Diffuse posterior scleritis associated with HLA-B14* managed with multimodal imaging: case report and review of the literature.

PURPOSE: To report a case of posterior scleritis (PS) in an 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 (RE), presented conjunctival hyperemia, keratic precipitates involving the anterior segment and four chorioretinal elevations with macular folds at fundus examination. Multimodal imaging and systemic diagnostic work-up 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, while molecular typing of HLA genes was positive for HLA-B*14. Diagnosis of PS 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 management of PS, which should be diagnosed on the basis of multimodal imaging.

Management of recurrent corneal ulcers: use of amniotic membrane.

PURPOSE: Amniotic membrane (AM), or amnion, is a thin membrane on the inner side of the fetal placenta; it completely surrounds the embryo/fetus and delimits the amniotic cavity, which is filled by amniotic liquid. In recent years, the structure and function of the amnion have been investigated due to its pluripotent properties, which are an attractive source for tissue transplantation and reconstructive surgery. The pioneering use of AM in skin transplantation by Davis dates back to 1910; in 1913, Sabella and Stern employed it in the treatment of burns and superficial scars. Certain characteristics make the AM ideally suited to its application in ocular surface reconstruction. It can be easily obtained and its availability is nearly unlimited. We report a case of AM transplantation to treat ocular surface abnormality. METHODS: A 28-year-old man came to our attention for persistent foreign body feeling and pain in his right eye. Because of progressive clinical worsening, we decided to perform surgical apposition of AM. RESULTS: Clinical and instrumental follow-up was conducted with periodic complete checkups. At 1 year follow-up, best-corrected visual acuity was 4/10. CONCLUSIONS: Characteristics of AM make it potentially useful to treat ocular surface abnormalities.