Rituximab and Acute Retinal Necrosis in a Patient with Scleromalacia and Rheumatoid Arthritis.

BACKGROUND: Rituximab is a widely used biologic agent, which has shown favourable results in the treatment of vasculitis. But immunosuppressive treatment also bears the risk of severe complications. METHODS: A patient with rheumatoid arthritis, progressive scleromalacia, and acute retinal necrosis on therapy with rituximab is reported. RESULTS: For the first time, a correlation between rituximab and acute retinal necrosis in a patient with progressive rheumatoid scleromalacia is shown. CONCLUSIONS: Although rituximab is a promising biologic agent for the treatment of autoimmune diseases, it bears the risk of reactivation of viral infections, including the onset of acute retinal necrosis.

Five-year outcome in immune-mediated scleritis.

BACKGROUND: Immune-mediated scleritis is a rare condition, and the information on the clinical course and complications is scarce. The aim of this study was to identify prognostic factors, complications, and therapeutic effects in patients with immune-mediated scleritis. METHODS: Patients with diagnosis of scleritis and a follow-up time of 5 years were identified. Systemic disease, laboratory investigations, type of scleritis, disease activity, therapy, and complications were recorded. The study design was a retrospective, non-comparative, interventional case series. RESULTS: Systemic disease was identified in 15 (37%) patients at presentation and in 18 (45%) after 5 years. Rheumatoid arthritis (15%), granulomatosis with polyangiitis (7.5%), and polychondritis (7.5%) were the most predominant disorders. Persistent scleritis (>5 years) was associated with systemic disease (66 vs. 6%; p < 0.05) and positive auto-antibodies (48 vs. 23%; p = 0.18). Control of ocular inflammation was achieved in 38 of 40 (95%). Prednisone (14 patients) and/or methotrexate (8) were the predominant drugs to control persistent disease. Complications included interstitial keratitis (2), inflammatory astigmatism (2), corneal melt (3), macular edema (6), and severe systemic disease (5). CONCLUSION: The presence of systemic disease and positive auto-antibodies are associated with persistent scleritis. Immunosuppressive agents allow control of scleritis, but may contribute to severe systemic complications.

Ocular surface problems following topical medication.

BACKGROUND: Adverse effects following topical medication account for a significant ocular morbidity. Toxic and allergic reactions are second in frequency among all external eye diseases (after keratokonjunctivitis sicca). Knowledge on the clinical background that predisposes to such reactions is scarce. This study aims to identify the factors that render commonly used topical medications to powerful ocular irritants. PATIENTS AND METHODS: 168 consecutive tertiary referrals with external eye disease problems were studied. The adverse effects on the ocular surface were analysed using a modified Wilson's classification (1983). RESULTS: At least 39 out of 168 (24 %) patients had problems related to topical medication. Factors that predisposed to adverse reactions included a compromised ocular surface in 17 patients (43 %), long-term drug exposure in 8 (21 %), intensified treatment in 8 (21 %), concomitant acute disorders in 4 (10 %), and additive drug toxicity (> 3 medications) in 2 patients (5 %). Toxic papillary keratokonjunctivitis was the most common adverse reaction (n = 31; 80 %) and was associated in 13 patients with epithelial defects, in 2 with keratinisation of the ocular surface and in one with conjunctival scarring. Aminoglycoside antibiotics were the drugs that were most frequently involved in adverse ocular surface reactions. CONCLUSION: Toxic reactions are far more common than allergic ones. They are frequent in eyes with compromised surface, and after long-term or intensified therapy.

The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators.

OBJECTIVE: We aimed to develop consensus-based recommendations for streamlining medical communication among various health care professionals, to improve accuracy of diagnosis and treatment, and to facilitate future investigations for mucous membrane pemphigoid. PARTICIPANTS: Because of the highly specific nature of this group of diseases, the 26 invited participants included either international scholars in the field of mucous membrane pemphigoid or experts in cutaneous pharmacology representing the 3 medical disciplines ophthalmology, oral medicine, and dermatology. EVIDENCE: The first author (L.S.C.) conducted a literature search. Based on the information obtained, international experts who had contributed to the literature in the clinical care, diagnosis, and laboratory investigation for mucous membrane pemphigoid were invited to participate in a consensus meeting aimed at developing a consensus statement. CONSENSUS PROCESS: A consensus meeting was convened and conducted on May 10, 1999, in Chicago, Ill, to discuss the relevant issues. The first author drafted the statement based on the consensus developed at the meeting and the participants' written comments. The draft was submitted to all participants for 3 separate rounds of review, and disagreements were reconciled based on literature evidence. The third and final statement incorporated all relevant evidence obtained in the literature search and the consensus developed by the participants. The final statement was approved and endorsed by all 26 participants. CONCLUSIONS: Specific consensus-based recommendations were made regarding the definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators for mucous membrane pemphigoid. A system of standard reporting for these patients was proposed to facilitate a uniform data collection.