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PubMed | Instituto Oftalmologico Integral, Harvard University, Hospital Clinic of Barcelona and Massachusetts Eye Research and Surgery Institution MERSI
Type: Journal Article | Journal: The British journal of ophthalmology | Year: 2016

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.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.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.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.


Arcinue C.A.,Massachusetts Eye Research and Surgery Institution MERSI | Arcinue C.A.,Ocular Immunology and Uveitis Foundation | Ceron O.M.,Massachusetts Eye Research and Surgery Institution MERSI | Ceron O.M.,Ocular Immunology and Uveitis Foundation | And 3 more authors.
Journal of Ocular Pharmacology and Therapeutics | Year: 2013

Purpose: To evaluate the efficacy and safety of the fluocinolone acetonide (Retisert) implant compared with the dexamethasone (Ozurdex) implant in patients with noninfectious uveitis. Design: Comparative case series. Study Participants: Twenty-seven eyes received either the fluocinolone acetonide (FA) (n=16) or dexamethasone (n=11) implant. Methods: Chart review of patients at the Massachusetts Eye Research and Surgery Institution (MERSI) was done and patients were selected and matched according to age, sex, and type of uveitis. Eyes that received either the FA or dexamethasone implant, with follow-up ranging from 6 months to 2 years, were included. Main Outcome Measure: The recurrence rate of uveitis after implantation. Results: There were no significant differences in the baseline demographic characteristics. The majority of cases were idiopathic panuveitis, with 36.4% and 31.3% of eyes in the Ozurdex and Retisert groups, respectively. Recurrence rates of uveitis were 1.7 and 0.5 per 100 person-months in the Retisert and Ozurdex groups, respectively, with Retisert-implanted eyes 3.16 times more at risk of recurrence; however, this difference was not statistically significant (P=0.41). No significant differences were seen in terms of improvement in inflammatory score and best-corrected visual acuity (BCVA). The median survival time for a second implant was 13 and 28 months for the Ozurdex and Retisert groups, respectively (P=0.0028). Eyes with the Ozurdex were 5 times more likely to receive a second implant (P=0.02). No eyes in the Ozurdex group needed additional glaucoma medications, surgery, or laser compared to 44% of eyes in the Retisert group. Eyes with the Retisert implant had a statistically higher rate of having more glaucoma medications, surgery, or laser (P=0.02). In the Ozurdex group, 50% of phakic eyes at baseline had cataract progression and subsequent surgery compared with 100% of Retisert phakic eyes. Eyes with the Retisert implant are 4.7 times more at risk of cataract progression (P=0.04). Conclusions: The dexamethasone (Ozurdex) implant seems comparable to the fluocinolone acetonide (Retisert) implant in preventing recurrence of noninfectious uveitis and in improving inflammation and BCVA. However, there were higher rates of cataract progression and need for glaucoma medications, laser, and surgery with the Retisert implant. © Copyright 2013, Mary Ann Liebert, Inc.


PubMed | The August Pi i Sunyer Biomedical Research Institute IDIBAPS, University of Barcelona and Massachusetts Eye Research and Surgery Institution MERSI
Type: Journal Article | Journal: Acta ophthalmologica | Year: 2016

To evaluate serum cytokine profile from patients with active scleritis in a two-centre prospective case-control study.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)-1, IL-6, IL-2, IFN-, IL-10, IL-12p40, IL-13, IL-17A, IL-5, TNF-, and TNF-, and with ELISA to determine the levels of TGF-1, 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.Serum levels of IL-22 were elevated in active scleritis patients compared to controls (6.411.52pg/ml versus 1.930.39pg/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.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.


Sarup V.,Massachusetts Eye Research and Surgery Institution MERSI | Sarup V.,Ocular Immunology and Uveitis Foundation OIUF | Sarup V.,Harvard University | Foster C.S.,Massachusetts Eye Research and Surgery Institution MERSI | And 2 more authors.
Seminars in Ophthalmology | Year: 2013

Chronic uveitides can lead to serious sequlae over time including blindness. Human Leukocyte antigen (HLA) plays an important role in immunological response of the eyes. Some of these uveitides are associated with certain Human Leukocyte antigen (HLA) types. This article reviews these relationships and their significance. © 2013 Informa Healthcare USA, Inc. All rights reserved.

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