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C. Stephen Foster - One of the best experts on this subject based on the ideXlab platform.
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Scleritis associated with relapsing polychondritis
The British journal of ophthalmology, 2016Co-Authors: Maite Sainz-de-la-maza, Nicolas Molina, Luis Alonso Gonzalez-gonzalez, Priyanka P. Doctor, Joseph Tauber, C. Stephen FosterAbstract:Aims 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). Methods 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. Results 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 with patients who had Scleritis associated with other SIMD. Nine patients (69.2%) had one or more SIMD other than RP, including systemic vasculitis (4) or other autoimmune disease (8); they antedated RP by 9 years (range 2–21 years). Successful therapy included cyclophosphamide (5), methotrexate (3), azathioprine (3), mycophenolate mofetil (2), infliximab (2) and adalimumab (1). Conclusions Scleritis may be the first manifestation whose study leads to the diagnosis of RP. Scleritis associated with RP is more often bilateral, necrotising, recurrent and associated with decrease of vision than Scleritis associated with other SIMD. About 69.2% of patients will have an additional SIMD disorder. Scleritis associated with RP most often will require immunomodulatory therapy. Occasionally, Scleritis with RP may appear while using antitumor necrosis factor α agents.
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Scleritis in patients with granulomatosis with polyangiitis (Wegener)
The British journal of ophthalmology, 2015Co-Authors: Lidia Cocho, Maite Sainz-de-la-maza, Luis Alonso Gonzalez-gonzalez, Priyanka P. Doctor, Nicolas Molina-prat, C. Stephen FosterAbstract:Aims To describe and compare clinical features, complications and outcomes in patients with granulomatosis with polyangiitis (GPA)-associated Scleritis with those seen in idiopathic and other autoimmune-associated Scleritis, and to further describe the features that may serve as an indicator of life-threatening systemic disease. Methods We retrospectively reviewed electronic health records of all patients with Scleritis seen at two tertiary care centres. Of 500 patients, 14 had GPA-associated Scleritis and were included in this analysis. Measures included were age, gender, laterality, visual acuity and underlying systemic or ocular diseases. Clinical features (location, pain, inflammation) and ocular complications of these patients (decrease of vision, concomitant anterior uveitis and ocular hypertension) were studied and correlated. Results Fourteen of 500 patients with Scleritis were GPA associated. Most of the patients with GPA-associated Scleritis presented with sudden onset, bilateral, diffuse anterior scleral inflammation, with moderate-or-severe pain. Vision loss was not significantly different, and pain was more severe in these patients than in those with idiopathic Scleritis. When compared with patients with other underlying autoimmune diseases, there were no significant differences found in epidemiological or clinical signs. Necrotising Scleritis and corneal involvement were more commonly observed in GPA than in idiopathic Scleritis and other autoimmune diseases and are often the presenting feature of the disease. Conclusions The presence of necrotising changes or corneal involvement in the setting of scleral inflammation is highly suggestive of an underlying systemic vasculitis, of which GPA is the most common. These features should alert the doctor/optometrist and prompt a thorough diagnostic approach and an aggressive treatment given that it could reveal a life-threatening disease.
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Scleritis therapy.
Ophthalmology, 2011Co-Authors: Maite Sainz-de-la-maza, Nicolas Molina, Luis Alonso Gonzalez-gonzalez, Priyanka P. Doctor, Joseph Tauber, C. Stephen FosterAbstract:To delineate factors associated with a successful response to treatment in patients with various manifestations of Scleritis. Retrospective case series. A total of 392 patients with noninfectious anterior Scleritis. We reviewed the electronic health records of 392 patients with noninfectious anterior Scleritis seen at 2 tertiary referral centers and studied the factors associated with successful treatment. Patient characteristics (age, sex); ocular disease characteristics (laterality, type of Scleritis, degree of scleral inflammation, ocular complications, delay in presentation, and follow-up period), systemic disease association (associated disease, potentially lethal associated disease); and anti-inflammatory and immunosuppressive medications were studied in patients with Scleritis. Successful treatment response to nonsteroidal anti-inflammatory drugs (NSAIDs), steroidal anti-inflammatory drugs (SAIDs), immunosuppressive therapy drugs (immunomodulatory therapy [IMT]), or biologic response modifiers (BRMs) was assessed. Treatment of 392 patients with noninfectious anterior Scleritis included NSAIDs in 144 (36.7%), SAIDs in 29 (7.4%), IMT in 149 (38.0%), BRMs in 56 (14.3%), and none (N = 14). Successful response to treatment with NSAIDs was associated with idiopathic diffuse or nodular Scleritis with a low degree of scleral inflammation (≤ 2+) (odds ratio [OR] = 2.89, P < 0.001) and with idiopathic diffuse or nodular Scleritis without ocular complications (OR = 3.13, P < 0.001). Successful treatment with SAIDs was associated with idiopathic diffuse or nodular Scleritis with a high degree of scleral inflammation (>2+) (OR = 4.70, P = 0.001). Successful treatment with IMT was associated with diffuse or nodular Scleritis with associated systemic disease (OR = 1.57, P = 0.047), mainly potentially lethal (OR = 17.41, P=0.007), and necrotizing Scleritis (OR = 4.73, P = 0.026). Successful treatment with BRMs was associated with diffuse or nodular Scleritis with associated systemic disease (OR = 3.15, P < 0.001). This study did not require institutional review board approval because the information does not contain any subject identifiers. Patients with idiopathic diffuse or nodular Scleritis with a low degree of scleral inflammation or without ocular complications may respond to NSAIDs. Patients with idiopathic diffuse or nodular Scleritis with a high degree of scleral inflammation may respond to SAIDs. Patients with diffuse or nodular Scleritis with associated systemic disease may respond to IMT or BRMs. Patients with necrotizing Scleritis may respond to IMT, mainly alkylating agents. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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Clinical characteristics of a large cohort of patients with Scleritis and epiScleritis.
Ophthalmology, 2011Co-Authors: Maite Sainz De La Maza, Nicolas Molina, Luis Alonso Gonzalez-gonzalez, Priyanka P. Doctor, Joseph Tauber, C. Stephen FosterAbstract:Objective To evaluate the demographic characteristics, clinical features, ocular complications, and disease associations of patients with Scleritis and epiScleritis; as well as to delineate the risk factors for decreased vision in patients with Scleritis. Design Retrospective case series. Participants Five hundred patients with Scleritis and 85 patients with epiScleritis. Methods The electronic health records of 500 patients with Scleritis and 85 patients with epiScleritis seen at 2 tertiary referral centers were reviewed and their clinical features were studied. Main Outcome Measures Clinical features (pain, scleral inflammation), ocular complications (decrease in vision, anterior uveitis, peripheral ulcerative keratitis, ocular hypertension), and disease associations. Results In a series of 585 patients, 500 patients had Scleritis (85.5%) and 85 patients had epiScleritis (14.2%). Ocular complications were more frequent overall in patients with Scleritis versus in those with epiScleritis (45.0% vs. 19.0%), including decrease in vision (15.8% vs. 2.3%), anterior uveitis (26.4% vs. 16.5%), peripheral ulcerative keratitis (7.4% vs. 0%), and ocular hypertension (14.2% vs. 3.5%; P P P P = 0.042), degree of scleral inflammation of more than 2+ (range, 0–4+; OR, 3.60; P P = 0.033), ocular hypertension (OR, 3.19; P P P Conclusions Scleritis is associated more often with ocular complications than epiScleritis, and necrotizing Scleritis is the type of Scleritis most often associated with ocular complications and disease association. Risk factors for decrease in vision in patients with Scleritis include necrotizing Scleritis, posterior Scleritis, scleral inflammation of more than 2+, anterior uveitis, ocular hypertension, and associated infectious disease. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Infliximab for the treatment of refractory Scleritis
The British journal of ophthalmology, 2009Co-Authors: Priyanka P. Doctor, Amyna Sultan, Sana Syed, William G. Christen, Pooja Bhat, C. Stephen FosterAbstract:Background Scleritis is a potentially blinding inflammatory disorder. Standard care consists of systemic corticosteroids and immunosuppresants. The authors describe a series of 10 patients suffering from Scleritis treated with the TNF inhibitor infliximab because this Scleritis was refractory to standard therapy. Methods The authors reviewed the medical records of patients with Scleritis at the Massachusetts Eye Research and Surgery Institution, treated with infliximab. All cases had non-infectious Scleritis refractory to traditional immunomodulatory therapy and received 5 mg/kg of infliximab at 4–8-weekly intervals. The main outcome measures evaluated were clinical response, reduction in concomitant immunomodulatory therapy and adverse effects. Inflammation control and visual acuity were assessed using life-table methods. Results A favourable clinical response to infliximab was seen in 100% of the patients, with six (60%) of them achieving remission and cessation of concomitant immunosuppression. A clinical response to infliximab therapy occurred within 13.24 weeks on average. Based on clinical response, the authors found that repeat monthly infusions were required to maintain remission. One (10%) patient developed a lupus-like reaction necessitating discontinuation of infliximab. Conclusion Infliximab may be considered in the treatment of non-infectious Scleritis refractory to other treatment.
Jyotirmay Biswas - One of the best experts on this subject based on the ideXlab platform.
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Current Approach for the Diagnosis and Management of Noninfective Scleritis.
Asia-Pacific journal of ophthalmology (Philadelphia Pa.), 2020Co-Authors: Parthopratim Dutta Majumder, Peter Mccluskey, Rupesh Agrawal, Jyotirmay BiswasAbstract:Scleritis is a rare, vision-threatening inflammation of the sclera that is often associated with life-threatening systemic illnesses. Rheumatoid arthritis remains the most common associated systemic rheumatic disease and the commonest systemic association of Scleritis. Granulomatosis with polyangiitis is the most common cause of vasculitis-associated Scleritis. The etiopathogenesis of Scleritis remains unclear, but can be immune complex-mediated or due to a local delayed hypersensitivity reaction. Scleritis can involve either the anterior or posterior sclera, and has a wide spectrum of clinical presentations. Among the subtypes of Scleritis, necrotizing Scleritis has an increased risk of complications and is more commonly associated with anterior uveitis and peripheral ulcerative keratitis. Posterior Scleritis is often not diagnosed or missed due to its subtle clinical signs and protean manifestations. Meticulous history taking, detailed ocular examination, and a targeted array of investigations with a multi-disciplinary approach to find any underlying systemic disease are crucial for the management of a case of Scleritis. Corticosteroids remain the mainstay of short-term treatment of Scleritis; mild to moderate scleral inflammation may respond well to treatment with nonsteroidal antiinflammatory drug or topical corticosteroid. Corticosteroid-sparing immunosuppressive therapies are useful in cases with an inadequate response or failure to provide long-term control of inflammation, and to prevent recurrence of Scleritis. Biologic agents are increasingly used in the management of Scleritis, not responding to the conventional therapies. This review provides an overview of the various subtypes of Scleritis and its systemic associations and evaluates current trends in the diagnosis and management of noninfective Scleritis.
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Clinical Profile of Scleritis in Children
Ocular immunology and inflammation, 2018Co-Authors: Parthopratim Dutta Majumder, Sowkath Ali, A.e. George, Sudha K Ganesh, Jyotirmay BiswasAbstract:Purpose: To describe the clinical pattern of Scleritis in patients ≤16 years of age at a tertiary care eye hospital in India. Methods: The medical records of 24 eyes of 20 children with Scleritis were included in this retrospective study. Collected data included age, subsets of uveitis, best corrected visual acuities (BCVA), detailed laboratory investigations and treatment. Results: Mean age at presentation was 12.2 ± 2.5 years. Scleritis was unilateral in 80% patients and an equal gender distribution was observed. Posterior Scleritis (41.7%) was the most common subtypes of Scleritis and nodular Scleritis was the most common type of anterior Scleritis (33.3%). Necrotizing Scleritis was seen in 16.7% eyes. Tuberculosis was the only systemic association and found in three (15%) patients. Conclusions: Clinical profile of Scleritis in children can be different from that of adults.
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Antineutrophil cytoplasmic antibody-positive Scleritis: Clinical profile of patients from a tuberculosis-endemic region
Wolters Kluwer Medknow Publications, 2018Co-Authors: Parthopratim Dutta Majumder, Sudha K Ganesh, Sridharan Sudharshan, Amala Elizabeth George, Jyotirmay BiswasAbstract:Purpose: To report the clinical profile of a series of antineutrophil cytoplasmic antibody (ANCA)-associated Scleritis in Indian population. Methods: We conducted a retrospective review of medical records of 33 eyes of 26 consecutive patients with Scleritis, who tested positive for either antibody to proteinase 3 [anti-PR3/cytoplasmic antineutrophil cytoplasmic antibody (cANCA)] or myeloperoxidase [anti-MPO/perinuclear anti-neutrophil cytoplasmic antibody (pANCA)] between 2006 and 2015. Results: The mean age at presentation was 54.1 (11.1) years and 61.5% of the patients were female. Underlying systemic disorder was found in 46.2% of patients and includes granulomatosis with polyangitis (30.8%) and tuberculosis (15.4%). Necrotizing Scleritis (48.5%) was the most common Scleritis observed, followed by diffuse anterior Scleritis (42.4%). Positive cANCA was found in 65.4% of patients and 34.6% was found positive for pANCA. Four of the six patients with positive Mantoux test were started on anti-tuberculosis treatment (ATT) by pulmonologist. Cyclophosphamide was the most common immunosuppressive and 11.5% of the patients required combination of two immunosuppressives. Seventeen eyes developed cataract and four eyes required patch graft. Female gender was more frequently associated with pANCA-associated Scleritis than cANCA (P = 0.037). Incidence of necrotizing Scleritis was higher in patients with positive cANCA, but this difference was not statistically significant (P = 0.806). cANCA-positive patients had statistically significant higher association with systemic rheumatic diseases (P = 0.021). Conclusion: Necrotizing Scleritis is the most common subtype of Scleritis in ANCA-positive individuals and even in the absence of systemic involvement. All patients with ANCA positivity should be thoroughly screened to rule out any evidence of tuberculosis, especially in tuberculosis-endemic region before planning aggressive immunomodulatory therapy
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Clinical profile of patients with posterior Scleritis: A report from Eastern India
Wolters Kluwer Medknow Publications, 2018Co-Authors: Amitabh Kumar, Jyotirmay Biswas, Avirupa Ghose, Parthopratim Dutta MajumderAbstract:Purpose: This study aimed to report the clinical profile of patients with posterior Scleritis at a tertiary eye center in Eastern India. Methods: This was a single-center retrospective case series of patients who were diagnosed as posterior Scleritis between January 2010 and December 2014, with a follow-up period of at least 6 months. Results: The study included 18 patients of posterior Scleritis with a mean age of 41.2 ± 10.6 years (range: 26–63 years). With female preponderance (55.6%), majority of the posterior Scleritis cases were unilateral (88.9%). Sixteen patients reported with diminution of vision, eleven patients (61.1%) had ocular pain on presentation, and five patients complained of headache. Concurrent anterior Scleritis was found in three eyes (15%) with posterior Scleritis. Choroidal folds and subretinal fluid at the posterior pole were the most common fundus findings and were seen in seven eyes (35%) each. No systemic association was detected in any patient even after extensive laboratory workup and multidisciplinary consultation. All patients received oral steroid, and 11 (61.1%) of them required intravenous pulse steroid therapy. Immunosuppressive was used in 6 (33.3%) patients, and oral azathioprine was the most common immunosuppressive used in the study. Recurrence was noted in eight eyes (40%). The mean best-corrected visual acuity improved to logarithm of the minimal angle of resolution (logMAR) 0.06 ± 0.051 at the final follow-up from 0.47 ± 0.45 logMAR at presentation (P = 0.00608). Conclusion: Posterior Scleritis is relatively rare but can occur without systemic involvement. Aggressive immunomodulatory therapy is required to treat vision-threatening condition
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Bilateral Posterior Scleritis: Analysis of 18 Cases from a Large Cohort of Posterior Scleritis.
Ocular immunology and inflammation, 2015Co-Authors: Julio J. González-lópez, Parthopratim Dutta Majumder, Jyotirmay Biswas, Alenka Lavric, Nishat Bansal, Carlos Pavesio, Rupesh AgrawalAbstract:ABSTRACTPurpose: To describe the clinical and epidemiological characteristics of patients and analyze factors associated with bilateral posterior Scleritis.Methods: In this retrospective cohort study, records of patients with diagnosis of bilateral posterior Scleritis at two tertiary-care centers in the UK and India were analyzed in comparison with the clinical profile of patients with unilateral Scleritis.Results: In total, 18 patients with bilateral posterior Scleritis were identified and compared with 96 patients of unilateral posterior Scleritis; 14 (77%) were women and the median age was 48 years. Headache (p = 0.04), optic nerve swelling (p = 0.01), and elevated antinuclear antibodies (ANA) titers (p = 0.03) were present more frequently in patients with bilateral than in unilateral posterior Scleritis. Seven patients (38.88%) required immunosuppressive therapy to attain resolution of the inflammation and to prevent relapse.Conclusions: Bilateral posterior Scleritis is an uncommon but severe inflamma...
Stephen C Foster - One of the best experts on this subject based on the ideXlab platform.
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remission of non infectious anterior Scleritis incidence and predictive factors
American Journal of Ophthalmology, 2021Co-Authors: John H Kempen, Maxwell Pistilli, Hosne Begum, Tonetta D Fitzgerald, Teresa L Liesegang, Abhishek R Payal, Nazlee Zebardast, Nirali P Bhatt, Stephen C FosterAbstract:Purpose To assess how often non-infectious anterior Scleritis remits and identify predictive factors. Methods Our retrospective cohort study at four ocular inflammation subspecialty centers collected data for each affected eye/patient at every visit from center inception (1978, 1978, 1984, 2005) until 2010. Remission was defined as inactivity of disease off all suppressive medications at all visits spanning at least three consecutive months or at all visits up to the last visit (to avoid censoring patients stopping follow-up after remission). Factors potentially predictive of remission were assessed using Cox regression models. Results During 1,906 years' aggregate follow-up of 832 affected eyes, remission occurred in 214 (170 of 584 patients). Median time-to-remission of Scleritis = 7.8 years (95% confidence interval [CI]: 5.7, 9.5). More remissions occurred earlier than later during follow-up. Factors predictive of less Scleritis remission included Scleritis bilaterality (adjusted hazard ratio [aHR] = 0.46, 95% CI: 0.32-0.65); and diagnosis with any systemic inflammatory disease (aHR = 0.36, 95% CI: 0.23-0.58), or specifically with Rheumatoid Arthritis (aHR = 0.22), or Granulomatosis with Polyangiitis (aHR = 0.08). Statin treatment (aHR = 1.53, 95% CI: 1.03-2.26) within ≤90 days was associated with more remission incidence. Conclusions Our results suggest Scleritis remission occurs more slowly in anterior Scleritis than in newly diagnosed anterior uveitis or chronic anterior uveitis, suggesting that attempts at tapering suppressive medications is warranted after long intervals of suppression. Remission is less frequently achieved when systemic inflammatory diseases are present. Confirmatory studies of whether adjunctive statin treatment truly can enhance Scleritis remission (as suggested here) are needed.
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rituximab in the treatment of refractory noninfectious Scleritis
American Journal of Ophthalmology, 2016Co-Authors: Jennifer H Cao, Lidia Cocho, Merih Oray, Stephen C FosterAbstract:Purpose To describe the outcomes of the use of rituximab in the treatment of refractory noninfectious Scleritis. Design Retrospective case series. Methods 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. Results 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 of rituximab. Conclusion Rituximab can be an effective treatment modality for recalcitrant noninfectious Scleritis and, in some, can result in long-term durable drug-free remission.
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interleukin 22 serum levels are elevated in active Scleritis
Acta Ophthalmologica, 2016Co-Authors: Maite Sainzdelamaza, Blanca Molins, Marina Mesquida, Victor Llorenc, Javier Zarranzventura, Anna Salapuigdollers, Jessica Matas, Alfredo Adan, Stephen C FosterAbstract:Purpose To evaluate serum cytokine profile from patients with active Scleritis in a two-centre prospective case–control study. Methods 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. Results Serum levels of IL-22 were elevated in active Scleritis patients compared to controls (6.41 ± 1.52 pg/ml versus 1.93 ± 0.39 pg/ml, p = 0.012) and significantly decreased after Scleritis remission with the use of IMT (p = 0.005). There was no statistical association with Scleritis type, degree of inflammation, or associated systemic disease. The serum levels of other cytokines were not significantly different from controls. Conclusion In our study cohort, IL-22 serum levels were significantly elevated in active Scleritis patients compared to controls and decreased significantly after remission. Our results suggest that IL-22, a T helper (Th) 17- and Th22- derived cytokine, may play a critical role in the physiopathology of Scleritis.
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clinical features and presentation of posterior Scleritis a report of 31 cases
Ocular Immunology and Inflammation, 2014Co-Authors: Luis Alonso Gonzalezgonzalez, Maite Sainz De La Maza, Priyanka P. Doctor, Joseph Tauber, Nicolas Molinaprat, Stephen C FosterAbstract:AbstractPurpose: To describe clinical features, ocular complications, and visual outcomes of patients with posterior Scleritis.Methods: Clinical characteristics of a subset of 31 patients with posterior Scleritis were studied and compared with 469 patients with anterior Scleritis.Results: Of 500 patients, 31 (6.2%) had posterior Scleritis. Most patients presented with subacute (80.6%), unilateral (61.3%) scleral inflammation. Pain was moderate to severe in 54.8% of patients. Concomitant anterior Scleritis was observed during follow-up in 77.4% of patients and in all patients with moderate to severe pain. Patients with posterior Scleritis were significantly younger (43.6 vs. 54.4 years, p < 0.001) and had significantly higher decrease of vision (29.0 vs. 14.9%, p = 0.027) than those with isolated anterior Scleritis.Conclusions: Posterior Scleritis must be considered in patients with decrease of vision, mild to severe pain, optic disc edema, and/or posterior uveitis. Moderate to severe pain may be associate...
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clinical features and presentation of infectious Scleritis from herpes viruses a report of 35 cases
Ophthalmology, 2012Co-Authors: Luis Alonso Gonzalezgonzalez, Priyanka P. Doctor, Joseph Tauber, Nicolas Molinaprat, Maria Teresa Sainz De La Maza, Stephen C FosterAbstract:Purpose To describe clinical features and presentation of infectious Scleritis resulting from herpes viruses. Design Retrospective case series. Participants Thirty-five patients out of 500 with Scleritis. Methods We reviewed the electronic health records of 500 patients with Scleritis, 35 of whom were diagnosed with herpes virus infection, seen at 2 tertiary referral centers. We studied the clinical features and ocular complications of this subset of patient with Scleritis. Main Outcome Measures Correlation between classification, severity, and symptoms (i.e., pain) and diagnosis of herpetic-associated Scleritis. Vision loss, presence of associated uveitis, keratitis, glaucoma, or systemic disease were documented over the follow-up period. Other outcome measures included epidemiologic data: age, gender, laterality, visual acuity, duration of symptoms, and underlying systemic or ocular diseases. Results Of 500 patients with Scleritis, 47 (9.4%) had an underlying infectious cause. Thirty-five (74.4%) of these were diagnosed with herpes virus infection, 5 (10.6%) with tuberculosis, and the remaining 7 (14.8%) with other infectious disease. Patients with herpes-associated Scleritis were analyzed as a group and then compared with those with idiopathic Scleritis. Most patients with herpetic Scleritis presented with acute (85.7%) and unilateral (80%) scleral inflammation. Pain was moderate or severe in 68.6% of the patients. The most common type of Scleritis was diffuse anterior in 80% (n = 28), followed by nodular anterior 11.4% (n = 4), and necrotizing in 8.6% (n = 3). Necrotizing anterior Scleritis was more commonly seen in patients with herpetic Scleritis versus patients with idiopathic disease (8.6% vs 1.2%; P P P Conclusions The association between Scleritis and infectious disease may be higher than previously reported by other series. Herpes viruses account for 7% of all Scleritis cases and its diagnosis may be challenging when there is not a classically diagnostic clinical picture. We present the observed clinical features of herpetic Scleritis and describe the clinical differences at presentation between patients with idiopathic Scleritis and those with herpes infection. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Todd P. Margolis - One of the best experts on this subject based on the ideXlab platform.
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Tofacitinib for refractory uveitis and Scleritis
Elsevier, 2019Co-Authors: Michael A. Paley, Todd P. Margolis, Humeyra Karacal, Kumar P. Rao, Jonathan J. MinerAbstract:Purpose: To report the successful use of tofacitinib in the treatment of refractory uveitis and Scleritis. Observations: Two patients, one with Scleritis and another with anterior and intermediate uveitis, presented with refractory disease after failure of multiple steroid-sparing therapies. Treatment with tofacitinib led to durable resolution of uveitis and Scleritis. Conclusions and importance: Tofacitinib is a potential novel treatment option for refractory, noninfectious inflammatory eye disease. Keywords: Uveitis, Scleritis, Tofacitinib, JAK, STA
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Tofacitinib for refractory uveitis and Scleritis.
American journal of ophthalmology case reports, 2018Co-Authors: Michael A. Paley, Todd P. Margolis, Humeyra Karacal, P. Kumar Rao, Jonathan J. MinerAbstract:Abstract Purpose To report the successful use of tofacitinib in the treatment of refractory uveitis and Scleritis. Observations Two patients, one with Scleritis and another with anterior and intermediate uveitis, presented with refractory disease after failure of multiple steroid-sparing therapies. Treatment with tofacitinib led to durable resolution of uveitis and Scleritis. Conclusions and importance Tofacitinib is a potential novel treatment option for refractory, noninfectious inflammatory eye disease.
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Conjunctival Sensation in Scleritis.
Ocular immunology and inflammation, 2015Co-Authors: Thanapong Somkijrungroj, Weeraya Pimolrat, John A. Gonzales, Jeremy D. Keenan, Todd P. MargolisAbstract:ABSTRACTPurpose: To investigate conjunctival sensation in patients with Scleritis.Methods: Retrospective cross-sectional study of patients with Scleritis. Conjunctival sensation was tested by Cochet-Bonnet aesthesiometer in four quadrants of the bulbar conjunctiva plus the area(s) of active or previously active inflammation; sensation was compared with the contralateral eye.Results: Of 28 patients with Scleritis, nine had active Scleritis and 19 had inactive Scleritis. Eleven patients had a systemic autoimmune condition and five had infectious Scleritis. The mean conjunctival sensation score of areas of inactive Scleritis was significantly less than that of corresponding normal areas in the contralateral eye (p
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Brief ReportsNocardia Scleritis
American journal of ophthalmology, 1997Co-Authors: C. Michele Knox, Todd P. Margolis, John P. Whitcher, Vickey Cevellos, Alex R. IrvineAbstract:To describe a case of Nocardia Scleritis, an unusual ocular infection. Case report and review of pertinent literature. An 83-year-old man with leukocytoclastic vasculitis was initially examined for infectious necrotizing Scleritis after explantation of an extruded scleral buckle. The patient was successfully treated with sulfonamides. Nocardia asteroides may cause infectious Scleritis in the absence of cataract surgery or trauma. Treatment with sulfonamides can result in a satisfactory outcome.
Priyanka P. Doctor - One of the best experts on this subject based on the ideXlab platform.
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Scleritis associated with relapsing polychondritis
The British journal of ophthalmology, 2016Co-Authors: Maite Sainz-de-la-maza, Nicolas Molina, Luis Alonso Gonzalez-gonzalez, Priyanka P. Doctor, Joseph Tauber, C. Stephen FosterAbstract:Aims 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). Methods 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. Results 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 with patients who had Scleritis associated with other SIMD. Nine patients (69.2%) had one or more SIMD other than RP, including systemic vasculitis (4) or other autoimmune disease (8); they antedated RP by 9 years (range 2–21 years). Successful therapy included cyclophosphamide (5), methotrexate (3), azathioprine (3), mycophenolate mofetil (2), infliximab (2) and adalimumab (1). Conclusions Scleritis may be the first manifestation whose study leads to the diagnosis of RP. Scleritis associated with RP is more often bilateral, necrotising, recurrent and associated with decrease of vision than Scleritis associated with other SIMD. About 69.2% of patients will have an additional SIMD disorder. Scleritis associated with RP most often will require immunomodulatory therapy. Occasionally, Scleritis with RP may appear while using antitumor necrosis factor α agents.
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Scleritis in patients with granulomatosis with polyangiitis (Wegener)
The British journal of ophthalmology, 2015Co-Authors: Lidia Cocho, Maite Sainz-de-la-maza, Luis Alonso Gonzalez-gonzalez, Priyanka P. Doctor, Nicolas Molina-prat, C. Stephen FosterAbstract:Aims To describe and compare clinical features, complications and outcomes in patients with granulomatosis with polyangiitis (GPA)-associated Scleritis with those seen in idiopathic and other autoimmune-associated Scleritis, and to further describe the features that may serve as an indicator of life-threatening systemic disease. Methods We retrospectively reviewed electronic health records of all patients with Scleritis seen at two tertiary care centres. Of 500 patients, 14 had GPA-associated Scleritis and were included in this analysis. Measures included were age, gender, laterality, visual acuity and underlying systemic or ocular diseases. Clinical features (location, pain, inflammation) and ocular complications of these patients (decrease of vision, concomitant anterior uveitis and ocular hypertension) were studied and correlated. Results Fourteen of 500 patients with Scleritis were GPA associated. Most of the patients with GPA-associated Scleritis presented with sudden onset, bilateral, diffuse anterior scleral inflammation, with moderate-or-severe pain. Vision loss was not significantly different, and pain was more severe in these patients than in those with idiopathic Scleritis. When compared with patients with other underlying autoimmune diseases, there were no significant differences found in epidemiological or clinical signs. Necrotising Scleritis and corneal involvement were more commonly observed in GPA than in idiopathic Scleritis and other autoimmune diseases and are often the presenting feature of the disease. Conclusions The presence of necrotising changes or corneal involvement in the setting of scleral inflammation is highly suggestive of an underlying systemic vasculitis, of which GPA is the most common. These features should alert the doctor/optometrist and prompt a thorough diagnostic approach and an aggressive treatment given that it could reveal a life-threatening disease.
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clinical features and presentation of posterior Scleritis a report of 31 cases
Ocular Immunology and Inflammation, 2014Co-Authors: Luis Alonso Gonzalezgonzalez, Maite Sainz De La Maza, Priyanka P. Doctor, Joseph Tauber, Nicolas Molinaprat, Stephen C FosterAbstract:AbstractPurpose: To describe clinical features, ocular complications, and visual outcomes of patients with posterior Scleritis.Methods: Clinical characteristics of a subset of 31 patients with posterior Scleritis were studied and compared with 469 patients with anterior Scleritis.Results: Of 500 patients, 31 (6.2%) had posterior Scleritis. Most patients presented with subacute (80.6%), unilateral (61.3%) scleral inflammation. Pain was moderate to severe in 54.8% of patients. Concomitant anterior Scleritis was observed during follow-up in 77.4% of patients and in all patients with moderate to severe pain. Patients with posterior Scleritis were significantly younger (43.6 vs. 54.4 years, p < 0.001) and had significantly higher decrease of vision (29.0 vs. 14.9%, p = 0.027) than those with isolated anterior Scleritis.Conclusions: Posterior Scleritis must be considered in patients with decrease of vision, mild to severe pain, optic disc edema, and/or posterior uveitis. Moderate to severe pain may be associate...
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clinical features and presentation of infectious Scleritis from herpes viruses a report of 35 cases
Ophthalmology, 2012Co-Authors: Luis Alonso Gonzalezgonzalez, Priyanka P. Doctor, Joseph Tauber, Nicolas Molinaprat, Maria Teresa Sainz De La Maza, Stephen C FosterAbstract:Purpose To describe clinical features and presentation of infectious Scleritis resulting from herpes viruses. Design Retrospective case series. Participants Thirty-five patients out of 500 with Scleritis. Methods We reviewed the electronic health records of 500 patients with Scleritis, 35 of whom were diagnosed with herpes virus infection, seen at 2 tertiary referral centers. We studied the clinical features and ocular complications of this subset of patient with Scleritis. Main Outcome Measures Correlation between classification, severity, and symptoms (i.e., pain) and diagnosis of herpetic-associated Scleritis. Vision loss, presence of associated uveitis, keratitis, glaucoma, or systemic disease were documented over the follow-up period. Other outcome measures included epidemiologic data: age, gender, laterality, visual acuity, duration of symptoms, and underlying systemic or ocular diseases. Results Of 500 patients with Scleritis, 47 (9.4%) had an underlying infectious cause. Thirty-five (74.4%) of these were diagnosed with herpes virus infection, 5 (10.6%) with tuberculosis, and the remaining 7 (14.8%) with other infectious disease. Patients with herpes-associated Scleritis were analyzed as a group and then compared with those with idiopathic Scleritis. Most patients with herpetic Scleritis presented with acute (85.7%) and unilateral (80%) scleral inflammation. Pain was moderate or severe in 68.6% of the patients. The most common type of Scleritis was diffuse anterior in 80% (n = 28), followed by nodular anterior 11.4% (n = 4), and necrotizing in 8.6% (n = 3). Necrotizing anterior Scleritis was more commonly seen in patients with herpetic Scleritis versus patients with idiopathic disease (8.6% vs 1.2%; P P P Conclusions The association between Scleritis and infectious disease may be higher than previously reported by other series. Herpes viruses account for 7% of all Scleritis cases and its diagnosis may be challenging when there is not a classically diagnostic clinical picture. We present the observed clinical features of herpetic Scleritis and describe the clinical differences at presentation between patients with idiopathic Scleritis and those with herpes infection. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Scleritis therapy.
Ophthalmology, 2011Co-Authors: Maite Sainz-de-la-maza, Nicolas Molina, Luis Alonso Gonzalez-gonzalez, Priyanka P. Doctor, Joseph Tauber, C. Stephen FosterAbstract:To delineate factors associated with a successful response to treatment in patients with various manifestations of Scleritis. Retrospective case series. A total of 392 patients with noninfectious anterior Scleritis. We reviewed the electronic health records of 392 patients with noninfectious anterior Scleritis seen at 2 tertiary referral centers and studied the factors associated with successful treatment. Patient characteristics (age, sex); ocular disease characteristics (laterality, type of Scleritis, degree of scleral inflammation, ocular complications, delay in presentation, and follow-up period), systemic disease association (associated disease, potentially lethal associated disease); and anti-inflammatory and immunosuppressive medications were studied in patients with Scleritis. Successful treatment response to nonsteroidal anti-inflammatory drugs (NSAIDs), steroidal anti-inflammatory drugs (SAIDs), immunosuppressive therapy drugs (immunomodulatory therapy [IMT]), or biologic response modifiers (BRMs) was assessed. Treatment of 392 patients with noninfectious anterior Scleritis included NSAIDs in 144 (36.7%), SAIDs in 29 (7.4%), IMT in 149 (38.0%), BRMs in 56 (14.3%), and none (N = 14). Successful response to treatment with NSAIDs was associated with idiopathic diffuse or nodular Scleritis with a low degree of scleral inflammation (≤ 2+) (odds ratio [OR] = 2.89, P < 0.001) and with idiopathic diffuse or nodular Scleritis without ocular complications (OR = 3.13, P < 0.001). Successful treatment with SAIDs was associated with idiopathic diffuse or nodular Scleritis with a high degree of scleral inflammation (>2+) (OR = 4.70, P = 0.001). Successful treatment with IMT was associated with diffuse or nodular Scleritis with associated systemic disease (OR = 1.57, P = 0.047), mainly potentially lethal (OR = 17.41, P=0.007), and necrotizing Scleritis (OR = 4.73, P = 0.026). Successful treatment with BRMs was associated with diffuse or nodular Scleritis with associated systemic disease (OR = 3.15, P < 0.001). This study did not require institutional review board approval because the information does not contain any subject identifiers. Patients with idiopathic diffuse or nodular Scleritis with a low degree of scleral inflammation or without ocular complications may respond to NSAIDs. Patients with idiopathic diffuse or nodular Scleritis with a high degree of scleral inflammation may respond to SAIDs. Patients with diffuse or nodular Scleritis with associated systemic disease may respond to IMT or BRMs. Patients with necrotizing Scleritis may respond to IMT, mainly alkylating agents. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
