ABSTRACT
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.
Subject(s)
Sclera/pathology , Scleritis/diagnosis , Tertiary Care Centers , Adolescent , Age Distribution , Biopsy , Child , Female , Follow-Up Studies , Humans , Incidence , India/epidemiology , Male , Retrospective Studies , Scleritis/epidemiology , Sex Distribution , Visual AcuityABSTRACT
Purpose: To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in the treatment of recalcitrant intermediate uveitis in a tertiary referral eye-care center over a 1-year period. Methods: Patients with at least three recurrences of intermediate uveitis per year, defined as relapse of disease after quiescent phase for >3 months after discontinuing all treatments and those with a minimum follow-up of 1 year, were analyzed retrospectively. MMF was initiated with oral steroids and the Standardization of Uveitis Nomenclature guidelines were used to evaluate patients at every visit. Response to treatment, worsening of uveitis, visual benefit, steroid withdrawal rates, and side-effect due to MMF were monitored. Results: Data from 30 eyes of 19 patients were analyzed, of which 10 were men and 11 has bilateral disease. The mean age of presentation was 32.6 ± 15.4 years and the commonest presenting complaints were floaters (26 eyes). The mean vitreous haze was 3+ at presentation and reduced to 0 at last follow-up (24 eyes). Out of the 30 eyes, 80% had complete resolution of vitreous haze at the end of one year. Worsening intermediate uveitis was seen in six eyes (15.78%). Steroid withdrawal was successful in 85% of eyes. Vision improved in 56% of eyes. None of the patient developed serious systemic complications warranting withdrawal of MMF. Conclusion: MMF in our series was a safe and effective drug in controlling disease and preventing worsening in majority eyes with the most severe forms of intermediate uveitis. Larger studies are required before MMF is widely adopted for the management of recalcitrant intermediate uveitis.
Subject(s)
Enzyme Inhibitors/therapeutic use , Immunosuppressive Agents/therapeutic use , Mycophenolic Acid/therapeutic use , Uveitis, Intermediate/drug therapy , Adult , Aged , Enzyme Inhibitors/adverse effects , Female , Humans , Immunosuppressive Agents/adverse effects , Male , Middle Aged , Mycophenolic Acid/adverse effects , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Sarcoidosis and tuberculosis (TB) share epidemiological, immunological, and molecular features common to both, and often, it becomes difficult to differentiate them especially in a highly TB-endemic country like India. We report a case of optic disc granuloma along with epididymitis and infertility in a male who showed a response to treatment with anti-tuberculosis therapy and steroids. RESULTS: A 35-year-old Indian male who presented with complaints of blurring vision in the right eye for 6 months and treated elsewhere with two intravitreal injections of anti-VEGF was found to have optic disc granuloma in the right eye. His investigations revealed highly positive Mantoux test, negative QuantiFERON test, elevated serum ACE, and HRCT of chest showing features of sarcoidosis. He also gave a history of primary infertility. Ultrasound Doppler of the scrotum was suggestive of epididymitis. After getting a chest physician opinion, the patient was started on the first line of ATT followed by oral steroids. On subsequent follow-up visits, the patient showed resolution of lesions along with the return of fertility. CONCLUSIONS: The index case of optic disc granuloma along with epididymitis had features of both tuberculosis and sarcoidosis and falls in the gray zone of tuberculous sarcoidosis and showed a response to both ATT and corticosteroids. We report this case report for its unique presentation.
