Navegando por Palavras-chave "Scleritis"
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- ItemAcesso aberto (Open Access)Comparative study of ophthalmological and serological manifestations and the therapeutic response of patients with isolated scleritis and scleritis associated with systemic diseases(Conselho Brasileiro de Oftalmologia, 2011-12-01) Sousa, Jacqueline Martins de [UNIFESP]; Trevisani, Virgínia Fernandes Moça [UNIFESP]; Modolo, Rodrigo Pilon [UNIFESP]; Gabriel, Luís Alexandre Rassi [UNIFESP]; Vieira, Luis Antonio [UNIFESP]; Freitas, Denise de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo AmaroINTRODUCTION: Scleritis is a rare, progressive and serious disease, the signs of which are inflammation and edema of episcleral and scleral tissues and is greatly associated with systemic rheumatoid diseases. PURPOSE: To perform a prospective and comparative study between ophthalmologic manifestations, serologic findings and therapeutic response of patients with isolated scleritis and scleritis associated with systemic rheumatoid disease. METHODS: Thirty-two outpatients with non-infectious scleritis were studied, from March 2006 to March 2008. The treatment was corticoid eye drops associated with anti-inflammatory agents, followed by systemic corticoids and immunosuppressive drugs if necessary, was considered successful after six months without scleritis recurrence. RESULTS: Fourteen of 32 patients had scleritis associated with systemic rheumatoid disease, of which nine had rheumatoid arthritis, two systemic lupus erythematosus, one Crohn's disease, one Behçet's disease and one gout. There were no difference in relation to involvement and ocular complications, there was predominance of nodular anterior scleritis and scleral thinning was the most frequent complication. The scleritis associated with systemic rheumatoid disease group had 64.3% of autoantibodies, versus 27.8% among those with isolated scleritis and this difference was statistically significant. In the isolated scleritis group 16.7% used anti-inflammatory, 33.3% corticosteroids, 27.8% corticosteroids with one immunosuppressive drug, 5.5% two immunosuppressive drugs, 16.7% corticosteroids with two immunosuppressive drugs and 33.3% pulse of immunosuppressive drugs, there was remission in 88.9%. In the scleritis associated with systemic rheumatoid disease group 7.1% used anti-inflammatory, 7.1% corticosteroids, 50% corticosteroids with one immunosuppressive drug, 7.1% two immunosuppressive drugs and 22.2% pulse of immunosuppressive drugs, 100% had treatment success. CONCLUSION: Prevalence of unilateral nodular scleritis was noted in both groups and higher rates of all the parameters tested were noted in the scleritis associated with systemic rheumatoid disease group. There were no differences between the groups with respect to the use of immunosuppressive drugs and therapeutic response, which was fully satisfactory in the scleritis associated with systemic rheumatoid disease group and satisfactory in the isolated scleritis group.
- ItemAcesso aberto (Open Access)O emprego da biomicroscopia ultra-sônica no diagnóstico e evolução clínica dos diferentes tipos de esclerite anterior(Conselho Brasileiro de Oftalmologia, 2001-06-01) Sternlicht, Telma [UNIFESP]; Allemann, Norma [UNIFESP]; Muccioli, Cristina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To correlate findings on ultrasound biomicroscopy with types of anterior scleritis. Methods: Six patients with clinical findings of anterior scleritis were examined by ultrasound biomicroscopy (50 MHz transducer), performed at the Ocular Ultrasound Section of Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina for elucidation of histopathological alterations in anterior scleritis. Results: Patients with nodular scleritis had well-limited lesions, with homogeneously low reflectivity and localized increased thickness with lower reflectivity of adjacent tissues. Patients with diffuse scleritis had an heterogeneous increased thickness with heterogeneous reflectivity (a mottled appearance). Patients with necrotizing scleritis presented loss of tissue with scleral thinning and inflammatory adjacent vitreous changes. Conclusions: Ultrasound biomicroscopy is an excellent noninvasive method in identifying involved ocular tissues in anterior scleritis, helping the ophthalmologist in his/her diagnosis and treatment.
- ItemAcesso aberto (Open Access)Evolução da esclerite nodular com biomicroscopia ultrassônica: relato de caso(Conselho Brasileiro de Oftalmologia, 2013-12-01) Martinez, Andrea Alejandra Gonzalez [UNIFESP]; Matos, Kimble Teixeira Fonseca [UNIFESP]; Trevisani, Virgínia Fernandes Moça [UNIFESP]; Hirai, Alcides [UNIFESP]; Allemann, Norma [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo Amaro Departamento de Medicina Urgência e Medicina Baseada em EvidênciasTo stablish evolutionary pattern of a case of nodular scleritis with high frequency ultrasound during treatment. Twenty-seven year old female, initial manifestation of intermediate uveitis, bilateral macular edema after clinical treatment with topical and oral steroids. After four months, we observed the formation of a scleral nodule in the right eye when patient underwent high frequency ultrasound (Paradigm, 50 MHz transducer, immersion technique). The lesion in right eye was characterized at high frequency ultrasound as a nodular lesion located at the anterior inferior temporal wall associated with localized reduction of scleral thickness. After intravitreal injection of triamcinolone for treatment of macular edema, clinical regression of the scleral nodule was observed in right eye, maintaining reduced scleral thickness. High frequency ultrasound assisted in the diagnosis of nodular scleritis during the phases of treatment and in the identify its characteristic sequel feature, the scleral thinning.
- ItemSomente MetadadadosManagement of necrotizing scleritis after pterygium surgery with rituximab(Consel Brasil Oftalmologia, 2016) de Alencar Fidelix, Tania Sales [UNIFESP]; Vieira, Luis Antonio [UNIFESP]; Moca Trevisani, Virginia Fernandes [UNIFESP]The authors present a case of necrotizing scleritis after pterygium excision successfully treated with rituximab after attempts with high doses of corticosteroids and immunosuppressive drugs. A literature review revealed case reports and a phase I/II dose-ranging randomized clinical trial using rituximab for necrotizing scleritis with or without association with autoimmune disease. This is the only case report on rituximab treatment for necrotizing scleritis after pterygium surgery. In cases with refractoriness to immunosuppressive drugs, a CD20 antibody can be used.
- ItemAcesso aberto (Open Access)Manifestações destrutivas da córnea e esclera associadas a doenças do tecido conectivo: relato de 9 casos(Conselho Brasileiro de Oftalmologia, 2004-08-01) Santos, Namir Clementino [UNIFESP]; Sousa, Luciene Barbosa de; Trevisani, Virgínia Fernandes Moça [UNIFESP]; Freitas, Denise de [UNIFESP]; Vieira, Luis Antonio; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual do Piauí; Universidade Estadual do Piauí setor de Doenças Externas Oculares e CórneaPURPOSE: To study the clinical features, diagnosis, treatment, and outcome of nine patients with corneal and scleral involvement associated to connective tissue disease. METHODS: Description of anterior segment abnormalities observed in nine patients with connective tissue disease, five of them previously diagnosed and four with the ocular involvement being the first manifestation of the disease. All patients were evaluated at the Corneal and External Diseases outpatient clinic of the Federal University of São Paulo - Escola Paulista de Medicina (UNIFESP-EPM) between July/1999 to December/2000 and were submitted to a complete ophthalmologic examination, clinical evaluation and laboratory investigation. Clinical or surgical treatment was indicated according to the ocular disease evolution. RESULTS: The clinical diagnoses of the patients with anterior segment inflammatory disease were rheumatoid arthritis in seven patients (77.8%), systemic sclerosis and Wegener´s granulomatosis in each of the remaining patients (22.2%). The most frequent ocular manifestation was scleritis (66.6%), followed by peripheral ulcerative keratitis (55.5%) and dry eye syndrome (44.4%). Eighty-nine percent (89%) of the patients required immunosuppressive therapy to control the ocular inflammatory disease. Remission of the ocular symptoms were observed after 3 months of the beginning of imunossupressive therapy on average. In 55.5% of the patients a surgical approach (conjunctival resection, application of cyanoacrylate tissue adhesive, penetrating keratoplasty and scleral patch graft) was necessary. CONCLUSION: The finding of corneal and scleral involvement associated with connective tissue disease is a sign of the disease activity and usually requires imunossupressive therapy. The ophthalmologists should be aware of these conditions in order to early diagnose and apply the appropriate treatment.