Scleral Necrosis: Is It Really Obsolete? Optom Vis Sci 2021; 98:1016-1020. [PMID: 34433205 DOI: 10.1097/opx.0000000000001761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Recent studies have established the safety of subconjunctival steroids for anterior scleritis, refuting scleral necrosis as a potential complication. However, presently, we report a rare case of scleral necrosis associated with subconjunctival triamcinolone acetate. PURPOSE The purpose of this study was to report a case of scleral necrosis after subconjunctival triamcinolone acetate administration for nonresponsive anterior nodular scleritis. CASE REPORT A 45-year-old man diagnosed with nodular anterior scleritis was administered subconjunctival triamcinolone acetate (4 mg) adjacent to the nodule after noting nonresponse for 4 months. Worsening of congestion was noted 3 weeks after the injection. Slit-lamp examination revealed diffuse congestion, 10 clock hours of anterior scleral necrosis, superior whitish depot of subconjunctival triamcinolone acetate, anterior segment flare, and few posterior synechiae. Ultrasound biomicroscopic imaging and contrast-enhanced computerized tomography showed a localized outpouching of sclera and buckling of anterior scleral wall superiorly. The result of the comprehensive blood profile and systemic evaluation undertaken to rule out any underlying autoimmune disorders and herpes zoster ophthalmicus was found negative. A diagnosis of subconjunctival triamcinolone acetate-associated scleral necrosis was made, and the patient was managed conservatively. Gradual improvement with dissolution of subconjunctival triamcinolone acetate and no recurrences till 2 years of follow-up were noted. CONCLUSIONS Scleral necrosis is a potential complication of subconjunctival triamcinolone acetate. Judicious and cautious use of subconjunctival triamcinolone acetate is advocated for nonresolving anterior scleritis.
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Affiliation(s)
| | - Rahul Kumar Bafna
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Chetan Chetan
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Namrata Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Feizi S, Meshksar A, Naderi A, Esfandiari H. Anterior Scleritis Manifesting After Coronavirus Disease 2019: A Report of Two Cases. Cornea 2021; 40:1204-1206. [PMID: 34351874 PMCID: PMC8330625 DOI: 10.1097/ico.0000000000002795] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this study was to report 2 patients with anterior scleritis manifesting after coronavirus disease 2019 (COVID-19). METHODS The patients with confirmed COVID-19 developed anterior scleritis after their systemic symptoms were markedly improved. A thorough systemic workup identified no underlying autoimmune diseases. Ocular characteristics and safety and efficacy of systemic immunosuppressive therapy were evaluated. RESULTS Case 1 was a 67-year-old woman who presented with necrotizing anterior scleritis in both eyes 3 weeks after the onset of COVID-19. One-week treatment with topical betamethasone and oral prednisolone (65 mg daily) did not result in improvement, so she was started on intravenous cyclophosphamide and subcutaneous adalimumab in addition to oral prednisolone. Necrotizing scleritis was gradually improved over 3 months. Case 2 was a 33-year-old man who presented with sectoral anterior scleritis in his right eye 2 weeks after the onset of COVID-19. He was started on topical betamethasone and oral prednisolone (85 mg daily). One week later, all signs and symptoms disappeared, and topical and oral corticosteroids were gradually tapered off over 2 weeks. There was no recurrence of respiratory symptoms or active scleritis in any cases after discontinuation of treatment. CONCLUSIONS These cases suggest that COVID-19 can be associated with anterior scleritis, which responds to immunosuppressive and biologic agents. Ophthalmologists should consider anterior scleritis in patients with COVID-19 who present with ocular pain and redness during the convalescent phase of the illness.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Aidin Meshksar
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Ali Naderi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Hamed Esfandiari
- Department of Ophthalmology, Olmsted Medical Center, Rochester, MN
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