Successful cataract surgery in a patient with refractory Wegener’s granulomatosis effectively treated with rituximab: A case report

Alfawaz, Abdullah M.

doi:10.1016/j.sjopt.2016.02.002

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Here, we report a rare case of severe necrotising scleritis associated with peripheral ulcerative keratitis (PUK) that simultaneously occurred in both eyes of a patient with GPA. Recently, uncomplicated cataract surgery was reported in a patient with refractory GPA presented with scleral thinning; however, this was without any signs of associated inflammation or active necrosis (2). To our knowledge, here presented case is the first report of uneventful cataract surgery in a patient with extreme, widespread staphyloma following inflammation that compromised the entire anterior globe and peripheral cornea.…”

Section: Introductionmentioning

confidence: 65%

Cataract surgery in a patient with bilateral necrotising scleritis and peripheral ulcerative keratitis associated with granulomatosis with polyangiitis (Wegener’s granulomatosis)

et al. 2021

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Inroduction. To describe a rare case of cataract surgery in a patient with an extreme, widespread anterior staphyloma following severe bilateral necrotising anterior scleritis associated with granulomatosis with polyangiitis (GPA). Case report. A 61-year-old man with a history of GPAdeveloped bilateral rapidly progressive necrotising scleritis and peripheral ulcerative keratitis (PUK). Inflammation compromised the entire anterior globe and peripheral cornea in both eyes. More than 90% of the surface area healed within 8 weeks following treatment with 3 pulsed doses of methylprednisolone in addition to cyclophosphamide treatment. Systemic steroid therapy was slowly tapered over 6 months. Extraordinary scleral loss with a uveal bulge developed following severe necrotising anterior scleritis associated with PUK. Once full remission had been achieved for 6 months, uncomplicated phacoemulsification was performed in his left eye; only the left eye was functional. Conclusion. Preoperative and postoperative control of inflammation, careful surgical planning and meticulous surgical techniques are critically important for optimal surgical outcomes. To our knowledge, phacoemulsification in a patient with coexisting uveitic cataract and severe anterior staphyloma has not been previously reported.

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Section: Introductionmentioning

confidence: 65%

Cataract surgery in a patient with bilateral necrotising scleritis and peripheral ulcerative keratitis associated with granulomatosis with polyangiitis (Wegener’s granulomatosis)

et al. 2021

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“…There have been a total of 36 reports describing 121 patients who received treatment with RTX for non-infectious scleritis [ 11 , 12 , 24 , 37 – 40 , 46 – 65 , 66 , 67 – 70 , 71 , 72 , 73 , 74 ]. These patients possessed a male to female ratio of 0.56 to 1 and a mean age of 48.5 ± 16.6 years (range = 16.0 to 81.0 years; median = 52.0 years) when first treated with RTX.…”

Section: Resultsmentioning

confidence: 99%

Rituximab for non-infectious Uveitis and Scleritis

Cunningham

2021

J Ophthal Inflamm Infect

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Purpose To provide a comprehensive review of rituximab use for the treatment of non-infectious uveitis and scleritis. Methods Review of literature through December 2020. Results Individual data was available for 229 patients with refractory non-infectious uveitis (n = 108) or scleritis (n = 121) who received treatment with rituximab (RTX). Rituximab was generally utilized as third-line or later treatment (uveitis: 67/90, 74.4%; scleritis: 90/96, 93.8%) at a mean of 33.5 months following the diagnosis of uveitis (range = 0 to 168.0 months; median = 24.0 months) and 39.4 months after diagnosis of scleritis (range = 1.0 to 168.0 months; median = 21.0 months). Patients with non-infectious uveitis and scleritis either received prior treatment with corticosteroids only (uveitis: 18/90, 20%; scleritis: 4/94, 4.3%), or with one (uveitis: 19/90, 21.1%; scleritis: 30/94, 31.9%), two (uveitis: 11/90, 12.2%; scleritis 27/94, 28.7%), or three or more (uveitis: 37/90, 41.1%; scleritis: 31/94, 33.0%) corticosteroid-sparing immunosuppressive agents with or without corticosteroids before initiation of RTX treatment. The rheumatologic protocol (two infusions of 1 gram of RTX separated by 14 days) was utilized most frequently (uveitis: 45/87, 51.7%; scleritis: 87/114, 76.3%), followed by the Foster protocol (eight weekly infusions of 375 mg/m2 RTX; uveitis: 18/87, 20.7%; scleritis: 10/114, 8.8%), and the oncologic protocol (four weekly infusions of 375 mg/m2 RTX; uveitis: 5/87, 5.7%; scleritis: 6/114, 5.3%). Various other off-label regimens were used infrequently (uveitis: 19/87, 21.8%; scleritis 11/114, 9.6%). Rituximab treatments resulted in a positive therapeutic response for the majority of patients with non-infectious uveitis (81/97, 83.5%). Commonly treated uveitic diagnoses included non-paraneoplastic autoimmune retinopathy (30/107, 28.0%), juvenile idiopathic arthritis (21/107, 19.6%), Vogt-Koyanagi-Harada disease (12/107, 11.2%), and Behçet disease (11/107, 10.3%). Cases of non-infectious scleritis were most commonly attributed to granulomatosis with polyangiitis (75/121, 62.0%) and rheumatoid arthritis (15/121, 12.4%), and showed an even greater rate of positive therapeutic response (112/120, 93.3%) following RTX treatment. No side effects were reported in 76.3% (74/97) of uveitis and 85.5% (71/83) scleritis cases. Of those cases associated with RTX-induced adverse events, the most common were infusion reactions of various severity (11/35, 31.4%). Conclusions Overall, RTX appeared to be both effective and well-tolerated as second or third-line therapy for patients with non-infectious uveitis and scleritis.

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Successful cataract surgery in a patient with refractory Wegener’s granulomatosis effectively treated with rituximab: A case report

Abstract: In this patient, rituximab was a well-tolerated and effective remission induction agent for severe refractory Wegener's granulomatosis and led to successful cataract surgery.

Cited by 2 publications

References 14 publications

Cataract surgery in a patient with bilateral necrotising scleritis and peripheral ulcerative keratitis associated with granulomatosis with polyangiitis (Wegener’s granulomatosis)

Cataract surgery in a patient with bilateral necrotising scleritis and peripheral ulcerative keratitis associated with granulomatosis with polyangiitis (Wegener’s granulomatosis)

Rituximab for non-infectious Uveitis and Scleritis

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