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Uveitis Specialists and Rheumatologists Select Different Therapies for Idiopathic Non-necrotizing Anterior Scleritis Uveitis specialists and rheumatologists treat patients with anterior scleritis, but data from controlled trials to guide management are scarce, making differences in treatment paradigms possible.1044 uveitis specialists and rheumatologists were surveyed regarding therapy for a patient with anterior scleritis. Respondents were asked to select first- and second-choice therapies (...) < 0.015). Cost and insurance considerations were not significant.Uveitis specialists and rheumatologists have different preferences in the treatment of anterior scleritis. The difference is impacted more by specialty practice than by cost/insurance.
Refractory necrotizing scleritis successfully treated with adalimumab Necrotizing scleritis is the most severe and destructive form of scleritis with vision-threatening sequelae. It is divided into with inflammation and without inflammation (scleromalacia perforans). Adalimumab is a tumour necrosis factor (TNF)-inhibiting anti-inflammatory medication licensed for the treatment of rheumatoid and psoriatic arthritis, ankylosing spondylitis and inflammatory bowel disease (in the USA). We report (...) two cases of necrotizing scleritis successfully treated with adalimumab.
Perichondrium Autograft in Refractory Necrotizing Scleritis Perichondrium Autograft in Refractory Necrotizing Scleritis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Perichondrium Autograft in Refractory (...) Necrotizing Scleritis (PCRNS) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02864823 Recruitment Status : Completed First Posted : August 12, 2016 Last Update Posted : August 12, 2016 Sponsor: Chung-Ang University Hosptial, Chung-Ang University College of Medicine Collaborator: Ministry of Science, ICT
Trabecular Micro-Bypass Stent Use in Necrotizing Scleritis. In this case report, we describe the successful implantation of multiple trabecular micro-bypass iStents in a patient with necrotizing scleritis.The study design is a case report.The participant was a patient who underwent multiple micro-bypass iStent surgery.A 71-year-old man with primary open-angle glaucoma, diagnosed with necrotizing scleritis and treated with steroids consequently resulting in significantly elevated intraocular (...) pressure in the right eye.Following uncomplicated surgery, IOP was reduced from 42 to 12 mm Hg 18 months after surgery on 2 drops and prednisone 40 mg daily CONCLUSIONS:: iStents may be considered as a possible intervention to lower IOP in patients with necrotizing scleritis in whom traditional glaucoma surgery is challenging or contraindicated.
Intravitreal dexamethasone implants for the treatment of refractory scleritis combined with uveitis in adult-onset Still's disease: a case report. Adult-onset Still's disease is a systemic inflammatory disease which presents with uveitis and scleritis in the eye. Intravitreal dexamethasone implants are used for the treatment of refractory uveitis.A 19-year-old woman diagnosed to have adult-onset Still's disease for fevers, joint pain, and a salmon-colored bumpy rash presented with scleritis (...) and uveitis in the left eye. Topical and systemic steroids with oral methotrexate failed to control the inflammation. We performed intravitreal injections of dexamethasone implants for side effects of steroid and refractory ocular inflammation. The therapy resulted in improvements in the patient's uveitis with reductions in scleral vessel engorgement and redness. There was no recurrence of uveitis or scleritis during 4 months following treatment.Intravitreal injections of dexamethasone implants may result
Gevokizumab in the treatment of autoimmune, non-necrotizing, anterior scleritis: Results of a phase I/II clinical trial. To evaluate the safety and potential efficacy of gevokizumab, an anti-interleukin 1β (IL-1β) monoclonal antibody, in the treatment of active, noninfectious, non-necrotizing anterior scleritis.Phase 1/2, open label, nonrandomized, prospective, single-arm pilot trial.Eight patients with active, noninfectious, non-necrotizing anterior scleritis with a scleral inflammatory grade (...) scleritis grading system by 16 weeks in the study eye compared to baseline. Secondary outcomes included changes in visual acuity, intraocular pressure, and trends in scleral grading. Participants who met the primary outcome were eligible to continue in the study for up to 52 weeks and received additional gevokizumab injections every 4 weeks until week 36, followed by 2 safety visits at weeks 40 and 52.Seven eyes from 7 patients met the primary outcome within a median time of 2 weeks following the first
Interleukin-22 serum levels are elevated in active scleritis. To evaluate serum cytokine profile from patients with active scleritis in a two-centre prospective case-control study.The serum of 20 active scleritis patients not treated with any local, periocular, or systemic immunomodulatory therapy (IMT) was analysed with multiplex assay to determine the levels of 11 cytokines interleukin (IL)-1β, IL-6, IL-2, IFN-γ, IL-10, IL-12p40, IL-13, IL-17A, IL-5, TNF-α, and TNF-β, and with ELISA (...) to determine the levels of TGF-β1, IL-22, and IL-23. Twenty-five age-matched healthy volunteers were used as controls. In a subgroup of 13 patients with active disease, a second serum sample was obtained when the disease was inactive and levels of IL-22 were determined. Serum IL-22 levels from patients with active scleritis were correlated with type of scleritis (non-necrotizing and necrotizing), degree of inflammation (0-4+ :≤2+ and >2+), and associated systemic disease.Serum levels of IL-22 were elevated
ScleritisScleritis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 ScleritisScleritis Aka: Scleritis , Nodular Scleritis (...) , Necrotizing Scleritis From Related Chapters II. Epidemiology Rare III. Pathophysiology Severe l inflammation Variations Nodular Scleritis Necrotizing Scleritis (most destructive) Anterior Scleritis (deep to ) Posterior Scleritis (overlying ) IV. Causes Idiopathic in 50% of cases (most common cause) Accounts for up to one third of Scleritis cases Scleritis occurs in 4-10% of RA cases (previously known as ) Infectious (uncommon) Pseudomonas V. Symptoms involving one or both eyes Blurred vision Photophobia
Rituximab in the Treatment of Refractory Non-Infectious Scleritis. To describe the outcomes of the use of rituximab in the treatment of refractory noninfectious scleritis.Retrospective case series.Review of the medical charts of patients with noninfectious scleritis refractory to conventional immunomodulatory therapy who were seen at the Massachusetts Eye Research and Surgery Institution between 2005 and 2015. The primary outcome measure in this study was steroid-free remission. Secondary (...) outcomes were favorable response (decrease in scleritis activity score) and decrease in steroid dependence.There were 15 patients, with a mean follow-up duration of 34 months. Fourteen patients (93.3%) showed a clinical improvement, with 13 (86.6%) achieving a scleritis activity score of zero at 6 months. To date, 2 patients continue to enjoy durable drug-free remission (28 and 32 months follow-up). There was only 1 adverse effect recorded (infusion hypotension) requiring cessation
Scleritis associated with relapsing polychondritis. To evaluate ocular disease characteristics and successful therapeutic regimens in patients with scleritis associated with relapsing polychondritis (RP). To compare these features with those seen in patients with scleritis associated with other systemic immune-mediated diseases (SIMD).Electronic health records of 13 scleritis patients associated with RP were analysed and compared with those of 113 scleritis patients associated with other SIMD (...) seen at two tertiary referral centres.Scleritis in patients with RP was often bilateral (92.3%), diffuse (76.9%), recurrent (84.6%), sometimes with decreased vision (46.2%), anterior uveitis (38.5%), peripheral keratitis (15.4%) and ocular hypertension (30.8%). Patients with scleritis associated with RP more often had bilateral scleritis (p=0.001), necrotising scleritis (23.1%; p=0.02), recurrences (p=0.001) and decreased vision (three of the six with legal blindness; p=0.012), as compared
Ocular toxocariasis presenting as bilateral scleritis with suspect retinal granuloma in the nerve fiber layer: a case report. This report details ocular toxocariasis presenting as bilateral scleritis with suspect retinal granuloma in the nerve fiber layer.The patient presented with scleritis, which did not improve with systemic steroid. Intraocular pressure was elevated, and well demarcated hyper-reflective round lesion were noted in both eyes. He had a history of general ache and concurrent (...) onset of ocular symptoms the day after eating raw meat. Systemic work-ups revealed no remarkable abnormalities except antibody for toxocara. Oral albendazole and steroid were prescribed. The inflammation and swellings resolved without recurrence. In the current case, scleritis with suspect granuloma in the nerve fiber layer seems to be caused by toxocara.Ocular toxocariasis can be presented as atypical features. Serologic exams for toxocariasis would be considered not only in typical features
Multifocal Surgically Induced Necrotizing Scleritis Following Strabismus Surgery: A Case Report. To present clinical findings of a 28-year-old woman with multifocal surgically induced necrotizing scleritis following uncomplicated strabismus surgery.A 28-year-old woman underwent uncomplicated strabismus surgery of her right eye for sensory exotropia under general anesthesia (6 mm right medial rectus muscle resection and 8 mm right lateral rectus muscle recession).Retrospective, observational (...) case report and literature review.One month after strabismus surgery, the patient presented with surgically induced necrotizing scleritis in the nasal aspect of sclera. Bacterial culture of the bed of the scleral melt showed no growth and all laboratory evaluation was normal. The scleritis completely resolved after initiation of systemic corticosteroids and oral azathioprine. Three weeks later (after tapering dose of systemic medication), the patient returned with large area of necrotizing
Assessment of the Accuracy of Using ICD-9 Codes to Identify Uveitis, Herpes Zoster Ophthalmicus, Scleritis, and Episcleritis. With the increased use of data from electronic medical records for research, it is important to validate International Classification of Diseases, Ninth Revision (ICD-9) codes for their respective diagnoses.To assess the accuracy of using ICD-9 codes to identify ocular inflammatory diseases.Retrospective secondary database analysis. The setting was Kaiser Permanente (...) for individual uveitis codes ranged from 0% to 100%, and 11 uveitis codes had a PPV exceeding 80%. Herpes zoster ophthalmicus and scleritis/episcleritis ICD-9 codes had PPVs of 91% (95% CI, 86%-95%) and 60% (95% CI, 54%-66%), respectively.Our results suggest that using ICD-9 codes alone to capture uveitis and scleritis/episcleritis diagnoses is not sufficient in the Kaiser Permanente Hawaii healthcare system, although there were specific uveitis codes with high PPVs. However, the electronic medical record
Surgical treatment of peripheral ulcerative keratitis and necrotizing scleritis in granulomatosis with polyangiitis The efficacy of surgical management of refractory ophthalmic complications of granulomatosis with polyangiitis (GPA), which is a sight threatening was reported. A 70-year-old man presented with a progressively worsening pain and redness in his right eye during the previous 6 months, and decreasing visual acuity that started one month earlier. He was misdiagnosed and treated (...) as keratitis elsewhere, but the pain has not decreased. The diagnosis of necrotizing scleritis with peripheral ulcerative keratitis (PUK) in GPA was made in our department. Surgery was performed with necrotic tissue removal, combined with cryotherapy and a conjunctival flap covering surgery. The symptom was relieved after surgery, and the patient's ocular condition remained stable thereafter. This case first demonstrates limited ophthalmic GPA (such as, PUK and necrotizing scleritis) that was not sensitive
Rheumatoid polyarthritis suspected in an HIV patient with scleritis, peripheral ulcerative keratitis, and anterior uveitis Scleritis and peripheral ulcerative keratitis are ocular manifestations found in many inflammations and infections. Therefore, their association should prompt a search for inflammatory or infectious causes that may be life-threatening, especially in the context of AIDS due to HIV infection.We report the case of a 37-year-old female, first seen in 2011 with a nodular (...) scleritis in the right eye and a peripheral ulcerative keratitis, a necrotizing scleritis, and a granulomatous anterior uveitis in the left eye, in the context of chronic polyarthropathies that had evolved over 6 months. The patient was diagnosed with AIDS (HIV) in 2008 and was on antiretroviral therapy for the past 2 years. Ophthalmic workup was negative for opportunistic infections and potential causes of scleritis and peripheral ulcerative keratitis, and the patient was unresponsive to topical
Aspergillus fumigatus Endophthalmitis with Necrotizing Scleritis following Pars Plana Vitrectomy We present a case of Aspergillus fumigatus endophthalmitis complicated by necrotizing scleritis in a 68-year-old man with diet-controlled diabetes, after retinal detachment repair. He was initially treated with systemic steroids for surgically induced necrotizing scleritis following routine pars plana vitrectomy. An additional diagnosis of endophthalmitis was made when the patient developed (...) a hypopyon. Repeat vitreous culture isolated Aspergillus fumigatus. Symptoms improved following antifungal treatment leaving the patient with scleromalacia and an advanced postoperative cataract. Fungal scleritis and endophthalmitis are rare complications of intraocular surgery with sight-threatening consequences, and, as this case demonstrates, may even occur concomitantly. The overlapping features of both conditions can make differentiating one from the other difficult. A fungal aetiology should
Nodular Scleritis Associated with Herpes Zoster Virus: An Infectious and Immune-Mediated Process Purpose. To describe a case of anterior nodular scleritis, preceded by an anterior hypertensive uveitis, which was primarily caused by varicella zoster virus (VZV). Case Report. A 54-year-old woman presented with anterior uveitis of the right eye presumably caused by herpetic viral disease and was successfully treated. Two months later, she developed a nodular scleritis and started oral nonsteroidal (...) anti-inflammatory without effect. A complete laboratory workup revealed positivity for HLA-B27; the infectious workup was negative. Therapy was changed to oral prednisolone and an incomplete improvement occurred. Therefore, a diagnostic anterior paracentesis was performed and the polymerase chain reaction (PCR) analysis revealed VZV. She was treated with valacyclovir and the oral prednisolone began to decrease; however, a marked worsening of the scleritis occurred with the reduction of the daily
Scleritis and Kidney Disease - More than meets the eye... Renal Fellow Network: Scleritis and Kidney Disease - More than meets the eye... | | | | | Wednesday, March 11, 2015 Scleritis and Kidney Disease - More than meets the eye... Scleritis is a severe inflammation involving the deep episclera and sclera. Symptoms include moderate to marked pain, hyperemia of the globe, lacrimation, and photophobia. Scleritis tends to recur and is frequently associated with an underlying systemic illness (...) , such as rheumatoid arthritis, lupus, IgA vasculitis, polyarteritis nodosa and granulomatosis with polyangiitis. A few cases are infectious in origin and about half of the cases of scleritis have no known cause. In Renal Grand Rounds on Tuesday, Patrick McGlynn presented a case of 30 year-old healthy female who came to clinic complaining of pain and redness on her right eye. Blood pressure was elevated at 155/90 mmHg. On exam, right eye had redness on sclera. No involvement of left eye. No papilledema