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1.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472807

RESUMO

Infectious scleritis is a rare but important cause of scleral inflammation. It is usually associated with an underlying ocular (prior ocular surgery or trauma) or systemic risk factor. A 53-year-old apparently systemically healthy woman presenting with spontaneous-onset pain, redness and watering in the left eye for 10 days was diagnosed with culture-proven Pseudomonas aeruginosa anterior scleritis. However, she was non-responsive to organism-sensitive antibiotics and scleral graft was performed twice, which showed graft re-infection. On repeated extensive systemic evaluations, the patient was diagnosed with biopsy-proven granulomatosis with polyangiitis (GPA). The patient was started on mycophenolate mofetil for both induction and maintenance phases and showed dramatic improvement with no recurrence till 1 year follow-up. High index of suspicion for autoimmune disorders, especially GPA, must be maintained for unilateral relentless infective scleritis masquerading as autoimmune necrotising scleritis. Mycophenolate mofetil holds a promising role for inducing as well as maintaining disease remission in ocular GPA.


Assuntos
Doenças Autoimunes/diagnóstico , Diagnóstico Diferencial , Granulomatose com Poliangiite/diagnóstico , Infecções por Pseudomonas/diagnóstico , Esclerite/diagnóstico , Antibacterianos , Cefazolina/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Humanos , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Ácido Micofenólico , Polimixina B/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/patologia , Pseudomonas aeruginosa , Esclerite/tratamento farmacológico , Esclerite/etiologia , Esclerite/patologia , Tropanos/uso terapêutico
2.
Arq Bras Oftalmol ; 84(1): 74-77, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33470345

RESUMO

A 45-year-old female patient presented with a complaint of right eye redness and pain for 7 days. She was under investigation for urinary abnormalities and reported a previous history of recurrent oral ulcers and ocular hyperemia in both eyes. Best-corrected visual acuity was 20/30 and 20/20 in the right and left eyes, respectively. Slit-lamp biomicroscopy of the ocular surface of the right eye revealed nasal scleral hyperemia that persisted after instillation of topical phenylephrine 10%, reinforcing the diagnosis of anterior scleritis. Renal biopsy showed immunoglobulin A immune complexes and confirmed the suspected diagnosis of Berger's disease. Maintenance immunosuppressive therapy with azathioprine following a 6-month induction of remission with cyclophosphamide was necessary after pulse therapy with methylprednisolone. Scleritis is usually related to systemic autoimmune diseases, such as rheumatoid arthritis, and polyangiitis. Herein, we describe a rare case of unilateral anterior scleritis associated with Berger's disease.


Assuntos
Artrite Reumatoide , Glomerulonefrite por IGA , Esclerite , Feminino , Humanos , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Esclerite/diagnóstico , Esclerite/tratamento farmacológico , Esclerite/etiologia
7.
BMJ Case Rep ; 13(2)2020 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041758

RESUMO

Penetrating injury of the orbit with a wooden stick is not an uncommon finding in ocular emergencies. A 36-year-old man presented with redness, pain in the left eye following fall from a motorcycle 3 days ago. Ocular examination showed features of combined anterior and posterior scleritis in the form of an anterior scleral nodule, retinal folds and T sign on ultrasonography. There was worsening of symptoms along with new onset diplopia following scleral deroofing which led to the suspicion of an intraorbital wooden foreign body (IOWFB). CT scan of orbit showed a well-defined hypodensity between the medial rectus and optic nerve resembling a pocket of air surrounded by a rim of hyperdensity. IOWFB was removed under direct visualisation via transconjunctival orbitotomy. This is the case of a missed retained IOWFB presenting with features of combined anterior and posterior scleritis.


Assuntos
Corpos Estranhos no Olho/diagnóstico por imagem , Ferimentos Oculares Penetrantes/diagnóstico por imagem , Órbita/diagnóstico por imagem , Esclerite/etiologia , Adulto , Corpos Estranhos no Olho/complicações , Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/complicações , Ferimentos Oculares Penetrantes/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Ultrassonografia , Madeira
8.
Eur J Ophthalmol ; 30(3): NP7-NP10, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30638053

RESUMO

PURPOSE: Posterior scleritis is the least frequent form of scleritis accounting for around 2%-8% of all scleritis cases. We aim to present the 6-year clinical course of a 62-year-old female patient with bilateral progressive necrotizing posterior scleritis who suffered from concurrent active psoriasis and psoriatic arthritis. METHODS: Descriptive case report. RESULTS: A middle-aged female patient was referred to our clinic because of left eye peripheral progressively enlarging white retinochoroidal lesions. Her previous work-up ruled out infectious and malignant etiologies. A second diagnostic vitrectomy was performed because of the slowly progressive and the atypical nature of the sectoral retinochoroidal patches in the retinal periphery. Again malignancy was ruled out. With the onset of cystoid macular edema and diffuse retinal vasculitis, which occurred concurrently with the reactivation of psoriasis and psoriatic arthritis, treatment was initiated with systemic immunosuppressants which initially included oral steroids and methotrexate and at the last follow-up 6 years after the first presentation included also cyclosporin and golimumab. Vision was preserved with quiescent uveitis and posterior scleritis. CONCLUSION: Posterior scleritis is an uncommon condition and it is even rarer in the setting of psoriasis. The necrotizing inflammation observed in the present case and by others revealed sectoral progressive chorioretinitis as a clinical manifestation which may initially raise the suspicion of masquerade malignant and infectious etiologies. Detailed thorough history-taking remains the cornerstone in identifying the possible systemic associations even when occult or subclinical.


Assuntos
Artrite Psoriásica/complicações , Psoríase/complicações , Esclerite/etiologia , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/tratamento farmacológico , Feminino , Angiofluoresceinografia , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Esclerite/diagnóstico , Esclerite/tratamento farmacológico
11.
Medicine (Baltimore) ; 98(35): e16886, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464918

RESUMO

RATIONALE: Posterior scleritis is an ocular inflammatory disorder that can be associated with both infectious and non-infectious immune reactions. Behcet disease is a chronic, relapsing, multisystemic inflammatory disorder with uveitis. There are no reported cases of posterior scleritis with Bechet disease. PATIENT CONCERNS: A 50-year-old man previously diagnosed with systemic Behcet disease presented with ocular pain and decreased vision in the left eye. DIAGNOSIS: Posterior scleritis associated with Behcet disease was diagnosed based on optical coherence tomography showing choroidal folds, as well as contrast computed tomography and ultrasound sonography demonstrating thickening of the posterior sclera. INTERVENTIONS: Treatment with systemic corticosteroids was initiated. Since inflammation relapsed during steroid tapering, anti-tumor necrosis factor-alpha (TNF-α) therapy was used in combination, and tapering of steroids was possible without recurrence of inflammation for 12 months. OUTCOMES: Posterior scleritis was resolved and visual acuity improved. With the continuation of TNF-α therapy, oral prednisolone was successfully tapered and discontinued. No relapse of inflammation was observed at follow-up 1 year after discontinuation of prednisolone. LESSONS: Ophthalmologists should be aware of the possibility of rare manifestation of posterior scleritis in patients with Behcet disease, and that combined use of systemic steroids and anti-TNF-α therapy may resolve the scleritis without recurrence of inflammation.


Assuntos
Corticosteroides/uso terapêutico , Síndrome de Behçet/complicações , Esclerite/diagnóstico por imagem , Fator de Necrose Tumoral alfa/uso terapêutico , Corticosteroides/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerite/tratamento farmacológico , Esclerite/etiologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator de Necrose Tumoral alfa/farmacologia , Ultrassonografia , Acuidade Visual/efeitos dos fármacos
12.
Indian J Ophthalmol ; 67(8): 1360-1362, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31332143

RESUMO

A 52-year-old woman presented with idiopathic active scleritis not responding to oral cyclophosphamide, azathioprine, and oral steroid. Her intraocular pressure in the left eye was 45 mm of Hg in spite of using combination of brinzolamide 1% and brimonidine 0.2% (thrice a day), timolol maleate 0.5% (twice a day) eye drops in both eyes and oral acetazolamide. She was administered subcutaneous golimumab 50 mg injection every 4 weeks along with oral methotrexate 15 mg/week. The scleral inflammation responded and she underwent Ahmed glaucoma valve implantation after two months of initiation of golimumab therapy. After one week of surgery her IOP in left eye was the reduced to 8 mm of Hg. The index case showed that Golimumab can be a useful drug in the management of necrotizing scleritis refractory to the conventional therapy.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Implantação de Prótese , Esclerite/tratamento farmacológico , Anticorpos Monoclonais/administração & dosagem , Feminino , Glaucoma/diagnóstico , Glaucoma/etiologia , Humanos , Injeções Subcutâneas , Pressão Intraocular , Pessoa de Meia-Idade , Esclerite/diagnóstico , Esclerite/etiologia , Tonometria Ocular
13.
BMC Ophthalmol ; 19(1): 144, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291929

RESUMO

BACKGROUND: Rosai-Dorfman disease is a rare non-Langerhans cell histiocytosis. Ocular involvement is even rarer, mostly involving the orbit and eyelids, although marginal corneal ulcers, uveitis, and epibulbar masses have also been reported, and is characterized by multiple recurrences. However, the disease course and optimal treatment strategies remain undetermined, in light of the rarity of this disease. CASE PRESENTATION: We reported a 36-year-old male patient with the extranodal form of Rosai-Dorfman disease, presenting with scleritis and anterior uveitis in the left eye, who experienced subsequent development of an epibulbar tumor in the same eye. The patient was also complicated by a relapsing facial nodule on the right cheek. After the pathological diagnosis of Rosai-Dorfman disease was obtained, the patient underwent surgical excision of the epibulbar tumor and the facial nodule, accompanied by systemic immunosuppression therapy. At the last follow-up, the patient was asymptomatic without signs of recurrence. CONCLUSIONS: This report highlights the progression of ocular manifestations of Rosai-Dorfman disease and emphasizes the importance of systemic therapy.


Assuntos
Túnica Conjuntiva/patologia , Histiocitose Sinusal/complicações , Esclera/patologia , Esclerite/etiologia , Uveíte Anterior/etiologia , Doença Aguda , Adulto , Biópsia , Diagnóstico Diferencial , Progressão da Doença , Histiocitose Sinusal/diagnóstico , Humanos , Masculino , Esclerite/diagnóstico , Uveíte Anterior/diagnóstico , Acuidade Visual
14.
Jpn J Ophthalmol ; 63(5): 417-424, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31183624

RESUMO

PURPOSE: We evaluated patient profiles, clinical features, associated systemic diseases, treatment modalities, and ocular complications in cases of scleritis and episcleritis. STUDY DESIGN: Retrospective. METHODS: Clinical data of 128 patients referred to the ophthalmology clinic at Jichi Medical University Hospital during the 4-year period from April 2011 to March 2015, and diagnosed with scleritis or episcleritis were examined. Gender, average onset age, unilateral or bilateral manifestation, classification type, associated systemic diseases, and treatments were retrospectively investigated. RESULTS: The cohort consisted of 57 men and 71 women. Average onset age was 54.3 ± 17.4 years. Diffuse anterior scleritis was the most common type. It was noted in 43 (32.8%) patients, followed by episcleritis in 35 (27.3%), nodular anterior scleritis in 23 (18.0%), necrotizing anterior scleritis in 22 (17.2%), and posterior scleritis in 6 (4.7%). Eighteen (81.8%) of 22 patients with necrotizing anterior scleritis required some type of systemic medication, including corticosteroid, cyclophosphamide, cyclosporine, azathioprine, methotrexate, or rituximab administration. Forty (31.3%) had associated systemic diseases, which included 10 with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and 8 with rheumatoid arthritis (RA). Patients with ANCA-associated vasculitis had a tendency to develop scleritis first and had significantly worse visual prognoses compared to those with RA. CONCLUSIONS: Approximately 30% of the patients with scleritis and episcleritis had complications involving systemic diseases, including ten patients with ANCA-associated vasculitis and 8 with RA. ANCA-associated vasculitis was more often diagnosed after scleritis and patients suffered poorer visual prognoses than those with RA.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Artrite Reumatoide/complicações , Esclerite/etiologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Artrite Reumatoide/diagnóstico , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclerite/classificação , Esclerite/epidemiologia
18.
Rheumatol Int ; 39(3): 489-495, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30706192

RESUMO

Ocular involvement is present in 50-60% of granulomatosis with polyangiitis (GPA) patients and can affect any part of the ocular globe. The present study describes ophthalmologic manifestations, association with systemic symptoms, disease activity and damage in GPA. A cross-sectional study was conducted including patients with GPA who underwent rheumatologic and ophthalmologic evaluation. Demographics, comorbidities, ophthalmologic symptoms, serologic markers, radiographic studies, disease activity and damage were assessed. Descriptive statistics, correlation, univariable logistic regression analyses, Student's t, Mann-Whitney U, Chi-square and Fisher's exact tests were performed. Fifty patients were included, 60% female, the median age was 56 years, disease duration 72.5 months. Nineteen (38%) patients had ocular manifestations at GPA diagnosis, scleritis being the most frequent; 27 (54%) patients presented ocular involvement during follow-up, repeated scleritis and dacryocystitis being the most common manifestations. Concomitant ophthalmic and sinonasal involvement was present in 12 (24%). Ocular and ENT damage occurred in 58% and 70%, respectively. Epiphora and blurred vision were the most frequent symptoms; scleromalacia and conjunctival hyperemia (27%) the most frequent clinical abnormalities. Ocular involvement at diagnosis was associated with concomitant ocular and sinonasal involvement at follow-up (OR 4.72, 95% CI 1.17-19.01, p = 0.01). Ocular involvement at follow-up was associated with age at GPA diagnosis (OR 0.94, 95% CI 0.90-0.99, p = 0.03), VDI (OR 1.29, 95% CI 1.03-1.61, p = 0.02), and ENT damage (OR 5.27, 95% CI 1.37-20.13, p = 0.01). In GPA, ocular involvement is frequent, therefore, non-ophthalmologist clinicians should be aware of this manifestation to reduce the risk of visual morbidity and organ damage.


Assuntos
Dacriocistite/fisiopatologia , Granulomatose com Poliangiite/fisiopatologia , Doenças Nasais/fisiopatologia , Doenças dos Seios Paranasais/fisiopatologia , Esclerite/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Túnica Conjuntiva/etiologia , Doenças da Túnica Conjuntiva/fisiopatologia , Estudos Transversais , Dacriocistite/etiologia , Oftalmopatias/etiologia , Oftalmopatias/fisiopatologia , Feminino , Granulomatose com Poliangiite/complicações , Humanos , Hiperemia/etiologia , Hiperemia/fisiopatologia , Doenças do Aparelho Lacrimal/etiologia , Doenças do Aparelho Lacrimal/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças Nasais/etiologia , Doenças dos Seios Paranasais/etiologia , Esclerite/etiologia , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia , Adulto Jovem
19.
J Clin Pathol ; 72(5): 386-390, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30723093

RESUMO

The sclera is an uncommon site of primary inflammation. Biopsy is infrequently employed in the evaluation of scleritis, but familiarity with its differential diagnosis is instrumental in ensuring efficient histological evaluation. This review provides a clinical overview of scleritis and describes the context in which scleral biopsy might arise. Most cases are associated with systemic autoimmune disease, but a sizeable proportion occur as an isolated disorder. Conditions mimicking autoimmune scleritis include infection and neoplasm. Histological patterns of inflammation in eyes removed surgically or at autopsy have been placed into three groups: (1) autoimmune scleritis characterised by varying mixtures of palisading granulomas, necrosis and vasculitis; (2) infectious scleritis, characterised by acute inflammation and necrosis; and (3) idiopathic scleritis, characterised by chronic non-specific inflammation with follicles and varying amounts of fibrosis. This traditional system of classification may be oversimplified. Aetiological or categorical classification is not always possible on small biopsies given the histopathological overlap of infectious and non-infectious scleritis.


Assuntos
Esclera/patologia , Esclerite/patologia , Biópsia , Humanos , Esclerite/classificação , Esclerite/diagnóstico , Esclerite/etiologia
20.
J Glaucoma ; 28(2): e21-e23, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30300308

RESUMO

PURPOSE: The main purpose of this study was to report a case of panscleritis after gonioscopy-assisted transluminal trabeculotomy (GATT). METHODS: We describe the case of a 33-year-old man with a history of unilateral anterior uveitis and glaucoma, who developed panscleritis after GATT surgery. RESULTS: Uneventful GATT surgery was performed in a glaucomatous left eye. On the second postoperative day, the patient developed tenderness on palpation of the eye. Ophthalmic examination revealed significant diffuse hyperemia, elongated and tortuous upper bulbar conjunctival/scleral vessels, and exudative retinal detachment at the superior nasal quadrant, with diffuse scleral thickening. The patient was diagnosed as having panscleritis, which was attributed to the GATT surgery. Although the scleritis resolved completely with intravenous and oral methylprednisolone treatment, localized retinal detachment persisted. CONCLUSIONS: Surgery-induced posterior scleritis may occur following minimally invasive glaucoma surgeries such as GATT. Control of uveitis for at least 3 months before surgery is indicated in patients with uveitis if GATT surgery is planned.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Gonioscopia , Esclerite/etiologia , Trabeculectomia/efeitos adversos , Adulto , Antialérgicos/uso terapêutico , Técnicas de Diagnóstico por Cirurgia , Combinação de Medicamentos , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Glucocorticoides/uso terapêutico , Humanos , Pressão Intraocular/fisiologia , Etabonato de Loteprednol/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Período Pós-Operatório , Estudos Retrospectivos , Esclerite/tratamento farmacológico , Resultado do Tratamento , Acuidade Visual
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