Disease relevance of Scleritis

• BACKGROUND: Cogan's syndrome is a chronic inflammatory disease of unknown origin, characterised by sensorineural hearing loss, episcleritis, and vasculitis [1].
• It is well known that polyarticular joint diseases such as rheumatoid arthritis, HLA-B27-associated arthritis and Borreliosis can be associated with eye diseases, such as uveitis, scleritis and keratitis [2].
• Systemic treatment of MRL/lpr mice with a monoclonal anti-L3T4 antibody (anti-CD4) resulted in a dramatic reduction of both the frequency and severity of the ocular disease, supporting the hypothesis that the CD4-positive T-cells play an essential role in the pathogenesis of the choroiditis and scleritis in this strain [3].
• The results of this study emphasize that the eye is a sensitive indicator for potentially lethal occult systemic vasculitis in patients with rheumatoid arthritis who develop peripheral ulcerative keratitis or necrotizing scleritis [4].
• In posterior scleritis, LFP was accurate in monitoring response to systemic steroid therapy and a small flare increase was predictive for disease recrudescence in five of six cases (predictive value 0.83, sensitivity 100%) [5].

High impact information on Scleritis

• All of these six patients with scleritis were identified as having "IgA nephropathy." None of the patients other than those with IgA nephropathy showed scleritis during the study period [6].
• Adverse events assessed as possibly or probably related to risedronate included, six of facial edema and one each of Stevens-Johnson syndrome, swollen tongue, palpitation and episcleritis [7].
• In 3 of the 4 patients started on MMF as a steroid-sparing agent, the scleritis remained controlled while the prednisone dosage was tapered by more than 50% [8].
• Mycophenolate mofetil administration was initiated as a steroid-sparing agent in 4 patients with controlled scleritis and as an additional immunosuppressive agent in 4 patients with active scleritis receiving concomitant treatment with prednisone and cyclosporine or methotrexate [8].
• Mycophenolate mofetil for the treatment of scleritis [8].

Chemical compound and disease context of Scleritis

• CONCLUSIONS: Although MMF maybe be useful as a steroid-sparing agent, it was not effective as an adjunctive immunosuppressive agent in patients with active scleritis in our small, tertiary referral series [8].
• Mycophenolate mofetil was determined to be an effective steroid-sparing agent if the daily prednisone dosage could be reduced by 50% or more and was determined to be an effective adjunctive immunosuppressive agent if the scleral inflammation was controlled in patients with active scleritis [8].
• Fluorescein angiography was found to be particularly useful in the detection of those patients who have early, but not clinically recognisable, necrotizing scleritis [9].
• PURPOSE: Prospective evaluation of the efficacy and safety of subconjunctival triamcinolone injections for resistant, nonnecrotizing, anterior scleritis [10].
• Patients with nodular and necrotizing scleritis were controlled with azathioprine and cyclophosphamide, respectively [11].

Biological context of Scleritis

• Two cases of episcleritis and one case of allergic conjunctivitis that responded very well to local steroids but showed an increase of the intraocular pressure were treated with fluorometholone [12].

Anatomical context of Scleritis

• PURPOSE: To evaluate the usefulness of mycophenolate mofetil (MMF) (CellCept, Roche, Nutley, NJ), an antimetabolite immunosuppressant with a selective antiproliferative effect on T and B lymphocytes, for the treatment of scleritis [8].
• Large cells containing prominent, refractile PAS-positive inclusions were found in cytological smears prepared from scrapings of the conjunctiva of an elderly diabetic patient with idiopathic scleritis progressing to scleromalacia perforans [13].
• Autogenous periosteum offers advantages over other tissues as a tectonic graft for necrotizing scleritis, since it is easy to harvest and handle, it is strong and vascular, and is not subject to immunologic rejection [14].

Gene context of Scleritis

• MMP overexpression can lead to tissue destruction which is characteristic of chronic inflammatory diseases such as rheumatoid arthritis and scleritis [15].
• Concurrently, the DRB1 (the -DBR1*0405), and/or DQB1 (the -DQB1*0401 and -DQB1*0302) alleles might provide protection against leprous episcleritis [16].
• MRL/Mp mice bearing the Fas deletion mutant gene, lpr (MRL/lpr), spontaneously develop polyarthritis, sialoadenitis and dacryoadenitis, resembling rheumatoid arthritis (RA), and also corneal involvement such as keratopathy and scleritis, which is a major complication in RA patients [17].
• Leukocyte adhesion molecule expression in scleritis [18].
• Results of treating 24 cases of diffuse anterior scleritis with the novel selective COX-2 inhibitor celecoxib are reported [19].

Analytical, diagnostic and therapeutic context of Scleritis

• CONCLUSION: Anterior and posterior scleritis may complicate the use of topical mitomycin C during trabeculectomy, Prompt diagnosis and treatment reverses the inflammation, maintaining the success of the surgical procedure [20].
• Changes at the periphery of a lesion in necrotising scleritis: anterior segment fluorescein angiography correlated with electron microscopy [21].
• METHODS: In this prospective, randomised, double-blind study, 38 eyes of 37 patients presenting with idiopathic episcleritis were allocated to receive either topical ketorolac (0.5%) or artificial tears three times a day for 3 weeks [22].
• Peripheral ulcerative keratopathy and necrotizing scleritis have been reported in rheumatoid arthritis patients after cataract surgery, but the incidence of these complications during the immediate postoperative period is unknown [23].

References