Use of cyclosporin in the management of steroid dependent non-necrotising scleritis.

Many patients with non-necrotising scleritis can be treated adequately with non-steroidal anti-inflammatory drugs or steroids. But, as many of them are young, treatment may present problems if they require high doses of steroids to control the scleral inflammation and then relapse when the dosage is reduced. Five such patients were treated with a combination of steroids and low-dose cyclosporin therapy, and in all cases the scleritis remained under control on a much lower dose of steroids than when steroids were used alone. Cyclosporin is therefore a useful drug in the management of younger patients dependent on high-dose steroids to control their scleral inflammation.     

A prospective evaluation of subconjunctival injection of triamcinolone acetonide for resistant anterior scleritis

PURPOSE: Prospective evaluation of the efficacy and safety of subconjunctival triamcinolone injections for resistant, nonnecrotizing, anterior scleritis. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Twelve eyes of 10 consecutive patients seen in the Doheny Eye Institute between August 1999 and December 2000 with diffuse, nonnecrotizing anterior scleritis that was resistant to systemic antiinflammatory therapy. Eyes with a history of steroid response were excluded. INTERVENTION: Subconjunctival injection of triamcinolone acetonide to the areas of maximal inflammation. MAIN OUTCOME MEASURES: Scleritis activity, adverse treatment effects, and number of systemic medications required at the end of the follow-up period. RESULTS: Within 1 to 14 days after injection, complete resolution of signs and symptoms was achieved in 11 eyes and partial resolution in 1 eye. Two patients had one recurrence each, 2.5 and 11 months after injection. Six of 10 patients were able to discontinue all systemic therapy (prednisone +/- immunosuppressive drugs); the remaining 4 needed continued oral therapy for systemic indications. Transient ocular hypertension and subconjunctival hemorrhage occurred in one eye each. Median follow-up period was 15 months. No eye developed necrotizing scleritis. CONCLUSIONS: Subconjunctival injection of triamcinolone acetonide is a safe and effective treatment for resistant, nonnecrotizing anterior scleritis. It provides rapid effect, is well tolerated, and may spare patients the significant complications and side effects of systemic corticosteroid and immunosuppressive therapy.     

曲安奈德球结膜下注射治疗前部非坏死性巩膜炎的疗效观察

目的：观察曲安奈德球结膜下注射治疗前部非坏死性巩膜炎的临床疗效。方法回顾性病例系列。前部巩膜炎患者12例（14只眼）,弥漫性2例,结节性10例。曲安奈德4～8 mg巩膜病灶处结膜下注射,小于二象限做1点注射,大于二象限做2点注射。观察治疗方法的有效性及局部和全身的不良反应。结果注射后病变轻者1周显效,重者2周显效,一次注射后均治愈。结论曲安奈德结膜下注射治疗前部非坏死性巩膜炎简单安全有效。     

Subconjunctival injection of low-dose Mitomycin-C for treatment of failing human trabeculectomies

Purpose: To evaluate the safety and efficacy of a low-dose Mitomycin C injected subconjunctivally after a guarded filtration operation in humans. Methods: Fourteen patients with failing filters received an injection of 0.01 mg Mitomycin C (0.25 ml of 0.04 mg/ml solution) into the filtering bleb. Eyes with end stage glaucoma of patients with healthy or successfully operated fellow eye were selected for the treatment. In 6 of the cases 2 to 5 days later a needle revision of the bleb was performed. Results: In 12 of the treated eyes (86%) we found a lowering of the IOP with a mean of 8.08 mmHg (range, 4 to 13 mmHg) and a development of a typical wide, pale, avascular filtering bleb. Complications, such as conjunctival, scierai or corneal necrosis, wound dehiscence, bleb leaks, hypotony or any clinically detectable signs of toxic damage of the anterior segment of the eye were not observed. Conclusion: Subconjunctival injection of low-dose Mitomycin C in the early postoperative period may offer a useful option for improving the outcome in some cases of failing trabeculectomies. This alternative method of application seems to enhance the effect of a subsequent needle revision. With the concentration used we did not find any undesirable complications after a follow-up of 1 to 9 months.Abbreviations 5-FU 5-Fluorouracil - HM hand movements - IOP intraocular pressure - MMC Mitomycin-C - PL perception of light - TE trabeculectomy - VA visual acuity     

Fungal endophthalmitis complicating subconjunctival injection of triamcinolone acetonide in anterior scleritis

Fungal endophthalmitis following subconjunctival triamacinolone acetonide in anterior scleritis is a rare complication. Two patients with aneterior scleritis, who received subconjunctival injection of triamcinolone developed fungal endophthalamitis. Both patients were positive by smear and polymerase chain reaction for 28S ribosmal RNA gene for fungus. Colletotrichum dematium was identified in one patient. Both patients responded well to pars plana vitrectomy and antifungal therapy.     

Use of orbital floor steroids in the management of patients with uniocular non-necrotising scleritis.

Most cases of non-necrotising scleritis can be successfully treated with non-steroidal anti-inflammatory drugs. If these are ineffective, then high-dose systemic corticosteroids, with all their attendant side-effects, are usually required. We have used orbital floor injections of depot steroid in the management of nine patients with non-necrotising scleritis in an attempt to avoid the use of systemic steroids, or to allow the dose of steroids to be reduced while maintaining disease control. A temporary reduction in inflammation was achieved in all cases, which allowed the use of systemic steroids to be avoided altogether in two patients and delayed in the others. Non-steroidal anti-inflammatory drugs and systemic corticosteroids remain the mainstay of treatment for non-necrotising scleritis, but orbital floor injections may be a useful adjunct in certain cases.     

Subconjunctival bevacizumab injection for corneal neovascularization

PURPOSE: To report on the clinical use of subconjunctival bevacizumab in patients with corneal neovascularization. METHODS: The charts of 10 consecutive patients with corneal neovascularization who received subconjunctival injections of bevacizumab (2.5 mg/0.1 mL) were reviewed. Digital photographs of the cornea were graded by 2 masked observers for density, extent, and centricity of corneal vascularization. Image analysis was used to determine the area of cornea covered by neovascularization as a percentage of the total corneal area. RESULTS: No significant ocular or systemic adverse events were observed during 3.5 +/- 1.1 months of follow-up. Seven patients showed partial regression of vessels. The extent decreased from 6.0 +/- 1.2 (SD) clock hours before the injection to 4.6 +/- 1.0 clock hours after bevacizumab injection (P = 0.008). Density decreased from 2.7 +/- 0.2 to 1.9 +/- 0.3, respectively. (P = 0.007). No change was noticed in the centricity of corneal vessels. Corneal neovascularization covered, on average, 14.8% +/- 2.5% (SD) of the corneal surface before the injections, compared with 10.5% +/- 2.8% (P = 0.36, t test) after bevacizumab injection. Therefore, bevacizumab decreased corneal neovascularization by 29%. CONCLUSIONS: Short-term results suggest that subconjunctival bevacizumab is well tolerated and associated with a partial regression of corneal neovascularization.     

Intralesional corticosteroid injection in the treatment of chalazion

OBJECTIVE: To evaluate the efficacy of intralesional corticosteroid injection in the treatment of chalazia in black African patients. METHODS: In a prospective study conducted between February 1999 and February 2000, 25 black African patients with chalazion (25 eyes, 29 chalazia), ranging in age from 15 to 54 years (mean age +/- SD, 30.6+/-9 years), were treated with intralesional triamcinolone (injection of 0.075 - 0.5 ml triamcinolone acetate at a 5-mg/ml concentration). RESULTS: Success was achieved in 18 (72%) of 25 patients [20 (74%) out of 27 eyes, 22 (76%) out of 29 chalazia)]. In 11 of 25 patients, two intralesional injections were necessary to obtain these results. Recurrence occurred in five eyes (five chalazia, 17%) after 5-6 weeks. During a mean +/- SD of 4.68 months (range, 3.5-12 months) of follow-up, no postinjection ocular complication occurred. CONCLUSION: Intralesional corticosteroid injection appears to be effective in managing chalazion in black African patients, as reported in previous studies in Caucasian patients. This treatment can be used when curettage is contraindicated.     

Infliximab for the treatment of active scleritis

Objective: This study aimed to evaluate the possible safety and effectiveness of infliximab in patients with active scleritis.Study Design: Prospective, nonrandomized, open-label pilot study (Protocol No. 04-EI-0065).Participants: Five patients with active anterior scleritis.Methods: This single-centre, pilot study of infliximab for the treatment of active anterior scleritis was conducted at the National Eye Institute, National Institutes of Health, between 2003 and 2007. Scleritis patients with active disease who had used at least 1 conventional immunosuppressive agent in the past were included. Primary outcome was a 2-step decrease in scleral inflammation within 14 weeks. Patients received infliximab (5 mg/kg) at baseline, at weeks 2 and 6, and every 4 weeks through week 30, after which the infusion interval was increased (week 36, 48).Results: All patients met the primary outcome by achieving quiescence of their active scleritis by week 14 with no additional immunosuppressives. However, after 14 weeks 1 patient developed new-onset intraocular inflammation that did not respond to reinduction and was terminated from the study. Side effects attributable to infliximab included ear infection with transient decreased hearing, urinary tract infection, lower respiratory tract infection, and facial rash in 1 patient and urinary tract infection, diarrhea, upper respiratory tract infection, nasal congestion and headache, mouth sores, head tremor, and occasional numbness and tingling in extremities in another patient, all of which resolved spontaneously or with appropriate treatment.Conclusions: Infliximab may be considered as a viable option in treating patients with active scleritis; however, patients should be monitored closely for potentially serious side effects.