Management of necrotizing scleritis after pterygium surgery with rituximab

Fidelix, Tania; Vieira, Luis Antonio; Trevisani, Virgínia Fernandes Moça

doi:10.5935/0004-2749.20160097

Cited by 4 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Immunomodulatory Agentsmentioning

confidence: 99%

“…78 A case report of necrotizing scleritis after pterygium surgery also reported successful treatment on rituximab after the failure of corticosteroids, azathioprine, and cyclophosphamide. 79 Other less commonly used biologics have been reported to be used in scleritis patients. Tocilizumab is a monoclonal antibody that targets the interleukin-6 receptor, which inhibits interleukin-6-mediated lymphocyte activation.…”

Section: Biologicsmentioning

confidence: 99%

See 1 more Smart Citation

Management of noninfectious scleritis

et al. 2022

View full text Add to dashboard Cite

Scleritis is a manifestation of inflammatory eye disease that involves the sclera. It can be divided into multiple subtypes, including diffuse anterior, nodular anterior, necrotizing, and posterior scleritis. In many cases, scleritis is restricted to the eye; however, it can occur in the context of systemic illness, particularly autoimmune and infectious conditions. Patients with autoimmune conditions, such as rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, and polyangiitis with granulomatosis, may develop scleritis flares that may require topical and systemic therapy. Initial therapy typically involves oral nonsteroidal anti-inflammatory drugs (NSAIDs); however, it is important to address the underlying condition, particularly if systemic. Other treatment regimens typically involve either local or systemic steroids or the use of immunomodulatory agents, which have a wide range of efficacy and documented use in the literature. There is a myriad of immunomodulatory agents used in the treatment of scleritis including antimetabolites, calcineurin inhibitors, biologics, and alkylating agents. In this review, we highlight the various subtypes of noninfectious scleritis and explore each of the mainstay agents used in the management of this entity. We explore the use of steroids and NSAIDs in detail and discuss evidence for various immunomodulatory agents.

show abstract

Section: Immunomodulatory Agentsmentioning

confidence: 99%

Section: Biologicsmentioning

confidence: 99%

Management of noninfectious scleritis

et al. 2022

View full text Add to dashboard Cite

show abstract

“…RTX yielded a rapid benefit in an interesting case of severe and refractory scleritis associated with IgG4-related disease and initially misdiagnosed as idiopathic scleritis, advocating for a potential role of CD20 blockade as a therapeutic option in such cases [ 73 ]. Anecdotal evidence has been disclosed for RTX efficacy in scleritis diagnosed in the context of chronic lymphatic leukemia [ 74 ], lymphocytic hypophysitis [ 75 ], and surgically induced scleritis [ 76 ]. RTX appears to be a promising agent in the management of refractory scleritis in both idiopathic scleritis and scleritis associated with immune-mediated systemic disorders.…”

Section: Anti-cd20 Therapymentioning

confidence: 99%

“…Mild reduction of visual acuity expressed in logMAR. No differences in intraocular pressure between baseline and last follow-up visit Herpes zoster ( n = 1), cytopenia with bronchitis and bacterial pneumonia ( n = 1) 30 (median) Fujita, 2018 [ 70 ] Case series 1 NS scleritis + PUK + macular edema GPA Clinical improvement and stabilization of BCVA NR 24 Hardy, 2017 [ 69 ] Case series 1 NeS + PUK RA Clinical resolution, switch to golimumab after 2 years for suboptimal control of articular symptoms NR 24 Fidelix, 2016 [ 76 ] Case report 1 NAS Surgically induced scleritis Clinical resolution, VA NR 6 Kasi, 2016 [ 68 ] Case report 1 NeS, serous retinal detachment IOI and TFIL Improvement of symptoms and VA NR 12 Cao, 2016 [ 8 ] Case series 15 Sectoral AS ( n = 4) Diffuse AS ( n = 5) Nodular AS ( n = 1) NAS ( n = 4), PS ( n = 1) Idiopathic ( n = 4) GPA ( n = 6) RA ( n = 4) UMCTD ( n = 1) Favorable response in 14 patients (93.3%) and significant improvement of McCluskey grading scale for scleritis activity score at 6 months. Steroid-free remission Infusion hypotension ( n = 1) …”

Section: Anti-cd20 Therapymentioning

confidence: 99%

Biologic Therapies and Small Molecules for the Management of Non-Infectious Scleritis: A Narrative Review

et al. 2021

View full text Add to dashboard Cite

Scleritis refers to a wide spectrum of ocular conditions ranging from mild to sight-threatening scleral inflammation that may compromise visual function and threaten the anatomical integrity of the ocular globe. Most aggressive forms like necrotizing or posterior scleritis are often difficult-to-treat cases, refractory to conventional treatment. The association with systemic diseases, namely rheumatoid arthritis, Sjögren syndrome, granulomatosis with polyangiitis, and relapsing polychondritis, may have prognostic implications as well. A better understanding of the pathogenesis of ocular inflammatory diseases have paved the way to more effective and targeted treatment approaches. In this regard, a growing body of evidence supports the potential role of biologic agents in the management of non-infectious scleral inflammation, either idiopathic or in a background of immune-mediated systemic disorders. Biologic agents such as anti-tumor necrosis factor agents, interleukin-1 and interleukin-6 inhibitors as well as CD20 blockade have displayed promising results. More specifically, several studies have reported their ability to control scleral inflammation, reduce the overall scleritis relapses, and allow a glucocorticoid-sparing effect while being generally well tolerated. Anecdotal reports have also been described with other biologic agents including abatacept, ustekinumab, daclizumab, and alemtuzumab as well as targeted small molecules such as tofacitinib. Further studies are warranted to fully elucidate the role of biologic agents in non-infectious scleritis and investigate specific areas with the aim to administer treatments in the context of personalized medicine. This review summarizes the available data regarding clinical trials, small pilot studies, and real-life experience of the last two decades reporting the use of biologic agents in the management of non-infectious scleritis.

show abstract

Ocular Emergencies

Tarff

Behrens

2017

Medical Clinics of North America

View full text Add to dashboard Cite

Management of necrotizing scleritis after pterygium surgery with rituximab

Cited by 4 publications

References 12 publications

Management of noninfectious scleritis

Management of noninfectious scleritis

Biologic Therapies and Small Molecules for the Management of Non-Infectious Scleritis: A Narrative Review

Ocular Emergencies

Contact Info

Product

Resources

About