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.

Influence of contrast media (iopromide, ioxaglate, gadolinium-DOTA) on blood viscosity, erythrocyte morphology and platelet function.

The influence of contrast media on blood viscosity, erythrocyte morphology and platelet function was studied. In vitro blood was incubated with iopromide (Ultravist), ioxaglate (Hexabrix) or gadolinium-DOTA (Dotarem). Plasma viscosity and whole blood viscosity were measured and the mean erythrocyte volume and morphology were assessed. Platelet aggregation was measured with a PFA-100 instrument. In an ex vivo study on patients receiving these contrast media the same measurements as described above were done. All contrast media increased blood viscosity at high shear rate in a dose dependent manner (e.g. with ioxaglate: from 4.9+/-0.2 mPa x s to 8.6+/-0.5 mPa x s at 160 mg I/ml), decreased low shear viscosity (for ioxaglate: from 44.9+/-2.5 to 27.7+/-4.8 mPa x s), increased plasma viscosity (ioxaglate: from 1.2+/-0.1 to 2.8+/-1.3 mPa x s), decreased the mean erythrocytic volume (ioxaglate: from 89.7+/-1.4 to 79.7+/-2.0 fl) and decreased platelet aggregation. Iopromide induced an echinocytic shape transformation of erythrocytes. Ex vivo a decreased hematocrit and a consecutively decreased whole blood viscosity were found with iopromide and ioxaglate. We conclude that contrast media influenced blood rheology, erythrocytes and platelet aggregation in vitro and ex vivo.